Leadership C- lutions . Improving Responsiveness to Maori with Diabetes

1. Leadership C-lutions. Improving Responsiveness to Maori with Diabetes Parliament 22 May 2012 Terry Ehau

2. Presentation Outline • Context • A brief of two projects and their impact on Maori communities • Leadership C-lutions • Conclusion

3. Context

4. Minister of Health Ministry of Health District Health Boards Primary Health Organisations Multitude Non-Government Organisations Maori Health Organisations National Maori Specialist Groups

5. Awhiowhio Framework Te Ao Hurihuri Te Ao Hurihuri Au Whanau Whanaunga Whanaungatanga Te Ao Hurihuri Te Ao Hurihuri Whakawhanaungatanga Ehau T . Adapted from the teachings of Huata P (1996)

6. Indigenous Ideology and Knowledge Scientific Ideology and Knowledge Indigenous – Scientific Interface Adapted from Durie, (2004 p.9)

7. Two Community Projects

8. Ngati & Healthy N o r t h l a n d A u c k l a n d W a i t e m a t a C o u n t i e s M a n u k a u B a y o f P l e n t y W a i k a t o T a i r a w h i t i L a k e s H a w Tairawhiti DHB Region T a r a n a k i k e ' s B a y W h a n g a n u i M i d C e n t r a l N e l s o n W a i r a r a p a M a r l b o r o u g h H u t t C a p i t a l & C o a s t W e s t C o a s t C a n t e r b u r y S o u t h C a n t e r b u r y O t a g o S o u t h l a n d

9. Ngati & Healthy • Collaborative Community Intervention • Ngati Porou Hauora • Edgar National Centre for Diabetes Research • Aims were reducing • Incidence of insulin resistance in the short term • Type 2 diabetes in the long term.

10. Ngati & Healthy • Increasing • consumption of fruit and vegetables • consumption of wholegrain foods • exercise levels • Reducing • consumption of fat • level of smoking • alcohol intake

11. Pouwhenua Clinic Bay of Plenty DHB Region N o r t h l a n d A u c k l a n d W a i t e m a t a C o u n t i e s M a n u k a u B a y o f P l e n t y W a i k a t o T a i r a w h i t i L a k e s T a r a n a k i H a w k e ' s B a y W h a n g a n u i M i d C e n t r a l N e l s o n W a i r a r a p a M a r l b o r o u g h H u t t C a p i t a l & C o a s t W e s t C o a s t C a n t e r b u r y S o u t h C a n t e r b u r y O t a g o S o u t h l a n d

12. Poutiri TrustPouwhenua Clinic • Ministry of Health • Te Ao Auahatanga Fund • Te Kakano: Seeding Innovation • Te Parakeke: Sharing Innovation • Te Ruinga: Spreading Innovation • Innovative Solutions to reducing high levels of inequity in Maori Health

13. Pouwhenua Clinic • To increase clinical access • To provide access to specialist health service • To provide workforce development • Access to culturally appropriate wrap around services

14. C-lutions

15. C-lutions • Challenge • Community • Continuity • Connectivity • Culture • Concientisation • Conflict / Change • Champions • Competency • Credibility

16. Challenge States of Power Paradigm Dependence Independence Interdependence Powerless I am Powerful We have the power Ehau T. 2008. Integrating a Maori Health Team into a Non-Maori Health Business (Unpublished)

17. Community • Engage effectively with communities • Communities are tired of getting red widgets when they actually require blue widgets • Ie others making decisions on their behalf without engaging • Access to the whanau and community knowledge • Our people are having their feet chopped off - What are we doing about this?

18. Continuity • Knowledge sharing • Transfer of knowledge through generations and over time • Achieved through storytelling • Effective transmission • Effective receipt • Effective internalisation

19. Continuity Te Ao Hurihuri Awhiowhio Framework Te Ao Hurihuri Au Whanau Whanaunga Whanaungatanga Te Ao Hurihuri Te Ao Hurihuri Whakawhanaungatanga Ehau T . Adapted from the teachings of Huata P (1996)

20. Continuity T.Ehau. (2008) with information gathered in hui over a period of 20 years

21. Connectivity • How authentic are our practices? • Cultural framework or Eclectic framework? • Do we have a social disconnect? • Do we have a technology disconnect? • Kanohi ki te kanohi (Face to face)

22. Connectivity Relationship creates opportunity for Global Knowledge Indigenous Ideology and Knowledge Scientific Ideology and Knowledge Indigenous – Scientific Interface Adapted from Durie, (2004 p.9)

23. Culture • Matauranga Maori allows us access to the past • Mohio Maori • Testing through practice • Acknowledgement of precedents in decision making • Supports development of Maori positions on contemporary issues by providing a rich background of phenomenological references

24. Culture Awhiowhio Framework Te Ao Hurihuri Te Ao Hurihuri Au Whanau Whanaunga Whanaungatanga Te Ao Hurihuri Whakawhanaungatanga Te Ao Hurihuri Ehau T . Adapted from the teachings of Huata P (1996)

25. Conflict • Hegemony – the impact of colonisation still hinders possible development • Technology – possibility of taking out the human factor (“kanohi ki te kanohi”) • Counter to conflict?

26. Concientisation • Need to critically `conscientise’ themselves about their needs, aspirations and preferences • Free up indigenous imagination and thinking • State of power continuum • Control own destiny • Move out of dependence status

27. Change • Conflict offers the opportunity for change • Move from a grievance based mode to a success based mode

28. Champions • Whanau / Community • Organisational • NGO • Funder • MoH • DHB • PHO • Partners • Tertiary Institutes

29. Credibility • Challenges vs Competencies • Appropriate resources being utilised to gain maximum benefits • Right people, right bus, right seats

30. Credibility AROUSAL High Challenge ANXIETY IndigenousPopulations FLOW WORRY CONTROL APATHY RELAXATION BOREDOM High Competence Indigenous / ScientificIdeologyandKnowledge Source: Mihaly Csikszentmihalyi, Good Business 2003

31. CelebrationCelebrationCelebrationCelebrationCelebrationCelebrationCelebrationCelebrationCelebrationCelebrationCelebrationCelebrationCelebrationCelebrationCelebrationCelebrationCelebrationCelebration

32. Conclusion • Two statements half a century apart • Both from the same source • United Nations General Assembly • United Nations Permanent Forum for Indigenous Issues

33. Conclusion “Indigenous people constitute a vulnerable group which has long been neglected. Their social structures and lifestyles have suffered the repercussions of modern development. They have been subject to growing pressure to bring their languages, religions, knowledge, arts and oral traditions, and the other manifestations of their ways of life, into conformity with those of the majority social groups around them” United Nations General Assembly (1949)

34. Conclusion “Indigenous peoples are custodians of some of the most biologically diverse territories in the world. They are also responsible for a great deal of the world’s linguistic and cultural diversity, and their traditional knowledge has been and continues to be an invaluable resource that benefits all of mankind”. “Yet, indigenous peoples continue to suffer discrimination, marginalization, extreme poverty and conflict. Some are being dispossessed of their traditional lands as their livelihoods are being undermined. Meanwhile, their belief systems, cultures, languages and ways of life continue to be threatened, sometimes even by extinction”. ShaZukang (2009)

35. Durie (2004) challenges the notion of this statement that this litany of characteristics does not give weight to indigenous aspirations for self determination and repatriation of resources. Although embracing wider society is important as is the desire to live in the modern world, a primary desire of indigenous peoples is to maintain indigenous values, properties, and language and to exercise a degree of autonomy. With this, is the shared view that indigenous peoples believe that the fundamental starting point is a strong sense of unity with their environment.