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‘Kua Takato te Manuka: Lifting our Game’

Hon Tariana Turia, Associate Minister of Health
Friday 2 September 2011

Te Ohu Rata o Aotearoa Maori Medical Practitioners Association
Te Ora Hui a Tau and Scientific Conference

Makaurau Marae

‘Kua Takato te Manuka: Lifting our Game’

It is a great pleasure to be in the company of a group of people dedicated to improving Maori health.

And it is both a credit to this organisation, and the initiatives you have pioneered, that I am told there are now over 250 Maori students and medical practitioners currently registered with Te Ora.

That’s 250 guardians to advance outcomes for whanau, hapu and iwi!

It also means we have 250 champions to pursue article 24 of the United Nations Declaration on the Rights of Indigenous People: that is,

that indigenous peoples have an equal right to the enjoyment of the highest attainable standard of physical and mental health.

Of course we all know we need significantly more numbers recruited and retained into the Maori health workforce to achieve the change we desire.

And so I can not emphasize enough, that your position at the vanguard of change, is absolutely crucial to make the difference.

And make the difference we must.

As we sit here today, a report is being issued entitled He Ara Hou: the Pathway forward, from the group, Every Child Counts.

The report presents the situation for just over half of the 200,000 New Zealand children living below the poverty line – and they are of Maori and Pasifika descent.

As a result Maori and Pasifika children experience significantly poorer health, educational and social outcomes than other groups.

Dr Hone Kaa in his forward to the report, sums it up:

“Maori and Pasifika children and families do not share in the success and prosperity enjoyed by other populations of Aotearoa. There is no level playing field and our children are subjected, disproportionately, to the malaise that emerges out of poverty”.

Te Ora Rata o Aotearoa is motivated by the need to increase the capability and capacity of the Maori medical workforce to lift your game – to improve health outcomes, to increase representation in the medical profession; to support our whanau.

But we are experiencing health in an unequal world.

The fiscal environment presents a challenge for everyone but none more so than for those who are already experiencing social disadvantage.

So why should you care? What can you do about seemingly intransigent issues such as poverty and health inequalities?

If there is one thing we know for sure, the circumstances and conditions in which our children grow have a significant influence not just on their immediate health, but also on longer term outcomes.

And if we also reflect on the legacy of nga korero a koro a kui ma, we understand that the plight of our most vulnerable should be the concern of us all.

Where then, do we find the solutions and strategies to make the difference?

Some of you may not know that at times I have been known to retreat to a nunnery.

Well more to the point, I have the utmost respect and admiration for a community of women grouped together as the Sisters of St Joseph.

I am thinking particularly of Sister Makareta Tawaroa who remains a very dear friend and influence on me.

Sister Makareta has shared with me the inspiration of a Hindu Indian Catholic priest, Phillipe Fanchette, who has asked the question:

‘Who are the poor? Why are they poor? Who benefits? Who loses? Who owns? Who controls? Whose interests are served”.

These are the questions of conscientisation, the same questions we could ask ourselves around health inequalities. These questions are just as pertinent for Te Ora as they are for Parliament as indeed they are for every whanau.

I raise these questions because sometimes I get the impression that poverty is the word that no one dare say.

I came across a website the other day called theyworkforyou: which is a site set up to track what MPs do in Parliament each day. One of the topics they had looked at, was the number of times that the Child Poverty Action Group has been mentioned in debates. And I thought the results were quite fascinating in themselves.

Out of 54 parliamentary debates in which CPAG had been referred to, it had been referred to twice by National, five times by Labour, nine times by the Greens and 42 times by the Maori Party.

I thought it was an interesting insight into how prepared different parties are to raise the issue of poverty up for debate within parliament.

And of course it was even more interesting to see what parties weren’t mentioned.

We must be ready to place poverty on the agenda and give it serious consideration as a parliament, to talk about it in our communities, and to think, collectively, what can we do to make the difference – to ensure our care extends to our most vulnerable.

In this year’s budget we were able to invest $12 million to implement a campaign to stamp out rheumatic fever.

But the question we could all be asking is why is it that the long-term health of too many young Maori is at risk from rheumatic fever in the first place?

And so I come to the issue that you have asked me to share some ideas around – and that is the Welfare Working Group’s recommendations – and in particular how we do ensure our whanau can escape from the long term reliance on the social welfare system.

I start from the basic premise that we must have the audacity and the courage to think we can change the world.

There has been a lot said about the disproportionately high numbers of Maori receiving income support and the adverse impacts of long term welfare dependency.

What we know is that these factors form part of the crucial social determinants of health have a direct impact on health outcomes.

Warm and dry housing is also part of this context. Over the last two years the Government has invested in improving installation in 190,000 homes on the very firm basis that warm, dry houses can directly reduce the incidence of avoidable health conditions.

It has been one solution – but of course we need more.

We must improve education outcomes - and I am hopeful that the cultural competency standards my colleague Dr Sharples launched on Tuesday this week, will help to achieve a positive impact - and it better be soon.

But perhaps one of the most significant things we can do is to help more people find and stay in work.

There is substantial evidence that improving employment outcomes can improve health outcomes. In short, for most people work is good for you.

So much so that earlier this year the Australian and New Zealand Consensus statement on the health benefits of work was issued by the Royal Australasian College of Physicians and the Australasian Faculty of Occupational and Environmental Medicine.

The statement calls on health professionals to think more carefully about the potential impact of certifying that someone is unable to work.

I don’t want to give anyone an impression that any of this is easy. Welfare reform is not exactly a popular political strategy – in short it’s hardly a vote catcher.

But neither is it easy to wake up each morning, without having meaningful employment, or lacking sufficient income to provide for your family or forever placed in the position of being denied or deprived opportunities that should rightfully be yours.

And of course, it’s not just a matter of people being willing to apply for work – the crucial foundation of reform rests in the generation of employment opportunities to meet the demand.

But do we really have any choice? Government must move mountains to make sure there is sufficient creativity and investment to guarantee meaningful work. Our collective negligence to our future can no longer be tolerated. We must all do more to open up opportunities and ultimately improve health and wellbeing outcomes.

Over the last two years I have been really proud of the way our marae and runanga have responded to the challenge of the recession, by working alongside Government in the Community Max Scheme.

This was a really successful initiative which not only provided our rangatahi with a change to learn new skills but also encouraged our communities to engage with their young ones, to take ownership of their futures.

The river flowed both ways.

I see in your own way, that what you have been doing with the Maori Specialist Clinical Leadership Programme is trying also to open up the opportunities for the Maori workforce – to nurture specialists into areas of high need for Maori such as cardiology, paediatrics and respiratory.

But is there more Te Ora could be doing?

And I guess this is where I see the great potential of Whanau Ora coming through.

Because with the momentum of Whanau Ora I see around the country; the control that whanau are exhibiting in their lives – will make long term positive changes for whanau across every area of influence.

I look forward to the day when whanau will indeed enjoy the highest attainable standard of physical and mental health articulated in the Declaration of indigenous rights.

A day when the only reports we receive are ones demonstrating remarkable improvements in Maori health outcomes.

I know we can all achieve that day – kua takoto te manuka.


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