Forum 2019 - Wellbeing

The aim of this session was to build a shared understanding of how we can work together to support the priorities outlined in the Wellbeing Budget 2019.

Keynote speeches were delivered by Hon Julie Anne Genter, Associate Minister of Health; Paul Hunt, Chief Human Rights Commissioner, and Holly Walker, Acting Director, Office of the Children’s Commissioner. These were followed by presenters from a range of health and community settings.

Presenters and presentations

Hon Julie Anne Genter, Associate Minister of Health

Video: Hon Julie Anne Genter - Forum 2019 - Wellbeing

[Hon Julie Anne Genter presenting to an audience as part of the Wellbeing session of Forum 2019]/p>

Tēnā koutou, tēnā koutou, tēnā tatou katoa.

It's really wonderful to be here with all of you this morning. I'd like to start by thanking Dr. Ashley Bloomfield who's the director general of health and is my go-to person every time I need to try and make something happen in my portfolios. And of course, he's leading a really excellent team at the ministry who are working as hard as they can to help the government implement a slightly different and more holistic approach to health and well-being.

Thank you so much, as well, for the welcome, Charlene. Firstly, I just want to thank all of you for the work that you're doing in whatever area you are working in health.

I know that to get the sorts of outcomes that the government aspires to, like eliminating child poverty in New Zealand and ensuring better equity of access to health services and healthy outcomes, especially for Maori and Pacifica people, to make Aotearoa New Zealand truly the country that we aspire for it to be, one where everyone has the opportunity to live a good life, the government can't do it alone.

We need thousands and thousands of New Zealanders out there every day doing their bit, whether it's through their professional work, or through their volunteer work, through their families and their communities. So thank you for what you do.

I thought I would just bombard you with some slides since I have the opportunity quickly this morning. But I'll put on my timer so I don't go over time. So before I became a politician, I worked in transport and urban design.

And the reason I'm so passionate about it is because it's one of those areas where we truly can get win-wins, where we can get much better health outcomes, where we can get better mental health outcomes, where we can address the harmful pollution in our towns and cities that affects our air quality but also affects climate change, and where we can have the opportunity to have more connected and happy communities.

So healthier, happier towns and cities is the way in which I want to link up my associate health portfolio and associate transport portfolio. And I think it's helpful-- some of you will be already aware of all of this and working in this area. But sometimes, we think in the health system, it's all about responding to illness and that's what our hospitals, and our GPs, and our specialists, and our nurses-- what they all help with.

But we want to get out in front of illness and we want to promote wellness. We want people not to get those non-communicable diseases in the first place. And to do that, we need the health system, but we actually need to use a lot of the levers out there in our physical environment and in our services that we're delivering through housing, through education, making sure people have sustainable incomes.

I would recommend, for anyone who's interested in this topic, there's a lot of excellent research in this book, Happy City, which talks about just absolute wealth of research. Although it was published in 2013, so there'll be even more since then, it's a fantastic read about how urban design can help support well-being. And so up here on this slide, I say healthier, happier towns and cities are absolutely necessary to deliver the government's objectives, in terms of improving well-being of our people.

And a big part of this that is often overlooked is walkable neighborhoods. That's a place where people can easily get to the store, get to work, get around town, kids can get to school under their own steam. And that's something that we used to have in New Zealand and that we can have again. But the reality is that it's been declining.

People's use of walking, and cycling, and public transport declined significantly from the late 1950s, early 1960s right up until the early 2000s. And it's only really turned around in our big metro centers. Wellington kept it pretty well, but Auckland's made a big turnaround in the last 15 years due to choices made by central and local government about what to invest in.

So when we create walkable cities like this, walkable neighborhoods, it gives people greater choice about where they live and it reduces the amount that they have to spend, the amount of time they have to spend in a car. And that has directly related to some of the health outcomes we want to achieve. But studies show those neighborhoods are associated with increased physical activity, lower levels of obesity, hypertension, and diabetes.

And actually, it goes further than that. We know that higher levels of physical activity are associated with reduced rates of breast and colon cancer, better mental health, again, the lower obesity rates, lower heart disease, stroke, and the list goes on. But many people aren't getting their minimum sort of required or recommended physical activity.

And although we try to promote physical activity through sport, and gyms, and other things, the reality is, it's not working. But when we create physical environments where it's inviting for people to walk, where it's safe for them to use a bicycle, it won't work for everyone, but there are large numbers of children and adults for whom walking and cycling is a realistic option if we prioritize the infrastructure and if we make it that easy and convenient thing to do.

And this is true in New Zealand. So this is from the New Zealand Medical Journal. There was a research from University of Otago. New Zealanders who walk or cycle to their main activity each day have a 76% higher chance of achieving those physical activity guidelines compared to those who are reliant on cars to get where they need to go.

And this association works for people who are in work or not in work-- it holds for both those groups. So that's here in New Zealand. Now, why aren't people walking and cycling? I don't think it's rocket science. This is an aerial photo of a part of Auckland, Botany. And what do you notice about this? Most of the land is used.

There are some trees, which is a good thing. We know that trees and nature are important for mental and physical health, as well. But the rest of the environment is either for moving or storing cars. A lot of it's empty, and it creates a really unpleasant environment for people. So in this area, people are likely not even to walk from one shop to another because the environment tells you, drive.

And actually, it makes it very unsafe and difficult for people to walk and cycle. And so it's not surprising. We can't really encourage people to get on their bikes, especially children, when this is what their urban environment looks like. But it is possible to change that urban environment. We ended up with this environment not because it had to be this way, but because traffic engineers and urban planners in the '60s and '70s thought the biggest problem we had was not enough parking and not enough lanes to move cars.

And that's totally understandable why you would define the problem that way. But the solutions they came up with ended up reducing people's choices, and ended up making it harder to get around towns and cities without a car. And so now, it's totally understandable, and I would never blame people for using a car. It's not on them.

It's on us politicians, and planners, and traffic engineers to create an environment that gives people real choices and that facilitates that everyday activity that we know will benefit our communities. And what are we here for if not to deliver communities that just support people's health and happiness? So we have all the research. We know how to do it.

We know that these sorts of solutions don't eliminate congestion, but they do cut off communities and make it really hard for people to get around in other ways. And then here, look at this poor school girl trying to get around in an environment where she's the only person on a bike. And the environment is perceived to be dangerous. In fact, it probably is dangerous for her.

And we know that there aren't equitable outcomes because in communities like South Auckland, Maori and Pacifica children are not only more likely to suffer from inactivity, which leads to obesity, which leads to other health challenges, they're also more likely to be hit and killed by a car. And that's because of this physical environment.

But we can do it differently. And if we look overseas, we can see countries who have chosen to prioritize the infrastructure that makes it safe and comfortable for walking and cycling. And in those places, more people walk and cycle. And you can see the same thing in New Zealand. In the places where we create these wide, separated, cycleways, where we have slower speeds, more people choose to walk and cycle.

And this is because people respond to the physical environment, but it's also, people copy each other. So when it looks normal, when lots of people are cycling, then more people do it. And so in an environment we're in now, where it's pretty abnormal because the normal thing to do is drive, it's really hard to break that cycle, to get people walking and cycling.

But the key way to do it is through infrastructure change. And I want to show you how that can happen just to kind of inspire you about the possibility. So this is a typical sort of place that's put aside a lot of space for moving and storing cars and hasn't given much attention to people.

And if we changed our planning rules and allowed more flexibility, took a different approach to managing parking, really prioritized that pedestrian and cycling infrastructure that is really much cheaper to provide than providing for each person traveling alone in a car, and we allowed more housing to be delivered over shops and more diversity of housing-- you'd still have standalone houses, but let's offer some more housing within the urban area.

And then over time, you build up that population of people and you turn an area that was totally unwalkable into one that is balanced, walkable, has the public transport priority. And of course, there's still cars in this picture. But it's not 8 out of 10 trips by car, it's more like 4 out of 10, or 5 out of 10, and there are huge benefits to this. And here's a couple other examples of how things could be different.

And I do want to emphasize that overcrowding is also not good for mental and physical health, but we can strike a balance. And all of the research around health and happiness shows that people are actually happier when they have those face-to-face engagements with people on the street, on the bus, on the train, in the shops.

And when they, again, get that physical activity, there's not just physical health benefits, but there are mental health and resilience benefits to that, as well. Not to mention that, although this might look more expensive, it's actually less expensive than what we're currently doing where we rely on very expensive infrastructure, everyone having to own their own car and run it, which is very costly.

So this is the sort of change that I would like to see in New Zealand, and I believe the research is there that people want these sort of options. And ultimately, it's not they who have chosen car-dependent suburbs and having to commute by car. Some people will like that. A car is a perfect option for somebody who has an injury or a disability, for when you're moving house, for tradies who are carrying around lots of heavy equipment, and that will still be an option for them.

But we have to put people first in our transport planning and urban design if we really want to support the sorts of communities that will help people's physical and mental health and promote that well-being. And of course, we have to be thinking about equity as we're delivering this, ensuring the community is involved in the designs, ensuring that it's delivering not just for the wealthiest New Zealanders, but actually for those who, right now, face the greatest financial and social barriers because that's the kind of New Zealand we want.

So moving on, your next concurrent sessions, you'll be hearing about three initiatives that have or will contribute to improving the being of children, whaunau, and groups right across the [NON-ENGLISH] in New Zealand. The cause collective, a Pacifica social change agency that assists communities facing social problems and work with them and others to ensure that they have what they need to thrive. And this is currently through Healthy Families.

Secondly, Te Ara Tika, an initiative showing how listening to the voices of young [NON-ENGLISH] Maori will improve the way our providers enable support to stop smoking and to design and deliver services. And finally, how the Manaaki program will support the mental health of children in primary and intermediate schools in Canterbury and Kaikoura.

So I encourage you to listen carefully to the stories being told in this session, the lessons being learned and to use this to reflect on your own work, your situations, how you can adapt and innovate your services and strategies to better reach the well-being aspirations of your communities and their waunau. And of course, if you can share the message that I've delivered this morning about the importance and the opportunity of changing the built environment in a way that will enrich the lives of all New Zealanders,

No reira, tēnā koutou, tēnā koutou, tēnā tatou katoa


Clare Shepherd and Greg Hamilton, Mana Ake Project leads

Video: Clare Shepherd and Greg Hamilton - Forum 2019 - Future directions

[Clare Shepherd and Greg Hamilton present to an audience as part of the Future directions session of Forum 2019]

Kia ora Sharn. Tēnā koutou katoa.

Mana ake, to us, represents a new way of working, and it's a way of working in which it's health alongside of our social sector and education, working together for the benefit of young people. But it wasn't actually born in a well-being setting. It came from a mental illness problem. And that was post quake. Canterbury looks pretty much like almost all other recoveries in terms of our population. We're seeing significant increases in mental health problems for people as they recover. And most of the international literature says somewhere between 5 and 10 years, you see a peak, and then a drop off for adults.

But for children and young people, out to 10 years, there's still problems increasing. And so in Canterbury, in the first seven years after the February 2011 earthquake, we saw an increase of 97% of children in our mental health specialist services. And obviously, that's a terrible place to be in. But it was also recognized, and one of the election commitments of the new government coming in was to address this. And in terms of addressing it, they said, we need to-- they actually listened to school principals who said, we're in trouble here.

We've got a series of kids who've got problems that we are not used to dealing with, and we don't think we're the best people to deal with them. And so the principals themselves identified that. And the response to that from government was to say, well, we're going to go with 80 workers in schools that are there to support our children through primary and intermediate schools in Canterbury. And what's more, we wanted to ramp up really rapidly. We had the first go ahead at the end of January 2018. It was announced by the prime minister on the 22nd of February, our anniversary day of 2018. And then the first workers were in place by April.

And so it was about getting a program up and running really quickly. We needed a way in which we could engage and in a different setting. And so for Canterbury, we went to something that we knew had worked within health circles. And so our Canterbury clinical network, our alliance, was a way of working in which we knew it engaged people across the health system. It had strong leadership. It was independent. So it didn't belong to anyone. It actually belonged to all of us. And it's a mechanism for designing services and designing systems to work for people based around people.

And so in the case of Mana ake, we thought it's a way in which we can move forward and think about how we get a design of a service and a new system based around children and schools. And so our challenge was really to convert something that had been successful in a health setting and to see if we could engage and bring new partners in across schools, education, social services. Because we'd had partnerships in place, we were also fortunate enough to have gone out to schools just at the end of the last week of school of 2017 and asked them what was it like for them and what were they doing. And almost all of those schools had initiatives in place.

The fact that almost all of them were different was a bit problematic. And very few of them had an evidence base. They were just doing something to try and innovate, to try and meet a gap. They also told us-- the head referrals that went everywhere and the hope that somebody would pick them out. So we were creating duplicate work. We created waiting lists within health and others and other services, and they were for the same kids. So it was a difficult environment that they saw themselves in, and they just had a general lack of clarity.

So what we found in the early February workshop we did with them, which was engaging across the whole sector, was there were some things that we were able to identify really quickly. People wanted timely access. They didn't want waiting lists. They wanted to be able to get to support and get to it straight away when they saw that need for their kids. And they wanted more knowledge about what supports were actually available because there was a lot out there to support, but it was very fragmented. They wanted to see more presence of health within their schools.

They saw public health nurses who came around and visited, but they really hadn't had that higher engagement or that level where they could see people in their schools. They wanted wraparound support, and they wanted to do that early, before the problems became more serious. They needed to improve communication, not just with the services, but between the services so that each of the services wasn't using the school as their primary hub for communication, that they were communicating between themselves if they were sharing care and support. And they also just wanted us to reduce complexity.

And they brought us another problem as well. We'd had earthquake funding through the Red Cross for a period of time, and a lot of that funding was coming to an end. And so it gave us an opportunity when we thought about 80 workers, about some of the people that might help in that. But we were also conscious-- we didn't want to grab the next 80 people out of other services that were also under pressure. So we had to think about a way of approaching it for a new workforce.

So yeah, the challenge that they set us, really, through these range of opportunities was really to think about how we could make the greatest impact with the opportunity that we'd been given. And schools were really clear that they're the hub of the community. They see children every day, mostly, and they see their families. So they see themselves as a real community and family hub in the same way that general practice see themselves as a hub that knows families really well. So they were really keen to join that gap between health and education, so that they could all meet the well-being needs of children and families.

But schools told us they don't know what they don't know. So even within clusters of schools-- so we've worked through geographic clusters of schools. And from one school to the next, even when they're quite closely located, they didn't necessarily know what was in their community. So one school might know something another school wouldn't. So when we looked at a model that we could use to help impact that wide range of opportunities, we needed to cover from joining the community up through to being able to support individuals and their families. Because we know that child well-being doesn't sit in isolation and it doesn't start and end at the school gate.

And schools felt really overwhelmed, as Greg referred to. So part of what we also wanted to be able to do was support them in feeling really confident about the things that they can do and walk alongside them whilst they maybe add some practices in support child well-being. But also, destigmatize that concept of child well-being and mental health needing to only be treated by a specialist service and reaffirming the role of really strong adults being able to support children, mitigate their anxieties and their well-being concerns, and the importance of people doing that in a really consistent way.

So we worked with multiple stakeholders in those very early days to develop our response, which is completely child and whanau centered, but within the context of that school community. As Greg said, we have 80 FTE now. And to be able to do all of this, we need a really broad range of people. So that's really good for the wider workforce in that we weren't taking one brand of person and putting them into the Mana ake workforce. We were able to be really broad with the range of skills that we have brought into this workforce alongside the providers who employ those people.

And the funding that we got was for three years, so we've got a really, really strong eye to that sustainability of what it is that we're leaving behind. So knowing that if we just treat children and families one by one, we're not going to get that wider impact and bigger effect. So flexible and responsive is our byline. And by working in clusters of schools, we're able to bring their strengths together. And by working across agencies and with workers with a multitude of skills, we're able to really build that range of support. So our approach has been shifting in thinking from a service to a resource, from contracting and to service delivery to thinking about how cooperative and collaborative working across schools, across services, between services will allow us to build on the good things that are in place already. Because there's lots that's great in places.

We've heard across all the workshops today. There's lots of really good things going on already. How do we enhance and build and strengthen those? And we needed to do that by building a strong partnership culture in multiple contexts, so within and across schools, within and across providers, and within and across health, social sector, and education settings. I guess one of the things that helped us with that was that we were moving so fast that we had to really rely on working with our providers, with our schools to help us frame up what this would look like to share ideas and to really support the development of that culture of trust, evidence-informed responses, and whilst we built that robust infrastructure around us so that we could support quality practice.

To help build the culture of partnership, we really focused on the outcomes and the vision that we were trying to deliver on, which is that Maya and her family are supported to flourish and thrive. We focused on making progress rather than the processes we needed to be in place. So how do we progress this? How do we do this really well? And we focused on ours, not yours or mine. So really building that joint responsibility for the outcomes.

And it was challenging because people wanted to know what do we do, how do we do it, how much of it should we have. So people are very used to a service thinking and a contract thinking. Like, I'm big, I should have more. I'm small, I probably don't have the voice here. So really, our approach was to work back with those people and say, so how will Mana ake work best for you, with your skills, knowledge, and in your context? So what we've done so far is that we have our 80 FTE. They rolled out basically 20 by 20 across school terms and across 26 clusters of schools that run from Kaikoura down to just south of Ashburton. So there were 220 schools there, and each of those 26 clusters is quite different in the way that they function and in the supports that they have available to them.

Some are very rural, and some of them have significant deprivation as well, and some of them have a mix of those things within them. We formed a partnership with the 13 NGOs who provide kaimahi. And they really do work together to that common view of Mana ake is the way we work, not a funding stream. And we have Leading Lights, which is a little bit like Health Pathways, but focused on education. So from a teacher's point of view, we've brought together our system partners to develop those pathways about what are the things that you can do within a classroom with children through to when would you access support. So trying to clarify some of those systems.

We've developed our evaluation framework that looks across the system-- looks to pull data together from across the system. And we've just recently asked schools how we're doing. And in terms of where to next, I think the biggest thing in all of those are our language really matters when we're working across systems and when we're moving to a well-being model from a mental illness model. And we've had to be really careful with our language and really consistent with it. I think as we've built the platform of joint responsibility, that sense of crowdsourcing. And people have heard about Mana ake in Canterbury, and they want to join, they want to contribute their skills, knowledge, and resources to our Mana ake kaimahi because they know that if they do that, they're in schools, in communities, and can support families better with that wider knowledge. Thank you.


Annie Ualesi, Strategic Partnerships Manager for Healthy Families South Auckland

Video: Annie Ualesi - Forum 2019 - Wellbeing

[Annie Ualesi presents to an audience as part of the Wellbeing session of Forum 2019]

Thank you, Sha. Talofa lava and good morning. I acknowledge the minister this morning. I acknowledge mana whenua, tangata whenua and the special place in Aotearoa of those peoples. I acknowledge our Māori providers in the house. Our South Auckland providers in the house, and our Pacific providers in the house, and our healthy families colleagues are up and down the country. And I acknowledge you beautiful people and all the mahi that you do across our nation. Thank you.

OK, I'll tell you how blessed are we to have a minister who is passionate about health and well-being? She talked to us today about happy cities, and I'm going to build on her conversation to talk about happy neighborhoods. And what they can look like from a neighborhood in South Auckland. I am from the Course Collective. We're about systems change. We're not a service provider, we are up about challenging the system. And we heard today about the changes required for our health and disability system, so can I encourage you-- I'm going to review-- I'm just going to reference three things that the panel talked about this morning. And I'd like you to dwell on them as I speak to you.

One, collaboration and KPIs and accountability that support that. We're going to talk to some examples about that this morning. Two, capacity for inter sectorial engagement and partnership. If we're really about health and well-being, health, we cannot do it alone. Our ministers talking about urban design and transport. How are we working with them? How can we work more strongly together for connected and happy communities in cities? And workforce development. What kind of capability do we need in our system to really deliver health and well being for all parts of our community? We are building a workforce like that, and we'd encourage you to think about that too.

So. See, this is my first day. I haven't even like figured out how to use the technology. OK. I'm going to talk to you about a neighborhood in South Auckland. And this neighborhood is Mangere and its amazing neighborhood, with all the people in it. I'm going to talk to you drawing from three pieces of work that innovation funding received from the Ministry of Health. One is Healthy Families South Auckland, the other is One Love Mangere. Proof of concept of regeneration without gentrification. And the third is Do Good, Feel Good, our youth movement.

And our neighborhoods. Because we take a systems change approach we always think about ecosystems, and what are the interconnected parts of a system that are actually impacting and limiting or restricting the choices that people can make as the minister talked about earlier. So I'm going to take you to our neighborhood in Mangere with 1,000-- about 1,000 people living there. 122 households and about 40 minor dwellings. So in South Auckland, for those of you who don't visit our areas much, minor dwellings can be carports, can be containers, can be garages. And this is the kind of day to day accommodation of our families. It's high deprivation, and 3/4 of the people living in our beautiful neighborhood are Maori or Pacific.

So when we go out and engage with our communities, we just spend time. And so we asked our neighbor people in our beautiful neighborhood, what gets in the way of your well-being? And they told us things, so many things. Things like the dogs that roam around without a leash and scare our children and our older people. The young people who drink in the park reserve and cause trouble. The road design. The family arguments from next door, and not having enough food to provide for my children three meals a day.

A whole lot of individual issues that disrupt the well being of each of the families who together make up the neighborhood ecosystem. This is the chaos to clarity diagram which some of you may have seen before. The scribble pad on the left represents all the things that our communities tell us. They are many, and they are complex. They represent a set of issues that are symptoms of a much bigger problem that cannot be fixed by prescription or a food parcel or by referring onto a government service.

People often use this diagram to talk about design and working in complex social systems. Unfortunately you'll understand that very rarely results in that really straight beautiful line, because it's complex. It looks for us a bit more like this. We have used critical analysis systems thinking and design thinking to really understand the primary causes of well-being, and what are the conditions in the system that are holding these problems in place. They are across multiple sectors and across our whole society.

When we look at a problem just from one person's point of view, we miss the understanding of the wider context, and the wider well-being, and the wider issues that are impacting on and bothering people and our neighborhood. And we miss what's happening for a whole community and a whole population group. So we think about where well being intersects with inequity and results in our families being forgotten, unheard, apathetic and powerless by the systems they interact with. That's a big part of what they told us bothers them.

So in response we look at this in two ways. One, we think about and work with local leaders to think what can we do now to relieve the stress and anxiety, the toxic stress upon our families. And then we look at what we can do in the system. OK. So when we went-- first went in and spent time with our neighborhood, they told us that about this park reserve which is not even in the picture. It's all right. There were three pictures yesterday.

So there is a park in the neighborhood, and it's a large green space. But really underutilized, and we wondered why. And when our families told us that they had been four suicides in that park, in their little four streets, you can imagine what we felt. So we knew that there was-- what we were hearing was a feeling of hopelessness and a feeling of inevitability about when there's no choices, that's what our young people do. Sorry.

And so we knew that young people-- but we know our young people, men, they are resilient men, they are strong men, they are clever. So we supported mobilizing young people in that local neighborhood through the Do Good, Feel Good movement. And those young people told us, along with some of their parents, that they want to start first by replanting some of the harakeke that had become unwell in the local park. And the young people lead a wairua centered approach to connect back to the land, and to begin a process of healing.

The young people said we want some activity in our park, and our team supported local agencies to get a container of sports equipment in the park that the young people and their families can use for their own activations. The young people said, we don't use our alley ways because we don't feel safe. Especially the one that goes to the alcohol store. But we want to do something about it. They started a 10 week challenge with a monitor the alleyway, cleared all the rubbish. They cleared feces, they cleared mattresses, they cleared car radiators from their local alleyway. And the work that they did, because they joined them up to a global movement of young change makers actually inspired young people in South America to do so-- to follow suit.

Thank you, sister. OK. The neighborhood has become an important part of reclaiming-- of our residents reclaiming urban spaces for them and their families. This isn't just about people walking through alleyways or running sports in the park reserve. This is about building these young people's mental resilience, restoring hope, and equipping them with a set of leadership skills they can sustain in their own community led movements. It's about giving these young people a connection to place, and a sense of belonging. And that's what well-being looks like to them.

The second part, as I said earlier, is about systems change. Sorry, I am totally out of sync. But that's all right. OK. So, you know what was the most annoying thing and the thing that bothered our neighborhoods the most? Was the road design. And sadly, especially for my poor minister, it was actually with good intentions of supporting our families to walk and ride more. But the challenge was when old school consultation, where our communities have to engage on agency terms happens, our families don't come to the party. Their voice is not heard. And so when consultation is not fit for purpose, we get investment that doesn't work for our communities.

But we are up for change, and we're working with our minister. I want to really acknowledge our minister. I tell you, I've sat in rooms with her where she has challenged agencies to think differently and to deliver a transformational change and equitable investment for South Auckland for active transport in two years. Thank you minister. We honor you, we acknowledge you, we thank you.

OK, so. We work with system stakeholders, and we've been on a three year journey because the number of people who've told me over the last day or so that community engagement is the thing they find the hardest, we need to up our game. We need to up our game. Come and see us and others who can support you to learn to do differently if you're up for it.

Also, there's really something about-- we're very blessed to be able to mobilize our community really quickly. So when we're challenged-- we went to a meeting at three years ago now. Transport agencies we're talking about active investment for transport investment for South-- for the Auckland region. A 10 year plan, as some of you may know. When we asked how much for South Auckland, they said pretty much not-- and it's pretty low on the list.

Now this was completely at odds with what our communities were telling her-- as we have walking some Samoan community groups, and we have people who are out there doing the do. So but when we questioned agencies as to why they had low priority for South Auckland, they said that there was no demonstrated demand. So we mobilized our community through the hashtag willcanridesouthsidecampaign. 200,000 engagements, 60,000 people reached and insights about why our families do and why they don't walk, ride, cycle and scooter in South Auckland.

We need to understand the wider social determinants of why our families-- the limited choice that is placed on our families that drive them to the behaviors that result in poor social and health outcomes. The good news is that while it has been low and slow to move-- the system is slow to move. The minister will be aware that we are now working with those agencies on an $80 million package of sorry $80 million package of investment for South Auckland active transport, and what we are driving in a true partnership approach with the communities. So that what we have seen in the past does not get delivered again.

We use Peter Senge's "The Water of Systems Change" represented as a watermelon slice, in this instance here. We got to get to those mental modes that the underlying conditions that hold the system in place, when we think about shifting our health and disability system, if we are not open in our leadership and those of us who spend every day in the system are not open to opening our own mindsets and the ways of doing things to new and different ways, we are never going to get that shift in policies, practices, resource flows that are required.

What about that middle section? Relationships and connections and power dynamics. How open a way to allow communities to lead our change? And that's me. Hallelujah. Thank you.


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