28 August 2002
Hon Tariana Turia
Speech Notes

Asthma, Hauora, and Whanau Ora

Address to the Tu Kotahi Maori Asthma Society, Wainuiomata

E nga iwi o te rohe o te Upoko o te Ika, tena koutou katoa.

It is tempting to begin my korero with the traditional call of a speaker on the marae – Tihe Mauriora! – because it refers to that first breath, by which a child demands recognition that it is alive, and must be paid attention.

The kaupapa of this hui, asthma, is a matter of life and death, and all the shades of health and well-being in between. This kaupapa demands attention.

It was suggested that I talk of my own experiences of managing asthma, especially with alternative therapies. But I must tell you that I am reluctant to do that. You are all experts in asthma, and my two cents worth could not add much to your collective wisdom.

But I am passionate about asthma. I know how it drags me down some days, and others are much worse off than I am. Asthma takes a terrible toll on our people.

No matter what we do, as individuals managing our own health, or as local groups looking after each other, the broader picture keeps getting worse. I can’t stand this.

In my time as a community activist, people sometimes said ‘The Personal is Political’. I want to talk about what this means to me, and what it could mean for us as tangata whenua and asthmatics.

For one thing, it means we must look behind the personal issues we face day to day, to find an underlying pattern, or a cause, or a principle, that places individuals on common ground.

So, for example, what do the alarming numbers of Maori asthma sufferers, and the even more disturbing increases in asthma rates, tell us? Do they simply show there are a lot of sick individuals amongst us? Or is there some connection between our health, and our status as tangata whenua?

We could ask the same question about the rates of mental illness among tangata whenua, imprisonment, and many other issues.

We must ask these questions, not to lay blame on others, but because the answer can tell us how to seek solutions.

The other day I got a press release saying that the New Zealand asthma problem is out of control. The Patient Outcomes Manangement Study, conducted by P3 Research, shows that 70% of adults and 40% of children with asthma are not well controlled or are markedly out of control by international standards.

The release and background information highlights the extent of the problem – the huge cost, the high incidence, the worsening trend, and our poor performance internationally.

Despite the scale of the problem, the release says, more than 75% of people with the disease are not aware that their asthma can be better controlled.

The main reason for the lack of control, according to P3 Research, is under-treatment.

Well, now. The implication seems to be that if each asthmatic takes more treatment, visits the doctor more, does what they’re told and takes more drugs, they could feel better.

Meanwhile more and more of our mokopuna get caught up in a vicious cycle.

I don’t think that’s good enough. Of course we must manage our asthma as best we can – but we must look beyond individual cases to find a solution for ourselves as peoples.

That’s when the personal becomes political. Not party political – but groups of people acting together to take control of their own lives.

Tangata whenua are well-placed to do this because, embedded in our culture, we have the values, attitudes and structures to help us. I’m talking about our whanau, and whanaungatanga.

In the past, the medical profession took few steps to engage the whanau in health care. The emergence of Maori health providers has changed all that. Whanau ora is a new way forward for everybody, not just for Maori.

If all the whanau recognises the onset of an asthma attack, if they all understand the medication and how to administer it, asthmatics should get better treatment.

Our whanau also enable us look for the reasons why individuals get asthma, and tackle the causes. Family history might show little asthma among the iwi kainga, and much higher rates among city dwellers, for example. Knowledge is power.

Passive smoking is a risk factor for asthma. But a kainga auahi kore can only be established with the full support of the whole whanau.

Networking and sharing information, and collective action by the whanau, are sources of power. Our whanau, and cultural values like whanaungatanga, are inherently political. They are the well-springs of our rangatiratanga.

It’s no accident that our whanau, hapu and tribal structures have steadily been broken down over the past 150 years. Reports of the Waitangi Tribunal have confirmed the oral histories of iwi, that the Crown systematically attacked our political structures.

As our whanau and hapu networks broke down, together with the customary values and control over resources that kept them strong, disparities in social, cultural and economic development grew wider, and our people became exposed to serious stresses.

Stress is a recognised trigger for asthma. As our exposure to stress has increased, asthma rates have risen.

I see my personal experience of asthma as a highly political issue. I manage as best I can, but I don’t want my mokopuna to suffer.

The restoration of our whanau and hapu structures offers our people protection, especially our young. I think this is the long-term solution to asthma, and to many other issues facing tangata whenua.

It is a big task, to turn the tide of history. If we are to succeed in this as a strategy, we must hold fast to our tikanga tuku iho.

As individuals, and especially people like yourselves in leadership positions, we must commit ourselves to act according to the values of our tupuna.

This is where the political, in the sense of collective aspirations, values and behaviours, become personal. As members of whanau ora, we must live according to our tikanga.

I know I find this a hard thing to do, but I keep on trying because I believe it is a source of power – of rangatiratanga – not for me, but for all our people.

As representatives of our people, you and I must keep ourselves accountable to the people. We must act with integrity in their interests, and speak the truth as we see it.

Therefore, I feel I must raise a small matter with you.

I received another press release from Asthma New Zealand a few weeks ago, warning asthmatics to think carefully before switching medication, recommending an alternative, and inviting readers to lobby Pharmac.

We are entitled to expect Asthma New Zealand to represent our interests as health consumers. So I was concerned to hear that a drug company with a vested interest released almost exactly the same statement. Is there a potential conflict of interest here?

I note the same company is sponsoring your conference.

I see this as a test for your integrity and accountability. Funding can assist tangata whenua to achieve our goals, but we must be very clear about whose interests are served by the relationship.

I hope their sponsorship does not give the company undue influence over your decision-making, either as individuals managing your own asthma, or as tangata whenua developing solutions to a complex and critical problem for our people.

Heoi ano, kia ora tatou katoa.

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