Equality, Maori, News, Racism
A feature article on an Australian TV website has highlighted the issue of the indigenous health gap; an issue that echoes the situation of Māori here in Aotearoa New Zealand.   The article, by Bianca Nogrady, highlights the fact that indigenous Australians have a life expectancy ten years lower than non-indigenous Australians.  She identifies social determinants of health such as income, access to affordable housing, stress and race as key factors in this gap.   Crowded housing and ear infections   poverty-in-brazil-1237888-1600x1200   Nogrady cites an example, by Professor Dennis McDermott from Adelaide’s Flinders University, of housing and ear infections.  Where a large number of people live at close quarters – as is more common among poorer indigenous people – children are more likely to suffer repeat ear infections as they are passed around the household.   “What happens is that non-Indigenous kids get it maybe once, they have a brush with it, and then it’s gone,” says Prof McDermott. “But with Indigenous kids in an overcrowded situation, it goes around and comes back, goes around and comes back, such that it’s a huge impact on hearing loss.”   This hearing loss has life-long effects. Children can’t hear in school, adults can’t hear on the job, it can impact on mental health, anger management, and wellbeing, McDermott says.   The impact is doubled with racism According to Prof. McDermott racism has a clear and proven impact on people, as does connection to country – or the land from which people come.   “That psycho-spiritual connection to country, and doing these ceremonies, observing, burning the country when necessary…, is actually a positive contributor to health.”   In Australia there is hard evidence to support that those people living ‘on country’ and experiencing at least some elements of a traditional lifestyle are healthier.  They tend to be more physically active, have a better diet, lower body-mass index, lower blood pressure, lower blood glucose levels, lower prevalence of diabetes and a lower risk of cardiovascular disease.     Despite the issue seeming insurmountable Prof. McDermott is optimistic.  He compares the health gap to climate change, explaining that there is no vested interest in listening to the evidence and making a change.  However, he says; “I think if we can only get that message through and build a critical mass of discourse in the community, then the politicians will fall in line.” The original article appeard on www.abec.net.au.  Read it here.  

News, Policy, Racism
All but one of all the political parties of New Zealand have responded to last month’s invitation, by the Institutional Racism Special Interest Group (IRSIG), to state their position on addressing institutional racism in Aotearoa New Zealand. racism_thematic   Responses were as wide-ranging as the political parties.  A brief paragraph from the Act party suggested the issue centres on preferential treatment of Māori, while the Green Party issued an in-depth statement acknowledging that health and wellbeing is a basic human right and needs to be upheld for all New Zealanders, regardless of their ethnicity. The New Zealand Labour Party was the only party to decline to respond Institutional racism is defined as “an entrenched pattern of differential access to material resources and power determined by race, which advantages one sector of the population while disadvantaging another”[1].  Present-day examples of institutional racism can be seen in Waitangi Tribunal claims and lead to inequities in health, education, employment and criminal justice outcomes for Māori [and other ethnic minorities?]. The IRSIG is a tripartite group, with members from the Health Promotion Forum of New Zealand – Runanga Whakapiki Ake i te Hauora o Aotearoa, the Public Health Association and the Māori Public Health Leaders Alumni. Read the ISRIG’s report on the parties’ responses.  

Community, Maori, Racism

Why are the raids of Ruātoki in Uruwera a health promotion issue? What can our profession do to help all those involved, as well as prevent such traumatic effects in the future?  Hauora editor Jo Lawrence-King investigates.   In October of this year, the unlawful Uruwera raids of the small community of Ruātoki were once again brought into the public eye. An episode of TV One’s Marae Investigates, marked the sixth anniversary of the event and the feature was followed a few days later by a speech in Parliament by Te Ururoa Flavell MP.   Why is this distressing chapter in our recent history a health promotion issue?  And how might we, as health promoters help address it?  Answering the first question is relatively straightforward: we need only go back to the determinants of health and the four essential ingredients to Māori of hauora (wellbeing).  The second is perhaps a more complex conundrum, but Deputy Executive Director of HPF Trevor Simpson has some ideas.  

Operation Eight as a health promotion issue

Let’s look at why Operation Eight is an issue for health promoters.  Firstly we need to look at the Māori concept of hauora.  Professor Sir Mason Durie describes the four crucial factors of hauora as the four walls of a whare:  
  • taha tinana; physical wellbeing
  • taha hinengaro; mental and emotional wellbeing
  • taha whanau; social wellbeing
  • taha wairua; spiritual wellbeing.
For the whānau of Ruātoki all four of these factors were taken from them on 15 October 2007. Indeed, in an interview on TV One’s Marae Investigates, highly respected paediatrician Professor Innes Asher* referred to the incident’s effect on the children of the community as “one of the worst cases of child abuse by state authority figures in modern time.”   It is reported that people were detained at five properties in Ruātoki by armed police, dressed in combat gear wearing masks and carrying guns. They were denied food and drink for up to nine hours.  They even had to ask to use a toilet. Other children were taken from their parents or grandparents and held in prison, while their caregivers were arrested.  “They would have been terrified,” says Professor Asher.  A road block  by similarly clad and armed police intimidated the occupants of cars passing into and out of Ruātoki.  According to one report the officers even came onto a school bus; frightening the children on board.  The people caught up in this operation – which was later found to have been unlawful – described their experience as  terrifying.   For most of the people caught up in the raids, three of the four factors of hauora may well elude them to this day; those of taha hinengaro (mental and emotional wellbeing) taha whanau (social wellbeing) and taha wairua; (spiritual wellbeing). Six years on, the trauma suffered by these people (and particularly their tamariki and mokopuna) has had little acknowledgement; apology or attempt at helping those affected.  “They have been abandoned by the state that abused them,” states Professor Asher.  The raids continue to have a terrible effect on the people of the community.   As well as the four principles of hauora, we can look at the fundamental conditions of health as defined by the Ottawa Charter for Health Promotion (World Health Organisation, 2013) and how they are impacted by this event.  They are:  
  • peace
  • shelter
  • education
  • food
  • income
  • a stable eco-system
  • sustainable resources
  • social justice and equity.
Again, it’s clear to see that the people of Ruātoki were denied a number of these fundamental conditions on 15 October 2007, by some of the very people whose role it is to protect them.  It can be argued that those traumatised by the events of that day may still not feel they have peace.  They almost certainly do not feel they have social justice and equity.   In a speech to parliament on Wednesday 23 October, Te Ururoa Flavell called for action to acknowledge the events of six years ago.  “I do not understand how we can receive that sort of information and we can hear the horrific experiences our State forced upon children and not feel motivated to change or to act,” he said. “This is beyond party politics. It is beyond bureaucracy. This is about our children.”   In a later statement Flavell deplored the “ridiculous delays” by the Human Rights Commission in releasing their report on the incident:  “… are the human rights of Tuhoe people not important to the Commission? Is the Commission hoping the issue will just go away? The only other explanation would seem to be serious incompetence by the Commission, or political concerns about releasing an embarrassing report.”  

The role of health promotion

According to HPF’s Deputy Executive Director Trevor Simpson (himself Tūhoe) there is a lot health promoters can do; both to help address the raids’ effects on the community, and to prevent such effects in the future.  The work falls into three categories;
  1. to speak out about  the impact of such injustices on the health of a people;
  2. to support those who are working to address them and
  3. to help build a society that has no tolerance for such abuses upon any community.
To address the effects of the raids on the people of Ruātoki, Trevor suggests the community might:
  • Employ Māori health promoters to work in the community to regain self-determination, hauora and a revitalised sense of community.
  • Use the health promoting schools framework in the local schools to empower students and their whānau to seek the conditions they need for hauora.
  • Have health promoters help with health providers and other services to engage with the residents of the community in a culturally appropriate way to address their trauma.
Perhaps even more significantly, Trevor believes health promotion has a key role in preventing such devastating effects on wellbeing in the future.  “We must use the experience gained in Ruātoki to inform policies and actions; to equip communities with better information and empowerment and to seek support and measures to redress the harm caused,” he says.   He suggests health promoters might work alongside the authorities concerned to help them identify appropriate ways of redressing the injustices.  “If we can help them see the effects their actions have had, we might be able to help them identify the best ways to address them.”   And in the future Trevor envisages a time when all authorities – indeed all organisations – are required to conduct health impact assessments on their proposed initiatives; this will help to mitigate the devastating effects of bad policy imposed on both individuals and communities. Without this measure we will continue to run the risk of potentially harming people.   The Operation Eight story illustrates the breadth of our responsibility in health promotion.  Hauora is affected by a huge array of factors.  Freedom to live without fear is one of the most fundamental of these.  The experience of the people of Ruātoki – and particularly their tamariki – serves as a reminder of the work that still needs to be done to achieve hauora for all citizens of Aotearoa New Zealand.   The Health Promotion Forum of New Zealand (HPF) – Runanga Whakapiki Ake i te Hauora o Aotearoa – is the industry leader in health promotion.  It is founded on the principles of Te Tiriti o Waitangi, and the Ottawa Charter for Health Promotion.   HPF offers education and training in health promotion and Māori health models.  Visit our Māori section for more information. *Professor Asher is head of the department of paediatrics at Auckland University   Jo Lawrence-King  

Maori, Racism
On Friday 30 January 2009 the Committee adopted the General Comment on Indigenous Child Rights. This Comment urges State Parties to adopt a rights-based approach to indigenous children based on the Convention.   The Committee On The Rights Of The Child sits within the United Nations High Commission for Human Rights. NZ is among the State Parties to the Convention on the Rights of the Child and ratified the Convention in 1993.