Ngā Kōrero
Mai i Te Kete Hauora
Māori Health Business Unit
No. 18 August 2014
ISSN 1177-9128 (print)
ISSN 1177-911X (online)
Welcome to the second issue of Ngā Kōrero
for 2014.
In this issue we look at the recent launch of the updated He Korowai Oranga – Māori Health
Strategy, along with research releases and publications that complement the work of the
strategy.
You’ll also find the latest Māori health snapshot Health of Māori Adults and Children 2011–
2013 included as an insert with this issue of Ngā Kōrero. The snapshot outlines a range of key
statistics from recent research findings.
Lastly, we talk to a couple of providers working alongside local whānau and communities
around the country to see what we can learn from their experiences.
Thanks to all those who have agreed to share their experiences and knowledge with us. If you
have a story or case study that might be of interest to Ngā Kōrero readers, drop us a line at
whanauora@moh.govt.nz
He Korowai Oranga update launched
June 20 saw around 120 guests gather at Parliament for the launch of the updated He Korowai
Oranga – New Zealand’s Māori Health Strategy.
The strategy was first published in November 2002 and served the sector well over the initial
decade. It has now been updated for the coming decade to better support work underway to
improve Māori health and respond to a range of emerging health challenges.
Highlights of the launch included addresses from Associate Minister of Health Tariana Turia,
Professor Sir Mason Durie, and Acting Director-General of Health, Chai Chuah.
The updated He Korowai Oranga is outlined in detail on pages 6 to 8, and is available on the
Ministry of Health website www.health.govt.nz
Ngā Kōrero – No.18 August 2014 1
The most significant change in the updated strategy is the introduction of the concept of
Pae Ora (Healthy Futures), which builds on the work of Whānau Ora (Healthy
Families)
by adding Wai Ora (Healthy
Environments) and Mauri Ora
(Healthy Individuals).
From the Deputy Director-General
E ngā mana, e ngā reo, tēnā koutou kātoa.
Ka tahi me huri ki a tātou mate kua mene ki te Pō.
Haere, haere, haere atu rā.
Pike ake, kake ake I te ara whānui a Tane ki Hawaikinui, ki Hawaiikiroa, ki Hawaikipamamao,
ki te huihuinga o te mano.
No reira e ngā mate, haere, haere, haere atu rā.
Kāti rā, te hunga mate ki te hunga mate, te hunga ora ki te hunga ora. Tihei mauri ora.
Welcome to the second issue of Ngā Kōrero for 2014.
This really is a bumper issue, which reflects how much is happening across Māori health at the
moment – and, as you can see, there is a lot.
This issue of Ngā Kōrero highlights some outstanding and very practical work that is being
delivered in local communities – ranging from the Auckland Wide Warm Homes Initiative and
marae-based health literacy programmes to reduce the impact of gout, through to the
outstanding work of Māori health providers such as Korowai Aroha.
You will also be introduced to a range of recent research reports that cover issues such as
gestational diabetes, the performance of general practices based in Whānau Ora collectives
compared to a national sample, recent findings on the health status of Māori children and young
people, and further studies into the identification and impact of key determinants of health that
affect the wellbeing of New Zealanders across the country. As always, the results are a cause for
celebration, inspiration and encouragement – as well as concern and determination to see
things improve.
Perhaps the most significant feature of this issue of Ngā Kōrero though is the launch of the
updated He Korowai Oranga – Māori Health Strategy. This is the culmination of many hours of
work, dialogue and discussion among many very dedicated, talented and knowledgeable people.
After serving the sector for an initial decade, He Korowai Oranga has been refreshed and
updated to reflect our current knowledge and understanding and to build on the gains that have
already been made through initiatives such as the health targets and the Whānau Ora
programme.
The updated strategy expands on the concept of Whānau Ora with the introduction of Pae Ora –
Healthy Futures. As you will read, Pae Ora incorporates Whānau Ora’s focus on healthy families,
but expands it to include a focus on Mauri Ora (healthy individuals) and Wai Ora (healthy
environments).
I am very confident that these and other changes place He Korowai Oranga in a strong position
to continue to guide our approach to Māori health and wellbeing in a way that will remain
relevant for another decade as we strive to achieve further improvements in health outcomes for
Māori as individuals, as whānau and as communities.
Ngā Kōrero – No.18 August 2014 2
Thank you for everything you do in contribution to this.
As you’ll see within these pages, it is greatly appreciated.
Message from the Associate Minister of
Health
Winter is truly upon us – and while the weather has been trying for many communities, there is
still much to celebrate and reflect on. I always look forward to the celebrations of Matariki and
Puanga – bringing hope, acknowledging our achievements and paving the way forward for the
work yet to come. This is my last column as Associate Minister of Health, and it’s a great
opportunity to reflect on what has been achieved in health and what we must now focus on to
ensure our families are well and thriving into the future.
Over the past few years we have seen some great changes in health. We have made some solid
progress in the area of tobacco control and we are seeing positive results in the reduced uptake
of smoking. There is some great work being undertaken in our communities to reduce the
serious impact of tobacco on our health – including Smokefree Cars and Auahi Kore cessation
programmes. I believe that the Government must support the progress made by our
communities by continuing to legislate against the sale and availability of tobacco, and I am
confident the Government will be able to successfully pass the plain packaging legislation. We
must be vigilant and do everything we can to deter our young people from taking up the habit.
Branding, including labels, has a huge influence on our young people. Plain packaging will take
away the power of tobacco companies to influence and seduce our rangatahi with their killer
products.
The expansion of the Rheumatic Fever Prevention Programme is another crucial step in ridding
our communities of this third-world disease. To date, the Government has invested $65 million
focusing on improving access to Group A Streptococcal throat treatment, reducing household
crowding and raising rheumatic fever awareness among high-risk communities. Rheumatic
fever is the number one cause of early heart disease and disproportionately affects Māori and
Pacific people. The Government has committed to reducing the incidence of rheumatic fever by
two-thirds by 2017. To achieve this target means that the Government together with health
services and communities must continue to develop strong partnerships and work together in
new and different ways.
I am particularly pleased with the development of the Whānau Ora approach and the impact it is
having on the way Government agencies and health providers operate. In addition, with free
doctors’ visits and prescriptions for all children under 13 – we can be assured our young ones
will always have access to the medical care they need regardless. Through Whānau Ora we are
seeing positive changes in families who are being supported to make their own decisions and
change their lifestyles. I would like to acknowledge all those who have believed in the vision of
self determination for whānau and who have done everything they can to support our whānau
and families to make the changes needed to improve their lives.
A highlight for me has been in seeing the innovative Māori approaches that have come through
in response to Te Ao Auahatanga Hauora Māori. The key priority for the period to 2017 has been
Tikanga a Tamariki Mokopuna – supporting whānau wellbeing by focusing on improving child
health. I have also been really excited by the results from the Pacific Innovation Fund
established in 2012 to empower Pasifika communities to determine and achieve their own
measures of wellbeing. I truly believe the greatest difference we can see in health across
Ngā Kōrero – No.18 August 2014 3
Aotearoa is when the people are empowered to determine their own solutions to the issues they
face and when Government support local leadership to make it happen.
There is still much to do. I would like to see greater support for low-income whānau to access
equitable oral health. I would love to see cultural competency and health literacy taken up as
significant levers in helping the health sector to respond to the greater needs of our families and
communities. And of course I believe that the goals of He Korowai Oranga must become a
fundamental basis for every health professional in our country.
I take this opportunity to thank all those in the Ministry of Health and the district health boards
who have worked tirelessly for better healthier lives for our whānau and families. I pay
particular tribute to the tobacco control team for whom I have immense respect. Thank you for
all the work we have achieved together to rid this country of tobacco once and for all.
I wish you all well and thank you all for your time and commitment to ensuring our whānau and
families are better equipped to lead healthier lives.
Noho ora mai rā
Message from the Tumu Whakarae chair –
Riki Nia Nia
E te tī, e te tā, tēnā koutou katoa
Tumu Whakarae members attended the launch of the refreshed He Korowai Oranga at
Parliament recently.
I was enthused by the new vision for the refreshed strategy – Pae Ora (Healthy Futures) – which
provides a platform for Māori to live with good health and wellbeing in an environment that
supports a good quality of life. Pae Ora encourages everyone in the health and disability sector
to work collaboratively, to think beyond narrow definitions of health and to provide high-quality
and effective services.
At the centre of the refreshed strategy is the concept of Equity. The World Health Organization
defines equity as the absence of avoidable or remediable differences among groups of people.
The concept acknowledges that not only are differences in health status unfair and unjust, but
they are also the result of differential access to the resources necessary for people to lead healthy
lives.
The challenge for those of us who work in the health sector is to work together to accelerate
Māori health gain by eliminating persisting and unfair inequities. To do this we must
demonstrate greater commitment and move beyond our current, sometimes inadequate,
thinking and practices, as we pursue a greater level of performance excellence from our system.
In short we must become intolerant of the inequitable outcomes our system has been producing,
as inequity is in part a reflection of an ineffective system.
As such I was further heartened to hear about the Annual Māori Health Plan indicator
Excellence Seminars being implemented by the Midland DHB region recently, through Bay of
Plenty DHB. The aim of these seminars is to share learning and excellence occurring in specific
Ngā Kōrero – No.18 August 2014 4
Māori health plan indicator areas, with a view to identifying and implementing action that will
accelerate Māori health gains. This is outstanding leadership in my view!
I was also encouraged recently when in the company of over 80 secondary school students from the Wellington
region interested in pursuing health as a career. Most satisfying was that 60 percent of these students were
Māori.
I encouraged them all to pursue successful health careers in whatever field they aspired to but also challenged
them to develop a new leadership in health that is focused on accelerating health gains and is intolerant of health
inequity.
We must all develop this intolerance if we are to see more equitable health gains for Māori in our lifetime. This
intolerance will fuel meaningful progress toward Pae Ora and healthy futures for all in our most beautiful
country.
Message from the lead CEO for Māori
health – Dr Dale Bramley
Kia ora, ngā mihi maioha ki a koutou katoa.
In my first column for Ngā Kōrero, I thought it would be worthwhile looking at the overall
picture of Māori health in Aotearoa.
The broad fact is well known – as a population group, our whānau do have, on average, poorer
health status than any other ethnic group in New Zealand.
But the work that has been put in over the years is starting to bear much fruit, and there are
many positive signs of improvement.
For example, according to Statistics New Zealand, more than twice as many Māori are now over
80 years old compared with a decade ago.
Smoking rates for Māori – the leading modifiable risk factor for Māori health – has dropped
from nearly 50 percent to 33 percent, a fantastic achievement with more work to be done.
Gains are also being made in breastscreening rates nationally for Māori, although they remain
just under the national target of 70 percent. There are also bright spots at a more local level,
with some screening units like Waitemata-Northland having rates that are far higher for Māori
than their overall population’s rate.
The findings of the 2011/12 New Zealand Health
Survey also notes that almost all Māori
children were reported as being in good health by their parents and more than four-out-of-five
Māori adults reported being
in good health.
But the survey results also highlight some persisting health inequities for Māori in New Zealand.
Despite reporting similar levels of physical activity and dietary patterns as the national average,
Māori rates for obesity and diabetes, for example, still far exceed those of their non-Māori
counterparts.
High levels of unmet need exist in some communities.
If our whānau are to live longer,
healthier lives, then
the factors that cause inequalities in health need to be addressed.
Ngā Kōrero – No.18 August 2014 5
The upside in all this is that we have a solid foundation from which to build upon the gains that
have been made.
At local health district level, the Māori Health Plans each DHB now puts together annually
alongside their District Annual Plans provide the roadmap in which DHBs can work towards
reducing the disparities between their Māori and
non-Māori populations.
DHBs are also now collaborating and working together more intensively thanks to channels such as Tumu
Whakarae, the national reference group of Māori managers within district health boards.
A key factor that should not be overlooked is the capacity and expertise that has been built up over the years
within Māori health providers all over the country. Each will have their share of success stories and equally
examples of what doesn’t work. Leveraging each provider’s local knowledge, contacts and expertise will be pivotal
if we are to bring about meaningful change.
Greater sophistication in the way we as a sector collect and utilise data will also assist in better targeting our
interventions. The implementation of the Primary Care Ethnicity Data Toolkit, and the development of the Māori
DNS dashboard are good examples of this.
These initiatives occurring at health district level complement the national initiative that is Whānau Ora. Since its
inception in 2010, Whānau Ora has provided the framework in which greater integration, innovation and
engagement with whānau can be fostered not just in health but across all sectors.
The new Whānau Ora commissioning agencies will also provide a powerful platform for change.
The goal in all this, of course, is to see Māori living longer and enjoying a better quality of life with fewer ill
health episodes and hospitalisations. This ambition certainly isn’t impossible. It will, however, require an
unrelenting focus on reorientating a health system to meet the needs of whānau and for whānau to have the
resources available to them to be able to realise the goal of Whānau Ora.
Hei kona mai
He Korowai Oranga – updated for a new
decade
This article provides a more detailed overview of New Zealand’s updated Māori Health strategy,
He Korowai Oranga, following its launch at Parliament on 20 June 2014.
As Associate Health Minister, Tariana Turia, explained during the launch, ‘He Korowai Oranga
has a proud history. We have seen some gains in Māori health this last decade. The progress of
the health targets, the decline of smoking and the success of Whānau Ora have helped shift the
focus of the system towards supporting the collective health of families and communities, rather
than just treating individuals in isolation.’
He Korowai Oranga was first launched in November 2002 to set the direction for Māori Health
development in the health and disability sector. The introduction of Whānau Ora offered a
broader, more encompassing view of wellbeing and a strong vision for Māori health that centred
on the whānau, not just the individual. He Korowai Oranga 2014 builds on the work of Whānau Ora by introducing the concept of Pae
Ora, which incorporates three key elements of wellbeing: Mauri Ora (healthy individuals),
Whānau Ora (healthy families) and Wai Ora (healthy environments).
Each of the three elements of Pae Ora were outlined in further detail by both Mrs Turia and Sir
Mason Durie at the launch.
Ngā Kōrero – No.18 August 2014 6
‘Mauri Ora is about being person-centred – meeting the immediate and future needs across all
stages of life. Wai Ora urges us to consider not only the immediate health issues people present
with but also the environmental factors that give rise to these issues – such as poverty,
education, housing, water supplies and access to healthy food,’ Mrs Turia explained.
Sir Mason added, ‘Mauri Ora is about much more than just getting over an illness – the
challenge with Mauri Ora is to be able to shift the mauri of a person from a mauri that is
languishing to one that is flourishing. And the third aspect, Wai Ora, reminds us that you can’t
separate health from the environment that surrounds us.’
‘Building whānau capability, so that all members can enjoy good health, is one of the three
elements of the aim: Pae Ora. This has huge implications for health policy and health services.’
The full strategy is available online at www.health.govt.nz/our-work/populations/
maori-health/he-korowai-oranga. The strategy has been designed as an interactive
webpage that will be regularly updated with examples and case studies
from across the
sector as it is implemented over time (and if you have a story to add, you can let us know at
whanauora@moh.govt.nz).
He Korowai Oranga supports the expanded focus of Pae Ora – Healthy Futures with the same
four key pathways that resonated so strongly under the original strategy.

The first pathway focuses on whānau, hapū, iwi and community development – with the aim
of fostering conditions that build on the strengths and assets of Māori and encourage their
health and wellbeing.

The second pathway addresses Māori participation in the health system and is focused on
supporting Māori participation at all levels of the health sector.

The third pathway supports the provision of effective health and disability services –
acknowledging the need for timely, high-quality, effective and culturally appropriate health
and disability services.

Finally, pathway four focuses on working across sectors – supporting all levels of the health
and disability sector to work across a range of other sectors to improve Māori Health.
He Korowai Oranga is further supported by a short guide to the strategy (Guide to He Korowai
Oranga – also available through www.health.govt.nz) and an Equity Framework, which was
also released on 20 June. The Equity Framework offers further practical guidance as to how to
use the best of the leadership and knowledge we possess across the health system to address the
challenge of achieving equity for Māori in health care and outcomes.
He Korowai Oranga already has a proud history, but its job isn’t finished yet. As the Minister
added at the close of her address on 20 June.
‘I’m extremely proud of what has been achieved in recent years. We have come a long way but
we still have more to do. While we have seen some gains in Māori health this last decade, there
are still huge health inequities that must be addressed if progress is to be made. With the refresh
of He Korowai Oranga we have a robust framework that will continue to guide Government
agencies and health providers as we work together across the system to further improve health
outcomes for New Zealand families and whānau.
‘He Korowai Oranga is your strategy for Māori health – it is all of our strategy. May it continue
to provide the guidance, the perspective and the inspiration we need as we work together to
improve Māori health.’
Ngā Kōrero – No.18 August 2014 7
Equity of health care for Māori
The Ministry of Health has recently released Equity of Health Care for Māori: A Framework.
The research has been funded by the Ministry and undertaken by Dr Fiona Cram of Katoa Ltd.
The Framework is based upon current evidence in the field of quality improvement, and
research on improving access to health services for Māori, indigenous peoples and minority
ethnic groups. It can be downloaded from the Ministry of Health website:
www.health.govt.nz
The purpose of the Framework is to provide people working within the health sector with
accessible information on key actions to achieve health equity for Māori and all New Zealanders.
The Framework lists three types of actions that each level of the health sector can take to achieve
health equity for Māori. These are Leadership (by championing the provision of high-quality
health care that delivers equitable health outcomes for Māori), Knowledge (by developing a
knowledge-base about ways to effectively deliver and monitor high-quality health care for Māori)
and Commitment (to providing high-quality health care that meets the health care needs and
aspirations of Māori).
The Framework outlines the ways that health equity for Māori can be achieved through actions by
the health system (Government and agencies); health organisations (district health boards,
primary health organisations and other health providers); and health practitioners (doctors,
nurses and community health workers).
Three supporting literature reviews, a report on key informant interviews and an overview of the
findings of the entire research project can also be found on
www.katoa.net.nz/maori-access-to-health-services
Whānau ora information system ready for
launch
The Information System Procurement Project was tasked with identifying the information
technology needs for Whānau Ora Collectives nationally, and securing a shared IT solution to
meet those needs.
The project has been co-ordinated by the Māori Health Policy team on behalf of Te Puni Kōkiri,
Ministry of Social Development and the Ministry of Education. The ultimate aim of this project
is to support the provision of consistent information systems for Whānau Ora collectives and
providers across the country.
After the initial process of consultation with stakeholders, the primary IT needs of the collectives
were identified, and a contract has now been signed with the preferred vendor, IBM New
Zealand.
On 26 June the Ministry hosted a workshop in Wellington to introduce Whānau Ora collectives
to the IBM team who provided a demonstration of the system and discussed the process and
issues relating to implementation. The workshop was well attended and the system is beginning
to be implemented from July.
Ngā Kōrero – No.18 August 2014 8
Providers will be able to collect, use and report on whānau information and outcomes, and share
this information between providers in the Collective. Whānau will also be able to access their
own data, an aspect of the system that was identified early on as important in strengthening the
capability of families to manage their own dreams and aspirations.
Initial and ongoing training in the use and application of the system will be made available to
collectives as part of the implementation process. We will continue to keep you updated as the
implementation of the system progresses.
For more information, please contact kelly_bullen@moh.govt.nz
Māori child health determinants report
‘. . . important disparities can be eliminated while continuing to lift the health of the total
population with the right evidence-based strategies’.
A three-part series focusing on the health and wellbeing of Māori children and young people is
now complete. Te Ohonga Ake: The Determinants of Health for Māori Children and Young
People in New Zealand is the final report in the series and provides an overview of underlying
social determinants that influence health and wellbeing.
The two previous Te Ohonga Ake publications highlight the health status of Māori infants,
children and young people, and the health status of Māori children and young people with
chronic conditions. All three reports are now available through the University of Otago’s website
(see full link at the end of this article).
The Ministry of Health commissioned the New Zealand Child and Youth Epidemiology Service
from the Univeristy of Otago to conduct the Te Ohonga Ake series. The final report was
launched at the annual Child and Youth Health Workshops in May 2014, where the focus was on
the health implications of child poverty.
As Māori Research Manager, Paula Searle, explains, ‘The health effects of living in poverty are
significant – and Māori children and young people are disproportionately exposed to the
negative health effects of poverty’.
This series of research has been titled Te Ohonga Ake, which essentially translates as ‘The
Awakening’. The aim is that the reports in this series encourage a greater ‘awakening’ regarding
the reality of Māori child and youth health issues in New Zealand.
The reports examine many of the underlying determinants of health for Māori children and
young people in order to assist health providers in developing new services and strategies in
areas that have suffered from a lack of research previously.
‘The greatest long-term opportunities lie in targeting effective interventions early in life. Investing
in the health and wellbeing of tamariki Māori is key to achieving sustainable, intergenerational
health outcomes. This needs to be a priority that is shared by all agencies who contribute to the
lifestyle and wellbeing of children and young people and their whānau,’ Paula adds.
Te Ohonga Ake identifies four primary categories regarding the determinants of health and
wellbeing for Māori children and young people:

wider macroeconomic environment (income levels and living standards)

socioeconomic and cultural determinants (household composition, access to education)
Ngā Kōrero – No.18 August 2014 9

risk and protective factors (immunisation, access to health services, substance use)

health outcomes (hospital admissions, infant mortality, domestic safety).
The findings reveal disparities in health outcomes for Māori children and young people in
several key areas. These include hospital admissions for medical conditions and injuries,
educational outcomes, household composition, housing quality and self-harm and suicide.
Te Ohonga Ake also highlights a number of cross-sector initiatives that are being implemented
in response to these issues. This includes:

performance targets set for Ambulatory Sensitive Hospital (ASH) Rates

the Prime Minister’s Youth Mental Health Project

the Suicide Prevention Action Plan 2013–16

a range of activities to improve Sudden Unexpected Death in Infancy (SUDI) rates

increased and improved tobacco controls

the immunisation health target.
More information regarding each of these initiatives, along with links to the Te Ohonga Ake
reports, can be found through the Ministry of Health website www.health.govt.nz and
www.health.govt.nz/publication/targeting-prevention
The full series of Te Ohonga Ake reports are available online through the University of Otago at:
http://dnmeds.otago.ac.nz/departments/womens/paediatrics/research/nzcyes/
maori.html
Whānau Ora general practices continue to
outperform national sample
Since September 2012 the Ministry of Health has been providing quarterly reports that track the
performance of general practices within Whānau Ora collectives against 11 key indicators.
The data compares the performance of general practices in Whānau Ora collectives against that
of a general national sample.
The report for the quarter ending in March 2014 has recently been finalised and is now available
on the Ministry of Health website at: www.health.govt.nz
The report shows achievement against the smoking cessation advice, cardiovascular disease risk
recorded and diabetes patient review indicators exceeded the results of the national sample this
quarter.
Specifically Whānau Ora practices showed further improvements in achievement against the key
indicators of:

Smoking cessation advice, indicator up 20.7 percent (60.4 percent to 81.1 percent)

Cardiovascular disease (CVD) risk recorded, indicator up 17.1 percent (60.55 percent to 77.2
percent)

Diabetes patient review, indicator up 8.5 percent (67.6 percent to 76.1 percent).
Also, compared to the national sample, the Whānau Ora sample performed well in the following
indicators: CVD risk recorded, diabetes patient review, smoking cessation advice, flu vaccination
Ngā Kōrero – No.18 August 2014 10
65+, all four of the percentage of enrolled patients with prescriptions for conditions and
diagnosis indicators (asthma, depression, diabetes and IHD), mean fee charged and medium
BMI.
The Whānau Ora Sample performs as well in the following indicators: diabetes management,
cervical smear recorded, mammography for high needs and mental health.
Although it isn’t possible to attribute the trends in this performance data directly to specific
individual programmes or initiatives, it clearly highlights the positive changes that have resulted
from a whānau-oriented approach to the provision of health and social services.
The results are encouraging, especially considering 61.5 percent of patients enrolled with
Whānau Ora general practices have high needs, compared with 26.3 percent in the national
sample.
The report is based on data from general practices that are members of Whānau Ora collectives.
It considers their performance against 11 key indicators that link to major causes of morbidity
and mortality for Māori.
The full report is available online at: www.health.govt.nz/publication/reportperformance-general-practices-whanau-ora-collectives-march-2014
Marae-based hui to increase health literacy
for gout
In light of previous research highlighting gout as a growing issue, the Māori Pharmacists’
Association (MPA) has been commissioned by the Ministry of Health to trial a marae-based
health literacy project, designed to raise whānau literacy levels with a particular focus on gout.
The project is now under way with a series of marae-based informational hui for Māori with
gout and their whānau.
Gout is an acute form of arthritis. It is a serious, long-term condition with significant negative
health impacts. If left untreated, it can lead to major irreversible joint damage and kidney
damage, as well as an increased risk of chronic kidney disease and cardiovascular disease. Gout
requires ongoing management – even when symptoms are not present.
Gout is a significant health issue for Māori. Managing the condition effectively can be complex,
and this often takes a toll on the whole whānau.
The project is targeted at whānau that live in geographic areas with high rates of gout, have
whānau members who have been recently diagnosed, and who need to manage the condition in
order to prevent further attacks, and/or have a family history of gout.
By taking a whānau-based approach to this mahi, the aim is to ensure people with gout have
easy access to ongoing support and information close to home – rather than simply expecting
them to locate the services they require and then arrangement appointments and transport
themselves.
With each hui, the Māori Pharmacists Association visit marae and actively engage with gout
sufferers and their whānau to emphasise initial prevention of gout, early identification and the
importance of ongoing self-management. Future attacks can be prevented if the condition is
Ngā Kōrero – No.18 August 2014 11
treated correctly and the importance of continuing to take medication even when gout
symptoms are not present is one of the key messages.
The hui aim to provide whānau and local champions with the knowledge base and health literacy
skills they need to support family members with gout to self-manage the condition, promote a
better understanding of gout, and enable people to have more informed, more effective
communication with health providers.
This initiative runs from now until August 2015. The marae-based initiatives are being trialled at
three marae initially, with four quarterly hui being delivered in each site. The initial round of hui
dates and participating marae are:
Pōhara marae in Arapuni (13 July), Opape marae in Opotiki (17 August),
Papakura marae (27 August)
If you would like to learn more about this work, or would like more information regarding the
initial round of hui, please contact kiri_dargaville@moh.govt.nz
Understanding gestational diabetes
Further research has also recently been published identifying health literacy barriers that
prevent people from understanding and successfully managing gestational diabetes among
Māori.
The findings highlight a range of potentially beneficial interventions for pregnant Māori women
generally, as well as specific recommendations targeting those 25 years of age and under.
The research was conducted by the Workbase Education Trust and the full report Māori health
literacy research: Gestational diabetes mellitus is available online at www.health.govt.nz
In the analysis of the findings, Workbase Education Trust suggest, ‘Assisting women with the
management of gestational diabetes needs to be a partnership between diabetes services and the
LMCs (Lead Maternity Carers) and midwives, along with women and their families.’
A range of reasons for low rates of screening are revealed in the report, including a lack of
knowledge and understanding regarding the condition and its risks, as well as Māori women
being significantly influenced by the information and advice provided by lead materity carers
and personal advisors.
A copy of the full report, Māori health literacy research: Gestational diabetes mellitus, is
available from the Ministry of Health website www.health.govt.nz or directly through the
Workbase Health Literacy website www.healthliteracy.org.nz
Korowai Aroha Health Centre – Health at the
heart of the community
Korowai Aroha Health Centre gained quite a bit of media coverage earlier this year when they
were awarded the Cornerstone Accreditation by the Royal New Zealand College of General
Practitioners.
Ngā Kōrero – No.18 August 2014 12
Now a few months down the track, we caught up with Chief Executive, Hariata Vercoe, and
Clinical Quality Manager, Rose Whetu-Boldarin, to see how things are going and what
differences they’re seeing as a result.
‘We were already seen as a place that trains nurses and students, but we had a long term goal of
having doctors on site too. Prior to getting the accreditation it was sometimes a challenge to get
GPs to come and work here. Since being accredited we’ve had doctors knocking on our doors
asking to work here – we haven’t had that before,’ Hariata explains.
Cornerstone is an accreditation programme specifically designed for general practices in New
Zealand, it assesses the performance of a practice against established standards and introduces
a range of continuous improvement processes for the practice to adopt. (For more information
contact the Royal New Zealand College of General Practitioners on (04) 496 5999).
As Hariata explains, the practice and its staff are not the only ones to benefit from the
accreditation process. Korowai Aroha’s enrolled population – the number of patients on their
books that they serve – has grown as well. ‘We’re now six months down the track of being
accredited. Although you get the certificate that says you’ve been accredited and it lasts for three
years, it doesn’t stop there. There’s an obligation to continuously monitor that quality.’
‘That leads us to look at the total patient experience holistically and evaluate how well every
aspect of the organisation is lining up to support that. As a result, the whole practice is focused
on the patient journey – right from reception when the patient makes the appointment, through
to when they turn up for treatment and the care that follows afterwards,’ Hariata adds.
‘People choose to come here,’ Rose adds. ‘It’s about respecting that through the whole process.
Nothing happens to them. They chose Korowai Aroha so it’s about how they want to proceed
and how we can empower and support them to ensure they gain whatever it is they need from
us.’
As a kaupapa Māori practice, Korowai Aroha’s approach is built around seven kaupapa that
guide how they behave and operate: manaakitanga (welcoming and kindness), rangatiratanga
(promoting autonomy and empowerment), whanaungatanga (fostering relationships),
kotahitanga (unity and shared decision making), wairuatanga (spiritual wellbeing), ukaipotanga
(acknowledging our roots) and kaitiakitanga (stewardship).
‘It’s about acknowledging that we are a Māori service and although not all of our staff are Māori,
these kaupapa guide all of us. We’re always looking at the wider whānau perspective – a person
might present with diabetes but there may be a number of lifestyle issues for the family as a
whole that are contributing to this. If they know they can bring the whole whānau along then we
have a better chance of supporting this – and seeing sustainable change for the next generation
too,’ Hariata explains.
‘It’s also nice to have two or three others there for the kōrero,’ adds Rose. ‘If you’ve got three sets
of ears listening and they’ve all got the opportunity to ask questions, it leads to better
understanding and support for more sustainable health.
‘It’s about that whanaungatanga, that commitment to genuine relationship, and ensuring that
carries through to every dealing with patients and their whānau – for Māori and non-Māori
alike,’ says Rose.
Hariata continues, ‘We also don’t purport to be the only provider that can work with whānau –
we have a network of other organisations that specialise in other areas and we regularly offer to
Ngā Kōrero – No.18 August 2014 13
take patients over there and make introductions for them. It’s about keeping the patient at the
centre and that means knowing when they’ll benefit from the expertise of others as well.
‘We had wonderful assistance from other practices as they were going through the accreditation
process. It was a great help and we’d be more than willing to talk to anyone else considering the
accreditation as well,’ Hariata adds.
If you’d like to learn more you can contact the Korowai Aroha team on (07) 348 8454 or through
www.korowai.org.nz
Fit for surgery – health literacy whānau
health pilot
A new pilot aims to better prepare patients for cardiac or bariatric surgery by supporting
whānau members to better assist individuals to become ‘fit for surgery’.
The pilot focuses on building the health literacy of whānau so they can more effectively support
family members who are preparing for surgery.
There’s a direct relationship between an individual’s wellbeing prior to surgery and their
recovery afterwards. With this in mind, the Ministry commissioned Quigley & Watts, Toi
Tangata and the fono to implement the Fit for Surgery research pilot with a selection of patients
from the Counties Manukau and Waitemata DHB regions. The pilot is expected to conclude in
mid-2016.
New Zealand’s low levels of health literacy, especially among Māori, have been widely
acknowledged and a number of activities have already been implemented to improve the way
health professionals communicate with their patients, and the way that resources are developed
and used to assist patents.
However, direct support for patients and their whānau to improve health literacy has been
identified as a gap. The Fit for Surgery pilot is intended to help fill this gap by trialling ways to
improve health literacy and, as a result, health outcomes for those struggling with obesity.
The programme aims to:

ensure people with complex or chronic health needs who have been accepted for bariatric or
cardiac surgery are effectively supported by whānau and health services in preparing for
surgery

work with whānau to achieve and maintain lifestyle changes so that a home environment of
good nutrition, physical activity and effective self-management becomes the norm.
The pilot has been designed to support men and women who are eligible for surgery and have
children 15 years and under at home. These candidates need to make significant lifestyle
changes both before and after surgery in order for the surgery to be successful – to ensure this
success is sustainable, their whānau also need to demonstrate strong interest in setting and
achieving health goals.
The programme aims to use the candidate’s need to become fit for surgery as a ‘motivator’ for
the remainder of the whānau to set and meet health goals. It also encourages whānau to take
ownership of their journey towards health, with good nutrition and effective self-management
becoming the norm (particularly for parents and young children).
Ngā Kōrero – No.18 August 2014 14
It’s an important piece of work that stands to make a significant difference not just in the lives of
patients themselves, but also among those around them. We’ll keep you informed as this work
progresses.
Procurement of rongoā services
Rongoā Māori focuses on the holistic enhancement of Māori wellbeing – it is a wellbeing
oriented practice.
It is built on a body of knowledge accumulated by tīpuna Māori that is applied in totality to bring
about wholeness or interconnectedness of body, mind, emotion, spirituality, energy, society,
culture, relationships and environment.
It is a way of being in the world and sharing the appropriate knowledge to help restore balance.
As part of the Ministry’s ongoing commitment to support, develop and fund Māori traditional
healing, the Ministry will shortly advertise, through a Request for Proposal (RFP), for the
procurement of rongoā services across New Zealand.
The rongoā services to be procured are:

mirimiri (massage)

karakia (including pastoral support)

whitiwhiti kōrero (cultural support).
At this stage, it is expected that the RFP will be released in August 2014.
Interested rongoā service providers who would like to be notified of the release date of the RFP
and to have access to the RFP documents need to register on the Government Electronic
Tendering System (GETS). You can register at www.gets.govt.nz
This follows the release of the Tikanga-ā-Rongoā standards, available on the Ministry of Health
website: www.health.govt.nz
Rheumatic fever – A preventable disease
As part of the current drive to reduce the national rheumatic fever rate, the Ministry of Health’s
Rheumatic Fever Prevention Programme has developed a range of new initiatives. In this story
we take a closer look at one of these – the Auckland-wide Healthy Homes Initiative (AWHI).
The AWHI programme aims to identify children at risk of developing rheumatic fever and then
implement a range of housing-related solutions that reduce their risk.
‘Links have been identified between household crowding and rheumatic fever – essentially these
factors help to determine those children and families most at risk and then we work with them
to help change that,’ AWHI Manager Rawinia Mariner explains.
‘There are a number of practical solutions that can really help reduce household crowding and
prevent rheumatic fever. We’re working closely with Housing New Zealand and other agencies
on five key areas: ventilation, insulation, heating, curtains, and floor coverings. If
Ngā Kōrero – No.18 August 2014 15
every household was adequately provided for in these five things it would go a long way to
addressing the risks,’ Rawinia adds.
The AWHI team is based in Auckland and works with eight community service providers who go
into homes and undertake a housing assessment to identify the needs of the family in that
household and come up with a plan together.
In addition to supporting HNZ tenants, AWHI is able to help families living in private rentals by
making housing solution referrals to places such as curtain banks or EECA (the Energy
Efficiency and Conservation Authority) and supporting families, where necessary.
‘Curtains banks are another great resource. In Auckland we have two providers that use recycled
and donated curtains to create made-to-measure sets of curtains with thermal backing for those
in need. It makes a huge difference.’
AWHI is always on the hunt for other services and assistance from business and NGOs that
could support the programme because the supply of these services is critical for AWHI families.
‘Other families may be looking for housing so we help connect them with providers that are able
to help support that process.’
For example, AWHI is able to connect whānau with the Ministry of Social Development (MSD)
fast-tracking scheme, where families who qualify for social housing and also have children at
risk of rheumatic fever are given priority into appropriately sized state homes.
Rawinia and the team work closely with the MSD and Work and Income New Zealand (WINZ)
offices to ensure that any low-income or beneficiary families they are working with are accessing
and receiving all the support they are entitled to.
‘Initially, coming into the work, we thought we would have been working primarily with existing
WINZ clients but it’s mainly been low income earners,’ Rawinia said.
To be eligible for support from the AWHI programme, there are certain criteria that families
need to meet, such as having a low income, living in Auckland with New Zealand citizenship or
residency, experiencing household crowding, and having at least two children under 15 years in
the household. In addition, one of the children must have a specific medical condition.
AWHI currently only receives referrals from three sources: Hospitals such as Starship, Kids
First, and Waitakere; the Auckland-based school-based sore throat programmes; and the
community nurses who administer monthly bicillin injections for those who have already been
diagnosed with rheumatic fever.
At the end of June 2014, 613 families – with more than 4000 family members – had been
referred to AWHI.
‘Our low-income definitions are based on the Community Services Card Income thresholds and
we identify two different forms of household crowding,’ Rawinia said.
‘Structural crowding is when you have too many people living in a home. We use the
guidelines from the Canadian Occupancy Standard for this. The second form of crowding is
functional crowding. This is when you have enough bedrooms in the house but because of
poor heating and other issues everyone sleeps in a single living area to stay warm.’
Ngā Kōrero – No.18 August 2014 16
AWHI works with a range of people from hospital staff to community and social workers and
government agencies, and these relationships have been critical to the implementation of the
programme to date.
‘The AWHI programme has been running since December last year and the learnings during this
period have helped refine our approach to rheumatic fever in many ways,’ Rawinia said.
‘The whole AWHI team are there to make a difference and contribute. The social justice
element drives us too . . . all kids should have an equal opportunity to reach their potential. We
really could stamp out that inequality if we tackle this together.’
The Ministry of Health is working to expand the healthy homes initiative from Auckland to
other district health board (DHB) regions with a high incidence of rheumatic fever. These are
the Northland, Waikato, Lakes, Bay of Plenty, Tairāwhiti, Hawke’s Bay, Capital & Coast and
Hutt Valley DHBs.
You can learn more about rheumatic fever and the Rheumatic Fever Prevention Programme at
www.health.govt.nz/our-work/diseases-and-conditions/rheumatic-fever
Visit the Health Promotion Agency website www.hpa.org.nz to learn more about the
country’s first national rheumatic fever awareness campaign, which started on 1 May 2014.
Learn more about Curtain Banks at www.communityenergy.org.nz/curtain-banks
Southern iwi relationship board first to
experience governance training
In the last issue of Ngā Korero we highlighted the Governance Training Tools that were being
made available for DHBs and Iwi Relationship Boards.
Following the release of these courses, members of the Iwi Relationship Board for Southern
DHB gathered on the 29 and 30 May to go through the training together.
The training was extremely well received and, according to the feedback from participants, one
of the aspects of the training they found most valuable was the way the training: ‘goes further
than typical governance training might and acknowledges the importance of those strategic
discussions and networking opportunities with other mana whenua groups. Everyone left
wanting more.’
As Donovan Clarke, Executive Director Māori Health for Southern DHB, explains, ‘Everyone
found it really worthwhile – they want another one soon.
‘It was a great opportunity to be challenged to look at our governance role in another way. The
workshop helped discuss our governance roles and all the issues around audit, risk, and finance,
within a context of really understanding the strategic direction for where Māori health needs to
go across Te Wai Pounamu.’
For more information regarding the training, contact Eugene rewi at
eugene_rewi@moh.govt.nz
Ngā Kōrero – No.18 August 2014 17
Where can I find Health Information?
The Māori Health Business Unit has just published on its website the factsheet – Where Can I
find Health information?
What does it cover?
This factsheet provides a directory listing data sources commonly used when analysing the health of New Zealand
populations. The data sources covered are:
•
•
•
•
•
•
Burden of Diseases, Injuries and Risk Factors Study, 2006–2016
New Zealand Cancer Registry
•
Hospital Events
•
Mortality Collection
•
New Zealand Health Survey (NZHS)
•
Population Statistics
•
Disability Survey
General Social Survey: 2012
Life Expectancy
Te Kupenga: Māori Social Survey
New Zealand Census: 2013
How do I use it?
The following information is provided for each data source.
The data
source
What is this?
What can I find
here?
Who owns
the data?
Where can I find
this?
How often is it
produced?
This section includes
background
information about the
data source.
This section includes
keywords used to
summarise the
contents of the data
source.
This
section
clarifies
who has
produced
the data.
This section lists
the site the data
source has come
from, eg,
www.health.govt.n
z and directly links
to the data source.
This section
states how
often new data
is collected
and/or
published.
Information based
on data from the
NZCR includes:
• Cancer
registrations
• Deaths from cancer
• Most common
cancers
• Leading causes of
death from cancer
• Demographics
• Cancer survival
data
Ministry
of Health
New Zealand
Cancer Registry
(NZCR)
Information
based on
NZCR data is
updated
annually.
For example:
New
Zealand
Cancer
Registry
(NZCR)
This is a population
based register of all
primary malignant
diseases diagnosed in
New Zealand.
See Cancer data
and stats for
publications and
datasets.
To view the web-based factsheet and to access links to the different data sources go to
www.health.govt.nz/healthinfo
How to subscribe to Ngā Kōrero
Interested in subscribing to Ngā Kōrero?
Just email your name and contact address to Nga Metuangaro
nga_metuangaro@moh.govt.nz and your details will be added to the newsletter
distribution list.
You can also email Nga if you’d like to stop subscribing to this quarterly newsletter.
Ngā Kōrero – No.18 August 2014 18