Health Promotion Forum Symposium opening

May I begin by greeting everyone in the languages of the realm of New Zealand, in English, Māori, Cook Island Māori, Niuean, Tokelauan and New Zealand Sign Language. Greetings, Kia Ora, Kia Orana, Fakalofa Lahi Atu, Taloha Ni and as it is the afternoon (Sign). 

May I specifically greet you: Janferie Bryce-Chapman and Dr Alison Blaiklock, Chairperson and Executive Director respectively of the Health Promotion Forum of New Zealand Runanga Whakapiki Ake i te Hauora o Aotearoa; Rev Richard Wallace, kaumatua and council member; Guest speakers, particularly Professor Phillippa Howden-Chapman of the University of Otago; Kevin Hague, member of Parliament ; distinguished guests otherwise; ladies and gentlemen.

It is with pleasure that my wife Susan and I have accepted your invitation to attend Hauora—Everyone’s Right 2009, the Health Promotion Forum symposium.

I have been asked to formally open the symposium, and just before I do I would like address the theme of this gathering and work that you do as health promoters.

Under the banner reading “Hauora” it seems natural to use a Māori theme or structure in framing what I have to say.  As will be known to many here, an orator on the paepae starts with a recitation of whakapapa which is partly to connect with those present.   There is then some whaikorero and lastly a wero or challenge.

With reference to the theme of this symposium, I am speaking as the member of a family where health has been a primary concern.  My father practised as a GP in Auckland for many years whilst my mother worked as a Karitane nurse before being married. 

I am also speaking as someone with a long-standing interest in the health profession—an interest that was perhaps established courtesy of both my parent’s occupations, and subsequently repeated in my working life.

As a working lawyer, Judge and Ombudsman, I have had a number of opportunities to remain involved with many contemporary medico-legal issues.    One such example is the 16 months I spent chairing, at the Government’s request, the Confidential Forum for Former In-Patients of Psychiatric Hospitals. This, in 2005, was a legal first for New Zealand, which sought to add a ‘truth and reconciliation’ element to dealing with issues that some former patients wished to raise affecting their time in a hospital.  The Forum’s work was subsequently completed by my colleague, Judge Patrick Mahony when I was appointed Governor-General, and it released its report two years ago.

Those connections with health, disability and wellbeing have widened further since my appointment as Governor-General in August 2006.  The Governor-General role means being, with my wife Susan, Patron of about 150 organisations, many of which have an interest in health.  They include organisations as diverse as the Arthritis Foundation, the New Zealand AIDS Foundation and the New Zealand Organisation for Rare Disorders.

I am also speaking today as a former patient. After a road accident sustained by Susan and I in July 2002 and an odontoid fracture of C2, I spent three months in the “derrick round the head” environment of halo traction equipment. 

These three perspectives—family, professional and patient—have provided me with an appreciation for the work undertaken by those working in the health sector. I acknowledge the hard work and commitment health professionals display in their work.

Having thus established hopefully a place to stand, I would now like address the theme of your gathering.  My whaikorero is about the importance of holistic health and wellbeing in difficult times.

There several signposts in examining this issue.  The first is dated more than 20 years ago, when the first international conference on health promotion, held under the auspices of the World Health Organisation in 1986. 

Named after the city in which the conference was held, the Ottawa Charter, as will be well known to many of this audience, continues to guide the work of health promoters to this day.

The Charter while recognising that peace, shelter, education, food, income, sustainable resources and social justice were the fundamental conditions for health, went further by emphasising that these had to be achieved within a wider framework.  For example, whilst food is important, too much or the wrong kind can just as easily lead to as many problems as not having sufficient.

The Charter outlined five areas for action—building healthy public policy; creating supportive environments; strengthening community action; developing personal skills and re-orientating health care services toward prevention of illness and promotion of health.

A second signpost occurred last year, 2008.  The Ottawa Charter’s framework has been energised by the release of the final report of the Commission on Social Determinants of Health, established under the auspices of the WHO.  Chaired by a leading Professor of Public Health at University College London, the Commission’s report has won international praise for its forthright approach, by viewing health as a human right.

Not one to mince words, the Commission said reducing health inequities was an ethical imperative. As it noted: “Social justice is a matter of life and death.  It affects the way people live, their consequent chance of illness, and their risk of premature death.  We watch in wonder as life expectancy and good health continue to increase in parts of the world and in alarm as they fail to improve in others … Differences of this magnitude, within and between countries, simply should never happen.”

But where the Commission’s report differed from so many others, was that it outlined key recommendations for tackling differences between nations and within countries.  It is often said that good health promotion is about ensuring healthy communities, symbolically represented by the fence at the top of the cliff rather than the ambulance at the bottom.

The Commission went much further by effectively questioning why the cliff exists in the first place.  It called for a new approach to development that saw health as the goal of all social policies rather merely a welcome by-product.  And most strikingly, it challenged the nations, communities and the international community to close the health gap in a generation.

Those two signposts are international in character and one might think, what does this mean for New Zealand?   There are several points to make that are relevant to our country. 

First, we are familiar with many of these issues and New Zealanders continue to face serious challenges to our health.  For example, the media continues to run stories of increasing rates of preventable diseases such as diabetes and HIV-Aids.  Also, 45 years after the first American Surgeon-General’s report on the dangers of tobacco use,  one in five New Zealand adults continues to smoke.

Secondly, however, on the positive side of the ledger, the life expectancy of all New Zealanders continues to increase.  There continue be significant differences though between the average life span of Māori and Pacific New Zealanders and the rest of the population.  

Thirdly, with increasing life expectancy come other inevitable health issues we all face in the latter part of our lives and the increasing demands that that places on the health system.

And finally, if that is not enough cause for concern, we are now faced by an economic crisis.  History shows the stress and tension caused by the economic downturns often have a negative effect on the wellbeing of individuals, families and communities.  This all paints a somewhat grim picture.  But it does not have to be unremitting gloom.

I believe in New Zealand that we have several models that demonstrate the connections between health and other social indicators.  In keeping with the spirit of the Ottawa Charter, many successful initiatives have come from community responses to community needs. 

The first is model is that provided by Plunket.  One of the biggest providers of Well Child Tamariki Ora checks are by Plunket nurses.  As a couple, both Susan and I have had a long-term connection with Plunket, presently in the Patron role and Susan formerly as the president of a Plunket branch in Auckland when our children were small.

A second example was highlighted in The New Zealand Listener last year.  A programme called LANE, short for “Literacy and Numeracy Empowerment” at Christchurch’s Linwood College was not just about improving reading, although that was an important part.   With the support of a community trust, some 450 students in years 9 and 10 in 2006 underwent a detailed health check.  

The results were surprising.  Some 70 percent of the students needed a referral for at least one health problem, with 53 needing spectacles.  The results of dealing to these issues were equally dramatic, with not only improvements in the student’s health, but also in their education, with reductions in suspensions. 

Just in case this looked to be something artificial, I also looked at the College’s most recent ERO report dated late last year.  While it noted areas for continued improvement—not surprising in a decile 2 school—the evidence was clear.  A good example was its comments on Māori achievement.  In the careful language that is the hallmark of an ERO report it says:

“Analysis from a range of data indicates that Māori students make good progress compared to their peers nationally.  The percentage of Māori students leaving school with little or no formal qualifications has decreased while the numbers involved in stand downs and suspensions has halved in recent years.”

This LANE project is a classic example of a community initiative that looks more widely at the social determinants of health and the connections with education and achievement.  It may not be the right model for every community, but it certainly provides pointers for future action.

The immediate response one often hears to this is: “Oh well, but that requires money and with the economic slowdown, we don’t have any, so we can’t do it.”  Projects like this need funding, but funding should not always be the make or break point.

This point, leads me toward my wero or challenge to you. Within our communities are equally important resources in skills and time that people can offer.  Earlier, this year I issued a first New Year message in which I urged all New Zealanders to become more engaged in their communities through offering their time and skills to voluntary organisations.  A good example, albeit from a different field, is the move by a group of senior lawyers in Auckland to provide their services free of charge to the SPCA to assist in prosecuting animal cruelty cases.   As a member of the legal community, I know something of the charge-out rate of a senior lawyer’s time.  If one community group can build a relationship with senior lawyers, cannot others build relationships with senior health practitioners?   If the relationship is based around a clear and defined project, I am sure there would be willing partners.

My wero to health promoters is to continue to encourage and promote initiatives such as this.  I know you already have strong links with many community groups, but I urge you to look more widely.  I am certain that relationships can be built with willing partners so long as it is based on clearly defined projects or initiatives.  Can we close the gaps within a generation? Maybe not, but we have it within our own hands to make a start.

As the Māori proverb or whakatauki has it: Kaua e rangiruatia te ha o te hoe e kore to tatou waka e u ki uta which translates as: Do not lift the paddle out of unison or our canoe will never reach the shore.

And on a note that I hope is consistent with encouragement, I hereby declare the Hauora—Everyone’s Right 2009 Health Promotion Forum Symposium officially open.

I will close in New Zealand’s first language Māori, by offering everyone greetings and wishing you all good health and fortitude in your endeavours.  No reira, tēnā koutou, tēnā koutou, kia ora, kia kaha, tēnā koutou katoa.