Hague Kevin: Crown Entities Reform Bill — In Committee 
Text is incorporated into the Bound Volume 
Hague Kevin: Crown Entities Reform Bill — In Committee 
[Sitting date: 23 May 2012. Volume:680;Page:2333. Text is incorporated into the Bound Volume.] 
KEVIN HAGUE (Green) 
: 
 It is a pleasure to speak on this part of the Crown Entities Reform Bill. As I indicated in the second reading debate Part 1 is the one part of this bill that the Green Party will vote for and support but for different reasons from those advanced by Mr Auchinvole on behalf of the Government. Mr Auchinvole spoke about the efficiencies of combining back offices and I invite the Committee to reflect on the history of structural change in the health sector and the extent to which that has actually delivered efficiencies in the back office. In fact history tells us that the reverse is generally the case and that the structural changes that we have tended to make in the health sector no doubt for well-meaning reasons have tended to reduce efficiency. They have cost momentum in structures in the sector to our overall cost. So I make the argument to the Committee that that is not a good reason for making this particular change.  
What is a good reason for making the change though is the creation of this new entity because combining the functions of currently separate organisations better reflects the health promotion task that they have. It moves from the fragmentation that we currently have towards the possibility of integrated health promotion action and that is something definitely worth supporting.  
I indicated in the second reading that I congratulated the Government on its bravery in bringing to the House a bill that had the intent of implementing the Ottawa Charter and I invited the Minister of State Services and I invite him again to take a call to indicate that the Government will make that an explicit purpose in the bill because I think the bill would be enhanced by that. It would remove any confusion that might exist.  
I spoke yesterday about some of the origins of the health promotion model and the fact that it is a socio-environmental model of health. It actually says that the health status of populations depends largely on their level of empowerment and control over their life circumstances and the environment that surrounds them not only the physical environment but also the social environment. If we want to improve the health status of populations those are the things we need to tackle.  
The Ottawa Charter sets out a five-piece formula for doing so. It says we need to promote healthy public policy we need to create supportive environments we need to strengthen community action we need to develop personal skills and we need to reorientate health services. If we were to walk into any district health board public health unit around the country we would see a poster on the wall indicating those five action guidelines because they have become ingrained in health promotion practice in New Zealand. The interesting thing about those guidelines is that none of them is specific to the health sector. Sorry the reorientation of health services is of course but those other four action guidelines are more generic reflecting as Iain Lees-Galloway has just been speaking about the fact that many of the factors—probably most of the factors—that influence a person’s health status and a community’s health status lie outside of the health sector. This new agency the Health Promotion Agency will succeed only if the Government’s intention that it implement the Ottawa Charter is reflected in its power to influence policy outside of the health sector itself. That will be a crucial element in the success of the organisation.  
The second point I want to make about that is that none of those action guidelines is specific to a particular illness or a particular cause of ill health. Indeed one of the accepted parts of our understanding of health promotion is that if we take that formula if we empower communities and create supportive environments around them the consequence of that will be the improvement of the health status of that community not only in a particular health indicator or disease state but across the board. What that says is that when we go about improving the health status of a community we will improve not just one particular thing.  
I used to work as many in the House will know for the New Zealand AIDS Foundation. The formula that we eventually found to be successful was the health promotion formula. Although our concern was improving HIV infection rates amongst gay and bisexual men the health promotion formula of improving the empowerment of that community and improving the social legal and physical environment that surrounded that community actually produces health gain in all indicators not only that one indicator of HIV status. That is why it is such an advance to bring together agencies that are currently working apart from each other in a fragmented way on particular health issues or disease state issues into a single agency. What that agency will now be able to do is to concentrate and focus on the factors that are leading to disease and poor health status across all indicators not just single indicators.  
I certainly encourage the new agency to work in that way—to take the opportunity that is provided for it and to integrate health promotion practice. It is going to be critical to success and for it to be able to do that it is also going to need Government support to work in that integrated way. It will not be able to succeed to the extent that is possible if it has a Government that is focused not so much on the health of communities but on preventing a particular disease. So that understanding is going to be crucial not only to the agency itself but to the Government masters of that agency. I invite the Minister to take a call to express his Government’s commitment around that crucial element.  
I think it is also important to say and this is another particular advantage of this approach that in addition to improving health status across all of those indicators a health promotion approach such as the Ottawa Charter sets out and which this new agency will be empowered to implement will also produce gains in other sectors as well. The very same factors that drive poor health status and so see disease clustered in particular communities across our country those very same factors of disempowerment marginalisation and poor physical and social environments around those communities also drive poor educational outcomes. They also drive poor outcomes across any sector we care to name. Implementing the Ottawa Charter approach will produce not only great health outcomes but better educational social welfare justice and every other sector outcomes. That is something that we need to celebrate.  
The Green Party will be voting to support this bill. We believe that the bill would be strengthened if the Government were to add to it a specific commitment to the Ottawa Charter rather than having the community and the agency itself relying on the expressions of support in this debate for its mandate on those grounds. We look forward to a Government that gives the agency sufficient rein and licence to be able to do that work properly. We expect that that agency not only will be able to influence outcomes in the health sector and right across the sectors that are managed by the Government but also will gradually take on the function of funding health promotion work that is currently undertaken by the ministry. That is yet another way that health promotion practice in this country can become better integrated and that is precisely the outcome that we seek.