Taurite Ora
Māori Health Strategy
2019—2030
Kua
Takoto
te Rau
Tapu
The challenge of
health equity for Māori
is laid down
Taurite Ora
Māori Health Strategy
2019—2030
link to page 7 link to page 8 link to page 9 link to page 11 link to page 17 link to page 18 link to page 18 link to page 19 link to page 21 link to page 21 link to page 22 link to page 23 link to page 26 link to page 26 link to page 27 link to page 28 link to page 28 link to page 29 link to page 29 link to page 30 link to page 30 link to page 31 link to page 32 link to page 33 link to page 4
Contents
3 Mihimihi
11 Introduction
4 Glossary
14 Our vision: pae ora mo nga iwi
5 Foreword
i te Ūpoko ki te uru hauora
7
Executive Summary
15 Laying down the challenge
17 Taurite Ora: CCDHB Māori
Health Strategy 2019–2030
18 The legal foundation
19 Te ao Māori
21 A Snapshot:
What we Know
23 CCDHB population
24 Māori wellbeing
24 Life expectancy
25 Socio-economic profile of Māori
25 Barriers to health for Māori
26 CCDHB as a pro-equity
organisation
27 Workforce and commissioning
28 Maternal, child and youth health
29 Mental health and addictions
Capital & Coast District Health Board
Ūpoko ki te uru hauora
Postal address:
Wellington Regional Hospital,
Private Bag 7902,
Wellington 6242
Physical address:
Wellington Regional Hospital,
Riddiford Street, Newtown,
Wellington 6021
Website: www.ccdhb.org.nz
Email: [email address]
Phone: 04 385 5999
Back to Contents
link to page 37 link to page 37 link to page 38 link to page 38 link to page 39 link to page 39 link to page 40 link to page 40 link to page 40 link to page 40 link to page 40 link to page 40 link to page 40 link to page 40 link to page 42 link to page 42 link to page 42 link to page 43 link to page 43 link to page 44 link to page 44 link to page 44 link to page 46 link to page 46 link to page 47 link to page 50 link to page 50 link to page 51 link to page 52 link to page 52 link to page 52 link to page 62 link to page 62 link to page 62 link to page 66 link to page 66 link to page 66 link to page 68 link to page 68 link to page 68 link to page 73 link to page 73 link to page 73 link to page 77 link to page 77 link to page 77 link to page 83 link to page 83 link to page 85 link to page 86 link to page 86 link to page 88 link to page 4
31 The Challenge
45 Taurite Ora:
Action Plan
33 A context for poor health
34 Manaakitanga
47 Set up of the action plan
34 What we recognise
48 Strategic priority 1: Become a
35 What we know
pro-equity health organisation
35 Measuring impact
58 Strategic priority 2: Grow and
empower our workforce
36 Outcome 1: A stronger and more
responsive CCDHB health system
62 CCDHB will support a
workforce equipped to improve
36 Strategic priority 1: Become a
Māori health
pro-equity health organisation
64 Strategic priority 3: Strengthen
36 Strategic priority 2: Grow and
our commissioned services
empower our workforce
69 Service focus area 1: Maternal,
38 Strategic priority 3: Strengthen
child and youth
our commissioned services
73 Service focus area 2: Mental
39 Outcome 2: Improved health and
health and addictions
wellbeing outcomes for Māori
40 Service focus area 1: Maternal,
77 Appendix
1
Child and Youth Health
42 Service focus area 2:
79 Our environment
Mental health and addictions
81 Māori communities
43 What Māori have said they value
82 Age distribution of Māori and
non-Māori in CCDHB area, 2013
84 Endnotes
Taurite Ora: Māori Health Strategy 2019—2030
Back to Contents
link to page 4
2
Back to Contents
link to page 4
Mihimihi
E aku nui, e aku wehi, e aku whakatamarahi ki te rangi
Tēnā koutou, tēnā koutou, tēnā koutou katoa
Tēnā anō hoki ō tātou tini aitua, rātou kua huri ki tua o te ārai
E ngā mate huhua, haere, haere, haere oti atu
Tātou te urupā o rātou mā, tēnā huihui mai tātou
Nei rā te mihi a te waiora ki ngā manatapu, ki ngā reo, huri noa
He mahi taumaha, he mahi whakapau ngoi, te whakatinana i ngā tini
āhuatanga e ū ai te hā o te ora
Engari he mahi hei oranga ake mō tātou
Kua takoto te mānuka
Nā reira ko tā tātou he hiki ake te wero
ka kawea atu ai ki ngā tihi o te ao waiora
Ko aua tihi rā
ko te oranga tinana
ko te oranga wairua
ko te oranga hinengaro
3
ko te oranga whānau
Arā he oranga tangata tērā kei te whāia nuitia
Kāti ake i konei
ki konā mai rā koutou i roto i ngā mihi
Mā Rongo, mā Tāne koutou katoa e whakaruruhau
Taurite Ora: Māori Health Strategy 2019—2030
Back to Contents
link to page 4
Glossary
Hapū Pregnant
Rangatahi Youth
Iwi Tribe
Rangatiratanga Self-reliant, determine your
own way
Kaiāwhina Helper, assistant
Rongoā Traditional Māori medicine
Kaiārahi Navigator
and treatment
Kaiārahitanga Leadership
Tamariki Children
Kaitiakitanga Stewardship
Tangata whaiora me tangata whaikaha
Māori with lived experience of disability
Kaumātua Elder
Taurite ora Tau (to arrive), rite (to be
Kaupapa Māori Taking a Māori approach
prepared), ora (health/wellbeing)
Kōwhaiwhai Painted scroll ornamentation
Tauritetanga Balance, justice
Māmā Mother
Te ao Māori The Māori world
Manaakitanga Respect, care, generosity
Tiriti o Waitangi Treaty of Waitangi
Manawanui Commitment
Tikanga Correct manner, rule or protocol
4
Marae Meeting area; central area of a
Tūrangawaewae Place where one has rights
Māori village and its buildings
of residence and belonging
through kinship
Mātua Parents
Wahakura Woven baby’s bassinet
Mauri ora Healthy individuals
Wai ora Healthy environments
Mirimiri Massage
Wero Challenge
Motuhaketanga Authority, self-determination
Whakamana Empowerment, influence
Ngākau tapatahi Integrity
Whakapakari Strengthen, develop
Pae ora The Government’s vision for future
Māori health
Whakatipuranga Growth, development
Pēpē Baby
Whanaungatanga Building relationships
Pou Post, pillar, support
Whānau Family
Pūkengatanga Pursuit of excellence
Whānau ora Healthy families
Back to Contents
link to page 4
Foreword
Ultimately, everything we do at the Capital & Coast District Health
Board (CCDHB) is focused on achieving healthy outcomes for our
people – all 320,000 of them. Whether they live on the Kāpiti Coast,
Porirua or Wellington City, we aim to everyone with the best health care
services we can.
Twelve percent, or 38,000, of the population are Māori and they are not
getting our best. This is a problem we need to tackle. In our current state
our systems, policies and services have failed Māori. Taurite Ora draws
a line in the sand and says that, from now on, we are going to do better.
Many of the statistics here evidence the wide and, in some cases,
widening gap between Māori and non-Māori. This stark inequity of
health outcomes is systemic, avoidable and unfair. Māori experience
inequity across all social and economic markers of wellbeing, not just
health. This suggests that our current systems, policies and services
support inequity. We need to address this.
The pathway to doing better is challenging and will require significant
shifts, not just in the way we operate or in the processes and policies
we follow but also in our attitude and our thinking.
Delivering on the key outcomes outlined in Taurite Ora is foundational
to our strategy, and we will measure and report on our progress
5
regularly. By definition, a Māori health strategy must have its starting
point in te ao Māori. The wero laid down for the CCDHB is to draw on
the knowledge and expertise of our workforce, our Māori partners,
iwi, communities and whānau to work with us to become a pro-
equity organisation. We believe that a strengths-based approach,
concentrating our effort toward building fit-for-Māori health services,
will inevitably strengthen Māori capability across the health sector
and have a flow-on effect into policy and practice design. But we will
not rely on that alone. We will introduce overt, clear measures that
demonstrate our progress.
By partnering with Māori, we can move beyond our predominantly
monocultural delivery systems to form a health service that
understands and welcomes solutions underpinned by kaupapa Māori,
emboldened by tikanga and supported by whanaungatanga – in
other words, the conditions most likely to enable Māori to thrive.
Andrew Blair
Teresa Wall
Chairperson
Chairperson
Capital & Coast District Health Board
Māori Partnership Board
Taurite Ora: Māori Health Strategy 2019—2030
Back to Contents
link to page 4
6
Back to Contents
link to page 88 link to page 4
Executive Summary
Capital & Coast District Health Board (CCDHB), together
with the Māori Partnership Board (MPB), has set its sights
on achieving the following critical goal:
Pae ora mō ngā iwi i te
Section 1
Ūpoko ki te uru hauora
7
Health equity and optimal
health for Māori by 2030
Our efforts to bring about changes in Māori health outcomes are part of a broader public
health plan that is most cohesively described in the Ministry of Health’s He Korowai Oranga:
Māori Health Strategy
.1 This overarching framework and its underlying themes of Pae Ora
(Healthy futures for Māori) founded on Whānau Ora (Healthy families), Mauri Ora (Healthy
individuals) and Wai Ora (Healthy environments) guide us.
Taurite Ora: Māori Health Strategy 2019—2030
Back to Contents
link to page 4
In 2019, the Government announced its commitment
to recognising people’s wellbeing as the most
important driver of its priorities and funding
decisions. With that announcement comes an
expectation that the CCDHB will be able to measure
and report against a broader set of indicators
than previously to monitor our progress around
improving wellbeing2.
The CCDHB strategy is tailored to the identified
health needs of Māori living in its district.
We developed this action plan,
Taurite Ora: Māori
Health Strategy 2019–2030 (Taurite Ora), to describe
the outcomes and impacts we will be measured
against. We intend to establish a governance group
to oversee the implementation of this action plan.
We must also plan for the projected growth of the
Māori population of CCDHB, forecast to increase
by almost 40 percent over the next 20 years, from
38,000 to 52,000. What we do now will lay down the
foundations for getting it right today, in five, 10,
and 20 years. We must continuously measure our
progress to ensure that we are improving, and we
must be agile and courageous enough to take the
lessons from our evidence and change what we’re
8
doing if it’s not working.
Taurite Ora highlights the most critical priorities
to improve health outcomes for Māori. Success is
dependent on working with our partners to improve
Māori interactions with our services and address the
poor experiences many Māori have told us about.
The strategy
Equity
focuses on:
Equity, as a value that underpins everything we do
Workforce
System change through workforce development
Commissioning
Funding prioritisation through commissioning
of services.
Back to Contents
link to page 4
From our foundation up, we must rebuild ourselves
Key equity
as a
pro-equity organisation. In doing so, we will:
measures
› redevelop supportive organisational structures,
policies and processes
› actively counter racism and discrimination
› actively include Māori in decision-making,
particularly where it relates to Māori
› develop a strategy to improve proportionality
across all our employment groups
› improve the quality and efficacy of our data.
We will focus on five
key measures of equity that are
within the CCDHB area of responsibility and where
we can have an early positive impact on Māori
outcomes. These five key measures are:
› amenable mortality (deaths that are potentially
preventable given the appropriate effective
health care)
› avoidable hospital admissions
› accessible appointments
› primary care utilisation
› community-based services.
9
Priority
Taurite Ora has also selected
two service areas that
would benefit from directing efforts and measuring
service areas
positive service changes to improve outcomes
for Māori, whānau and communities. These two
services are:
› maternal, child and youth health
› mental health and addictions.
The choice of these two services does not preclude
positive work continuing across other service areas.
Taurite Ora: Māori Health Strategy 2019—2030
Back to Contents
link to page 4
10
Back to Contents
link to page 4
Section 1 › Introduction
Section 1
Introduction
11
Taurite Ora: Māori Health Strategy 2019—2030
Back to Contents
link to page 4
12
Back to Contents
link to page 4
Introduction
Despite our best efforts, the Capital & Coast District
Health Board (CCDHB) has made no progress across
the 10 national indicators of population health status
as listed in our 2016–2017 Māori Health Plan.3 Our
evidence suggests that a major barrier to achieving
better health outcomes is the institutional restrictions
Section 1 › Introduction
Māori experience when they try to access our services.
At a national level, it has become clear that the perennial
failure of policies and interventions to make more than
small dents in Māori privation levels require us to look
at the systems we use to deliver change.
Taurite Ora tackles this head on by emphasising
13
the importance of reshaping CCDHB as a pro-equity
organisation. We will do this by undertaking initiatives
that improve the cultural safety and cultural competency
of our organisation. We will invite our partners and
stakeholders to help us achieve the change we need
to improve Māori health outcomes.
Taurite Ora looks ahead 10 years from now, and
we will report against each of our outcomes on a
three-year cycle.
Taurite Ora: Māori Health Strategy 2019—2030
Back to Contents
link to page 4
We share the Government’s vision of building
“a health system that will enable Māori to live with
Our vision:
good health and wellbeing in an environment that
supports a good quality of life”.4
Pae ora mō
We can achieve this by thinking beyond narrow
ngā iwi i te
definitions of health and changing the way we
deliver hospital, mental health and commissioned
Ūpoko ki te
services under our direct control. We can also
uru hauora
become more active participants in joined-up
actions to improve Māori health and wellness in
areas of shared responsibility.
“A health system that
The Taurite Ora framework describes the direction
for change that we are seeking. It values te ao
will enable Māori to
Māori and kaupapa Māori as key elements that
live with good health
speak to the heart of Māori wellbeing and the
pathways to achieve that wellbeing.
and wellbeing in an
Taurite Ora also recognises that Māori health is
environment that
inclusive of a diversity of Māori realities. It strives
supports a good
to address the health needs and aspirations of our
pēpē, tamariki, rangatahi, mātua, kaumatua and
quality of life.”
tangata whaiora me tangata whaikaha (Māori with
lived experience of disability).
Taurite Ora has been developed in collaboration
with Māori community leaders, kaupapa Māori
14
providers, Māori researchers and academics,
staff of CCDHB and with the support of the
Māori Partnership Board (MPB).
Back to Contents
link to page 4
Section 1 › Introduction
15
Laying down
The Taurite Ora framework is a kaupapa Māori-
centred framework. It has been designed as a
the challenge
sequence of interconnected and interdependent
foundation blocks that set the direction and purpose
of the strategy and the action plan. The pou to the
left and the right reflect Māori and Crown roles
and influences. The left pou holds the key to Māori
The left pou holds
expressions of wellbeing and the right pou, those of
the key to Māori
the Crown.
expressions of
Taurite Ora follows true to the form and intent of
He Korowai Oranga: Māori Health Strategy.
wellbeing and the
right pou, those of
the Crown.
Taurite Ora: Māori Health Strategy 2019—2030
Back to Contents
link to page 4
Taurite Ora: CCDHB Māori Health Strategy 2019–2030
Kua Takoto te Rau Tapu
Partnership
TE TIRITI O WAITANGI
Participation
Protection
New Zealand Public Health and Disability Act 2000
PAE ORA MŌ NGĀ IWI I TE ŪPOKO KI TE URU HAUORA
Healthy Futures for Māori in CCDHB
He Korowai Oranga
MAURI ORA Healthy Individuals
WHĀNAU ORA Healthy Families
16
Whānau, Hapū,
Rangatiratanga
Iwi Community
Māori
Māori Aspirations
Development
Participation
and Contributions
MOTUHAKETANGA
WHAKATIPURANGA
WHAKAMANA
Kaupapa
Authority,
Growth,
Empowerment,
Self-determination
Development
Influence
Māori
Tikanga
KAIĀRAHITANGA
WHANAUNGATANGA
MANAAKITANGA
Leadership
Relationships
Respect, Care,
Māori
Generosity
MATERNAL,
CCDHB IS A
CHILD AND YOUTH
MENTAL HEALTH
PRO-EQUITY HEALTH
Outcomes for
HEALTH
AND ADDICTIONS
ORGANISATION
Māori Health
Back to Contents
link to page 4
Taurite Ora: CCDHB Māori Health Strategy 2019–2030
The challenge of health equity for Māori is laid down
TE TIRITI O WAITANGI
Operating
Environment
Section 1 › Introduction
New Zealand Public Health and Disability Act 2000
PAE ORA MŌ NGĀ IWI I TE ŪPOKO KI TE URU HAUORA
Healthy Futures for Māori in CCDHB
Overall Aim
WHĀNAU ORA Healthy Families
WAI ORA Healthy Environments
17
Equity
Workforce
Commissioning
Crown Aspirations
And Contributions
TAURITETANGA
PŪKENGATANGA
KAITIĀKITANGA
Balance,
Pursuit of
Guiding
Stewardship
Justice
Excellence
Principles
MANAWANUI
WHAKAPAKARI
NGĀKAU
Policies
Commitment
Strengthen,
TAPATAHI
Develop
Integrity
Practices
STRONG MĀORI
MĀORI HEALTH
HEALTH WORKFORCE
PROVIDERS ARE THRIVING
WORKFORCE EQUIPPED TO
CONTRACTED SERVICES
Outcomes for
IMPROVE MĀORI HEALTH
ARE ACHIEVING EQUITY
System Change
Taurite Ora: Māori Health Strategy 2019—2030
Back to Contents
link to page 4
Taurite Ora is underpinned by Te Tiriti o Waitangi.
The New Zealand Public Health and Disability Act
The legal
2000 provides a statutory link between Te Tiriti
and Māori health by requiring DHBs to work with
foundation
and be responsive to Māori when developing,
planning, managing and investing in services that
impact on Māori communities. This obligation
encompasses an expectation by Māori that a te ao
Māori perspective will be evident in policy and
service design. In this context, Te Tiriti principles
of partnership, participation and protection are at
the core of Taurite Ora.
Partnership
The principle of partnership between Māori and the
Crown is well established in law. Within the context of
Taurite Ora, we will look at how we can strengthen the
relationships with mana whenua and strengthen the
role of the MPB.
Partnership also means applying a te ao Māori
perspective to Māori service design. This will be
challenging and requires CCDHB to proactively seek
co-design opportunities and guidance and advice on
matters of tikanga and whanaungatanga. Partnerships
should apply across all levels of our organisation.
18
Participation
The principle of participation refers to Māori
collaboration at all levels of the health and disability
sector – in decision-making, planning, development
and delivery of health and disability services.
In practice, this means ensuring that Māori are a vital
and visible element throughout CCDHB as health
planners, professionals and advocates for improving
Māori health outcomes. In particular, this requires us
to strengthen the role of our Māori health providers
and recognise their unique contribution to pae ora.
Protection
The principle of protection encompasses an
obligation to protect the interests of Māori. The scope
of this duty includes CCDHB ensuring Māori have
at least the same level of health as non-Māori, while
actively protecting Māori cultural concepts, values
and practices in developing successful health policies.
In practice, this mean placing the concepts of health
equity at the forefront in respect to the planning,
management and delivery of health services within
the CCDHB area.
Back to Contents
link to page 4
Kaupapa Māori
Te ao Māori
Kaupapa is about ensuring that Māori ways of
working are recognised and embraced in how
we plan and deliver health services.
Tikanga Māori
Tikanga is about recognising and responding
positively to values, beliefs and practices that
are essential to Māori wellbeing. This includes
matters affecting taha tinana (physical health),
taha hinengaro (mental health), taha wairua
(spiritual health) and taha whānau (family health).
Section 1 › Introduction
19
Taurite Ora: Māori Health Strategy 2019—2030
Back to Contents
link to page 4
20
Back to Contents
link to page 4
Section 2 › A Snapshot: What we Know
Section 2
A Snapshot:
What we Know 21
Taurite Ora: Māori Health Strategy 2019—2030
Back to Contents
link to page 4
The following tables and figures have been
A full copy of the
data report is
specifically designed to provide a snapshot
available on the
‘whole’ view of the CCDHB Māori population, CCDHB website.
key wellbeing factors, and system and health
equity. They are aligned to the strategy.
A Snapshot
What we Know
22
The data shows that:
+
Our Māori population is
There are many
comparatively young
positive aspects to the
wellbeing of Māori
The socio-economic
We need to change what
status of Māori results in
we do and how we do it if
disproportionate impacts
we are to achieve health
equity and optimal health
for Māori by 2030
Back to Contents
link to page 4
CCDHB population
Section 2 › A Snapshot of what we know
In 2016/17 there were
CCDHB 2013 Māori Population
approximately 35,300
Māori living in CCDHB,
MĀORI FEMALE
MĀORI MALE
comprising 11.5% of
the total population.
80–84
Most Māori live in
70–74
Wellington City, with
60–64
smaller numbers in
50–54
Porirua and Kāpiti
Coast, although the
AGE
40–44
proportion of Porirua
30–34
residents who are
23
Māori is high (20%).
20–24
10–14
Māori are considerably
younger than non-
0–4
Māori; over 30% are
2,000
1,000
0
1,000
2,000
under 15 years (cf 17%
of Māori) and only
CCDHB 2013 Non-Māori Population
4% are over 65 years
(cf 13% of Māori).
NON-MĀORI FEMALE
NON-MĀORI MALE
80–84
70–74
60–64
50–54
AGE
40–44
30–34
20–24
10–14
0–4
12,000 9,000
6,000
3,000
0
3,000
6,000
9,000 12,000
Source: Statistics NZ, 2013 Census
Taurite Ora: Māori Health Strategy 2019—2030
Back to Contents
link to page 4
Māori wellbeing
Data from the 2013
Census showed many
Most (88%) Māori
Many (79%) of Māori
Being involved in
positive aspects of
adults reported that
adults find it easy or
Māori culture was
Māori wellbeing that
their whānau is doing
very easy to access
important to 69%
are often overlooked.
well, although 4%
whānau support
of Māori adults.
felt their whānau was
in times of need.
doing badly.
One in five Māori could Most (90%) of
The 14 kōhanga reo
have a conversation in Māori adults did
have spaces 409 (10%)
te reo Māori in 2013.
voluntary work.
of Māori children up to
age 5 in CCDHB.
At age 5, 88% of Māori
Among Māori youth,
were fully immunised.
smoking rates dropped
significantly from 2006
to 2013, although rates
remain considerably
Source: CCDHB Māori Health
higher than for non-Māori.
Profile 2015
24
Life expectancy
Life expectancy is
shorter for Māori
85.0
83.9
than non-Māori, by
5.6 years for males
and by 5.3 years for
80.3
females.
80.0
78.6
74.7
75.0
LIFE EXPECTANCY (YEARS)
70.0
65.0
MĀORI
NON-MĀORI
MĀORI
NON-MĀORI
MALES
MALES
FEMALES
FEMALES
Source: Stats NZ, based on mortality rates 2012–2014, Wellington region
Back to Contents
link to page 4
Socio-economic profile of Māori
Māori are
LINE OF EQUAL RATES
disproportionately
impacted by
LOWER IN MĀORI
HIGHER IN MĀORI
socioeconomic
Live in most
deprivation in
deprived quintile
CCDHB. In 2013,
Unemployed
compared to non-
Looking after ill or
Māori, Māori living
disabled person
in CCDHB were
more likely to live in
Low income family
deprived areas, be
Living in household
unemployed, look
without heating
Section 2 › A Snapshot of what we know
after an ill/disabled
Household crowding
person, live in a low
income family, live
No access to internet
with no heating or
in an overcrowded
No access to car
house, not have
Not achieved NCEA
access to a car or the
Level 2 or higher
internet, and not
0
0.5
1
1.5
2
2.5
have NCEA Level 2
education.
RATE RATIO OF EACH INDICATOR
Source: CCDHB Māori Health Profile, 2015
25
Barriers to health for Māori
Māori report
MĀORI CCDHB POPULATION
experiencing
TOTAL CCDHB POPULATION
significant barriers
to accessing health
Unfilled prescription
(cost: children)
care, specifically
due to cost and
Unfilled prescription
(cost: adults)
lack of transport.
Unmet need for
after-hours…
Unmet need for
after-hours (cost)
Unmet need for
GP (transport)
Unmet need for
GP (cost)
Unable to get appt
within 24hrs
0
5
10
15
20
25
30
PERCENT OF THE POPULATION REPORTING THIS
Source: NZ Health Survey 2014–17
Taurite Ora: Māori Health Strategy 2019—2030
Back to Contents
link to page 4
System equity
CCDHB as a pro-equity organisation
A pro-equity
LINE OF EQUAL RATES
organisation would
LOWER IN MĀORI
HIGHER IN MĀORI
show equity in
Amenable mortality
outcomes that
(2015)
are amenable to
change at DHB level,
Ambulatory sensitive
allowing Māori to live
hospital admissions
long and live well.
45–64yrs (2018)
Seeing GP, <5 yrs
(2017/18)
Seeing nurse, <5 yrs
(2017/18)
Inaccessible
appointments (2016)
0.00
0.50
1.00
1.50
2.00
2.50
MĀORI TO NON-MĀORI RELATIVE RISK
26
Amenable mortality
Ambulatory sensitive
Māori children are
measures the
hospital admissions
more likely to see a
performance of a
measure the failure
nurse but less likely to
health system. Māori
of primary or
see a GP than non-
have twice the rate of
community care.
Māori, indicating lower
non-Māori people.
Māori adults have
access to care.
over twice the rate of
ASH than non-Māori,
non-Pacific peoples.
Māori are more than
Additional measures
twice as likely as
of a pro-equity
the total population
organisation also
to find CCDHB
include a range of
appointments
health measures,
inaccessible.
in which significant
inequity is seen, and
are described in the
main data chapter.
Back to Contents
link to page 4
System equity
Workforce and commissioning
The CCDHB workforce
5% Māori
11% Māori
does not reflect the
population it serves: 5%
of employees are Māori,
compared to over 11%
of the population.
CCDHB
CCDHB
workforce
population
Section 2 › A Snapshot of what we know
CCDHB Māori Health
The majority of
portfolio funds three
Māori receive most
‘By Māori for Māori’
of their health care
and two mainstream
from mainstream
providers delivering
services. Currently
services specifically
these are failing Māori.
targeting Māori, to the
Conversely, Māori
value of $2.2 million.
providers meet targets
This represents 0.45%
that general services
27
of the DHB budget.
fail to meet for Māori.
Taurite Ora: Māori Health Strategy 2019—2030
Back to Contents
link to page 4
Health equity
Maternal, child and youth health
For almost all
LINE OF EQUAL OUTCOMES
indicators, Māori
LOWER IN MĀORI
HIGHER IN MĀORI
do less well than
non-Māori.
Perinatal mortality rate (2012–16)
Smoking during pregnancy (2015/16)
SUDI (2011–15)
6.9
Born small at term (2016)
Breast feeding rates at 3/12 (2017)
ASH 0–4years (2018)
Infant immunisations at 8/12 (2018)
Rheumatic fever age 15–24 (2011–13)
5.6
Inaccessible appointments (2016)
% with caries at age 5 (2017)
Asthma hospitalisations (2016)
Chlamydia inequity ratio (2016)
Youth smoking, age 15–17 (2013)
HPV Immunisations (2015/16)
0
1
2
3
4
MĀORI TO NON-MĀORI RATE RATIO
28
Māori have had higher
Māori mothers are
Māori have 4.5 times
Born small at term: Māori
perinatal mortality
more likely to smoke
higher risk of Sudden
have a 20% higher risk,
rates than NZ
when pregnant.
Unexpected Death in
and hence are more
European mothers.
Infancy.
likely to suffer adverse
consequences of this.
Māori are 25%
Ambulatory Sensitive
Infant immunisations
Māori have much
less likely to be
Hospitalisations
are not quite as likely
higher rates of
breastfeeding at
(ASH 0–4 years):
to be up to date.
rheumatic fever.
three months.
Māori children are
30% more likely to
be admitted for an
avoidable reason.
Inaccessible
Māori children have
Māori have a
Chlamydia inequity ratio:
appointments are
a 50% higher risk
much higher rate
Māori are slightly more
much more common
of caries at age 5.
of hospitalisation
likely to be tested for, but
among Māori.
for asthma.
considerably more likely
to be diagnosed with
chlamydia. This shows
inadequate testing on the
Smoking in young
HPV immunisation
basis of need.
people is much higher
rates are similar in
in Māori.
Māori and non-Māori
girls, but recent
data has not been
published for boys.
Back to Contents
link to page 4
Health equity
Mental health and addictions
Māori have a high
LINE OF EQUAL OUTCOMES
risk of mental health
LOWER IN MĀORI
HIGHER IN MĀORI
problems and alcohol
Bipolar disorder (2014–17)
and drug addictions.
The Mental Health
Anxiety/depression (2014–17)
Commissioner has
Mental health service use,
stated that “greater
20–64yrs (2017/18)
Māori participation
Community Tx Order
(treatment) (2016/17)
and leadership in the
Section 2 › A Snapshot of what we know
design and delivery of
Seclusion (2017/18)
services is needed to
Hazardous drinking patterns
address disparity”.
(2014–2017
Alcohol-related hospitalisations
(2007–16)
Self-harm hospitalisations
10–24yrs (2017/18)
Suicide (2011–13)
0
0.5
1
1.5
2
2.5
3
3.5
MĀORI TO NON-MĀORI RATE RATIO
Māori report higher
Māori are over twice
Māori are over three
29
rates of bipolar
as likely to use mental
times more likely to
disease, anxiety
health services.
be treated under a
and depression.
Community Treatment
Order and 2.5 times
more likely to
experience seclusion
than non-Māori.
Māori are 75% more
Hospitalisations
Self-harm rates in
likely to report
wholly attributable
youth, and suicide
hazardous drinking
to alcohol are higher
(all ages) are
patterns than
in Māori adults than
considerably higher in
non-Māori.
non-Māori.
Māori than non-Māori.
Taurite Ora: Māori Health Strategy 2019—2030
Back to Contents
link to page 4
30
Back to Contents
link to page 4
Section 3 › The Challenge
Section 3
The Challenge
31
Taurite Ora: Māori Health Strategy 2019—2030
Back to Contents
link to page 4
32
Back to Contents
link to page 4
The Challenge
A context for poor health
Historical disadvantage and alienation, poverty and
poor living environments lead to sustained poor health
outcomes.5,6 This applies to many Māori individuals and
whānau. Life expectancy for Māori males (75 years) and
Section 3 › The Challenge
females (79 years) living in the CCDHB area continues to
lag about five years behind non-Māori,7 and the evidence
shows that Māori continue to be over-represented in a
number of critical health care areas.
The starting point for Taurite Ora is to address the
inequities endured by Māori who use CCDHB services.
33
To be effective, we must first look within our organisation
to see what changes we can make to support better
health outcomes for Māori. Our first priority is to reshape
ourselves as a pro-equity health organisation.
Taurite Ora: Māori Health Strategy 2019—2030
Back to Contents
link to page 4
CCDHB is here to serve the people of our district.
Manaakitanga
Part of that ethos is to ensure that we have created an
atmosphere and a physical environment where those
who use and need our facilities are welcomed and
their presence is valued and respected.
The Health Quality & Safety Commission New
Zealand paper
Quality Improvement: No quality
without equity?,8 which has taken findings from
the Commission’s original report,
A Window on the
Quality of New Zealand’s Health Care, states:
“Māori consumers are consistently and
significantly less likely to always feel staff
treated them with respect and dignity while
they were in the hospital.”
What we recognise
34
As the district’s largest health provider, we
Our current system supports bias in
are failing to provide an equitable level of
the forms of institutional, personal and
care for Māori. This is reflected in our most
internalised racism. By this we mean:
recent performance against national Māori
health targets.
› Institutional racism
In part, this is due to higher overall demand
Refers to differentiated access to goods,
for services from Māori, but structural
services and opportunities based on a
considerations also apply.
person’s race. Often, it operates at a service
level supported by the institution’s policies
Our mainstream health services are not
and practice frameworks.
addressing Māori health need, and there
› Personal racism
is minimal expenditure and support for
services based on tikanga Māori and
Refers to situations where assumptions and
kaupapa Māori ways of working.
actions are in response to a person’s race.
Negative stereotyping of a person who is
Māori may lead to them receiving lesser
or no services.
› Internalised racism
One of the most powerful forms of racism
occurs when a person internalises racial
stereotyping, believing them to be true or not
having the confidence to challenge them.9
Back to Contents
link to page 4
What we know
The number of Māori living in the CCDHB area is
projected to grow by almost 40 percent (14,000)
over the next 20 years, from about 38,000 to 52,000.
This compares with a projected growth of about
10 percent for our non-Māori population.10
Māori population
Non-Māori population
40%
10%
Section 3 › The Challenge
projected increase over next 20 years
projected increase over next 20 years
Strong baseline data will help us measure the impact
Measuring
of our services. We are aiming for high-quality data,
including ethnicity data, to help inform all decisions.
35
impact
Currently, there are gaps in our data that need to
be addressed, otherwise the effectiveness of this
strategy will be hard to determine.
While we have good data against some outcomes; our
ability to collect quality data that justifies targeting
our services is currently very limited. To be truly
effective, we must integrate te ao Māori perspectives
into our measurement framework. It is important
that we ‘walk the talk’, measuring wellbeing through
a Māori lens and meeting the same standards
of tikanga and engagement we seek from our
commissioned providers. We will consider investing
in activities that support good data collection –
gaining trust or social licence from Māori to collect
and use information about them cannot be done
instantly.
A commitment to improve Māori health outcomes
across specific priorities by 2030 encourages us to
build up longitudinal data. We expect that a deeper,
more comprehensive understanding of what does
and doesn’t work in our service design and delivery
will emerge over time. For that reason, Taurite Ora
focuses on a four-year horizon, after which it will be
revisited to ensure its effectiveness.
Taurite Ora: Māori Health Strategy 2019—2030
Back to Contents
link to page 4
Outcome 1
A stronger and more responsive
CCDHB health system
As a district health board, we are accountable for delivering health
services across our district. We can improve the services we provide
for Māori by making changes in the way we engage with and include
Māori in our service design and delivery.
We can achieve this by focusing on the three strategic priorities
discussed below.
Strategic priority 1
Become a pro-equity health
organisation
This priority challenges CCDHB to reset our foundation by doing
some internal work starting at the top with the Board and our
executive leadership team.
36
Strategic priority 2
Grow and empower our workforce
Our current workforce
We have a great team at CCDHB, most of whom are committed to
improving health and wellbeing outcomes for Māori. Many non-Māori
staff members are undergoing cultural competency training to give
them a better understanding of tikanga and kaupapa Māori approaches
to health. However, the fact remains that Māori are substantially under-
represented at all levels of the CCDHB health system.
› Only a handful of Māori fill strategic or clinical leadership roles at
the management level.
› Māori make up less than 1 percent of medical staff (7 out of 856
doctors in October 2018).
› Māori make up only 5 percent of all nursing (149 out of 2,776) and
allied health professionals (44 out of 812).
We have made gains over the past decade, but it is hard to hear Māori
voices when there are so few.
Back to Contents
link to page 4
Section 3 › The Challenge
CCDHB will support a strong Māori
health workforce
Currently 5 percent of the CCDHB workforce identify as Māori. This
figure must increase if we are to transform ourselves into a pro-equity
37
organisation.
The projected increase in our Māori population – to 52,000 over the
next 20 years – provides further impetus for us to make changes now.
At the foundation level, the proportion of the workforce that is Māori
should mirror the population it serves, as well as the complex needs of
that population. This issue is going to become more acute as the Māori
population is growing at a faster rate than the non-Māori population
and the CCDHB is struggling with unmet need. A skilled Māori
workforce is a key element in our future success.
CCDHB will support a workforce
equipped to improve Māori health
Approximately 95 percent of CCDHB’s workforce is non-Māori.
To support a fit-for-purpose workforce, we will focus on cultural
competency as a necessary best practice standard for all health workers.
The training will comprise core Māori cultural competencies, including
cultural safety in health practices, Te Tiriti o Waitangi, patient- and
whānau-centred care, health literacy and implementing equity in the
workplace.
Within the next two years we will implement a staff development plan
that sets out how all staff will access cultural competency training and
cultural leadership and support.
Taurite Ora: Māori Health Strategy 2019—2030
Back to Contents
link to page 4
Strategic priority 3
Strengthen our commissioned
services
Despite clear differences in patterns of Māori ill-health compared with
non-Māori, the vast bulk of CCDHB’s in-house and commissioned
services are delivered through mainstream services and providers with
limited scope to vary their delivery approach to meet the individual
needs and aspirations. For example:
› of the over $1 billion health services budget, only 0.45 percent is
spent on services designed to reach Māori
› CCDHB currently contracts with four kaupapa Māori providers to
deliver community health services in areas of greatest need.
It is no surprise therefore that ‘commissioning’ is one of the three
systems areas that Taurite Ora focuses on. To truly tackle the issue of
equity of service, it is critical that
all commissioned providers identify
and work to develop equity outcomes. Anything less risks failing Māori
who are not enrolled with a kaupapa Māori provider.
If we emphasise the importance of more and better care within the
community, effective prevention and management will reduce the need
for hospital care. An increased allocation of funding to primary health
38
care and Māori services is essential to see a reduction in the number of
Māori tamariki and older people in particular presenting at hospitals
with preventable health issues.
We will also look at our current contracting model and decide whether
it is appropriate in an equity-focused environment. If we are working
towards ‘on the ground’ changes with whānau, establishing kaiārahi
roles and expanding the role of commissioned partners; our current
performance measures may no longer be relevant. We must favour
measuring effectiveness over enumerating services delivered.
Back to Contents
link to page 4
Section 3 › The Challenge
Outcome 2
39
Improved health and wellbeing
outcomes for Māori
To optimise the impact of adopting a pro-equity approach, we have
selected two services areas that are will be our priority and that, based
on the evidence, will achieve the greatest health gains for Māori over
the next 10 years. These are:
› maternal, child and youth
› mental health and addictions.
Our objectives for both priority areas are:
› Years 1–4
» Processes are in place and improving service performance.
› Years 5–6
» Hospital and community service delivery for these priority areas
have improved Māori health outcomes.
› By 30 June 2025
» The strategy has delivered incremental reductions in each priority
area, with the result that the gap between Māori and non-Māori
health outcomes has decreased by 80 percent.
Taurite Ora: Māori Health Strategy 2019—2030
Back to Contents
link to page 4
Service focus area 1
Maternal, child and youth health
We will focus on actions we believe will have an early and positive
impact. We acknowledge that many whānau are dealing with multiple
issues beyond the scope of health services. Wherever possible, we will
work alongside other agencies and providers to navigate solutions that
support the whole whānau.
Māmā me pēpē
The stage from conception through childhood provides a unique
opportunity in a person’s development. This is when the foundations
of optimal health, growth and neurodevelopment across the
lifespan are developed.11 Optimising the first 1,000 days is critical
and warrants special protections and provisions for māmā, mātua,
pēpē and their whānau.
› Monitor early childhood health, development and equity with a
comprehensive set of indicators and use the data to improve service
delivery and inform and evaluate public health interventions.
› Invest in more community-based initiatives to promote early
childhood development.
› Reduce the cost of accessing health supports and remove cost-
40
related barriers to health support.
› Ensure that whānau with high and complex needs have kaiārahi
to act as a single point of contact with the health system and
other services.
› More actively monitor unhealthy whānau behaviour that has a
direct impact on mother and child health, including smoking,
breastfeeding and better screening for family violence.
› Participate more actively in initiatives to improve living conditions
for whānau by providing warm, dry housing and helping to build
safer communities.
Back to Contents
link to page 4
Tamariki: up to 14 years of age
› Between 2007 and 2011, tamariki were three times more likely
compared to non-Māori to be admitted to hospital for injuries arising
from assault, neglect or maltreatment.12
› Self-reported data from the New Zealand Health Survey suggests
that asthma rates in this age group are only marginally higher than
for non-Māori in the same age group (18 percent of Māori aged
under 15 years reported that they have asthma, which is currently
medicated, compared with 16 percent for the total population),13 but
this may be because Māori are less likely to be diagnosed or treated
than non-Māori.
› The CCDHB rate of hospitalisation for skin infections in Māori
aged 0–14 years is 60 percent higher than for non-Māori in the
Section 3 › The Challenge
same age group.14
› Fifty percent of all five-year-old tamariki have caries,15 compared
with less than 25 percent for non-Māori in the same age group.
Rangatahi: 15–24 years of age
› Rangatahi have much higher rates of rheumatic fever than non-
Māori youth in the same age group.16
› Rangatahi are more likely to smoke than non-Māori youth in the
same age group.17
› Suicide rates are three times as higher for rangatahi than for other
population groups (this is national data, not CCDHB).18
41
› Hospitalisation as a result of self-harm is over 1.5 times higher
in 20- to 24-year-old rangatahi compared with non-Māori,
non-Pacific youth.19
› Rangatahi aged 15–19 years experience higher rates of admission to
hospital for hazardous alcohol abuse than non-Māori youth.20
Research reflects the desire of rangatahi to have services and
programmes developed with them for them: Rangatahi ki Rangatahi
peer support. As 29 percent of this group live in Porirua, investment in
the development of a service here should be prioritised.
Taurite Ora: Māori Health Strategy 2019—2030
Back to Contents
link to page 4
Service Focus area 2
Mental health and addictions
Māori experience a disproportionately high level of mental health and
addiction issues. The report of the Government Inquiry into Mental
Health and Addiction,
He Ara Oranga,21 identified that almost one in
three Māori will experience mental illness and/or addiction in a given
year, compared with one in five in the general population. The same
report noted that Māori are also more likely than non-Māori to access
services later and to experience serious disorders and/or co-existing
conditions. Māori also have the highest rate of suicide of all groups.
CCDHB’s Mental Health, Addictions and Intellectual Disability Services
arm (MHAIDS) is the largest provider of mental health and addictions
services to Māori in our region. Currently, one of our three kaupapa
Māori providers is funded through MHAIDS. We will consider how we
can strengthen those services as they come under increasing pressure
and fail to keep up with access demand. We also need to collect better
information to guide our investment in the sector.
As is the case for the CCDHB generally, Māori are under-represented in
this workforce, particularly in clinical roles. Workforce shortages and
workforce aging and retention are a continuing challenge across the
sector that we need to address.
42
› Māori are more than three times more likely to be subject
to a Community Treatment Order under Section 29 of the
Mental Health Act.22
› Māori aged 25–64 years are almost two and a half times more likely
to use mental health services23 and be kept in seclusion.24
› Self-harm rates in Māori youth25 and Māori suicide (all ages)26
are more than twice those of non-Māori in the same age groups.
› One in three Māori will experience mental illness and/or addiction
issues in a given year compared with one in five in the general
population (based on New Zealand-wide data).27
› Māori are more likely than non-Māori to have later access to services
(based on New Zealand-wide data). 28
› Alcohol involvement in youth emergency department (ED)
presentations is similar in Māori and non-Māori, but hospitalisations
wholly attributable to alcohol are higher in Māori adults than non-
Māori adults.29
› The proportion of frequent methamphetamine users who are Māori
increased from 22 percent in 2006 to 32 percent in 2014.30
Back to Contents
link to page 4
Kaupapa Māori mental health services
At present, CCDHB contracts with three community providers that offer
kaupapa Māori mental health services (only one of which is funded
from within the MHAIDS budget). We need to invest more in kaupapa
Māori services that:
› offer treatment and services based on whanaungatanga and
empowerment of tangata whaiora and their whānau
› work alongside general practitioners (GPs) and other community
mental health services to assess the needs of tangata whaiora and
plan pathways towards wellness.
What Māori have said they value
Section 3 › The Challenge
Māori wellbeing
While many statistics reflect poor health outcomes for Māori, how
Māori view themselves is a strength that CCDHB should use when
designing and delivering services to Māori whānau and communities.
The data from the 2013 Census may be dated, but it is still relevant in
that it shows many positive aspects of Māori wellbeing that are often
overlooked.31
› Most Māori adults (88 percent) reported that their whānau were
doing well, although 4 percent felt their whānau were doing badly.
› Many Māori adults (79 percent) reported finding it easy or very easy
43
to access whānau support in times of need.
› Being involved in Māori culture was important to 69 percent of
Māori adults.
› One in five Māori could have a conversation in te reo Māori.
› Most Māori adults (90 percent) did voluntary work.
› As at 2013, 88 percent of Māori 5-year-olds were fully immunised.
› Among Māori youth, smoking rates had dropped significantly
since 2006, although rates remain considerably higher than those
for non-Māori youth.
Taurite Ora: Māori Health Strategy 2019—2030
Back to Contents
link to page 4
44
Back to Contents
link to page 4
Section 4 › Taurite Ora: Action Plan
Section 4
Taurite Ora:
Action Plan
45
Taurite Ora: Māori Health Strategy 2019—2030
Back to Contents
link to page 4
Taurite Ora: Action Plan
This section of Taurite Ora presents the action plan for
2019–2030. Its aim is to capture information to show the
effectiveness of the pro-equity strategy in reducing the
five key measures of equity.
Avoidable hospital
admissions
Accessible
appointments
key measures
46
5
Amenable
of equity
mortality
Primary care
utilisation
Community-based
services
The plan also refers to the three
This will be achieved through:
overall Taurite Ora framework
› equity (as a value that underpins everything we do)
imperatives and describe the
› workforce development
actions that have been agreed
on to reach our goal of:
› commissioning of services.
Health equity and optimal
Oversight of the implementation of the Taurite Ora
health for Māori by 2030.
strategy and action plan will be the responsibility
of a Taurite Ora governance group that is yet to be
established. Core membership of this group will come
from the CCDHB Executive Leadership Team (ELT).
Back to Contents
link to page 4
Set up of the action plan
The action plan is set out as follows:
Equity
Workforce
Commissioning
Priority
Strategic priority 1:
Strategic priority 2:
Strategic priority 3:
service focus
Become a pro-equity
Grow and empower
Strengthen our
areas
health organisation
our workforce
commissioned
Service focus area 1:
services (Māori health
CCDHB will support:
Maternal, child
providers are thriving)
and youth
› a strong Māori
Section 4 › Taurite Ora: Action Plan
health workforce
Service focus area 2:
› a workforce
Mental health and
equipped to
addictions
improve Māori
health.
Action Plan owners
3DHBCCIO
3DHB Chief Clinical Information Officer
47
General Manager, 3DHB Mental Health, Addictions and
GM3DHBMHAIDS
Intellectual Disability Service
CE
Chief Executive
CAHO
Chief Allied Health Officer
CFO
Chief Financial Officer
CMO
Chief Medical Officer
CNO
Chief Nursing Officer
EDCS
Executive Director, Corporate Services
EDMH
Executive Director, Māori Health
EDMCC
Executive Director, Medicine, Cancer and Community
EDPC
Executive Director, People and Capability
EDQIPS
Executive Director, Quality Improvement and Patient Safety
EDSIP
Executive Director, Strategy, Innovation and Performance
EDSWC
Executive Director, Surgery, Women and Children
ELT
Executive Leadership Team
We are currently developing an indicator framework to monitor the
actions in the Action Plan.
Taurite Ora: Māori Health Strategy 2019—2030
Back to Contents
link to page 4
The action plan
Key
Measurement
Time frame
Owner
By how much/
By when
By who – first
to do what
role identified
owns the action
Strategic priority 1
Become a pro-equity health organisation
The overall aim of the CCDHB as a pro-equity organisation is to ensure that Māori live long
and well. This is clearly not happening at the moment, as is shown by the low levels of
health across a range of key indicators, reflecting the breadth of the inequities experienced
by Māori. Many of the indicators reported on are areas of the DHB’s remit that are directly
amenable to change, and, if addressed, could benefit Māori health.32
Outcome 1
CCDHB demonstrates its commitment to being a pro-equity organisation
48
Action
1 Adopt health equity for Māori as a strategic priority for
All ELT members have
the CCDHB Board and ELT.
Māori health equity key
performance indicators
(KPIs).
First year
CCDHB Board
CE
2 Commit to a pro-equity programme of work that
Indicators to be
delivers:
developed
a) a clear CCDHB equity goal and direction
First year
b) an agreed set of equity principles
Commences 1 July 2019
c) an operational framework that translates principles
CE
into policies and practices
ELT
d) a performance framework to monitor and
guide progress
e) an agreed target-staged implementation.
Back to Contents
link to page 4
3
Establish and set KPIs for Māori health equity,
All ELT members have
including improved Māori health outcomes, as annual
Māori health equity KPIs.
performance expectations of the CE and ELT.
1–4 years
CCDHB Board
CE
4
Share and discuss annual performance for Māori
Report annually to ELT
health equity KPIs as a regular agenda item for ELT
meetings.
meetings.
First year
CE
5 Establish a Taurite Ora governance group to oversee
A governance group is
Section 4 › Taurite Ora: Action Plan
and report on implementation of the action plan. The
established.
core membership will comprise ELT members.
2019
CE
EDMH
6
Make every member of the ELT responsible for
The Māori workforce
ensuring that the Māori workforce numbers, across all
is expanded across all
levels of the CCDHB, reflect the community we serve
levels of the CCDHB.
and the needs of that community and that all staff are
All staff provide
supported to provide culturally safe and competent
culturally safe and
services to Māori.
competent services to
Māori.
49
1–4 years
CE
ELT
7
Include an explicit accountability in the performance
All clinical leads and
plans of all clinical leaders and senior managers for
tier 2 managers have
promoting health equity and optimal health for Māori.
Māori health equity KPIs.
First year
Each ELT member for
direct reports
8
Develop and distribute a range of communications
A communications
to support, encourage and integrate pro-equity
strategy is developed
initiatives.
and implemented.
First year
EDCS
Taurite Ora: Māori Health Strategy 2019—2030
Back to Contents
link to page 4
Outcome 2
The relationship between the Māori Partnership Board (MPB) and the
CCDHB Board and ELT is strengthened
1 Engage with the MPB, including MPB attendance and
There is an MPB
agenda item at each Board meeting and regular Board
member on all statutory
member and CE attendance at MPB meetings, and
committees.
facilitate MPB representation on all statutory and
The CCDHB Board and
organisational boards.
CE attend every MPB
meeting.
1–4 years
CCDHB Board
CE
EDMH
2 Provide regular updates to the MPB and CCDHB Board
The framework is
on the implementation of Taurite Ora to track progress
reported on as it is being
and seek MPB advice as necessary.
developed.
Report to each meeting
of the MPB and CCDHB
Board.
First year and ongoing
CE
ELT
50
Outcome 3
CCDHB’s partnerships are strengthened with a range of Māori
stakeholders
1 Design and implement a CCDHB policy to provide
The policy is developed
guidance on strengthening relationships with a
and implemented.
range of Māori stakeholders (including Māori health
First year
and health equity experts) at every level of the
organisation, including enhanced representation on
EDQIPS
governance and advisory groups.
2
In implementing the health system plan, commit to
A Māori engagement
a specific plan of action to ensure comprehensive
plan is developed.
engagement with Māori health providers, communities
1–4 years
and whānau.
Report six-monthly to
the MPB and CCDHB
Board
EDSIP
Back to Contents
link to page 4
3
In implementing the sub-regional disability strategy
A Māori engagement
2017–2022, uphold the principles of Whāia Te Ao
plan is developed.
Mārama by engaging Māori disabled people and
1–4 years
engaging comprehensively with Māori health providers,
communities and whānau.
EDSIP
Outcome 4
CCDHB has the foundations in place for achieving health equity and
improving health outcomes for Māori
1 Implement an improvement programme to ensure CCDHB
An ethnicity data
has high-quality, complete and consistent ethnicity data for
programme for the
performance, monitoring and workforce development (see
whole of CCDHB is
Section 4 › Taurite Ora: Action Plan
also Strategic priority 2: Grow and empower our workforce,
completed.
CCDHB will support a strong Māori health workforce,
First year
Outcome 1, actions 1 and 3).
ELT
2
Initiate processes to ensure all performance data reported
All data is reported by
to the CCDHB Board is analysed by ethnicity.
Māori, Pacific and Other,
aligning with HISO 10001:
2017 Ethnicity Data
Protocols.
First year
CE, ELT
51
3
Implement a health literacy programme of work using
CCDHB is recognised
the Children’s Clinics Service Improvement Project and
as a health literate
Children’s Clinics Health Literacy Review Projects (see
organisation.
also Maternal, child and youth services) to inform
Indicators relevant
implementation across the organisation.
to the health literacy
programme will be
developed.
First year
CE, ELT
EDSWC, EDMH
4
Implement a range of IT initiatives to support CCDHB’s
All data is reported by
commitment to being a pro-equity organisation and improve
ethnicity.
equity through digital systems and investments, including:
First year
a) improving access to data and analytical reporting,
3DHBCCIO
including level 4 ethnicity data capture and reporting;
and the Whānau Care Services (WCS) smoking cessation
project
b) developing a business case to provide multilingual,
including te reo Māori, versions of an electronic patient
experience survey
c) extending free patient wifi to outpatients
d) making the te reo Māori keyboard the standard profile
(including the ability to add macrons).
Taurite Ora: Māori Health Strategy 2019—2030
Back to Contents
link to page 4
5
Implement a range of communications initiatives to
A communications
enable and support CCDHB’s commitment to being
plan is completed and
a pro-equity organisation and focused on improving
implemented.
Māori health outcomes, including:
First year and ongoing
a) updating the CCDHB style guide for te reo Māori,
EDCS, EDMH
macrons use and translation
b) developing guidelines for the use of the CCDHB
kōwhaiwhai and other Māori design work
c) supporting, promoting and encouraging key Māori-
focused events throughout the organisation with
culturally competent communications.
6
Consider Māori health equity and improved Māori
All quality initiatives
health outcomes as part of all quality improvement
include Māori health
discussions and activities, including co-design and
equity.
patient experiences.
1–4 years
EDQIPS
7
Specific patient- and service-focused initiatives will
Indicators to be
ensure patient-experience information is collected,
developed.
analysed and reported by ethnicity, including:
1–4 years
a) a complaints/compliments procedure
EDQIPS
b) adverse events
c) death review
52
d) Care Capacity Demand Management (CCDM),
including Improvement Movement project and
leadership programmes.
8
Incorporate cultural competency and cultural safety
A competency
requirements into the competency framework for
framework is completed.
quality managers and quality facilitators and adverse
1–4 years
events management.
EDQIPS
Back to Contents
link to page 4
Outcome 5
CCDHB implements specific programmes of work to achieve health
equity and improved health outcomes for Māori
1 The Māori Health Development Group’s Whānau Care
System barriers for
Services (WCS) implements a range of actions as
Māori patients and
CCDHB’s principal pro-equity, anti-racist, culturally safe
whānau are addressed.
service, including:
Referral rates to WCS are
increased.
a) addressing system issues (eg, inaccessible
The Māori patient and
appointments) for Māori patients and their whānau
whānau experience is
and enhancing the patient/whānau care journey
improved.
using a whānau-centred model of care approach.
The number of
This includes managing system failures for Māori
complaints from Māori
Section 4 › Taurite Ora: Action Plan
patients and whānau, influencing change and
patients and whānau is
implementing targeted solutions
reduced.
b) reviewing all data collected by WCS to determine
Access for Māori
future data priorities and to streamline WCS’ data
patients and whānau to
collection, collation, analysis and reporting to
culturally safe practices
efficiently align with Taurite Ora
and cultural leadership
is increased.
c) providing culturally safe social work services on
request from patients, whānau and services across
Further relevant
indicators to be
the organisation and district to facilitate practical
developed.
solutions and support the wellbeing of Māori
patients and whānau
1–4 years
d) delivering targeted speciality clinical nursing and
EDMH
system navigation for Māori patients and whānau
53
with cardiac and/or long-term conditions
e) providing kaiāwhina support for Māori patients,
whānau and all health care workers in response to
Māori patient requests for cultural and spiritual
assistance and pastoral care
f) providing a collaborative smoking cessation
programme, including WCS working with Māori
patients, whānau and staff, and addressing system
barriers to improve access and uptake
g) providing and strengthening bereavement care
to ensure CCDHB’s bereavement processes are
culturally safe for whānau Māori and the Māori
experience of the health system during culturally
sensitive events is facilitated in such a way to
encourage ongoing re-engagement
h) facilitating whānau Māori use of Te Peehi Parata
Whare Whānau for temporary accommodation
for whānau from outside the CCDHB district who
are supporting patients. The whare has a limited
capacity of 16 beds, so whānau with urgent needs
are prioritised. Where demand exceeds the capacity
of the whare, WCS facilitate finding alternative and
affordable accommodation for Māori patients and
whānau. Providing this service increases access to
health services for Māori and improves engagement
with patients and whānau.
Taurite Ora: Māori Health Strategy 2019—2030
Back to Contents
link to page 4
2
Strengthen the current MHDG and Research Advisory
Ensure any research
Group-Māori (RAG-M) strategic and operational
associated with the DHB
research activities, including working with the CCDHB
appropriately involves
research centre to ensure any research associated with
Māori at every stage.
the DHB appropriately involves Māori at every stage.
1–4 years
EDMH
3
Implement a range of actions through the ‘Equity for Māori
A plan is developed and
in Wellington Regional Hospital Emergency Department
implemented.
(ED)’ project including:
1–4 years
a) using health literacy and culturally competent
EDMCC, CMO
initiatives to provide a supportive environment for
Māori patients, whānau, new staff, current staff and
non-ED hospital staff
b) demonstrating and measuring delivery of culturally
competent care and equitable outcomes through
planning, implementation and reporting
c) promoting and protecting time for staff to attend
cultural competency training as a necessary component
of professional development for all Wellington
emergency department (ED) staff
d) implementing processes, practices, environments and
resources in ED to acknowledge te reo Māori as the
first language of Aotearoa/New Zealand
e) using co-design initiatives and patient experience
feedback to ensure meaningful engagement with Māori.
54
4
Implement the Te Wai Bereavement Symbol & Quilt Project
Relevant indicators will
in ED.
be developed
EDMCC
CMO
5
Implement a range of actions through the programme
A data review is
‘A Proposed New Way of Working for Allied Health’ including:
completed.
A dashboard is
a) undertaking a review of all data sources and processes
developed.
to ensure Allied Health Department has high-quality,
complete and consistent performance and workforce
The dashboard is used in
service development.
data for analysis and reporting in partnership with our
People and Capability Department
The dashboard is used in
recruitment.
b) capturing data and developing dashboards to monitor
Māori engagement is
quality, equity and impact; explicitly and routinely
increased.
monitoring equity of access and the delivery of Allied
Health services for Māori
1–4 years
c) using that data to understand Māori health needs and
CAHO
to drive improvements in equity of access, delivery and
outcomes for Māori in all new and existing services, and
to measure our progress
d) using the workforce data to increase the numbers, and
skills, of Māori working in Allied Health; eliminate
recruitment barriers; strengthen recruitment enablers;
and increase the rate of retention across the spectrum of
Māori Allied Health workers; focusing in the first instance
on the kaiāwhina Māori workforce to enable greater reach
and access for Māori individuals, whānau and communities
Back to Contents
link to page 4
5 e) seeking to understand the barriers for Māori in
accessing Allied Health services and being committed
Cont.
to addressing these issues
f) working in new ways to address barriers to services for
Māori using health literacy initiatives and to develop
technologies, where appropriate, skill sharing and other
ways to deliver services
g) working in partnership with Māori, whānau and
communities to develop pro-equity, anti-racist,
culturally safe services that drive improvements in
Māori health outcomes
h) engaging with the MHDG to consider options for
supporting the Allied Health leadership to grow
their proficiency to implement Allied Health
actions that are focused on pro-equity, anti-racist
Section 4 › Taurite Ora: Action Plan
and culturally safe services for Māori, including
understanding and use of data
i) ensuring that the cultural intelligence of the Allied
Health workforces increases so that the pro-equity
agenda is progressed smartly in the new way of the
working project.
6 The Medicine, Cancer and Community Directorate’s (MCCD)
A set of indicators will
Wellington Blood and Cancer Centre (WBCC) will undertake
be developed
the following through the Programme to Improve Cancer
1–4 years
Services:
EDMCC
a) Take an approach that emphasises the need to reduce
55
health inequities for Māori and ensure the programme
is driven by a strong equity approach.
b) Adopt a co-design methodology with Māori
consumers and stakeholders, including Māori health
professionals, to ensure the programme addresses
equity, opportunities, priorities and options available to
deliver good health for Māori, achieve health equity and
improve health outcomes for Māori patients receiving
cancer treatment across the health system.
c) Develop a data strategy that can be compared against
national and international data sets and includes:
› clinical benefits the programme is achieving for
Māori patients
› monitoring the reduction of health inequities
using equity and ethnicity data
› patient reported outcomes.
d) In all work to make improvements for ambulatory
services, consider the implications for Māori patients
and Māori patient flows across the sub-region,
in particular:
› how the proposed service changes will affect the
safety and quality of care for Māori patients
› how health inequities for Māori will be affected
› whether the proposed changes will reduce the
travel burden on Māori patients.
Taurite Ora: Māori Health Strategy 2019—2030
Back to Contents
link to page 4
6
e) In all work to implement the tumour stream approach,
engage with Māori stakeholders to discuss all aspects,
Cont.
including what implementing a tumour stream model
in an outpatient setting requires and how it can best
be achieved. Wellington Blood and Cancer Centre
(WBCC) will engage with the CCDHB Māori Health
Development Group in the first instance to seek
advice on which other key Māori stakeholders to
include in identifying improvements that will reduce
health inequities for Māori.
f) In all work to Improve the Senior Nursing Structure
of Ward 5 North, WBCC will consider the recruitment,
retention and professional development of Māori
nursing staff.
g) In all work to Improve Cancer Leadership, WBCC
will engage with Māori health experts and Māori
communities and in any strategic planning work
include a specific focus on Māori who have
demonstrably worse outcomes.
h) Instigate ongoing monitoring of progress and cancer
outcomes for Māori, including:
› the ELT’s KPIs
› reviewing the national quality performance
indicators under tumour streams to make a plan for
data collection and reporting by ethnicity
› inpatient ward improvements for Māori
› Māori patient reported measures and experiences,
56
systematically evaluated on a regular base.
7 Through a joint initiative between the Māori Health
A set of indicators will
Development Group (MHDG) and the EDMCC,
be developed.
establish a Māori Health Cancer Navigator/Nurse
1–4 years
Coordinator to intensify skills and resources to
support Māori patients and whānau through their
EDMCC
cancer care journey.
EDMH
a) In particular, the nurse coordinatorwill focus on
improving timeliness of access for Māori to all
CCDHB cancer services, coordinating care and
providing culturally safe services. Access barriers
will be identified and, working in collaboration
with Cancer Services team, these issues will be
addressed.
b) This position will be based in Whānau Care
Services, MHDG, and it will work closely with the
cancer nurse coordinator team. Collaboration
with primary health care and community non-
governmental organisations (NGOs), including
Māori health providers, will also be crucial to focus
interventions on early cancer detection and entry
into secondary health care.
Back to Contents
link to page 4
8
Increase the percentage of Māori enrolled in a primary
The Māori enrolment
health organisation (PHO) to match that of the total
rate is equal to the
population by:
non-Māori rate.
› providing enrolment processes that are easy to follow
1–3 years
› following up with people who are using DHB services
EDSIP
(ED, accident and medical, inpatient) to support
enrolment in primary health care as part of a warm
handover back to their primary health care provider
› developing models of care in general practice that
support Māori to be well, get well and stay well.
9
Invest in intensifying services in primary health care
There is a reduction in:
and community for populations of concentrated
› Māori ED
complexity (very low cost access (VLCA) practices).
presentations
Section 4 › Taurite Ora: Action Plan
These services will support people with higher health
› Māori accident and
needs to be well, get well and stay well; enabling them
medical presentations
to live their lives how they wish rather than spending
› Māori (ASH)
lots of time engaging with the health system.
admissions for
populations of VLCA
practices (adult and
child).
1–4 years
EDSIP
10 Develop and implement a DHB investment plan for
There is a reduction in
long-term conditions. It will be focused on prevention,
Māori hospitalised for
57
early intervention and coordinated management for
diagnosed long-term
people with one or more long-term conditions.
conditions.
Health/life expectancy
Within the first three years, we will develop new
is increased and onset
models of care for:
of long-term conditions
and complications as a
› people with respiratory disorders
result of those long-term
› people with cardiovascular disease
conditions is delayed.
› people with diabetes and associated conditions
Short term: 1–4 years
(for example, renal failure, podiatry)
Long term: 5+ years
› people at risk of developing long-term conditions
(that is, prevention programmes).
EDSIP
These models of care will be focused on care close to
home, provided through community health networks,
and empowering people to be active participants in
managing their health.
Taurite Ora: Māori Health Strategy 2019—2030
Back to Contents
link to page 4
Strategic priority 2
Grow and empower our workforce
CCDHB will support a strong Māori health workforce
The CCDHB workforce does not reflect the population it serves. Of the 5,767 employees
(as at October 2018), only 5 percent of the workforce were Māori, compared with over 11
percent of the population (10 percent of the working age population, age 15–64 years).33
As per the CE’s actions:
“It is the responsibility of every member of ELT to ensure that the Māori workforce
numbers, across all levels, reflects the community we serve and the needs of that
community, and that all staff are supported to provide culturally safe and competent
services to Māori.”
Outcome 1
CCDHB demonstrates its commitment to attracting and retaining more
Māori staff, particularly in clinical and leadership roles
1 Report regularly to CCDHB Board and ELT on workforce
There is regular
data by ethnicity.
reporting to the CCDHB
Board, MPB and ELT.
58
1–2 years
EDPC
2 Collaborate with the Māori Health Development Group
A Māori health
and agree on an overarching Māori workforce strategy
workforce plan is
to re-establish and update the Tū Pounamu Workforce
completed.
Programme with aspirations and targets for the
First year
recruitment, retention and professional development
of Māori staff.
EDPC
3
Review and strengthen current workforce data systems,
Workforce data systems
including staff ethnicity data collection, to ensure
are reviewed and
consistency and accuracy of collection, analysis and
strengthened.
reporting. This includes ensuring Māori/Māori Health
Resources are allocated
Development Group representation in the Workforce
to ensure Māori input.
Systems Improvement Programme.
First year
EDPC
EDCLS, CFO,
3DHBCCIO, EDMH
Back to Contents
link to page 4
4
Ensure that all planning and analysis of workplace
Māori participation in
engagement initiatives includes the use of ethnicity
workplace engagement
data and provides Māori staff with a voice in their
initiatives is increased.
workplace, for example, staff surveys and exit
1–2 years
interviews.
EDPC
5 Take a pro-equity approach, and use a priority
The organisational
populations lens in developing the organisational
wellbeing framework
wellbeing framework to ensure improved health and
includes a focus on
wellbeing for Māori staff.
equity and improved
health and wellbeing for
Māori staff.
First year
EDPC
Section 4 › Taurite Ora: Action Plan
Outcome 2
The numbers and skills of Māori working in health in the CCDHB district
are increased, recruitment barriers are eliminated, recruitment enablers
are strengthened and there is an increased rate of retention across the
spectrum of Māori health workers
1 Review and strengthen current attraction, recruitment,
All recruitment policies
hiring and ‘on-boarding’ practices, and continue to
and practices are
review and refine regularly to attract Māori applicants
reviewed and updated
59
to all roles, retain Māori staff and support their
as necessary.
professional development.
The Māori health
workforce is increased.
1–2 years
Ongoing
EDPC
EDMH
2
Implement a targeted scholarship and support
A scholarship
programme to support higher learning and
programme is
development for Māori in the health workforce across
developed.
the district in priority areas.
100% of scholarship
funding is used.
1–4 years
EDMH
3
Strengthen links with training and education providers
Links and partnerships
to support the workforce pipeline and increase
are increased.
the Māori health workforce overall (for example,
1–2 years
collaboration with Kia Ora Hauora). This includes
implementing workforce exposure strategies for
EDPC
rangatahi Māori.
EDMH
Taurite Ora: Māori Health Strategy 2019—2030
Back to Contents
link to page 4
4
Proactively support the implementation of professional
Indicators to be
Māori health networks.
developed
1–4 years
CNO
CAHO
CMO
Outcome 3
CCDHB attracts Māori applicants to all roles and is seen as an employer
of choice for Māori health professionals
1 Implement in CCDHB and track CCDHB progress on the
An increase in new
Central Region Māori & Pacific Nursing & Midwifery Workforce
level 1 certificated
Programme 2017–2021 for Māori nurses and midwives
Māori.
including:
All Māori graduates are
interviewed.
a) identifying and developing CCDHB Māori advanced
15% of Māori graduates
practice roles
are recruited.
b) meeting the Central Region target for nursing annual
There is a 95% Māori
practising certificates
retention rate.
c) ensuring all CCDHB services with Māori staff include
80% of Māori nurses are
professional development and care pathways for
in the DE unit.
those staff
3 Māori nurses attend
d) maintaining the CCDHB Māori nurses database
annually.
60
e) providing support for CCDHB Māori nurses to attend the
1–4 years
annual Māori & Pacific nurses’ forum and the national
forum (Ministry of Health)
CNO
f) working with tertiary education providers to ensure
support for Māori graduates in interview skills
g) offering all CCDHB Māori graduates an interview via
Advanced Choice of Employment (ACE) application to
promote 15 percent Māori graduate recruits
h) retaining 95 percent of CCDHB Māori graduates following
their completion of graduate programmes
i) placing 80 percent of Māori students in CCDHB’s
dedicated education unit
j) providing peer support training for Māori students in
CCDHB
k) providing culturally competent mentorship including
career pathways for upskilling CCDHB Māori nurses and
students
l) identifying Māori staff working in health of older people,
long-term conditions, registered nurse prescribers
and nurse practitioner development to provide Health
Workforce New Zealand funding and mentoring for
development into the senior workforce
m) supporting three Māori nurses/midwives to attend
Ngā Manukura o Apōpō to optimise Māori nurses
working to top of scope to improve care delivery
n) ensuring culturally competent contact people for
Māori nurses/midwives to approach re bullying and
discrimination.
Back to Contents
link to page 4
2 Māori Health Development Group’s capability
Māori workforce
team implements a range of actions focused on
programmes are
strengthening the Māori health workforce, including:
supported.
a) growing and coordinating the workforce
1–4 years
development programmes run through Māori
EDMH
Health Development Group including: Hauora Māori
Training Fund, Kia Ora Hauora, TAS Workforce
b) surveying the Māori health workforce across the
CCDHB district to determine career aspirations
and capability development needs and consider
options for providing professional development
opportunities for this workforce
c) collaborating with CCDHB People & Capability
to re-establish and update the Tū Pounamu
Workforce Programme with aspirations and targets
Section 4 › Taurite Ora: Action Plan
for the recruitment, retention and professional
development of Māori staff
d) collaborating with People & Capability on a range
of workforce initiatives to ensure CCDHB has a
strong Māori health workforce
e) reviewing all workforce data collected by the
People & Capability team to determine future
data priorities and to streamline the team’s data
collection, collation, analysis and reporting to
efficiently align with Taurite Ora.
Outcome 4
61
The Māori health workforce across the CCDHB district (employed by both
the DHB and in the community) reflects the demographic make-up of the
projected working-age population
1 Increase Māori staff numbers in each of the medical,
The increase in the
nursing and allied health professions, along with
Māori health workforce
support staff and management, in both hospital and
is tracked by hospital
health services and primary health care to reflect the
and health services and
community health.
Māori population of CCDHB district.
1–4 years
EDPC
CNO
2
Increase the percentage of Māori in the nursing and
Māori nursing and
midwifery workforce to reflect the CCDHB Māori
midwifery increases to
population (13%) as per the action in the CCDHB
13 percent.
Nursing & Midwifery Priorities 2018–2019.
1–4 years
CNO
Taurite Ora: Māori Health Strategy 2019—2030
Back to Contents
link to page 4
CCDHB will support a workforce equipped to
improve Māori health
Approximately 95 percent of CCDHB’s workforce is non-Māori. Having the competency to
engage with the people one serves is critical in the health sector.34
As per the CE’s actions:
“It is the responsibility of every member of ELT to ensure that the Māori workforce
numbers, across all levels, reflects the community we serve and the needs of that
community and that all staff are supported to provide culturally safe and competent
services to Māori.”
Outcome 1
CCDHB demonstrates its commitment to employing staff with the skills
and attributes necessary to achieve Māori health equity
1 Set core competencies and expectations for all staff
All position descriptions
to achieve health equity and improve Māori health
include Māori health
outcomes.
equity competencies.
1–2 years
EDPC
EDMH
62
2 Review recruitment practices to employ and retain
All recruitment policies
staff who have the necessary skills and attributes.
and practices are
(Note: this review may be incorporated with the
reviewed and updated
review in Strategic priority 2: Grow and empower our
as necessary.
workforce : CCDHB will support a strong Māori health
1–2 years
workforce, Outcome 2: Action 1).
EDPC
EDMH
3
Use the findings of the review (2 above) to inform the
1–2 years
development and implementation of a recruitment
strategy to attract and retain more staff with the
EDPC
necessary skills and attributes for achieving health
equity and improving Māori health outcomes.
Back to Contents
link to page 4
Outcome 2
All CCDHB staff understand and can demonstrate their responsibilities
around achieving health equity and improving Māori health outcomes
1 Review and revise all position descriptions, performance
All position descriptions
discussions and monitoring (for example, adherence to
are reviewed and
best practice in clinical decision-making) to reflect the
revised to include
responsibility of all staff (including all CCDHB health
health equity and Māori
health improvement
professionals) to achieve health equity and improve
competencies.
Māori health.
1–4 years
EDPC
Section 4 › Taurite Ora: Action Plan
Outcome 3
Cultural safety and competency is a requisite best-practice standard for all
CCDHB health workers, including all staff in clinical and leadership roles
1 In re-establishing and updating the Tū Pounamu
The Tū Pounamu
Workforce Programme in collaboration with Māori
Workforce Programme
Health Development Group, CCDHB includes workforce
is re-established and
development for all staff in Māori health and equity,
updated.
including cultural leadership, safety and competency,
1–2 years
anti-racism and health literacy.
EDPC
EDMH
63
2 Embed the Tū Pounamu Workforce Programme in
The Tū Pounamu
systems and processes.
Workforce Programme
is embedded in CCDHB’s
People and Capability
team.
1–4 years
EDPC
3
Increase the cultural competency of People and
100% of P&C staff
Capability staff by ensuring every People and
complete the Te
Capability staff member and particularly every
Tohu Whakawaiora
new staff member attends and completes Te Tohu
programme.
Whakawaiora.
First year and ongoing
EDPC
EDMH
4
Māori Health Development Group’s Capability team
Indicators to be
implements a range of actions focused on equipping
developed.
the CCDHB workforce to improve Māori health
1–4 years
outcomes and quality improvement across the
organisation including:
EDMH
a) centralising and coordinating the response to
requests from across the organisation for cultural
safety and competence training
Taurite Ora: Māori Health Strategy 2019—2030
Back to Contents
link to page 4
4
b) exploring options for centralising te reo Māori
translation services for all CCDHB services within
Cont.
the Capability team
c) providing cultural leadership
d) providing ongoing development and quality
improvement in a suite of education and training
options for cultural safety and competency, including
Te Tohu Whakawaiora, Treaty of Waitangi, te reo Māori,
Tikanga: A Guide for Health Care Workers
e) collaborating with our People and Capability
Department when re-establishing and updating
the Tū Pounamu Workforce Programme to include
workforce development for all staff in Māori health
and equity, including cultural leadership, safety and
competency, anti-racism and health literacy
f) partnering with training providers that include
robust health equity, health literacy and anti-racism
practices to support any new and updated workforce
development initiatives.
Strategic priority 3
Strengthen our commissioned services
64
Contracted services are achieving equity
Although other domains of equity may also be important in addressing this question,
our data demonstrates that for virtually every health outcome, Māori experience poorer
health outcomes than non-Māori.35 As the majority of Māori continue to receive most of
their health care from mainstream services, considerable effort is required to ensure that
mainstream services make it a key priority to reduce the health inequities that affect Māori
and to work effectively for Māori.36
Outcome 1
All new and renewing investments will support Māori health equity and
improved Māori health outcomes
1 The EDMH and EDSIP will develop a work plan that
A phasing plan is
phases all of the actions that are led by Strategy,
completed.
Innovation and Performance.
First year
EDMH
EDSIP
Back to Contents
link to page 4
2
Develop an equity plan with a focus on Māori health,
An equity plan is
including but not limited to:
completed and
implemented.
a) using a health equity framework and tools to
prioritise new and renewing investments
First year
b) having equity for Māori as a target for all priorities
EDSIP
in service-level measures plans
c) having PHOs provide actions to address/achieve
equity for their enrolled Māori population.
3
Develop and implement a monitoring and reporting
A monitoring and
framework to track the progress of Māori health equity.
reporting framework
is completed and
implemented.
Reporting is
Section 4 › Taurite Ora: Action Plan
six- monthly.
First year
EDSIP
EDMH
4
Include targets for Māori health equity and improved
100% of contracts
health outcomes for Māori, and expectations for
include Māori health
service delivery, in all new and renewing service
equity targets.
contracts.
1–4 years
EDSIP
65
5
Design a CCDHB commissioning policy and framework
A commissioning policy
in partnership with Māori providers and communities,
and framework is
primary health care and community providers and
developed.
ensure it is fit for purpose to support pro-equity
All Māori providers
approaches and improved Māori health outcomes.
are involved in the
framework development.
1–4 years
EDSIP
6
Undertake regular self-audits to ensure the
Self-audits are
commissioning processes are followed.
undertaken annually.
Ongoing
EDSIP
7
Explore opportunities to make available training
Training and
and development opportunities within CCDHB to
development
share with all providers (see also Strategic priority 3:
opportunities for all
Strengthen our commissioned services, Māori health
providers are explored.
providers are thriving, Outcome 2, action 2).
1–2 years
EDPC
Taurite Ora: Māori Health Strategy 2019—2030
Back to Contents
link to page 4
Māori health providers are thriving
The CCDHB Māori Health Portfolio funds three ‘by Māori for Māori’ and two mainstream
providers delivering services specifically targeting Māori to the value of $2.2 million, of
the total DHB budget of $689.6 million. This represents 0.45 percent of the DHB budget,
to serve 11 percent of the population.37
Outcome 1
CCDHB demonstrates its commitment to supporting Māori health
providers to deliver health services
1 Review the CCDHB Māori health funding portfolio to:
All CCDHB Māori health
funding portfolio
a) identify gaps, change and/or opportunities
contracts are reviewed.
b) align to the Taurite Ora strategic direction.
First year
EDMH
2 Design and implement a CCDHB policy to provide
Māori engagement is
guidance on strengthening relationships with a range
increased.
of Māori providers at every level of the organisation,
First year
including more representation on governance and
advisory groups (see also Strategic priority 1: Become a
EDMH
66
pro-equity health organisation, Outcome 3, action 1).
ELT
3
Implement processes to ensure annual planning, and
100% of Māori providers
other CCDHB planning and service design work is
are included in planning.
informed by strong and increased engagement with all
1–4 years
local Māori health providers.
EDSIP
ELT
4
Develop communications including, for example,
Two-monthly
profiles of providers, to ensure the contribution of
communication
Māori providers to the health of the CCDHB population
is developed and
is well understood throughout the organisation.
distributed.
First year
EDMH
EDCOS, ELT
Back to Contents
link to page 4
Outcome 2
CCDHB has a planned approach to supporting Māori health provider
capacity and capability
1 Support Māori health providers seeking to expand
100% of MPDS funding is
capacity and strengthen capability by:
allocated.
100% of Health
› supporting Māori Provider Development Scheme
Workforce New Zealand
(MPDS) applications
Hauora Māori funding is
› supporting Health Workforce New Zealand
allocated.
Hauora Māori applications
First year
› connecting to Haoura Māori scholarships
› promoting other development opportunities.
EDMH
Section 4 › Taurite Ora: Action Plan
2
Identify options to make available and share training
Options for
and development opportunities within CCDHB with
sharing training
staff in Māori health providers (Note: this review may
and development
be incorporated with the review in Strategic priority
opportunities with
Māori providers are
3: Strengthen our commissioned services: Contracted
identified.
services are achieving equity, Outcome 1, action 1).
1–2 years
EDPC
3
Survey Māori health providers to identify capacity and
A survey is designed and
capability strengths and opportunities for support.
undertaken.
67
First year
EDMH
4
Explore opportunities to collaborate with Māori
Collaboration with
providers to support the capacity and capability of
Māori health providers
their staff. Consider a secondment initiative as part of
to support the capacity
this programme between CCDHB staff and Māori health
and capability of their
staff is explored.
providers (Note: this review may be incorporated
with the review in Strategic priority 3: Strengthen
1–4 years
our commissioned services: Contracted services are
EDMH
achieving equity, Outcome 1, action 1).
EDPC
Taurite Ora: Māori Health Strategy 2019—2030
Back to Contents
link to page 4
Outcome 3
CCDHB Māori health providers are supported and funded equitably from
DHB investment in community-based services to demonstrate a genuine
commitment to a thriving Māori provider sector
1 Implement a system to track Māori health provider
A system is developed
funding.
and implemented.
First year
EDSIP
2 Report Māori health provider funding regularly to ELT
Reports are completed
and the CCDHB Board.
annually.
First year
EDSIP
3
Place greater emphasis on commissioning community
There is an increase in
health services from Māori health providers, especially
Māori portfolio funding.
in those areas identified as priority focus areas.
1–4 years
EDSIP
4
Increase funding to Māori health providers (as a
There is an increase in
proportion of total funding). In this increased funding,
Māori portfolio funding.
68
consider adequate funding for Māori health providers
1–4 years
to serve clients with complex needs and review the
Very Low Cost Access (VLCA) scheme funding formula
EDSIP
to ensure adequate funding for ‘doing more’.
5
Increase the number of Māori health providers.
1–4 years
EDSIP
6
Ensure there are culturally competent audits and
Māori health
reviews of Māori health providers.
providers are audited
appropriately.
1–4 years
EDSIP
Back to Contents
link to page 4
Service focus area 1
Maternal, child and youth
In almost all of the maternal, child and youth health indicators, Māori do less well than
non-Māori.38
Outcome 1
CCDHB shows a genuine commitment to equity and improved maternal,
child and youth health outcomes for Māori
Section 4 › Taurite Ora: Action Plan
1 CCDHB applies an equity lens to its Maternity Quality
The contractual report
Safety Programme work programme. The work
to the Ministry of Health
programme is approved by the Ministry of Health and
against planned actions
aligns to the New Zealand Health Strategy and the
and deliverables is
completed.
Minister of Health’s expectations.
Quarters 1–4
2019–2020 deliverables and timelines are detailed
in the MQSP work programme, with a focus on hapū
Multi-year
Māori under 25 years of age (specific aspects are
EDSWC
ethnicity data collection, antenatal education close
EDMH
to home, registering early for maternity care, breast
feeding support, smoking cessation, healthy lifestyles,
reducing and managing diabetes and safe sleep for
babies). This is a long-term deliverable (multi-year).
69
2 Women’s Health Service (WHS) co-designs an
Survey document
improvement project relating to equitable access and
service practices and
acceptability of care. This involves:
improvements are
implemented.
› developing a survey that is accessible in all WHS
maternity facilities on iPad – with questions in
First year
te reo (to be critiqued by Māori consumer input)
EDSWC
› providing survey results to support service and
practice improvement.
3 Community health services and WHS undertake an
Meeting structures are
initiative that improves Māori outcomes for maternal
reviewed.
wellbeing and child protection. This involves reviewing:
First year
› the current uplift policy for pēpē – changing the
EDSWC
focus to Pae Manaaki (translation of care)
EDMH
› CCDHB’s meeting structure, terms of reference
and processes – with involvement across sectors
and strong Māori input.
Taurite Ora: Māori Health Strategy 2019—2030
Back to Contents
link to page 4
4 Review progresses and complete activities across
As per previous project
two work streams of the Children’s Clinics Service
guidelines.
Improvement Project:
1–2 years
› Health Literacy: Communication and information
EDSWC
› Health Literacy: Workforce development.
EDMH
5 The new Children’s Hospital design and model of care
Planning and decision-
has an equity and health literacy approach to support
making is conducted
improved outcomes for Māori. This includes:
in consultation with
the Māori Partnership
› ongoing consultation with the Māori Partnership
Board and other
Board for two work streams (interior theming and
Māori stakeholders as
indoor activity spaces)
appropriate.
› consultation with the Māori Partnership Board
2019–2021 until new
around the “models of care” workstream,
hospital opening
including a health literacy approach
EDSWC
› consultation with other Māori stakeholders as
EDMH
appropriate
› consumer engagement, including Māori, as part
of the new Hospital Project work streams.
6 Commit to equitable achievement of child system-
There is a 6 percent
level measures for Māori, including child ASH rates,
reduction in child
newborn babies living in smoke-free homes and youth-
ASH rates.
appropriate services.
70 percent of all Māori
babies live in smoke-
70
free homes.
First year
EDSIP
7
Develop and implement an integrated mātua, māmā,
The model is
pēpē, tamariki service for mothers, babies, children
implemented.
and families to provide culturally responsive primary
Outcomes and measures
health care for Māori.
are developed.
First year
EDSIP
8 Develop and commission wahakura wānanga
There is an increase in
programmes to hapū, māmā and whānau, including
the number of safe-
focused messages around safe sleep, immunisation,
sleep devices provided
breastfeeding and smoking cessation.
for the care of Māori
pēpē.
Engagement with Māori
is increased.
December 2019
EDSIP
Back to Contents
link to page 4
9 Implement and monitor a smoking cessation incentives
The number of pēpē in
programme, focused on hapū, māmā and their whānau.
smoke-free homes is
increased.
First year
EDSIP
10 Develop and implement a culturally responsive
The model is
integrated youth services model.
implemented.
Outcomes and measures
are developed.
1–4 years
EDSIP
11 Develop a project focused on achieving equitable and
Relevant indicators will
Section 4 › Taurite Ora: Action Plan
improved maternal health outcomes for Māori women
be developed.
under 25 years, which looks at:
1–4 years
› rates of preterm labour (PTL), sexually transmitted
CMO
infection (STI), urinary tract infection (UTI), small for
gestational age (SGA), antepartum haemorrhage (APH)
› lead maternity carer (LMC) and family violence (FV)
screening
› Neonatal Intensive Care Unit (NICU)
› Postnatal (PN) contraception
› gestation at birth and booking
› smoking rates
71
› adverse outcomes
› other relevant data
12 Develop communications to remind LMC’s and community
LMC and CMT collect
midwifery teams (CMT) about best practice for ethnicity
high quality ethnicity
data collection (follow Ministry of Health guidelines)
data.
1–4 years
CMO
13 Undertake a stocktake of what services are available to
A review is completed.
Māori women under 25 years in the CCDHB district including
1–4 years
extra support for young pregnant women – schools, primary
health organisations, Family Planning clinics
CMO
EDMH
14 Design research with LMCs and midwives in Porirua on
Research project is
ways to improve services to Māori under 25 years
undertaken.
1–4 years
CMO
15 Use the information collected, including data,
1–4 years
stocktake and engagement with young Māori women,
LMCs and midwives to develop recommendations and
CMO
a five-year work plan to improve services for Māori
women under 25.
Taurite Ora: Māori Health Strategy 2019—2030
Back to Contents
link to page 4
Outcome 2
CCDHB services, including funded providers, are reaching all targets as
co-designed with whānau, rangatahi and tamariki
1 Co-design ambitious targets with whānau, rangatahi
Planning and decision-
and tamariki that reflect Māori families’ health and
making processes
wellbeing aspirations.
include whānau Māori.
1–4 years
EDMH
2 Set new benchmarks for delivering hospital and
All annual plan equity of
community-based services to achieve equity and
outcome measures are
improved health outcomes for Māori.
achieved.
1–4 years
EDMH
3
Put in place the infrastructure to deliver significant
A report framework is
improvements in service performance for achieving
developed.
equity and improved health outcomes for Māori.
Reports are given every
six months to the Māori
Partnership Board and
CCDHB Board.
1–4 years
EDMH
72
4 Increase funding to maternal, child and youth
Funding is increased.
health services, including Māori health providers, as
1–4 years
appropriate for achieving equity and improved health
outcomes for Māori.
EDSIP
EDMH
5 Develop and implement a monitoring framework
A report framework is
focused on equitable and optimum health outcomes
developed.
for pēpi, tamariki and rangatahi Māori through the best
Reports are given every
possible start in life.
six months to the Māori
Partnership Board and
CCDHB Board.
1–4 years
EDSIP
EDMH
6
Provide routine updates to the Māori Partnership
A report framework is
Board (MPB) and CCDHB Board, tracking spending on
developed.
maternal, child and youth services and progress on the
Reports are given every
DHB’s targets for pēpi, tamariki and rangatahi.
six months to the Māori
Partnership Board and
CCDHB Board.
1–4 years
EDSIP
EDMH
Back to Contents
link to page 4
Service focus area 2
Mental health and addictions
Māori at all ages use CCDHB mental health services more, compared with non-Māori, non-
Pacific peoples.39 For both Māori and non-Māori, non-Pacific peoples, older adults tend to
use mental health services less than children, youth or middle aged adults. The inequity
between Māori and non-Māori is greatest for adults aged 20–64 years. Within this large
age bracket, accounting for age (standardisation) would probably increase the inequity,
since the burden of mental health is higher in younger than older adults and Māori form a
greater proportion of younger rather than older adults.40
Section 4 › Taurite Ora: Action Plan
Outcome 1
CCDHB’s commitment to responding to the recommendations of the
Government’s Inquiry into Mental Health and Addiction prioritises
health equity for Māori and improving Māori mental health and
addictions (MHA) outcomes
1
Involve Māori with lived mental health and/
Planning and decision-
or addictions experience in priority setting,
making processes include
decision-making and service responses when
whānau Māori.
responding to the Mental Health Inquiry.
First year
73
GM3DHBMHAIDS
EDSIP
2
Prioritise health equity for Māori and improving
A prioritisation matrix is
MHA outcomes when implementing the
developed and implemented.
3DHB strategy for planning and funding MHA
GM3DHBMHAIDS
responses 2019–2025, Living Life Well, which
EDSIP
is to be informed by CCDHB’s response to the
Mental Health Inquiry.
3
Provide routine updates to the MPB and
A report framework is
CCDHB Board, tracking progress on CCDHB’s
developed.
responses to the Mental Health Inquiry and
Reports are given every
implementation of Living Life Well (as above),
six months to the Māori
in particular initiatives to increase health equity
Partnership Board and
for Māori and improve Māori MHA outcomes.
CCDHB Board.
1–4 years
GM3DHBMHAIDS
Taurite Ora: Māori Health Strategy 2019—2030
Back to Contents
link to page 4
4
Scope service development and improvements
Scoping has been completed.
that support achieving health equity and
Improvements are implemented.
improved health outcomes for Māori using
mental health services. This includes:
First year
2–3 years
› alcohol and other drug (AOD) modelling
GM3DHBMHAIDS
› suicide prevention.
EDSIP
5 Our 3DHB Mental Health, Addictions and
A report is completed on the
Intellectual Disability Service (MHAIDS) will
current numbers of Māori in the
have a stronger focus on growing and building
workforce and the positions
a Māori workforce across all levels within its
they hold.
service.
A workforce development plan
is completed that clearly shows
how the increases will occur.
1–3 years
GM3DHBMHAIDS
6
Review Te Ara Pai mental health services and
The review is completed.
develop improved service responsiveness and
Service changes are completed.
access for Māori.
First year
2–3 years
EDSIP
74
Outcome 2
The pace of change in the mental health provider arm is accelerated
1 Develop and implement a project to improve
The project is implemented.
MHA services by:
Engagement with Māori is
increased.
a) exploring how services connect from a
client’s first point of entry and throughout
First year
the service journey
GM3DHBMHAIDS
b) understanding the landscape and
identifying gaps and opportunities for
improvements.
2 CCDHB develops a partnership-based approach
Engagement with Māori is
with Māori providers and communities to
increased.
delivering services and integrating Māori
First year
models of MHA care in service delivery.
GM3DHBMHAIDS
3
Implement a capability programme that
There is an increase in
provides targeted training and development
Māori uptake of training and
opportunities for all Māori in Mental Health,
development and 100 percent
Addictions and Intellectual Disability Service.
use of Health Workforce
New Zealand Hauora funding.
1–4 years
GM3DHBMHAIDS
Back to Contents
link to page 4
Outcome 3
CCDHB has a target of zero for seclusion and compulsory treatment
for Māori
1 Develop and implement a plan focused on how
100% of seclusion and
to achieve the target of zero seclusion and
compulsory treatment episodes
compulsory treatment, including:
are reviewed.
Planning and decision-
a) undertaking a case review of every episode
making processes include
of seclusion or compulsory treatment to
whānau Māori.
identify how these might have been avoided
Reports are given every
and opportunities for system improvement
six months to the Māori
b) encouraging treatment services to partner
Partnership Board and
closely with other social services and
CCDHB Board.
Section 4 › Taurite Ora: Action Plan
agencies to ensure that all determinants of
1–4 years
mental health are addressed holistically
c) involving Māori (including tamariki and
GM3DHBMHAIDS
rangatahi) with lived experience of the
impacts of mental illness and addictions in
all planning and service design work
d) expanding and making the mental health
workforce more fit-for-purpose, including
exploring options such as peer health
coaches
e) reporting regularly to the ELT and CCDHB
Board on progress.
75
Taurite Ora: Māori Health Strategy 2019—2030
Back to Contents
link to page 4
76
Back to Contents
link to page 4
Section 5 › Appendices
Section 5
Appendix
77
Taurite Ora: Māori Health Strategy 2019—2030
Back to Contents
link to page 4
Capital & Coast
District Health Board
Ōtaki
Te Horo
Waikanae
Paraparaumu
78
Mana
Paremata
Upper Hutt
Porirua
Tawa
LOWER HUTT
Johnsonville
Wainuiomata
Eastbourne
WELLINGTON
Back to Contents
link to page 4
Appendix
Our environment
CCDHB is the largest district health board in the Central
Region and the sixth largest in New Zealand. Our district
covers an area of 739 square kilometres, from Wellington
City in the south to the Kāpiti Coast in the north.
Section 5 › Appendices
We are hosted by three main iwi:
Ngāti Toa Rangatira
Te Āti Awa
Te Ati Awa Ki Whakarongotai.
79
Wai ora – living environments
Based on data from the 2013 Census, reported in the CCDHB Māori
Health Profile41, most CCDHB Māori believe that they and their whānau
are doing well, but many face substantial environmental barriers on the
pathway to good health and wellness.
› In 2013, 26 percent of CCDHB Māori lived in the most deprived
neighbourhoods, compared with 11 percent of non-Māori.
› Māori tamariki are 70 percent more likely to be living in low-income
families compared with non-Māori tamariki.
› Māori are 70 percent more likely to be unemployed compared with
non-Māori.
› Māori whānau are almost twice as likely to be living in overcrowded
conditions, and 40 percent are more likely to live in a house with
no heating.
› Māori whānau are 70 percent more likely than non-Māori to be
caring for a sick or disabled person in their home.
› Despite substantial improvements in youth smoking numbers,
rangatahi are more than twice as likely to smoke regularly compared
with non-Māori youth. Upwards of 10 percent lived in a home
without a motor vehicle in 2013, and Māori were more likely to have
limited access to phone and internet.
Taurite Ora: Māori Health Strategy 2019—2030
Back to Contents
link to page 4
› On a more positive note, data from the 2013 Te Kupenga survey
found that most Māori (79 percent) could access whānau support in
times of need.
› Most Māori (69 percent) living in the CCDHB area believe that being
involved in Māori culture is important to them. Spirituality is also
important.
Who we serve
CCDHB spans three territorial authorities: Wellington City, Porirua City
and most of the Kāpiti Coast District, with a combined population of
320,000 people. About 38,000 (12 percent) of our population are Māori.
Ninety-nine percent of CCDHB’s health consumers live in urban areas,
although the make-up of the population varies widely by location.
Wellington City, for instance, has a high proportion of younger working-
age residents due to its role as the region’s principal employment centre
and tertiary education hub. By contrast, Porirua has a higher proportion
of tamariki aged under 15 years, while Kāpiti Coast has a higher
proportion of older residents.
Our regional role
Through the regional hospital and other facilities, CCDHB also provides
a range of specialist services to the wider Central Region, which
comprises six DHBs: CCDHB, Hutt Valley, Wairarapa, MidCentral,
Whanganui and Hawke’s Bay. The region currently has a population of
about 900,000 people, of whom about 170,000 (18.5 percent) are Māori.
80
The 3DHB sub-region
CCDHB is also part of the sub-regional grouping of three DHBs: CCDHB,
Hutt Valley and Wairarapa, known as 3DHB. The three DHBs share
services in a number of areas, the largest of which are Mental Health,
Addictions and Intellectual Disability, (MHAIDS), and Information and
Communications Technology (ICT).
The 3DHB sub-region currently has a population of about 500,000, of
whom approximately 72,000 (14 percent) are Māori.
Back to Contents
link to page 4
Section 5 › Appendices
Māori communities
Māori living within the CCDHB area differ markedly from non-Māori in
their demographic and socio-economic profile.42
› More than 10 percent of Māori living in the CCDHB area are under
81
five years old.
› More than 30 percent of Māori are aged under 15 years (17 percent for
non-Māori).
› More than 50 percent of Māori are aged under 25 years (32 percent for
non-Māori).
› By contrast, only about 5 percent of all Māori living in the CCDHB
area are over 65 years of age, compared with about 13 percent for
non-Māori.
Taurite Ora: Māori Health Strategy 2019—2030
Back to Contents
link to page 4
Age distribution of Māori and non-Māori in
CCDHB area, 2013
CCDHB 2013 Māori Population
MĀORI FEMALE
MĀORI MALE
80–84
70–74
60–64
50–54
AGE
40–44
30–34
20–24
10–14
0–4
2,000
1,000
0
1,000
2,000
CCDHB 2013 Non-Māori Population
NON-MĀORI FEMALE
NON-MĀORI MALE
80–84
70–74
82
60–64
50–54
AGE
40–44
30–34
20–24
10–14
0–4
12,000 9,000
6,000
3,000
0
3,000
6,000
9,000 12,000
Source: New Zealand Census of Population and Dwellings, 2013
Note: Due to data availability, the numbers in the graphs above are based on residents of Wellington City, Porirua City and
the whole of the Kāpiti Coast District (including Ōtaki and surrounds).
About half of all Māori living in the CCDHB area live in Wellington City (8 percent of the
total Wellington City population). A higher proportion of younger adults live in Wellington
as a result of increased employment and tertiary education opportunities in the city.
By contrast, about 35 percent of our Māori health consumers live in Porirua City and make
up more than 20 percent of the Porirua City population – including a higher proportion of
tamariki and younger families living in low-decile housing areas.
The 2013 census suggests that approximately 7 percent of Māori living in the CCDHB area
are affiliated to the three main tribal groups in the region.43 Work and family commitments
have put a physical distance between most Māori living here, although many maintain a
strong relationship with their home marae, hapū and iwi.
Back to Contents
link to page 4
Section 5 › Appendices
83
Taurite Ora: Māori Health Strategy 2019—2030
Back to Contents
link to page 4 link to page 4
Back to contents
Endnotes
1
Ministry of Health. 2014.
He Korowai Oranga:
12 See:
https://dnmeds.otago.ac.nz/
Māori Health Strategy. Wellington: Ministry
departments/womens/paediatrics/reserach/
of Health. See the Ministry of Health
nzcyes/pdf/rpt2012-hvdhb-ccdhb.pdf
webpage: He Korowai Oranga at:
www.health.
13 See:
https://minhealthnz.shinyapps.io/nz-
govt.nz/our-work/populations/maori-health/
health-survey-2014-17-regional-update/_w_
he-korowai-oranga
a96a9866/_w_152caae7/#!/compare-
2
The Treasury. 2018.
Budget Policy Statement
indicators
2019. See the Treasury webpage at: https://
14 Robson B, Purdie G, Simmonds S, et al. 2015.
treasury.govt.nz/publications/budget-policy-
Capital and Coast District Health Board
statement/budget-policy-statement-2019
Māori Health Profile 2015. Wellington: Te
3
The national indicators are: ethnicity data
Rōpū Rangahau Hauora a Eru Pōmare. URL:
quality; access to health care; child health;
www.otago.ac.nz/wellington/otago152540.
cancer screening; smoking; immunisation;
pdf
rheumatic fever; oral health, mental health
15 Ministry of Health, Age 5 and Year 8 oral
and sudden unexpected death of an infant
health data from the Community Oral Health
(SUDI).
Service. See: www.health.govt.nz/nz-health-
4
Ministry of Health. See the Ministry of Health
statistics/health-statistics-and-data-sets/
webpage at:
www.health.govt.nz/publication/
oral-health-data-and-stats/age-5-and-year-
guide-he-korowai-oranga-maori-health-
8-oral-health-data-community-oral-health-
strategy
service
5
Williams DR and Mohammed SA. 2013.
16 University of Otago, District Health
Racism and health I: Pathways and scientific
Board Māori Health Profiles, CCDHB data
evidence.
American Behavioral Scientist
tables. See: www.otago.ac.nz/wellington/
84
2013; 57: 1152. URL:
https://journals.sagepub.
departments/publichealth/research/
com/doi/abs/10.1177/0002764213487340
erupomare/research/otago147631.html
6
Paradies Y. 2016. Colonisation, racism and
17 Robson B, Purdie G, Simmonds S, et al. 2015.
indigenous health.
Journal of Population
Capital and Coast District Health Board
Research 33(1).DOI: 10.1007/s12546-016-
Māori Health Profile 2015. Wellington: Te
9159-y
Rōpū Rangahau Hauora a Eru Pōmare. URL:
www.otago.ac.nz/wellington/otago152540.
7
StatsNZ, based on mortality rates 2012–14
pdf
8
Poynter M, Hamblin R, Shuker C, et al. 2013.
18 Calculated from data tables available from
Quality Improvement: No quality without
the Ministry of Health, Suicide Facts: Deaths
equity? Wellington: Health Quality & Safety
and intentional self-harm hospitalisations
Commission New Z
ealand. URL: www.hqsc.
2013. See: www.health.govt.nz/publication/
govt.nz/assets/Other-Topics/Equity/Quality_
suicide-facts-deaths-and-intentional-self-
improvement_-_no_quality_without_equity.
harm-hospitalisations-2013
pdf
19 Nationwide Service Framework Library,
9
Barnes, Taiapa, Borell, McCreanor. 2013.
Youth SLM Data. See:
https://nsfl.health.
Māori experiences and responses to racism
govt.nz/dhb-planning-package/system-level-
in Aotearoa New Zealand.
MAI Journal, V2,
measures-framework/data-support-system-
issue 2, 64–77.
level-measures/youth-slm-0
10 NZ Stats Subnational ethnic population
20 Nationwide Service Framework Library,
projections, characteristics, 2013(base)–
Youth SLM Data. See: https://nsfl.health.
2038 update
govt.nz/dhb-planning-package/system-level-
11 Cusick S and Georgieff MK. n.d. The first
measures-framework/data-support-system-
1,000 days of life: The brain’s window of
level-measures/youth-slm-0
opportunity. UNICEF: For Every Child. URL:
www.unicef-irc.org/article/958-the-first-
1000-days-of-life-the-brains-window-of-
opportunity.html
Back to Contents
link to page 4 link to page 4
Back to contents
21 Government Inquiry into Mental Health and
29 Nationwide Service Framework Library, Youth
Addiction. 2018.
He Ara Oranga: Report of the
SLM Data. See: https://nsfl.health.govt.
Government Inquiry into Mental Health and
nz/dhb-planning-package/system-level-
Addiction. Wellington: Government Inquiry
measures-framework/data-support-system-
into Mental Health and Addiction. URL:
www.
level-measures/youth-slm-0
mentalhealth.inquiry.govt.nz/inquiry-report/
30 https://www.massey.ac.nz/massey/fms/
22 Nationwide Service Framework Library,
Colleges/College%20of%20Humanities%20
Mental Health, Alcohol and Drug Addiction
and%20Social%20Sciences/Shore/reports/
Sector Performance Monitoring and
IDMS%202014%20Final%20Report.
Improvement. See: https://nsfl.health.govt.nz/
pdf?38B9C5FBFC4F517CCB03BCA4C7CF64A
accountability/performance-and-monitoring/
31 Robson B, Purdie G, Simmonds S, et al.
baseline-data-quarterly-reports-and-
2015.
Capital and Coast District Health
reporting/mental
Board Māori Health Profile 2015. Wellington:
23 Nationwide Service Framework Library,
Te Rōpū Rangahau Hauora a Eru Pōmare. URL:
Mental Health, Alcohol and Drug Addiction
www.otago.ac.nz/wellington/otago152540.pdf
Endnotes
Sector Performance Monitoring and
32 CCDHB Taurite Ora Māori Health Strategy
Improvement. See: https://nsfl.health.govt.nz/
Data Profile 2019, page 24.
accountability/performance-and-monitoring/
mental-health-alcohol-and-drug-addiction-
33 CCDHB Taurite Ora Māori Health Strategy
sector
Data Profile 2019, page 57.
24 Data from QLIK shows that, in CCDHB in
34 CCDHB Taurite Ora Māori Health Strategy
2017/18, seclusion rates were 2.5 times higher
Data Profile 2019, page 62.
in Māori (10.5 percent) than non-Māori, non-
35 CCDHB Taurite Ora Māori Health Strategy
Pacific people (4.1 percent).
Data Profile 2019, page 66.
25 Nationwide Service Framework Library, Youth
36 CCDHB Taurite Ora Māori Health Strategy
SLM Data. See: https://nsfl.health.govt.
Data Profile 2019, page 65.
nz/dhb-planning-package/system-level-
85
measures-framework/data-support-system-
37 CCDHB Taurite Ora Māori Health Strategy
level-measures/youth-slm-0
Data Profile 2019, page 65.
26 Calculated from data tables available at
38 CCDHB Taurite Ora Māori Health Strategy
Ministry of Health, Suicide Facts: Deaths and
Data Profile 2019, page 67.
intentional self-harm hospitalisations 2013.
39 Nationwide Service Framework Library,
See: www.health.govt.nz/publication/suicide-
Mental Health, Alcohol and Drug Addiction
facts-deaths-and-intentional-self-harm-
Sector Performance Monitoring and
hospitalisations-2013
Improvement. Se
e: https://nsfl.health.govt.nz/
27 Health and Disability Commissioner. 2018.
accountability/performance-and-monitoring/
New Zealand’s Mental Health and Addiction
mental-health-alcohol-and-drug-addiction-
Services: The monitoring and advocacy report
sector
of the Mental Health Commissioner. Auckland:
40 Data report, page 91.
Health and Disability Commissioner. URL:
www.hdc.org.nz/media/4688/mental-health-
41 Robson B, Purdie G, Simmonds S, et al. 2015.
commissioners-monitoring-and-advocacy-
Capital and Coast District Health Board
report-2018.pdf
Māori Health Profile 2015. Wellington: Te
Rōpū Rangahau Hauora a Eru Pōmare. URL:
28 Health and Disability Commissioner. 2018.
www.otago.ac.nz/wellington/otago152540.pdf
New Zealand’s Mental Health and Addiction
Services: The monitoring and advocacy report
42 New Zealand Census of Population and
of the Mental Health Commissioner. Auckland:
Dwellings, 2013 (see
http://archive.stats.govt.
Health and Disability Commissioner. URL:
nz/Census/2013-census.aspx)
www.hdc.org.nz/media/4688/mental-health-
43 New Zealand Census of Population and
commissioners-monitoring-and-advocacy-
Dwellings, 2013 (see
http://archive.stats.govt.
report-2018.pdf
nz/Census/2013-census.aspx)
Taurite Ora: Māori Health Strategy 2019—2030
Back to Contents
link to page 4
Back to Contents
link to page 4
Pae ora mō ngā
iwi i te Ūpoko
ki te uru hauora
Health equity and optimal
health for Māori by 2030
Back to Contents
www.ccdhb.org.nz
Document Outline
