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Turia - Health: The Wealth of the Nation

Hon Tariana Turia

Associate Minister of Health
'Health: The Wealth of the Nation' conference

Wednesday 24 November 2010; 6pm Speech
Auckland University of Technology, Faculty of Health and Environmental Sciences, School of Health Care Practice

A fortnight ago we received some bad news from a mokopuna in Brisbane. He had received a diagnosis which left us all apprehensive. That night I hardly slept; interpreting and reinterpreting the results.

When the word came through, a week later, that it was not as bad as we feared, we all immediately celebrated. There is nothing quite as revitalising or as restorative, as knowing the health of your whanau is on the up.

It brought home, in a flash, the philosophy that underpins this symposium – that the greatest wealth in our nation is the people’s health.

And so I am delighted to be here, with health care professionals, academics, stakeholders, staff and whanau to focus on the challenge of supporting the health and wellbeing of your community to achieve long term gain.

This is a very important conference at a significant point in our journey towards the common goal – improving the wellbeing and circumstances of whanau.

Your interest in being here today demonstrates to me that you are believers in a view of health which places priority not so much on programmes, providers and premises – but more about ensuring greater access to holistic health and wellbeing.

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Alicia Keyes puts it another way in her classic, “If I ain’t got you’

Hand me the world on a silver platter
And what good would it be
With no one to share
With no one who truly cares for me

In the context of Aotearoa – that brings us to Whanau Ora – the collective health and wellbeing of the whanau.

It is impeccable timing, that this symposium is being held at this time, to encourage all of us to carefully consider the current state of our health system and the relationships health care professionals develop with their communities.

Because whether it be in the Government’s commitment to Better, Sooner, More Convenient primary health care; or the implementation of Whanau Ora; the capacity of providers to achieve enhanced health outcomes for their communities is absolutely critical.

What is the wealth that we might expect to measure in evaluating progress towards wellbeing? Professor Mason Durie has some ideas around this. In his lecture to the New Zealand Treasury, entitled Measuring Maori Wellbeing, he describes a vast range of indicators that exemplify good health other than the presence or absence of disease.

There are the four dimensions of wellbeing we know best as taha wairua; taha hinengaro; taha tinana and taha whanau.

Then there’s the notion of whanau capacities – the capacity to care, the capacity to empower; the capacity for long-term planning, the capacity to endorse Maori culture, knowledge and values, the capacity for guardianship and the capacity for consensus.

And in a third tier of measurement, Professor Durie describes a range of outcomes that might reflect Maori wellbeing, such as secure cultural identity; cultural and intellectual resources; collective and vibrant Maori communities; and the Maori estate – such as lands, forests, fisheries, waahi tapu.

What I really like about the challenges Mason lay upon Treasury is the incentive to evaluate different perspectives and worldviews about good health.

When we say, as a Government, that we are committed towards better, sooner, more convenient primary health care; what will it look like?

We have been inspired to create new collaborative alliances with more flexible funding arrangements to deliver services that are closer to home than in the past.

But we need to really tease out what we mean by ‘better’ – is a better service a more inclusive service? Is stronger clinical engagement likely to produce better services on its own, or is it more about being responsive to local needs?

As a case in point, patients in the Mangere Health Centre and the Bader Drive Medical Centre, that are part of Alliance Health Plus, have now formed a new network to share clinical resources across the practice. What this will mean is that patients at both of these centres, will be able to access a wider range of services within primary health care than they could previously. If the outcomes achieved illustrate that this approach is both better and more convenient, over time we are likely to see a lot more of these improved care pathways implemented.

So I come back to the treasure that Alicia Keyes sings of – the richness of abundant good health and wellbeing for all of our whanau.

I am firmly of the view that the wealth of the nation rests in the health of whanau and families.

And I want to be clear – I am not talking about doing it to whanau; services for and allegedly in the best interests of whanau.

We are talking about whanau doing it for themselves – about whanau setting the agenda. We are promoting a paradigm shift from the delivery of whanau related services to a focus on a mindset and a model which is driven by whanau themselves.

We are talking about the kaupapa of whaka whirinakitanga.

The beauty of te reo Maori is that a concept like whirinakitanga can be interpreted in so many ways. We might say:
E whakawhirinaki ana nga tamariki nohinohi ki nga mātua hai whāngai i a rātau – meaning our babies rely on their parents to feed them.
Or we might use it in the context of depending on another; trusting in each other; counting on the tautoko and the awhi of our whanau.
And the beauty of it all, is that each of these meanings – and all of them combined – speak to us of collective responsibility; of trusting in our own solutions; of being proud to be inter-dependent – to look to one another as the source of our greatest strength.
This is what we mean by Whanau Ora – being able to trust in ourselves.

And so, in trusting in our own strategies and solutions, I am so pleased to be able to launch today the Whanau Ora integrated Services Delivery Study, as a very tangible contribution, of the difference that Maori health providers are making to the health and wealth of the nation.

This is a study that looks into how Māori health providers deliver integrated services across health and other sectors.

Just to put the study into some context - there are now around 260 Māori health providers throughout the country, a substantial increase from only twenty in the early 1990s.

This study focused on just six of them:–
He Oranga Pounamu (Christchurch),
Ngati Porou Hauora (Te Puia Springs),
Ora Toa Health Services (Porirua),
Raukura Hauora o Tainui (Waikato),
Te Oranganui Iwi Health Authority (Whanganui) and
Tui Ora Ltd (Taranaki).

Without exception it found that the strong links that Māori providers have with communities puts them in a unique position to respond directly to their needs and realities.

It found also, that the Māori health providers studied recognise the importance of delivering a clinically sound and culturally competent service. Compromising one for the other is not an option.

And it revealed that the majority of clients served by many Māori providers present with multiple and complex needs. This study reveals that Māori providers meet those needs in comprehensive and integrated ways.

But the study also pointed out some particular challenges – including how whanau perspectives are embedded in the design and delivery of services; and the key – in how different service providers can collaborate and work together.

It is really wonderful to be able to have these results – results which many Maori health providers will replicate and exemplify every day of their operation.

And I want to congratulate Mauriora-ki-te-Ao/Living Universe Ltd – comprising Parekawhia McLean, Dene Ainsworth and Dr Fiona Cram – for their efforts in recording the distinctive features of whanau ora integrated service delivery.

As the report itself sums up, Whanau Ora remains a work in progress – and we should never resist the opportunity to revisit and revise our approach, in the interest of best outcomes for all.

But the results do provide us with a benchmark of care – care which is seamless and coordinated; where team work is valued; plans of care are coordinated and managed; funding is integrated; and the interventions are holistic and comprehensive.

There is one particularly key component in what I believe is fundamental to the health and wealth of this nation – and that is the shift I talked about earlier, as being whanau-centred; as placing the whanau at the very hub of all of our efforts.

If we are committed towards genuine and enduring transformation we must invest in whanau goals and outcomes. Whanau Ora is not about flashy facilities or a one-size-fits-all framework.

Whanau Ora empowers whanau and families as a whole – rather than separately focusing either on individual family members, or indeed isolating individual component problems.

We have had enough of fragmented and multiple contracts, and a policy maze of outputs and activities which keep people busy. We believe there is a much better way to use the millions of dollars current invested in families in need, to achieve much more meaningful outcomes for the families themselves.

It is about everyone coming together to build whanau capability; to strengthen whanau connections and to inspire whanau leadership.

I have the utmost confidence in our whanau that they can live up to the highest expectations that they set for themselves.

It now remains to be seen, how fully we – as agents of the Crown, as providers, as health professionals – can trust in the capacity of whanau to do for themselves.

Let’s make it happen.


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