Hon Tariana Turia
Associate Minister of Health
The NZ Nurses Organisation - Matariki
Grand Hall Parliament Buildings, Wellington
Wednesday 22 June 2011

Speech

I have been greatly looking forward to this event - to celebrate the wonder of Matariki in the best of company. For who could be better than nurses, midwives, kaimahi hauora, and healthcare workers to treasure the health and wellbeing of our whanau?

It is with great pleasure that I also welcome Members of Parliament from across the House to this special night.

Firstly, I want to mihi to Kerri Nuku - your kaiwhakahaere - Nano Tunnicliff - your President; and of course Keelan Ransfield, Tumu Whakarae for Te Runanga o Aotearoa - for your very positive initiative in celebrating Matariki as you have been every year since 2004.

It is of course, entirely appropriate that such key organizations as the New Zealand Nurses Organisation and Te Runanga o Aotearoa recognize Matariki as the perfect time to reflect on achievements gained, to review progress on ongoing challenges and to strategise for the solutions required in Aotearoa.

You have grasped the uniquely indigenous opportunity of Matariki to establish an annual process of review, and I commend you for that.

I want to share some words about Matariki I found on Astronomy New Zealand's website, describing Taatai Arorangi:

In an unpredictable world, the stars were predictable, unchanging, and immortal. Stars always rose in the East, and set in the West. The same constellations always appeared with each season. When Matariki first reappeared, she and her daughters were greeted with songs lamenting the loss of those who had died in the previous year. But the singers' tears were joyful too, because the New Year had begun.

This Matariki, more than ever, I have a particular and very personal understanding of the cycles of change.

As I came to this hui today, my thoughts are filled with the loss of a member of my whanau who lies on our marae in the valley of Whangaehu. As I sat by her yesterday, and wept, it felt as if the grief of our whanau would never ease because it is only three weeks that we buried her son, who died suddenly.

And yet, through our tears, we clung also to the incredible strength that whanau provide us with - that all-embracing love which wraps you in its fold, and restores us to the very essence of who we are.

The message of Matariki is that through our darkest hours, the dawn will always break.

And so as we look to Matariki - or in the case of Whanganui and Taranaki - we turn to the rising of Puanga - to focus on the wellbeing of our whanau, and our strongest resolve to do all that we can to create a better future for the generations to come.

It is a statement of great courage by this organisation that you have dedicated your 2011 Matariki event to the theme of 'closing the gap: increasing access and equity'.

This theme connects you to the challenge set by the International Council of Nurses, that increasing access to health services is critical if we are to improve the health, wellbeing and life expectancy of all.

There is no question that when we look at the experience and outcomes for Maori such an approach is desperately needed.
In an article describing the need for cultural competency, Peter Jansen, Kathleena Smith and Kira Bacal outlined exactly why health care providers needed to reflect on their practice.

"Maori receive fewer referrals, fewer diagnostic tests and less effective treatment plans from their doctors than do non-Maori patients. They are interviewed for less time by their doctors and are offered treatments at substantially decreased rates.

They are also prescribed fewer secondary services such as physiotherapy, chiropractors and rehabilitation.

All this, despite the fact that compared to non-Maori, Maori are on average sicker, for longer periods, during their shorter lives".

Such an insight is hardly a revelation - we have known such inequity to be the case for far too long. But what is so positive about an otherwise deeply depressing statement, is that once it is out there, there is no excuse for any of us to sit noho puku, to do nothing.

That is why this night - and your commitment to increasing access and equity is so important.

Nurses have a vital role in championing the cause of health equity; in shining a light on the significance of social determinants of health, and in demonstrating how understanding the barriers that exist is fundamental to adding quality to the outcome of care.

In this Matariki event for 2011 I want to share some of my ideas on improving health access and equity through a focus on health activism, and specifically whanau ora.

Health activism emerges out of a concern for our own health, the health of family members, and often the health of those who share our community.

It derives its source of reference from an understanding of the social epidemiology - the systematic study of health, wellbeing, and social determinants and the range of approaches that can be called on to promote health.

Maori health activism, therefore, has been influenced by the impact of colonisation, of land alienation and fragmentation, on population and loss and the subsequent damage incurred to the cultural resilience of the people.
In response to this, Maori have recommended the protective impact of whanau as one of the most effective strategies for improving health outcomes.

I really believe in the transformational power that underpins Whanau Ora. Whanau Ora is an approach driven by the needs of the whanau and is deliberately flexible to meet whanau needs and priorities.

A fundamental basis for Whanau Ora is in the aspiration to improve outcomes The Taskforce on Whanau Centred initiatives recommended that whanau outcomes will be met when whanau are:

* Self-managing
* Living healthy lifestyles
* Cohesive, resilient and nurturing
* Participating fully in society
* Economically secure and successfully involved in wealth creation.

As nurses, working alongside other health professional colleagues, you can contribute to Whanau Ora by respecting and relating to whanau as the central means for taking control and determining the health and wellbeing of its members.
That is probably the most significant difference - that whanau are empowered as a whole rather than separately with individual members. The collective approach is extended further in that multiple Government agencies are required to work together with whanau, appreciating them as the best people to take ownership of their solutions.

I started my address tonight, by reminding ourselves that Matariki serves as a time to not only assess our progress in addressing the problems, but also as a benchmark to look at all we have achieved and plan ahead.

And I do just want to acknowledge the amazing initiatives you have undertaken through your national professional development programme, with Nga Manukura o Apopo, specifically:

* Developing an Employer Toolkit
* Nursing Workplace Assessor Training
* Tertiary Provider Scorecard - the annual report on the performance of nursing and midwifery education providers;
* Recruitment of rangatahi and existing health workers - in association with Kia Ora Hauora; and
* Increasing access to quality clinical leadership training.
This last project is particularly exciting - a four year programme delivered to approximately 170 Maori nurses to focus on clinical competency, quality improvement, leadership and management.

Finally I want to mention the Barriers to Innovation project being lead by the Chief Nurse and Health Workforce New Zealand.

As part of this project the Minister of Health consulted with the health sector to identify legislation that unnecessarily restricts particular activities, powers or rights to doctors. He found legislative provisions in some 59 acts that if removed, would impact on the practice of certain nursing and allied health professionals.

As a result of this project, eight legislative priorities have been identified and work has begun to address these.

While this is fantastic, I did wonder if there should also be a project in place to identify the enabling factors in legislation that assist in addressing longstanding issues in access and equity.

And if I could be so cheeky as to suggest the first two - it would be:

* the Treaty clause in the New Zealand Public Health and Disability Act; and
* the requirement to develop cultural competency in accordance with the Health Practitioners Competence Assurance Act.

I am proud of the progress, the innovation and the commitment that New Zealand nurses make to increasing access and improving equity of outcomes across the health sector.

I wish everyone tonight, a warm and wonderful Matariki which provides you with a ripe environment for health activism to flourish, and for cultural competency to be expressed, in every aspect of your life, and the lives of the whanau you live and work with.

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