|PHA News Online – September 2010||Vol XIII, No 3|
Te Tiriti o Waitangi and Asian Public Health Practice
Contemporary New Zealand has been recognised as a multi-cultural society within a bi-cultural nation. Te Tiriti o Waitangi is an agreement between the Māori people as the indigenous people of New Zealand and the Crown; this defines our bi-cultural nation.
The Asian population recognises Māori as tangata whenua who hold a unique place in New Zealand. It further recognises te Tiriti o Waitangi as the nation’s founding document.
Because of the unique environment created by the signing of te Tiriti, the way New Zealand deals with multi-culturalism can be different from other jurisdictions.
Article the first [Article 1, English translation of the Māori version]
“The chiefs of the Confederation and all the chiefs who have not joined that Confederation give absolutely to the Queen of England forever the complete government over their land.”
This Article gives Asian people, along with other non-Māori people, the historical, constitutional and legal basis for being in New Zealand.
Article the third [English text]
“In consideration thereof Her Majesty the Queen of England extends to the Natives of New Zealand Her royal protection and imparts to them all the Rights and Privileges of British subjects.”
This Article imparts to Asian migrants the same rights as other non-Māori, including the right to health.
(Source: CMDHB Integrated Asian Strategic Action Plan 2010)
There are 180 ethnic groups in New Zealand and if we are to deliver the “right to health”, enshrined in Article Three of te Tiriti, then as public health practitioners we need to work towards determining how we can respond to them all to achieve health equity.
The principles of te Tiriti are the foundation of a framework (the Asian Responsive Health Indicator Framework) currently in development, that will be used by practitioners to respond in a culturally appropriate way to the health needs of, firstly the Asian population, but also the many different peoples of New Zealand.
Cultural responsiveness needs to be part of a health organisation both vertically (from governance level down) and horizontally (across all divisions). Only when all services, planners and funders aspire to this can there be a chance of true equity in health among all groups of New Zealanders.
"The life expectancy and mortality data used to calculate
inequalities in health give a
For example, consumers who occupy a minority ethnic group may find language a barrier to accessing a health service. Stakeholders, focussed on health equity through cultural responsiveness, could interview the consumers to find out why they weren’t making better use of the service. Having identified language as a barrier, the stakeholders would need to tell the funders who would respond by paying for interpreters.
The Treaty gives us all equal rights to good health, but currently, the life expectancy and mortality data used to calculate inequalities in health give a skewed picture of inequity because many Asian migrants haven’t lived in New Zealand long enough to provide those data.
Considering utilisation of health services, disability, disease prevalence, and quality of life measures may give a truer picture of inequity that exists in recent migrant populations living in the country.
So measures that we use and indicators we consider important to address health inequalities must also be culturally informed.
After all, that is what te Tiriti is also about.
District Health Board and local government elections – who’s keen?
Local government – both regional and city/district councils – are the bodies with the greatest immediate influence on environmental factors determining health: water, air, housing, transport, alcohol and gambling licences, recreational facilities and more. Be an informed voter and help make sure your candidates are informed of their public health obligations.
Join the PHA discussion on Facebook: www.facebook.com/pages/Local-elections-for-public-health-in-NZ/151778871505805. New material will be added over the election period, and please, add your contribution and get your friends and colleagues involved.
For example, you or your PHA branch could set up a meeting of DHB candidates, or mayoral/council candidates to assess their understanding of their responsibilities to public health. Depending on the timing of the meeting, PHA staff may be able to assist you. Put the details up on the Facebook page.
If you are not on Facebook the basic documents about local body elections are available on the PHA website – www.pha.org.nz/influencingph.html#supporting.
Making sure the early years get recognition
Its final report, Closing the Gap in a Generation, (CSDH 2008) contains three interrelated recommendations for civil society, governments and global institutions:
Closing the Gap in a Generation recognises the importance of the early years as a key intervention point in improving health and reducing inequalities. Hence, one key area for action is "equity from the start."
More recently, the New Zealand Public Health Advisory Committee’s report, The Best Start in Life: Achieving effective action on child health and wellbeing (PHAC 2010), is also concerned with achieving equity from the start – both reports are mutually reinforcing catalysts for action.
For some time, New Zealand has been grappling with high levels of childhood hardship, preventable disease, and marked inequalities. Taking action for equity from the start in Aotearoa New Zealand, a paper by Amanda D'Souza, aims to provide the health sector with background information to support action within New Zealand on achieving "equity from the start."
Also of interest: Some extracts from Closing the Gap in a Generation.
Your comments and feedback are welcome. We would also welcome your contact if you are interested in assisting the PHA to undertake further action in this area. Email firstname.lastname@example.org.
The conference theme “Tomorrow for Tomorrow’s People” has generated a varied and, as always, fascinating programme, from:
The conference is divided into the sub-themes of:
Day one (Wednesday 22 September) – health and environment – will reflect how factors as diverse as transport and equity in health affect wellbeing. The programme will also have a big focus on tobacco control and will take a look at breaking down the barriers to breastfeeding and the resurgence in the incidence of rheumatic fever.
A series of workshops will kick off day two (Thursday 23 September) – sustainable development – with topics as broad as changing the law to a Māori model of non-violent parenting, to the future of the health sector in a post-carbon world.
It will be difficult choosing which of the many fine presentations that follow, to attend! The streams for the rest of the morning include primary care, Whānau ora/community development, chronic disease, youth alcohol, drugs and gambling, and local government.
During the afternoon, there will be presentations on the public health pillars of physical activity and nutrition, and child health. Rounding out the afternoon’s programme will be presentations on evaluation and hinengaro and wairua.
The final day (Friday 24 September) – making connections – returns to the topics of equity, child health and primary care. Completing the day, and the conference, are presentations on evidence, policy and advocacy.
The conference committee is delighted with the international keynote speakers who have agreed to attend:
And the distinguished New Zealand keynote speakers are:
“The committee is getting revved up and ready to go with the best conference we can muster,” says Deborah Petersen, the convenor of this year’s organising committee. “We’ve planned plenty of extra-curricular activities to make our delegates’ visits as enjoyable and as interesting as possible.
“We are truly privileged to hold the conference at historic Turangawaewae Marae and we are sure delegates will enjoy their experience.”
Go to the official conference website www.pha.org.nz/phaconference.html to book your place at what promises to be an energising, provocative and absorbing conference.
Heroes of public health
E ngā iwi o ngā hau e wha, ngā mihi nui ki a koutou katoa.
After considerable thought, and it was quite considerable, I kept coming back to my own whānau. My older sister Jane and myself were very fortunate to have spent much time as young children under the spell of all four of our grandparents.
My nanny and grandpa on my father’s side, Wiremu and Warihia Broughton, lived at Kohupatiki, a pa at the back of Clive between Hastings and Napier. My mother’s family lived in Dunedin where my grandfather’s mother had arrived from England as a young child in 1853. My grandfather, Reginald Clive Thurston Evans had married Ani Parata, the youngest daughter of Tame Parata MHR and Peti Hurene.
What is not so unusual is that all four grandparents, who were born in the late Victorian period, shared the same values and philosophies of life. My recollection of my two grandfathers is they were formidable in their own way and, “Children were to be seen and not heard.” So our grandmothers had the major influences on our upbringing, each imparting their thoughts, values and belief systems.
"My first two public health heroes are my two grandmothers,
They instilled in us that we were Māori through stories and whakapapa, taking us to hui, birthday parties, family celebrations and occasions to meet and to get to know the relations. From this we learnt what was healthy:
So my first two public health heroes are my two grandmothers, Warihia Broughton and Ani Parata Evans.
My third public health hero is my own father, Dr Leonard William Broughton. On leaving Napier Boys’ High School he went to Auckland Teachers College. His first wish was to do medicine, but the powers that were in 1936 only awarded one of two Māori scholarships to attend the Otago Medical School. However, his mother, Warihia, and his kuia, Heeni Unaiki went to see Mr Cullen, the MP for Napier who intervened. In May of that year father received a telegram. “Proceed at once to Otago University.”
So he arrived in Dunedin and, after having to catch up on the first term’s work, he was one of a small number of Māori students at the Otago Medical and Dental Schools. As part of their undergraduate training they had to undertake a public health thesis. Father wrote his with his dear friend and fellow student, Henry Bennett in 1942 which was entitled, Some Psychological Aspects of the Māori. Henry wrote the chapters on education and religion (because of the Bennett family expertise in these areas) whilst father was responsible for the other chapters and the introduction. He was especially proud of his introduction that he would often quote it to us, word-for-word throughout his whole life:
"Will the next hundred years bring the Māori nearer to par with his Pakeha neighbours?”
"Growing up as a post-war baby boomer of the 1950s and a
teenager of the 1960s
Our mother, Margaret (nee Evans) took pride in the fact that she typed up the three copies of the thesis. The significance of this work, I believe, is that when it is placed within the historical context and dialogue of its respective time, some 70 years ago, it remains just as relevant today as it was when first written. This thesis was written in 1942 when the country had passed through the Depression of the 1930s and New Zealand was at war. A whole generation of young Māori men were on active service overseas, not only with the 28th Māori Battalion, but throughout the entire Armed Forces.
Growing up as a post-war baby boomer of the 1950s and a teenager of the 1960s our father imposed upon us a number of what we would regard today as public health guidelines. He did this in his own way through his little catch phrases:
My father spent his whole working life as Assistant Medical Superintendent to the Hawke's Bay Hospital Board and we lived in the large home in the grounds of the Hastings Memorial Hospital. He spent the last few weeks of his life under the medical and nursing care of what was his beloved hospital. He passed away in October 2006 and lies in the urupa at Kohupatiki next to his mother, Warihia and his kuia, Heeni Unaiki.
Father’s thesis sits on the desk in my office.
Around the branches
In preparation for the conference to be hosted by the Canterbury Branch in 2011, the Committee has decided not to undertake any other seminars or workshops this year. Towards the end of last year we undertook the task of archiving our old branch records which dated back to ANZSERCH days, prior to the formation of PHA New Zealand. This is now complete and we are seeking a 'home' for the records.
We have continued advocacy work, including submissions to the Law Commission on alcohol control, to Parliamentarians following the child discipline referendum, and to the Horn Committee on the matter of keeping a strong public health presence in the health system. We recently put in a submission to the Christchurch City Council expressing our concern about the application made by the Metropolitan Trotting Club for an extra 18 electronic gaming machines.
The City Council subsequently declined the application by 10 votes to two.
The branch provided support for the Dunedin conference with sponsorship of two registrations and the Health Promotion Breakfast, run by the Health Promotion Forum. We were proud and delighted that one of our number, Cheryl Brunton, was honoured as Public Health Champion 2010.
We have a strong and enthusiastic group together to organise the Conference to be held at the University of Canterbury Campus from 31 August to 2 September 2011. We are looking forward to the opportunity of hosting this event and will endeavour to make this a memorable and successful event.
National Office roundup
Activities have remained focused on the conference which has meant immediate media activity has taken a bit of a back seat. We will however be going out to the media in the next few weeks as we work with members on our campaign to influence local government and DHB elections.
Other local government work is taking up office time along with our continuing to participate with the Ministry of Health on implementing the Public Health Workforce Development Plan Te Uru Kahikatea, with a particular focus on developing an undergraduate certificate in public health and a code of ethics.
On 8 September Māori Party MP Rahui Katene's Members Bill to remove GST from healthy food was defeated at its first reading. We were immediately able to issue our media release calling on government to consider other ways of increasing the affordability of healthy food. We did this in partnership with Agencies for Nutrition Action.
Energy strategies submission
We have also found time to make a submission on the draft New Zealand Energy Strategy and the draft New Zealand Energy Efficiency and Conservation Strategy.
We are pleased to see government developing energy strategies that consider a wide range of energy options. We are particularly pleased to see the inclusion of affordability, sustainability and concern for the environment.
However, a major concern is that the strategies place these issues and the wellbeing of New Zealanders secondary to the policy goal of enhancing the economy. Health is very much influenced by energy availability and policies. Economic wellbeing is hugely important, but government policy must offer a balanced future.
In the media
PHA media releases are archived online at www.pha.org.nz/keydocs.html#mediareleases.