Forum 2019 - Ensuring equity: challenges and opportunities

Both in Aotearoa New Zealand and globally, our ability to address equity challenges in health has improved over the past decade. However persistent disparities in access to quality services and health outcomes remain. In Aotearoa New Zealand, Māori and Pacific peoples and those in low socioeconomic groups are still the most disadvantaged.

Keynote speakers

Minister of Health Hon Dr David Clark

Heather Skipworth, Iron Māori Founder

Video: Heather Skipworth- Forum 2019 - Ensuring equity: challenges and opportunities

[Heather Skipworth presenting to an audience as part of the Ensuring equity: challenges and opportunities session of Forum 2019]

[Heather Skipworth mihi]

If I did all the thank yous and acknowledgments to everybody, my 25 minutes would be gone. So I'm going to get on with it. My name's Heather Skipworth, not Heather Simpson, so when we're out there, don't get us confused. And I'm a mother of three. I've a son who's 23, Tony. Another son who's 17, Teo. And my little girl is Corrine Wilder. She's five years old. And I have a little moko, Truth. He's five too.

Yeah, so how did I get here today? It's quite a-- I never visioned that I'd be here, standing here today, if you go back 10 years ago. So I was an aerobics instructor. How many of you did the Billy Blanks thing? Just a couple? Richard Simmons? Oh, there's a few of those.

So how many of you hit the Lycra with the togs, that would turn back the front, and you went to a gym? And yep, there's a couple down there. So I wasn't in that era. Anyway, so I was an aerobics instructor. And I loved thrashing people and seeing how they felt afterwards. So they were hooting, and they were in pain. And then, by the time the class finished, they were happy, and the weight of the world was off their shoulders.

I was a posty-- so I was giving people bills all the time. I then became a meter reader and read your power meters. And then I gave you bills as well. Probably not you, but at that time I remember thinking I'm sure God put me on this earth for more than to just give people bills.

While I was doing aerobics instructing, the Billy Blanks Tae Bo thing came out. And there was a little local provider, hauora provider who did some great Kahungunu. And they had a gym that they weren't using. So I thought, oh, if I buy the Billy Blanks tapes and learn them, and then ask if I can use their gym for free, then I can help people come and exercise, not charge them. So I rang up the provider, asked them if I could use it.

In return, I said to them, if you let me use your gym for free, all your staff can come to my class for free. And at that time, they were charging $25 a class to go and do Billy Blanks Tae Bo. Anyway, it was quite a hit. All the whanau came. The classes were packed up. And at that time, they were looking for a lifestyle coach at te taiwhenua o heretaunga.

And the lifestyle coach was to motivate, mentor, and help change the lives of whanau Maori and Pacific whanau who were overweight or obese. And my auntie said to me, oh, you should apply for that job. I said, oh, I don't really know how to be a lifestyle coach, auntie. Well, anyway, every time I'd go to the gym and do Tae Bo, there was a gentleman that was in the gym, and he was working out.

And I'd always acknowledge him [MAORI] and it was just a hi. So how many of you in here had a boss or a colleague that's been a tosser. Hands up, but if your boss is here, keep your hands down. There's a few. Well, anyway, this guy I thought was an absolute tosser. I'd always try and engage a conversation, because I like building relationships with people.

Well, anyway, my auntie said, oh, guess what, the organization have agreed to interview you. I said, I haven't even applied for it auntie. So anyway, I get in my best dress clothes. I walk into the interview room. And guess who's interviewing me. The tosser. So anyway, long story short, we're really good friends now, that tosser and I.

And I got the job. So I got the job, and I left school when I was about 16, I think I was. And I didn't know what I wanted to do with my life. I just didn't want to be at school. So when I got my contracts, I've had pretty mundane jobs, where you didn't really have a contract. You had a paper and you signed it.

Well, this organization gave me this contract, was about this thick. And I remember just looking for my name and how much I was going to get paid. Liked it, signed it, and sent it back. I didn't read the details. Once I decided-- got the job and decided to read the detail, it was pretty daunting, that I was supposed to change the life of whanau who were overweight and obese. I honestly did not know what the term obese meant.

And I think it's quite derogative-- the word obese. Is quite convicting. It's invasive, because as soon as you hear it, or someone tells you you're obese, you feel a spotlight on yourself. Anyway, so we opened the gym. We had exercise programs and nutrition programs. Opened the gym. First client that walked through the door was 180 kgs.

He walked straight up to me and said, the doctor sent me. So all the referrals came from doctors. The doctor sent me. If I don't change my life, I'm going to. Die can you help? Me and that's something I really hard to have on your shoulders, is somebody's life in your hands.

So I said to him, yeah, I can. And I said to him, look, we'll have a chat, we'll sign you up, come back tomorrow, and we'll get going. When he left, I thought how the heck am I going to save his life? Honestly, I knew nothing about this guy, just from a paper that had come from the doctors.

Anyway, the next day, he came and we ended up with 30-- there were two of us-- 30 people that come in. And the weight ranges were from about 130 kgs. And he was our heaviest, at 180 kgs. And you know, it was a real eye opener.

There was a contract. The contract was given by the DHB. And to me, now that I look back at it, was quite a horrid contract to have to deliver. It told me that I had to weigh a person that was heavily overweight and tell them that they were heavily overweight, by showing them their weight.

I had to invade the personal space. I had to put a tape measure around their chest, around their waist, the inside of their thigh. Can you imagine a person of 180 kgs and I'm asking them to invade this space.

And every week, we had to weigh them. And it didn't really ask much about what we did with them. It just asked did they lose weight, how many inches off their legs, how many inches off their neck. We even had to measure their neck, and then, did you talk about nutrition.

And for me, it was like, it was wrong. It's invasive, it's convicting. And even the terminology that we use for people today. We call them diabetics. I'm Heather from Ngati Kahungunu. I'm not a diabetic. But we give them new identities. We tell them you're a diabetic. You're not a diabetic. Your Heather Skipworth from Ngati Kahungunu, who has a health issue.

And so for me, it was like I need to change the way that the system works. So my client's name was Tamati. He was 180 kgs. I said to him, we're going to go for a walk, a one kilometer walk. That's how we're going to start. We're going to start off slow.

So one kilometer in my eyes, and probably everybody in the room here, is not much. We could do it with ease. I basically nearly killed him by doing that to him. We walked as slow as he could. He hung onto a power pole and was sliding down the power pole. And I thought, oh, my gosh.

So took him back to the gym, reassessed. And thought, no, this isn't what we should be doing. I'll put him in a triathlon. So the reason for that was that the swimming and the cycling were non weight bearing. And the walking, well, we'd eventually get our fitness up to that.

So there were 30 of them. 10 of them were tasked with being swimmers, 10 cyclists, and 10 runners. And the 10 swimmers, can you swim? Yes. OK, you're going to go to the local pool, do your swimming. The cyclists, we put on stationary bikes in the gym. And we all went for a walk. Not a 1K. We built up to a 1K.

And then the day came. And there were 30-- I like to call them fuller figured, not overweight or obese, because fuller figured sounds a lot sexier than obese and overweight. So us fuller figured people tuned up to the event. It was a foreign environment for them.

When we tuned up, a lot of whanau who are fuller figured, they tend to run themselves down and joke about the body. And the reason for that is so that people don't do it before they do. And they feel comfortable talking about it, instead of others talking about them. So we got to the event, and it's a mainstream event.

So if you know triathlons, before IronMaori, was a typical middle aged, middle class, white man's sport. That's putting it true, real. And so when we got there, we weren't-- well, we might have been middle aged. We probably weren't middle class. And we weren't white. And we were very fuller figured.

So when we turned up, they were like, oh, half the people here need good food. Half of them are all anorexic. And what they were doing was trying to put up that barrier to block out any judgment from those that were there. And none of them were judging us.

So we huddled up in a circle. We did a [MAORI]. I said to them, look, today's about you. So all our 10 Olympic swimmers hopped in the water. The hooter went off. And after five seconds, most of them were star fishing or pretending they were drowning. And I'm like, just stand up, just stand up. Because the water wasn't even deep.

But, yeah, a little bit dramatic. But they finished. So it was a 200 meter swim. And then when they hopped out, I was like, you freakin' said that you could swim. But really, they were the best bombers and the best power divers from back in the day. Then we went to the bike. They take these cyclists.

So our triathlon attire for the day was black t-shirts, black shorts, and Crocs. That was for the swimmer, the cyclists, and the runner. Because we are fuller figured, so you had to change it up. The cyclist went out and Tamati, the gentleman that was 180 kgs, he was doing the bike ride.

And it was a 12K cycle. And when you were young, distance meant nothing. But as you got older, you felt every pedal. You felt every pedal and every kilometer. And for a man that was-- at that time, he'd lost kgs, and he was 150 kgs by the time we got to the triathlon. 12 kgs is a mammoth for any person if you haven't cycled for a while.

So how I think I've become successful is my best skill set. It's not any qualifications that I've earned, because I haven't earned any. But is that I know how to build relationships with people. And that's what I did with my clients. So there's different relationships for different people. And most of you that work in the community space, you'll know that. How you interact with one client is different to how you'll interact with another client.

So this client would often swear. So I don't swear. So at times-- that's a lie. But at times, I would have to communicate back to him in the language that he knew suited him. And he would always mind, when we were doing the stationary bike training. So if you imagine a person of 150 kg stature, on a seat that's about this big, probably a little bit smaller, in a gym, pedaling away, trying to get his breath.

And he'd always mind. And I see to him, why do you always mind? And he goes, because every day I come to this gym, and-- excuse my language-- and you [BEEP] put me on a stationary bike, and I feel like I'm being sexually violated. And I'm like, OK, just keep pedaling, we're good. So the relationship I had with him allowed me to enter into his personal space.

Anyway, back to the day of the triathlon. He finished his bike. He swore a lot. I swore a lot back. But he finished his bike. He came in and the event organizers of that race weren't used to people getting their money's worth while taking their time. So they had packed down the finish line, everything was packed up. And we were still in the bike leg of our event. And I don't think it was-- it wasn't intentional, it's just how they had done the event.

So I thought, oh, my gosh, for him to turn up and see that the event was almost closed and over wasn't good. But our whanau recognized it, and they circled him when he came in. And they started to haka, And I tell you, it was like he had won the Olympics. It was life changing for him and for all of us. All our teams finished. Fast forward, a couple of weeks later, I thought, man, I need to practice what I preach.

So I've often played-- I used to play netball, rugby, rugby league, touch, all the typical sports that Maori enter into. And I thought I needed to practice what I preach. My clients on that day, or my whanau-- I don't like to call them clients. Our whanau on that day did 100 meter swim, a 12 kilometer cycle and a 2K run. So I said to them, I'm going to do a triathlon. They were like, are you going to win? You better win. And it's a totally different sport to running fast five meters, triathlons are.

So I didn't do any training because I thought I was going to be good. Anyway, it nearly killed me. And it made me appreciate what I had put all our whanau through. So fuller figured and obese people aren't lazy. They just physically aren't able to do what we, as smaller people, can do. So when you go to the supermarket, hands up how many of us that drive to the furthest car park, leaving it for people that can't walk that far? No?

But we're able people. So just going to the supermarket as a mammoth. And you know how we walk up and down the aisles, they physically cannot do that. And yet, we have these preconceived ideas that they may be just lazy or non-motivated. It's really hard to be motivated, when you're a fuller figured person.

Anyway, so I did the triathlon, nearly died. Did another one, and thought, I quite like this sport. Everything I put in, I'm going to get out of it, instead of team sports-- you're relying on other people. So I decided I want to go from zero to hero. I want to go to New Zealand Ironman. So my 200 meter swim, my 12K cycle, and my 2K run turned into a 3.8K swim, 180K cycle, and a 42.2K run in one day. And you have to do it within 17 hours.

At the time that I was a lifestyle coach, my husband-- anybody, put your hands up if you smoke marijuana. No, jokes, get yourselves in trouble. So my husband, he used to smoke marijuana and a lot. So you know what a chain smoker is with tobacco? He was like that with dope.

And he used to call it giving thanks. I don't know why anyone would call it that. But anyway, he was smoking dope at that time. And then we decided to train for New Zealand Ironman, both of us together. He's really hyper. He's quite intense. And I'm the type of person that likes to go within myself, and just whakatau, just calm myself, before the big day.

I couldn't swim. I hadn't run the bike since school. And running was five meters really fast. So it was a totally different environment for me. Anyway, we got to the shore lines of Lake Taupo, March 2009. And I remember turning up. And I was probably 10K's lighter than what I am now, and I thought exactly like my clients-- oh, my gosh, they're all anorexic.

And they hit these helmets, and they were like round in the front and real pointy in the back, like an alien. And then someone told me they were called sperm helmets. So I was like, everybody, I'm in Taupo with sperm helmets. They weren't sperm helmets. They were aerodynamic helmets.

Anyway, my husband at the time was a dope smoker. He was really intense. It was the night before the event. And I was trying to just relax. And he had gone to give thanks, and I had fallen asleep in the lounge. And he came back into the lounge. He had his swim camp on, goggles on. And I was asleep on the couch.

And I woke up, and all I remember seeing him was-- and he was practicing the swim. And I was like, can you just [BLEEP]. You know what that last word was. But can you just go away, please? But that was him, really intense. People would see to us. It's your first time in, just go into it slow.

The day came. We had a karakia He gave his thanks to whoever. And then we had karakia tuned up to the event. And 1,500 people in Lake Taupo. And I remember, they said we have to go to the back, babe. and he's like, nah, we're going up the front. So we went right up the front of the race where all the elite were.

They have a big cannon. It goes off. And I remember just freaking out. You get 17 hours. And I thought at that time, I don't know if I can do this. And this is probably how all my clients feel. They're often judged. They're often told what to do and not who to do it with, and why they should do it. And this was me in Lake Taupo, a fully abled, fit, and healthy person.

Anyway, 17 hours to do it. It's 15 hours-- no, it's 14 hours, 51 minutes. And I'm at the beginning of the finish line. It's 100 meter red strip-- not like the red strip that some people know. It's 100 meter red striped carpet. And all I remember was thinking, I did it, I really, really did it.

So I want all of you to feel how I felt. Many of you have done things in your life where it's like an aha moment. You know, you've got degrees , or you've had a baby. And I want you to help me relive my moment. So I'm going to split you down the middle. I was told that people to the right, because Chad Chambers is on the right-- no, Chad Parone not Ted Chambers. I was told that people to the right could sing.

So we're going to start with you. And I need you all to just stand up for a moment, because we're all about exercise. And you're going to repeat after me. So you need to, like, lift your heats up, get your vocal cords ready. And you're going to repeat after me.

[SINGS] Ah.

Ready, go.

[SINGS] Ah.

I'll just re-explain. I'm trying to get you to relive how I felt mentally, not physically. Because what I hit was [SINGS] huh. Which is kind of how I felt on the day. So let's give it another go. Ready? Go.

[SINGS] Ah.

The back, you're really good. The front, you're just miming. So none of the back, the front only. Ready? Go.

[SINGING] Ah.

Oh, very good. So this side, we're going to take it to the next level. Are you ready?

[SINGS] Ah. Ready, let's go.

[SINGS] Ah.

That wasn't too bad, although you were half a note down. Let's get, ready? I'll do it again.

[SINGS] Ah. Ready, go.

[SINGS] Ah.

Pretty good. I should video this and put it live on Facebook. But have a seat. You're going to relive my day an Ironman New Zealand. I'm running down the finish line. There's thousands and thousands of people. It's like I've won it, but I haven't. The heavens open, the angels come over the top, and all you hear is

[SINGS] Ah.

Let's do that again. I want to relive it, you know, like it was-- ready, the heavens open, the angels look over, and I hear--

[SINGS] Ah.

Very good. Give yourselves a big clap. So I've got three minutes to finish it off. Anyway, that's how I felt at Ironman New Zealand. Was like an aha moment. It was like having a first child or getting married. And so to me, it was like that's what I want our whanau to feel, those that are struggling with health. I want to go back to kahunganu. I want to start a half iron man. And I want them to feel that sense of achievement that I felt on the day.

And the reason being is that sense of achievement, you can transfer into many parts of your life. It's not about a triathlon. So IronMaori was born. First year, we had 300 people. Some people signed up not even knowing what it was, but the name attracted them. So the name iron is the warrior or the taught instinct or aspect that we have in each and every one of us, whether we're Maori or non-Maori. And the name Maori, well, that's the people that I wanted to train.

IronMaori is not exclusive. We're inclusive. We have everybody come to IronMaori. We've been targeted as a racist event, and we let it go. And those that are non Maori come to our defense and tell people that it's not about racism and that it's very inclusive.

First year, we had 300 people. Second year, 600 people. Third year, 1,200. Fourth year we had 2,200. We've plateaued to about 1,500 people. And it's not about a swim, it's not about a bike, and it's not about a run. It's about a state of mind. IronMaori is a state of mind, a positive state of mind. It's infectious. And how many of us in this room have done IronMaori? There's a lot of IronMaori potentials in this room.

OK, so IronMaori has helped develop me as a person. I'm now, if I'd been asked to speak here 10 years ago, I would have stood up and cried. I was not a very confident person. I now have confidence, because the people from IronMaori have confidence in me. I'm a director on the Takitimu Seafoods, which is the newly purchased Kahungunu investment. I'm a director on the Kahungunu Holding Company.

I was the chair of Ngati Ruanui Taha, which was a Maori health provider in Taranaki. I am a newly elected member of the Hawkes Bay District Health Board. And has anyone watched that movie "Boy." There's a whole lot of terminology that they use in-- like 'giz a turn'. Do you know what that means? It means, give me a turn. So I want you all to say 'giz a turn'.

Giz a turn.

So as Maori, we like to say real quirky sentences. So I've actually put my name forward for to be appointed for the chair of the Hawkes Bay District Health Board. So I'm just going to say 'giz a turn'. Anyway, my experience-- I've got 25 seconds. My experience on the DHB is that often Maori health people think it's a Maori problem. It's everybody's problem.

And if Maori are given more, it doesn't mean that others get less. And sometimes we find it hard when we see in the media that Maori are given more money. It doesn't mean that anybody misses out. My plan for the next three years on the DHB is devolution of services.

Our communities are the best places for services to be delivered. We do far too much in the hospital. We do everything, we do everything at our DHB. And we wonder why people turn up on our doorstep. Devolution of services and preventative education. It's not about getting them when they're needing to be cured. Services, Kaupapa Maori services that are preventative and educative. You can't just prevent it and not educate people.

No reira, tena koutou, tena koutou, kia ora tatoa katoa.

[APPLAUSE]

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