Pae ora – healthy futures

Pae ora is the Government’s vision for Māori health. It provides a platform for Māori to live with good health and wellbeing in an environment that supports a good quality of life.

Pae ora encourages everyone in the health and disability sector to work collaboratively, to think beyond narrow definitions of health, and to provide high-quality and effective services.

Pae ora is a holistic concept and includes 3 interconnected elements:

  • mauri ora – healthy individuals
  • whānau ora – healthy families
  • wai ora – healthy environments.

All 3 elements of pae ora are interconnected and mutually reinforcing, and further strengthen the strategic direction for Māori health for the future.

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Sir Mason Durie at the launch of He Korowai Oranga – Māori Health Strategy


[Sir Mason during speaking infront of a large audience within the Grand Hall at Parliament]

Ōtira, tēnā koe, tēnā korua rā, i whakatau mai i a tātou, i karanga mai ki a mātou i roto i tēnei piringa whare o te wā.  Ngā reo, ngā karangatanga maha tēnā tātou katoa.  Ko Te Manatu Hauora, tēnā koutou, nā koutou te reo pōwhiri, te reo karanga, ā, kua tae mai tātou.

Ōtira te minita tēnā hoki koe, nāu i tautoko mai tēnei kaupapa ātaahua o te hauora.

So thank you for the opportunity to be here at what is a historic launch of the revised version of He Korowai Oranga. It’s an important day for Māori Health. It’s an important day for the nation. But probably most important, it’s for our future – and that’s embodied in the notion of Pae Ora – a health horizon.

It doesn’t start today. This has had a long genesis over a number of years. We’ve heard today that over twelve years ago He Korowai Oranga was launched. Twenty years ago the Health Reforms took place and that enabled some great things to happen for Māori Health. Thirty years ago this year, the hui Whaka Oranga and the hui Taumata were held. They both set completely new directions for Māori development and this is part of it. But I want to talk about two things that happened fifty years ago.

Those of you that are my age will know that it’s much easier to think about things that happened fifty years ago than five years ago. Fifty years ago there were two events that occurred in New Zealand. One took place at the Tokanui Hospital, just out of Te Awamutu, and one took place at Palmerston North Hospital.

You’ll all know about the one at Tokanui Hospital and none of you except me will know about the one at Palmerston North Hospital.

The Tokanui event saw the appointment of Dr Henry Bennett as the superintendent of Tokanui fifty years ago this year. Tokanui was a huge hospital – some 1200 patients – and Dr Bennett was the first Māori psychiatrist, and this appointment was a hugelysignificant one for Māori and, as it happened, for the hospital.

He came as you know from a very distinguished family and in his time at Tokanui he supported a group of Māori staff members – largely a group of Māori nurses – to form themselves into a small roopu – Te Roopu Hauora Tokanui, and they had ideas about building something that was rather different for Māori patients. And out of that came Whaiora. Whaiora was the first hospital unit that focused on kaupapa Māori health. So it was a pioneering development and it happened in Dr Bennett’s time and with Dr Bennett’s support. I mention this because that was an important start and here we are fifty years later continuing that same theme.

The other event that happened fifty years ago in 1964 occurred in Palmerston North Hospital when a 14 year old Māori girl was admitted to hospital. A week prior to her admission she’d had some behavioural changes – she was difficult at school. The school were concerned about her behaviour. She refused to go to school. Five days before admission she developed headaches and seemed confused. Three days later she was drowsy. She couldn’t walk properly. Two days before admission she began to have hallucinations. Her speech was garbled. And one day before admission she had a seizure and was febrile and then was admitted to the hospital.

Three days before she was admitted the General Practitioner thought she might have a psychiatric disorder and was urging her family to commit her to Porirua Hospital.

While she was in hospital she had a visitor who was with her every day she was in hospital. That visitor was her koro, her grandfather. And he came in quietly. He was a shearing contractor so he would get up early in the morning, organise his gang for the day, then come to the hospital to sit with his moko.

He spent most of the time at her bedside. Every day he brought her flowers and some greenery. He just sat very quietly and in those days it was unusual to have a visitor at your bed all the time – you had to come at visiting hours.

The Sister on the ward, Sister Kirnahan, was Irish so she usually didn’t tolerate anyone breaking the law but this man was very unobtrusive and quiet and he was allowed to sit by her.

He didn’t make many requests, he just sat with her.

There was a House Surgeon at the ward looking after this girl. He was a Māori doctor. He had just graduated the year before, so this was his first medical job. He was very knowledgeable and very keen but he had no idea what to do. When I mention that you will know that the House Surgeon was me!

And over time the House Surgeon and Koro began to discuss the case and their views on it. This was a conversation that happened between the two:

After sometime the House Surgeon said, ‘Koro, what do you think has caused the illness?’

‘My moko was the victim of mākutu.’

The House Surgeon struggled a little, ‘What do you mean?’

And Koro explained, his daughter, who was the mother of the child, went to Australia with another man and her husband’s family took their revenge.

And the Hosue Surgeon – remember he’d just graduated – said, ‘That sounds a little too hard to believe.  An illness such as this does not develop because of an unseen ‘curse’ or mysterious  force.’

So the Koro said, ‘Well  Doctor, what do you think caused the illness?’

And the House Surgeon said, ‘It was a virus’

And Koro said, ‘A virus! What did it look like?’

And the House Surgeon said, ‘Well I never actually saw it.’

‘No? But did you touch it, or smell it, or taste it?’

‘No.’

‘Doctor I admire your faith in unseen things and your belief in the power of invisible forces.’

And the House Surgeon was speechless.

There was a third conversation with Koro.

He said, ‘Doctor, is it OK to leave these flowers and these leaves here all night?’

And the House Surgeon said, ‘The nurses move them into the corridor at night’

‘But still close to the room?’

‘Yes; why? Is it important?’

And the Koro said, ‘Doctor these leaves come from our place.” They were kawakawa leaves, and karamu leaves and kowhai?’

And the House Surgeon said, ‘Will they help her?’

And Koro replied, ‘Doctor they are part of her.’

And once again the House Surgeon was speechless.

And then there was a fourth conversation. The girl did remarkably well, despite all odds. There was a real concern whether she would actually survivie, but she did – and made a good recovery.

‘Koro your granddaughter has made a great recovery

And Koro said, ‘I knew she would.’

Did you?’

‘Yes.  Her mother called.  They have fixed things up in the whānau and the makutu has been lifted. But how is that virus thing Doc?’

And the House Surgeon said, ‘Well, that’s been lifted too.’

And then there was a final conversation.

And the House Surgeon said, ‘Well you can take the moko home now.  Call me if there are any problems.’

And Koro said, ‘Doctor, I have learned a lot from you.’

And the House Surgeon was speechless, but what he should have said – and I didn’t realise this until twenty years later – was, ‘Koro I have learned much more from you.’ So I just said, ‘That’s ok.’

And the Koro said, ‘Thank you Doctor.  Kia ora’

And the House Surgeon said, ‘Kia ora Koro.’

The full impact of this did take twenty years to mature but by the time of the Hui Whaka Oranga in 1984, this thinking was not too different from what we began to accept as important. The importance of it is that matauranga Māori underpins health. And that’s what this koro had been talking about. He’d been talking about Māori knowledge and the way Māori knowledge can impact on health and recovery. And that’s what underpins these three new elements in the Pae Ora, He Korowai Oranga framework: Mauri Ora, Whānau Ora, and Wai Ora.

Mauri Ora is much more about getting over an illness. And the mauri of a person is quite different from brain function and heart function. It’s got a much wider meaning and there’s much greater energy attached to it. It’s sometimes called a lifeforce – the mauri of a person is different from the health of a person and it’s different from not having an illness. The challenge with Mauri Ora is actually to be able to shift the mauri of a person from a mauri that is languishing to one that is flourishing. That is a big challenge and that is a little bit of a different prescription than curing an illness.

So what it means is that everytime a health problem requires some intervention, everytime there is a health problem, treating that problem should also be associated with fostering health lifestyles: working towards a flourishing mauri, increasing health literacy – knowledge and power, strengthening identity, encouraging self management and restoring dignity. And they are the things that will lead to a strong mauri. Getting over the illness is important; it is not an end point.

So a good outcome then reflects gains in health status but importantly a strengthened mauri as well.

The second part of this three part edition: Whānau Ora, which the Minister has enlarged on.

Whānau have the potential to impact on health; they can do it positively or negatively.

Remember the episode with Koro? In the first approach, the whānau had a negative attitude towards it, but it can work both ways.

What health interventions have to do, they often decide – and this is a balance for health professionals – when do you focus on the whānau and when do you focus on the individual? And what is the balance between those?

So building whānau capability as part of an intervention, so that all members can enjoy good health, is one of the three aims of Pae Ora and it’s got huge implications for health policy and health services.

And the third aspect, Wai Ora, and you remember Koro brought in the leaves from the trees and he was saying that they are part of my moko – he was saying that you can’t separate the environment from health.

So the environment then is a hugely important part of health – and whether we’re talking about the natural environment, and that’s what Koro was talking about, or whether we’re talking about man-made environments: the number of alcohol outlets per head of population, the number of fast food outlets per head of population, the traffic density on a road that goes past a school or past a house: that’s the modern environments we have to live in. So whether we’re talking about natural environments or man-made environments we should remember that they are hugely important determinants of good health and a flourishing mauri.

What I really want to finish by saying is that the challenges for the health sector in this new strategy are huge. The challenges are beyond the health sector by itself. So if we are talking about Mauri Ora, or whānau Ora, or Wai Ora, the health Sector can play a hugely important part but cannot by itself bring about the changes that are necessary.

What I think is important is that the Health Sector itself has recognised this, and I believe the Health Sector should take the leadership in taking an inter-sectorial approach that will enable great things to happen.

We have some models in place. The Whānau Ora approach is about intersectorial collaboration, and that’s an important guide.

So the Health Sector really has an opportunity to take the leadership of this and some ownership of it. And that is what the strategy is about. What iant is recognising that the Whānau Ora approach, which requires collaboration at two ends – at the government end and at the community end; and the colective impact programmes that are beginning to shape up in various communities around New Zealand – one in Napier, one in Whangarei – where communities come together and bring all of the agencies and the services together so they can have a collaborative approach so that the impact is much greater. And then the other programme that is gaining momentum in various parts of the world: the HIAP programme: Health In All Policies – recognising that every policy has a health impliocation and making that explicit so that we can genuinely move towards this notion of Pae Ora with its components of Mauri Ora – strong flourishing mauri; Whānau Ora – strong healthy, independent, empowered whānau; and Wai Ora – an environment that is compatible with good health and with a strong mauri.

Ōtira, i roto i ēnei whakaaro, tēnā koutou kua tae mai ki tēnei rā whakanui, rā whakahirahira, mo to tātou nei mokopuna. Kia ora.

Pae Ora: Māori health horizons – 2009 lecture (PDF, 273 KB)
In this lecture Sir Mason Durie considered the future developments of Māori health in a rapidly changing world where indigenous aspirations and strengthened Māori capability interact with technological innovation, demographic transitions and capability development. He concludes that Māori health will be a function of Māori determination and know-how and sees a growing role for whānau in increasing health. 

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