Te Tiriti o Waitangi and Asian Public Health Practice

This month, Dr Kawshi de Silva, PHA Asian Caucus member, and Chairperson of the Asian Health Foundation of NZ, examines what te Tiriti means for 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
skewed picture of inequity because many Asian migrants haven’t lived in New Zealand
long enough to provide those data."

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?

The coming elections are hugely important for public health. District Health Boards (DHBs) are the local health funding organisations that not only plan hospital and primary care services, but also work with the Ministry of Health to set priorities for public health funding. The majority of DHB members are locally elected so it’s in your hands as voters as to the type of people who will set those priorities and administer those funds during the next three years.

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

The World Health Organization (WHO) is very clear. Inequities in health are an issue of social justice and a major public health concern. The WHO established the Commission on Social Determinants of Health to generate action to promote health equity.

Its final report, Closing the Gap in a Generation, (CSDH 2008) contains three interrelated recommendations for civil society, governments and global institutions:

• Improve daily living conditions
• Tackle the inequitable distribution of power, money, and resources
• Measure and understand the problem and assess the impact of action.

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 submissions@pha.org.nz.

Conference news

With just weeks to go, the members of the organising committee of Conference 2010 are in the home stretch toward making “He ao mō ngā whakatupuranga o āpōpō” the best experience they can for delegates!

The conference theme “Tomorrow for Tomorrow’s People” has generated a varied and, as always, fascinating programme, from:

• a decade of walking school buses in Auckland to reducing New Zealand’s sodium footprint
• links between gambling access and community harm to putting public health into the local elections
• the mental health of four-year-olds to improving the health and wellbeing of released prisoners
• improving the health outcomes of people with intellectual disabilities to researching racisms to achieve health equity.

The conference is divided into the sub-themes of:

• health and environment
• sustainable development
• making connections.

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:

• Dr Camara Jones is a Research Director on the Social Determinants of Health and Equity at the National Center for Chronic Disease Prevention and Health Promotion, Atlanta, US. Dr Jones’ work focuses on the impact of racism on health and wellbeing.
• Professor Fran Baum is Professor of Public Health at Flinders University, South Australia. She is considered one of Australia’s leading researchers on the social and economic determinants of health, and of community-based health promotion.

And the distinguished New Zealand keynote speakers are:

• Associate Professor Love Chile, who is the Academic Director of the Centre for Community Investment and Development at the Auckland University of Technology. He is a consultant in community development in New Zealand and overseas.
• Dr Manuka Henare, who is a Senior Lecturer in Māori Business Development at the University of Auckland. He is Associate Dean (Māori and Pacific Development) and founder Director of the Mira Szaszy Research Centre and co-ordinator of the Huanga Māori Masters Programme in the Graduate School of Business.
• Shelley Campbell is a health consultant overseeing the Better, Sooner, More Convenient health reforms for the Auckland region. Until recently she was Chief Executive of Waikato Primary Health. Shelley has worked in paediatrics, Māori and community health as well as across the health, education and social service sectors.

“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

In this, our fourth instalment in a series of profiles of people public health folk regard as their heroes and inspiration, Associate Professor John R Broughton (Ngāti Kahunghunu Ki Heretaunga, Ngāi Tahu), of the Dunedin School of Medicie, pays tribute to his.

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,
Warihia Broughton and Ani Parata Evans."

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:

• Kai (No pudding until you eat your greens)
• Road safety (Don’t let me catch you kids out on the road)
• Sunstroke (Don’t go outside without your potae)
• Water safety (Your cousin will take you down to the river for a swim, do as he says)
• Smoking (Filthy, I won’t have it in the house)
• Alcohol (Lips that touch liquor will never touch mine)
• Behaviour (“Please remember don’t forget, Never leave the bathroom wet, Nor leave the towels upon the floor, Nor keep the bath an hour or more…”).

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?”
The answer lies with the Māori people themselves."

The Pakeha has been in this country a hundred years. In the time he has been here he has tried to impose upon a primitive race of people his European civilisation. It has taken the Pakeha some hundreds of years to attain the standards of his co-called modern civilisation. He has come to Māoriland, imposed new customs, new conventions and new methods of living upon a primitive race and has expected the Māori to be his equal. This the Māori people have tried to be, but with what results? The Māori people have done exceedingly well in so short a space of time to be where they are today. They have remarkably adapted themselves to western methods but adaptation must be a slow process. The question arises – “Can the rate of adaptation be increased? Will the next hundred years bring the Māori nearer to par with his Pakeha neighbours?” The answer lies with the Māori people themselves; their salvation must emerge from within their midst, but the Pakeha may profitably lend his aid by closer study and understanding of the psychology of the Māori people.

Much has been done, much more remains to be done. The Māori of old no longer survives. In his place is a race of people who are still in a state of flux. Old beliefs persist but newer ones are displacing them. Old habits remain but new ones are being adopted. The old religion is dead, but new cults are still appearing. The old educational system has disappeared but a new system is still being evolved. The old environment has changed, but the new one is still changing.

The Māori is on the difficult, discouraging road of adaptation. In this process it is inevitable that the psychological makeup of the individual and the race must play a big part in determining its course. It is with the intention of stressing some of the more important psychological factors affecting the Māori today, that this thesis has been undertaken. The writers are fortunate in being members of the Māori race for some of the more intimate problems are inevitably better understood and appreciated.

"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."

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:

• Drink driving (Alcohol and petrol don’t mix)
• Diet (Like a motor car engine you have to have fuel, so it is with you, your daily fuel is a good cooked breakfast, you need that to start the day)
• Money (Put your money in the bank, or it will burn a hole in your pocket)
• Prevention of colds and flu (Dry feet keeps out the cold: When you come home from school these winter days, take off your wet shoes and socks off and put them by the fire to dry)
• Kai moana (fish) makes your brains work
• Healthy kai (Clean plates. You don’t leave the table until you’ve eaten all your dinner, vegetables included)
• Sweets (If you eat them all today, you’ll have nothing for tomorrow)
• Sleep (We spend a third of our lives in bed, so make sure you get a good eight hours of sleep)
• Behaviour (Manners maketh the man)
• Family (Look after each other)
• Parents (Love your mother, respect your father).

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.

Pauline Barnett
Chair, Canterbury Branch

National Office roundup

We know we say this every time, butt has been yet another busy month for us all at for Head Office.

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.

View the PHA's submission on the draft New Zealand Energy Strategy and the draft NZ Energy Efficiency and Conservation Strategy online.

In the media

Note: The PHA has a government contract to encourage and facilitate informed debate on effective public health approaches. However, a lot of our public face in the media comes from advocacy which is not funded under that contract. Instead it depends on members and fundraising. Remember, the PHA only exists because of members' support! Please consider making a donation (however small) to help maintain the PHA's independent profile.

Media activity

PHA media releases are archived online at www.pha.org.nz/keydocs.html#mediareleases.