Forum 2019 - Equity

Having a common understanding of equity is an essential foundation for coordinated and collaborative effort to achieving equitable outcomes. This workshop was designed to increase collective understanding of equity and develop ways to use this knowledge across the health and disability system.

Keynote speakers

Meng Foon, Race Relations Commissioner

Video: Meng Foon - Forum 2019 - Equity

[Meng Foon presenting to an audience as part of the Equity session of Forum 2019]/p>

[Meng Foon mihi whakatau]

And it's good to see Hikurangi right here, kia ora Agnes. And as you know, the first city in the world to see the sun, and which gives us a lot of inspiration. Nothing is impossible. When Maui fished up the ika nui ika roa, ika nui, Te Whenuanui and slowed down the sun so that we can actually have some time to mow the lawns, it was fantastic.

So thank you. Thank you for the opportunity to talk about equity. I didn't learn about equity when I was at school, and nor did I know what it was till I actually was an adult, and an adult when I was about 50. And I'm saying, oh, yeah, what is this word equity? And they were saying, well, if you go to the warehouse and buy size 10 shoes, that would be equal, equality, because everybody will have shoes. But does everybody fit them? And that is the point of equity, because some people fit different sized shoes and some people might need a higher heel because their feet, their legs are longer or shorter. And so in my mind I said, oh, well that's quite easy to comprehend.

Then I went back to my time at school. My time at school when I started in 1964. We lived next to the Goldsmiths. And one of my friends was intellectually handicapped. This was in 1964. And the principal of the day went and bought a typewriter for her to type on. I said, that's remarkable. I mean, looking back it's remarkable.

Looking back at it now and I said, why didn't we get a typewriter? Because now we're all on the keyboard tapping away, and she can type faster than us. And it's interesting. And so at that early stage, just want to say thank you to our principal, Mr. Pax Kennedy, for buying that typewriter for our friend.

And interesting also when I became the mayor. People said, well, I don't use the library. Why do I have to pay for the library services? I don't use the dog park. Why do I have to pay for that? And I don't use the swimming pool. And so quite bluntly, we said, look, it's not about what you use. It is a tax, and it is about the equalization of this tax to the different needs of our community.

You may not have children, but our children love the swimming pool and they love the library and they love going there. And we spend inordinate amounts of money on those aspects, facilities for our communities. And we say, well, that's equality in terms of our tax that's available for everyone.

But there is aspects of equity. So our disabled community, our elderly community, they are on these scooters. They travel at 50 K's an hour and run everybody down. But however, they cannot fly over the curb. And actually, New Zealand is getting very good at that. And I must acknowledge all the councils that are actually putting in these ramps at the roadside where the people can cross.

I go and see my grandchildren once a month in the UK. And do you think UK actually has these ramps? No, especially not in the suburbs. You have to lift the pram and plunk it down and mum's in the front and we've got to bend our back and all that sort of stuff. So the access is not that easy in a lot of places.

Have you ever been to a toilet in a UK pub? It's actually downstairs somewhere about four or five, 10 flights down. I don't know how the wheelchair people actually get to go to the toilet. And so as a council, we focus on those basic things. Basic that we provide opportunities for everybody to actually have access into buildings, into facilities, toilets. We haven't got it right yet. After building many toilets in the Tairawhiti, we built a new one. And interestingly enough, it was right by the port. And there wasn't a toilet there before. And we said, yes, we're going to build a million dollar toilet. All right?

And then I went to the Tuitu 50 and you know what? Old Clarke was there. Jacinda's fiancee was carrying Neve. He said, Men's, where's the changing pad place for our baby? And I said, it must be in the disability toilet. Well, there was nothing. I said, after all that, after all these years of trying to get it right and being equitable to the needs of the babies and the young, the mums and dads in our place and our visitors, we still couldn't get it right. So there's still a lot of learning to do.

Now, I'm in a room of decision makers. Is that right? Major decision makers. We all have a role. We all have a role to try and have equity at the heart of all that we do. Yesterday I was at Waitara. Now, you wonder why Maori are in the state they are now. It's not because of their diet or anything like that. It's because of the economics and the opportunity. And in 1860, and the war raged on for 20 odd years, their land was taken.

And that is the core of taking away people's economic well-being, their cultural well-being, their [NON-ENGLISH SPEECH] status, their [NON-ENGLISH SPEECH] More particularly, there's decision making. And the opportunity of providing finance to actually go to school, go to the-- have good housing, to have good education opportunities has been degregated.

And we sometimes say, well, hey look, it is their fault. No, it's not their fault. It is the fault of the crown back those days. And if you think about inequity, it actually started at the signing of the Treaty of Waitangi in 1840. It's not a thing that is 10 years ago or 20 years ago. It is actual fact nearly 178, 180, 179 years ago, I think. Because I think in 21 years time, it will be 200 years of the signing of the treaty.

And we got to ask ourselves the question, 200 years time in the signing of the treaty, which is 20 years time, I'll be 79. I hope that I live to see that day. What would equity in your organizations look like? A challenge for each and every one of us. What would that look like in terms of opportunities, providing enough resource for those people that actually need it?

Now, I pay taxes, and I have no problems in paying my taxes, because I know that in our communities, throughout Aotearoa, there are needs. I do not subscribe to the social welfare benefit, I don't subscribe to the police system, and I don't subscribe to many services that the crown actually provides. But I am happy to actually pay my taxes so that my money can go towards those people of higher need.

Now, just about 10 years ago, I became one of those high need persons. I actually had psoriasis for a number of years, and now I get a Enbrel, a injection that I inject into my body once a week, and I'm grateful for that. And it is interesting how different-- I said to my mate, I said, mate, you need to get one of these injections, because this psoriasis is debilitating. It's actually terrible. So he said, well, how do you do it?

I said, make sure you keep going to the doctor, because what happens is that you will be given this drug, this drug, this drug till they all fail. And then you get this biological thing, and it creates magic. And that is the inequity of some patients. And you read about it in the health reports through the Waitangi tribunal. You actually know about it through newspaper articles, journal publications that not everybody is actually treated in an equitable way.

Now, science is a wonderful thing. So they found out that Maori people actually have a different gene in terms of treatment of gout. All right. So they require a different pill. So all I just say is I encourage you from the bottom of my heart, for the sake of humanity, human rights, that everyone has the right to health. Everybody has the right to a warm home.

And the interesting thing that we're sort of getting our head around it now, it's not isolation of anything. You can't just focus on the body health or the physical health of people. You've got to look back at what is causing this. Sometimes it is a cold, damp home. Now, the warm homes proceeds through the ecosystem where there's subsidies for councils and philanthropic organizations to actually warm up homes.

And I was actually amazed that in today's life that there are still people that have eight kids. And their children used to go to the hospital often. When we put these people into a home that had been rehabilitated with bats and under floor impol and double glazed windows, they didn't even go to the hospital after that. That is an amazing stat. So primary health is very important.

I can tell you in the Tairawhiti that Turanga health, Ngati Porou health, they're at the coalface and if you're part of primary health, you're probably doing the same. But I'm just saying they actually are very close to their clients. It's not about the clients coming to you, because you've got to drive two or three hours from Ruatoria to somewhere to go to a medical center or you've got to drive at least an hour from Mautu or Tiniroto to a health center in Gisborne or even an hour and a half. And you say, well, is that right?

So what they do is actually go to the Marae or go to the community hall and they take-- they provide a bus. So it picks up everyone and they go to their particular area, and everybody gets their eyes and ears and blood pressure and blood tests, diabetes, and all that sort of stuff. And it's done wonders for those people. It actually saves public health money rather than at the ambulance at the bottom of the cliff. If we can actually spend more money and acknowledge that the money is well spent in primary health, that is going to go a long way in helping our communities becoming healthier.

We know that equity is a word which is sexy now. And it should be sexy. And I just want to say, please, with all your power, with all your passion, make equity the center of your work, your community, your families, other people's families, your organization itself. It's very important in terms of the reflection of the faces of your community. People, if they can see themselves in your community, they are more likely to go and do something with their health.

So no rewa whānau

Great to spend my 15 minutes with you today. I'm not quite sure. Am I on this afternoon to repeat my thing later on? Yes. Thank you. And we all have an important role to play. I'm here to support you. If you need any support from the Human Rights Commission, we do have the equal rights, equal opportunities person. So hopefully you all get paid evenly for what you do, because that's very important. And we know that Pacific and Māori are well below the average.

And so if you are the chief executive of your organization, please give the respect to your staff that pay equity is important. Also, we have the disabilities commissioner, Paula, and she is really focused on disabilities, and you've probably seen her around. And give those people the opportunity to participate in your organization as well. There are things that you can do.

I like that program in the morning. I don't know what it's called, but it's on Sundays, I think, about this attitude, absolutely. And so inspiring. I'm just going to say it's so inspiring that nothing is absolutely impossible. Everything is impossible if you make application to it, and I hope that you put equity in front of you and yourself. Feel what it feels like not to have equity, because you never know what will happen to us at any one time.

[Meng Foon farewell]

I just speak three-- five languages. And the interesting thing is that there are over 300 dialects in the whole of New Zealand, even though there are 216 ethnicities. There are say like for Chinese people, there are 30 dialects. Good luck to translation line. Kia ora, everyone. Have a great day.


Haami Piripi, ONZ, Chair of Te Rūnunga o Te Rarawa


Yasser El Shall, Kāhui Tū Kaha, victim support volunteer

Video: Yasser El Shall - Forum 2019 - Equity

[Yasser El Shall presenting to an audience as part of the Equity session of Forum 2019]/p>

I would like just first to acknowledge the Ministry of Health and the DHB and the people. They have supported us to be here and supported us to be in Christchurch for the last eight months. I also would like to acknowledge the people passed away and the injured, who are still suffering in Christchurch.

As Mr. Ming said, we all have power in our position to make a difference in equity. That's why we're here today, to talk about equity and what we've seen in Christchurch. How did we get there, the diversity in our organization Kāhui Tū Kaha, having 10 of the Muslim mental health team in the organization?

I remember the first on 15th of March, after we came back from the prayer, our CEO, she came and she asked us to go home. And we didn't know why. She said, you have to be with your family if something went wrong. So we didn't know what happened until we got home. And then we realized massive what happened to all of us as Muslims.

Next day, she asked us if we would like to go and support our people there. And then next day, she booked tickets for 10 of us, and we went there. We didn't know what we're facing. We didn't know what we're going to see. And we-- this is the reason I'm here today, to tell you what is inside of what we're seeing there in the last eight months.

What we want you to know this, our people, they never knew what it means to be victims. We always have been terrorist. For more than 20 years, since 9/11, that's how we have been treated, and how we have been looked after.

Everyone knows the Muslim. This is a terrorist. And so our people didn't know how to behave as victims. This was a big thing for us, for all of us to see. All the agencies there need to know what to have to do. We stayed there. We tried to explain to them the needs of the people. But they didn't know. It goes far, far away from reality to understand from SSC, the police, from every agencies was there.

They didn't know what they're dealing with. So this is a lack of knowledge and culture. They never heard about-- they only heard about it as a terrorist. It was so sad. So we started to-- the first thing we started to do is to give kids [INAUDIBLE], training the GPs, the psychologists, the Pegasus Health. We based there for the last eight months.

We trained them. We explained to them what you can do to support our people. And they did it, every single one of them. And I repeat again, in your beliefs, you can make a difference. One person before I move from here to-- I would like to acknowledge Mr. Steve Mahery. Mr. Steve Mahery, when I was in Palmerston North for 10 years, without his support, without him believing in the ethnic groups, I would never be here today. My kids would never be here today. Believing in us is a huge thing. And I would like to thank him again.

Why the system didn't work? Muslims have been targeted in their religion, in their own home. The mosque, for the Muslim, is home. So we have been targeted in home. The people we were dealing with, they lost their home already from their own countries. They lost their land. And we know when you lose your land, you lose your safety.

So we lost safety. The attack was an attack on our identity as Muslims, in our faith, in our religion, the video made specifically to damage our people. And I promise you, the people, they have seen the video and downloaded it. They're still watching it until now because they wanted to know their husbands, where are they. Their family, how they died. The kids are keeping it because they can see the father and their auntie. And that's how we are damaged to the lower level.

Police taking statement after statement after statement, they didn't understand our widows can't leave home for three months. We will have to go to them. People didn't understand why our people have to be buried as soon as possible. They have marked. They have rotten. People exposed to, for days, for grieving about nobody touches the body. When they started to wash them, to bury them, they exposed to the trauma of people without faces, and it has to be washed.

And all these people attended them. They came back to Auckland. Nobody looked after them when they came back. So I'm just identifying the problem. Our problem is so big. And how we're going to address this-- how we address this as Kāhui Tū Kaha team, mental health team. We were from the people. We were from the same culture. We understood what people felt at the time and what they would need.

And we were working on their level. We were working from 8:00 in the morning to 11:00 at night, visiting people at home. This is a service what are people needed. And nobody could offer them this service.

We talked to them. We advised them. We supported them in every way they wanted. And it was about them. It's about the people. And the loss was huge. When the human has lost all sense of feeling and being safe, they become emotionally turmoil. They're lost.

When the social service of a country have a lack of ability to respond with a minimum understanding of culture, of language, and religion, to the needs of fellow citizens, holistic rights are not recognized. And over a short period of time, victims are further tragically traumatized and socially isolated. Our people are isolated to today.

But I wanted to thank the people of New Zealand who gives the love and the aroha. Without you, I think our people would be completely lost by now. Thank you for your love and aroha. What we have learned is that the government needs to take an action and understand by employing people in different culture so they can support the groups and the other ethnicities.

There's still, until now, little understanding from agencies of the Muslim community in Auckland, too, where there's a huge population of Muslim reside. The most important learning from Christchurch mosque shooting is we're still learning. To date, we still have a lack of true understanding across all of New Zealand of the full extent of the incident.

Part of this lack of understanding is that the victims' narratives is still unfolding. The other is that such a small group have been tasked with just a huge role that knowledge and needs have not been fully shared or addressed within all our communities across the country. If there is another tragedy, these issues will be escalated too far.

One of the biggest things we used when we arrived there was our values as Kāhui Tū Kaha, which is a manakitanga, rangatiratanga, whanaungatanga.

We establish this relationship, the relationship, the relationship, the relationship. When we establish the relationships with our people, this when we started to have a sense of belonging. And they allowed us into their own space. They trusted enough. We spoke all the language for most of the victims.

We had 64 widows at home. They needed support at the time. We did something we believed in, which we do whatever it takes. And that's what we have done. We stayed with them until today. We're still there. We're still there for them. We're still supporting them. We're leaving our home every week, Monday to Friday, coming back to Auckland. But it's all worth it.

Some of the learning, the culture support is count. Relationships matter. A time-critical approach is essential. You can't provide somebody with support after a month or after two months. You provide the support when they need the support. And that's what we have done.

The importance of empathy, when sharing the same culture, the necessity of trust to create a safe environment for our people so they can thrive. We have to be together to solve this. Everyone has the power to address these issues. Everyone has the ability to help other ethnicities.

We are talking about equity. And we're talking about how we all accept each other. So acceptance is a big thing. We have to open our heart to accept each other who we are and who we believe and help the people that need help at the time they need it.

Tēnā koutou, tēnā koutou, tēnā koutou katoa.

Thank you.


Dr Helen Paterson, Te Waka Wahine Hauora

Video: Dr Helen Paterson - Forum 2019 - Equity

Dr Helen Paterson presenting to an audience as part of the Equity session of Forum 2019]

Kia ora. I really want to welcome everyone here today and thank you for coming and listening. I don't really feel qualified to be here and talk about at Equity. But I was asked to come and talk about Te Waka Wahine Hauora. We've been being developed for probably about two years now.

I've actually been up and running for just five months. So who are we? Well, we're a non-profit making organization. We have a bus. It's actually really just a big posh mobile home.

And the reason why we set ourselves up was because I was working in Dunedin Hospital as a gynecologist and I met many, many women who were coming down particularly for a positive cervical screening. And they traveled 3 and 1/2 hours to see me. And they were going to travel 3 and 1/2 hours back.

And I really became unsure of the fact of whether I was improving their health care or increasing their risk of dying on driving on our roads. Then they told me their stories whilst they were having their colposcopy. And they told me how their whānau was outside and they were going to have to stay the night, because their clinic appointment was at half past three. And they didn't have time to get home. And the kids were not able to go to school.

And I really started to think this was a little bit crazy. So I started to talk to them and ask them, how would they think if actually a bus had come to them and they'd had their treatment on the bus? And they said, oh, well, that's great, but can I have my contraception and my prolapse and my everything else that I want to have managed on the bus as well?

So the planning went on. And we talked to lots of people. And we developed a bus. Sorry, gone massively forward there.

So the buses got a little bit of press as it's been going through, but that's really, because we had a lot of community engagement. We ran out, and we engaged with New Zealand rural women specifically, but also any medical practice that would listen to us, anyone who wanted to talk to us. We felt that it was really important that we heard what they wanted.

So the big thing was that it must be sustainable. Apparently, we used to have a te waka. And the waka used to go around and provide various services in Otago, but it disappeared and stopped being funded. So they really wanted a sustainable funding model.

At one of our lunch meetings that I was having where I went up to see the New Zealand rural women group at Waka Wahine someone said to me, what happens if you get run over by a bus? OK, good point. So you really have to think about that when you're developing these projects. And you really need to think about, what matters to the community, and how are you going to achieve that?

They spoke about the fact that there was an issue with access. And they didn't want to have to go and see their doctor to talk about their sexual reproductive health to come and see us. So we made it so that it was self-referral.

We had a fortunate incident when we received the bus. It was white when we received it. And so it was going to have the logo that's on here, this one up the top with all the names, but we didn't have enough money.

And also at that time I had the opportunity to actually consult, particularly with some Pacific groups who said they really wouldn't want their name on it. So now we just have the logo of the wheel. And there's a bike rack on the back.

So it looks like a camper van. And we've now discovered that not only that you need to park it so that the door is not facing the health institution that you're parked at so people don't see someone walking in. And these things are really, really important when it comes to actually engaging and enabling people to actually attend for care.

We also discovered that different areas would require different services. So at Omarama, that in the north of Otago, the women there, they're elderly. And they can't drive down and get their care for their prolapses. So there we provide a lot of prolapse care.

But in central Otago, we really needed to provide much more contraceptive care, because there's a lack of availability of long-acting reversible contraceptive. So there were now training. And we're training nurses.

So we're heard what the problem is and said, well, we actually need this to be in the community, not just in a bus that comes around once a month. We also note that there's different costing models. So we're talking about at Equity here.

And people challenge me and said, how can you charge a different amount of money for something? But I think it's that those raising of the shoes. So you've got to get everyone up to the same level. So therefore, you need to talk to people and hear what they're going to say.

So the women are able to choose what funding model they want to pay. And they can also pay us more if they want to. So we have some women who have insurance, but also pay as a social enterprise. So they pay for someone else.

So we're using a number of different mechanisms for trying to level the playing field and improve Equity of access. These were our goals. And they sound all audacious.

And we're nowhere near there, because we're only in for five months. But what we have done is we've gone down and we found some areas where there's some significant issues in terms of accessing care. And we're working with researchers to work out if we can improve, for instance, self-testing for HPV, rather than smears, whether we can go down and do services funded by the DHB or through trusts in the region.

We are managing to reduce the travel burden. We're now going to three areas. And we're just planning to spread out to five very soon. And hopefully, we'll be able to improve that.

We are also consistent with the national agenda of keeping health and the community closer to home, but we want to do more there. And what we want to do is train. So particularly with Marina having become funded, one of the things we're doing is we're going out and offering training. We've also been training some of the nurses in terms of at Jadelle insertions.

So we're trying to hear what do the community needs. I've had a number of emails in the last week saying, can you please come and train us? This is what the bus looks like inside. We basically can do anything that will be done in a gynecology clinic. But hopefully, we'll be able to move on and do more as we train people in the community and they don't need us, for instance, contraception.

It's really, really important that we continue engaging with the community. So we've been trying to work out mechanisms for doing this. We've been driving round to various areas and just literally having days to show off the bus. This is me heading down to a tappery. And I had the opportunity of a lovely, sunny day.

So we took a picture heading into Queenstown, but we hear from people through our Facebook ad. And that enables them to tell us what we're doing right and what we're doing wrong. And we also have a website.

And we're just about to put up a survey for our patients that's voluntary so that they can tell us what we really need to engage with that. And I think that that's probably one of the big things is if you're going to talk to people you have to listen and you have to hear. So our future plans are that we're aiming to design a model that will be sustainable.

So we're planning to be nurse practitioner led. We'll have gynecologists support it by audio visual. I'm traveling all around at the moment, but I have to recognize that someone else might not want to do it. And I don't want a system that's going to fall over if I get run over by the bus.

We're planning on having a second health practitioner. So we always have to have two people on the bus for safety of everybody. But we'd like them to be from the community so that when we care for someone we leave that care within the community. So that helps for everybody, but also improves training.

We'd like to set up a charity that sits above us that has got a guiding principle that's similar. So therefore, we can improve our sustainability. And we'd really like to provide more specialist services.

So one of our things is to think about how could we reduce time in terms of diagnosis of cancer. And so we're looking to add specialist services that we can provide safely on the bus. Thank you very much.

Dr Nina Scott, Waikato District Health Board, Chair of Hei Āhuru Mōwai

Video: Dr Nina Scott - Forum 2019 - Equity

[Dr Nina Scott presenting to an audience as part of the Equity session of Forum 2019]

[Dr Nina Scott mihi]

This is my reflection on the last 20 years. So it was a real honor to be asked to speak on my equity experience. And I offered to talk on two great little projects-- next door in the other sessions, on child health whānau ora randomized controlled trial, which is totally rocking, and Kaupapa Maori community codesigned project that's helping whānau come off insulin as well as getting fruit trees planted. But no, instead I was asked to talk on my cancer mahi, which is a long, convoluted, and incomplete story.

And here I am in 2000, my first job as a public health registrar. My only cancer experience had been working as a doctor in palliative care for six months. And this job was just to gain some experience and get my ticket. I had no idea that it would set the scene for the rest of my career.

Just to-- yeah, I was young and starry-eyed. To throw some stats at you, you can understand that the incidence of cancer for Maori being higher is logical given the inequitable distribution of the determinants of health like income and access to healthy jobs and food and lower access to screening and the really poor tobacco, you know, control that's not been happening. But the death inequity is so much higher than the incidence gap. It doesn't make sense.

So we should be doing lung cancer screening in New Zealand and better tobacco control, obviously. Our survival data is shameful. It's internationally horrendous, this gap. And these survival inequities are due to two things. The cancer system is designed to meet the needs of relatively well-off New Zealand Europeans. And they do quite well.

In our health system, you can only have one thing wrong at a time. Don't be poor and don't have mental health issues or be disabled. And you need to be able to navigate a disjointed, poorly-coordinated series of silos that have racist gatekeepers. So that's number one.

Number two, there is variable quality within this so-called system. The so-called postcode lottery, the biggest variation is not by postcode. It's by ethnicity. And this slide illustrates lower access, timeliness, and quality of care for Maori with stage 3 bowel cancer.

So back to the year 2000 when all of this seems so simple, I read up on cancer control. And it seemed pretty straightforward. Just follow the recipe on this World Health Organization list and all will be well. This list is basically two things, leadership and partnership or power sharing at the top. And the rest is just good governance, doing the proper things.

So the comprehensive program is what our new cancer agency is going to do. And that's a great opportunity to get all of these happening, these things happening for everybody. So we've got some of this already for non-Maori, but hardly any of it for Maori.

So, you know, 20 years and not much has actually happened. My great-grandfather-- great-great-grandfather-- had misgivings before signing the treaty. And I don't think we have yet arrived at a time where we can lay this-- these misgivings to rest.

So when I started my job, this had just happened. It was a failure of leadership and governance that had a disproportionate impact on Maori, which as I was to learn, is often the way when quality control is lax along cancer care pathways. So my job wasn't cervical, it was breast. The job was to ensure that the treatment pathway was high quality for women with screen-detected breast cancer.

And, you know, it was fairly straightforward. There was really good advice on how to do this internationally. So I got a team of experts. We developed about 20 indicators.

They didn't get the need for independent Maori monitoring and threatened to resign. But eventually, we got the Eru Pomare Maori unit to do the independent monitoring. And there were differences by ethnicity everywhere, especially with timeliness. Maori woman had to wait longer for everything.

But the providers had to develop detailed plans on how they were going to eliminate those inequities. And they did. So we now know that standardizing care eliminates inequities.

And I and others have failed over the last 20 years to get any other cancer treatment pathway standardized. But we've made a start at least with bowel cancer treatment. But, you know, we need to do better folks.

So equity focused reporting is really, really powerful. It's starting to be done. But it's still, once again, it's frustratingly slow. It just makes people look at the inequities. And if you report it-- monitoring things fixes them almost magically. It's fantastic.

So this is a good start. We've made a good start with bowel cancer. So we're startomg to measure what's going wrong. OK, so this is a bit of a good news story. It's not all bad.

So I helped form a national Maori cancer leadership group in 2012. And now I'm now the very proud chair. We have members of Hei Ahuru Mowai and every national cancer decision-making and leadership group. And we have international collaborations. And we've set up an international indigenous cancer leadership group. And we're going to have our first meeting in Hawaii, which is pretty cool.

So it must have been-- I'm just flipping back to 2008 when I heard rumors that a bowel screening program was on its way. I was concerned that it wouldn't be done in partnership with Maori and that it would increase the cancer and life expectancy gap. And that's actually what ended up happening despite being on all of these groups. And we're not giving up yet though.

So I worked with my national bowel cancer working group colleagues, mostly Pakeha surgeons who are now a group of radical Maori activists, as I call them, on the statement which the then-minister demanded be taken off the Ministry of Health website. Our new statement is even stronger and back on the website. So statements are very powerful, I think.

A Maori epidemiologist modeled the impact of bad screening on the equity gap for Maori and found that even though it will provide health gains for Maori-- so it's good-- it's going to provide double health gain for non-Maori. So it's going to increase the equity gap. But there are things that we can do.

And the creating a screening gap is unrealistic. Dropping the age for Maori is realistic. And we can do that. And that would make the health gain equal.

So I was really surprised and overwhelmed by the support for dropping the age for Maori by so many different people all around the country. We had a meeting of high profile experts who made these recommendations. Then the National Maori Medical Practitioners Association issued a statement of support.

And this graph shows that most Maori bowel cancer is diagnosed before the age of 60, which is the age the current-- the program starts currently. So this is going to happen. But when is the issue. How long do we have to wait for this to happen? I don't know.

The next issue is getting Maori into the screening program. It's been a little bit successful. I knew a well-designed invitation process was crucial. So we added a phone call for priority groups, Maori and Pacific, back in 2009.

And when the pilot started, they had other priorities. So they didn't get around to doing active follow-up. And as a result, the equity gap was huge. So we developed targets for active follow-up that had to be reported to the ministry and that worked.

They employed Maori and Pacific phone callers. And about one third of non-responders returned their kits. But then there was pressure to either stop or delay the active follow-up because, you know, this cost money. So we did a randomized controlled trial to justify. So this is over justification. I end up doing a lot of randomized controlled trials. It's not my fun thing to do. I'd rather do gardening.

But so active follow-up is now built into the national program. And the national team are doing an amazing job. They're getting at about a 30% response right now. So they are rocking. And that's a bloody good success story. Yeah, so we're going to eliminate that equity in participation I'm hoping.

So I haven't yet touched on our development rights. But it's mentioned in the new cancer plan. Clearly, we as a country are not yet meeting our responsibilities under it, let alone Te Tiriti. And I think my great-grandfather was right to be cautious.

So the necessary steps are still pretty straightforward. It's not rocket science, folks. But it does require power sharing. And people don't like to share power.

So I'm going to leave the final words to Rhys Jones. But on a personal level, over the last 20 years, this has been difficult, full, and rewarding at times. The undermining is real and hard work. Our whānau korowai over five coffins since I wore it, including my dad, who we lost to bowel cancer. So that's been tough. My-- I'm sorry.

My oldest daughter wants to be a doctor. So one day when she graduates, she'll wear it. And I hope that one day we can-- we can have this beautiful imaginary land where we can all work together in partnership to achieve equity. Thank you.


Dr Curtis Walker, Chair of the New Zealand Medical Council of New Zealand

Video: Curtis Walker - Forum 2019 - Equity

[Curtis Walker presenting to an audience as part of the Equity session of Forum 2019]/p>

[Curtis Walker mihi]

It is really humbling to stand up here after our great presenters that we've already had this morning and also John's already awesome sum up of everything. So as you all come up and give some reflections and he's kind of reflecting as we're going along. And I'm also conscious that I'm standing in front of a room full of-- every single person around every single table and I can see people I recognize out there-- who are all great health leaders and health decision makers.

And so turning this korero, this talk, into action as we walk out of this room and back into our institutions-- or in my case to my kidney clinic or wherever I am as well-- we all have to take the learnings from today back so that when we are standing here in 2040 we can genuinely answer their question what is healthy equity look like. Because we're still standing here asking some of these questions and acknowledging some of these bar graphs, we haven't done our job here today. Kia kaha, me haere atu, ai. Keep going when you're out there.

I want to reflect on John's quotes from Maya Angelou on courage. Again-- this is going to take courage. Courage to do right thing. If we don't have it-- and to paraphrase that quote, if we don't have health equity, all of the other streams that are going on in the other rooms are probably going to make the health equity get worse as we've already heard about with the bowel screening. So I think this is the most important stream of our hui. Aroha mai kau ra tau ma. Alright.

That's probably why it's the fullest and they were blocking people from getting in here. And I had to say, sorry, I'm actually on the panel. And even then they looked at me sideways and thought I was just trying to get in here on the cheap. There's that other Martin Luther King quote, and it's about of all the forms of inequality, and human inequality, injustice in health care is the most shocking and inhumane. And that's another reason why we're in here and why this has now become such an important korero for us to all have.

Courage. This used to be called closing the gaps I think, 20 odd years ago-- John, when you were at the ministry the first time possibly. There was a lack of political courage and perhaps our society wasn't really at that time to embrace this.

When it's health equity, it's actually about being fair and being right and being just. And that is probably why, along with our societal changes and diversity, this has become a more achievable goal than it was 20 years ago. And it is achievable. You know, equity's about needs. It's about right, it's about doing what's right, and it's about doing what's rights. And we've heard a bit of that korero today.

I want to acknowledge Ming. Ming your korero. Congratulations on becoming the Race Relations Conciliator in August 2019, I believe, so fresh. The quality of councils elected these days I can't vouch for, but the quality of elected councilors back in the day you know, absolutely awesome the way that you've done out Tairawhiti with my people out there as well as Ngati Porou.

You talked about making equity universal and central to what we do. And I just want to reinforce that point here today. We've heard about the equity lens and making sure that that's focused on everything we do. Nina, you brought up the korero around all of the barriers that get in the way of good health care. The equitable cancer pathway, at every step there's an opportunity where things are falling over, but also an opportunity to get things right and do things better. You could drive a bus through some of the inequity gaps that are around there and Helen, you've brought up how you're achieving that.


See, this is a thing, you've got to come up with this stuff on the cuff because I've got to sit there and PowerPoint this. So Aroha mai whanau. Was that bus, was that-- were the people making sure they weren't getting run over by that bu-- OK, all right. I was making sure that wasn't the case.

So the work that you've done with that Te waka wahine hauora, you know, awesome to address geographic inequities. And just along with gender inequities there's a lot of equity gaps that we can look at. I'm sort of pleased to say that one thing the Medical Council is keenly focused on is ensuring that our medical workforce is not only culturally safe so that every interaction that we have with the patient as a doctor is a culturally safe one for the patient. But also that our organizations that we are all part of as doctors and inform in our professional roles, we're advocating and agitating for those organizations to be culturally safe organizations, whether they're delivering health care, but also to grow and diversify our medical workforce.

And on that note, I really would like to acknowledge that-- some of you may not know this, but in 2023 we're expecting there to be an equal number of female doctors and male doctors in our medical workforce in New Zealand. And that's-- I mean I reckon that's an awesome statistic. And then it's going to go even more, so we're going to have more women in the workforce than men in due course.

And finally as I look around this room and I see this room, we talk about how far have we come and how far have we got to go. And also do we congratulate ourselves enough. I would certainly just want everyone to look around the room and just look at all of the strengths, all of the diversity that we have in this room. And I'd just put to you that it probably wouldn't have looked like this 20, 25, 30 years ago. John, maybe you can answer that question as well.

Anyway so we've got a great room of people here. Yasser. Your korero was very powerful, very raw. It's always going to be powerful and I suspect it's always going to be raw. But how we can, especially together, heal, learn, and be better as a people, as a country, through going through tragedy. And I just wonder whether there's that-- that tragedy is an acute example of, in some ways, the longest-term historical trauma which has happened in this country to our indigenous population as well. And so again this coming together to heal, to do better.

And when two cultures collide, as in the case in your talk, you had the Muslim community dislocated, displaced, and then running up against institutions of the state, which didn't know how to respond, and had to learn how to respond, and are going to have to keep learning how to respond.

Because not only the next time a tragedy happens-- God forbid-- but also just the everyday capability and capacity we need to deliver quality health care.

So look, I'd just like to finish that I think we are becoming a more mature nation able to have these difficult conversations, calling racism racism, calling institutional biases institutional biases But? Also supporting each other along the way. My Koro Ranginui Walker. We are so proud of him because we feel that he did a lot to change our society back in the 60s and 70s when these things weren't spoken about openly or as easily as they are today. So we can stand here and be able to move things forward, to make the most of our nation as we go into the 2020s.

One example here, my lapel pin is the tino rangatiratanga flag. If I reflect on what happened at Bastian Point, takaparawhau, 30 odd years ago compared to how the more recent land disputes have been held out at Ihumatao, and the governance role and all of our role in having a much more respectful dialogue, I have hope that by 2020 we will continue to be a better nation and hopefully have our health equity. So kia ora tatou.


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