SpeechDr ELIZABETH KEREKERE (Green): Kia ora koutou. I rise on behalf of the Greens to support the Pae Ora (Healthy Futures) Bill. Tēnā koe e te Minita mō tēnei mahi taumaha.[I acknowledge you the Minister for this demanding work.]And thank you to my colleagues on the Pae Ora Legislation Committee particularly our very able chair Deborah Russell and deputy chair Tāmati Coffey. I join other speakers in acknowledging all of those people who made submissions. It was worth the effort—dozens and dozens of changes were made to this legislation because of it. Special thanks to our Te Mātāwaka staff and the Rainbow Greens who supported many submitters to take part in this democratic part of our society. I note that the Greens did campaign on an independent Māori health authority and until it's actually established it remains one of our Māori priorities.Based on Te Whare Tapawhā the Māori health model created by Tā Mason Durie the Māori Health Strategy He Korowai Oranga was launched in 2002. It set a new direction an overarching framework that would guide the Government and the health and disability sector to achieve the best health outcomes for Māori. It was updated in 2014 to the Pae Ora (Healthy Futures) Strategy. That strategy has had no impact on the grim statistics for Māori because it did not address the institutional racism built into the health system that accounts for the horrifying health statistics for Māori and Pasifika people.This legislation aims to address this by acknowledging Māori leadership in the form of the Māori Health Authority the creation of iwi partnership boards and the Hauora Māori Advisory Committee. It acknowledges mātauranga Māori and it makes systemic the need to engage with experts in the field especially our Māori Pasifika and community health providers who turned the tide on COVID-19 through their vaccination efforts and personal support for their people.This new structure does not disrespect Māori doctors from the past or the current day as my learned colleague Shane Reti has suggested. I think it just acknowledges that a handful of them has never been enough to go up against the force of the settler colonialism that has formed the health system we're trying to change today. Also anything that has been designed by Tā Mason Durie we know is based soundly in kaupapa Māori. But most importantly instead of the usual goal of reducing health disparities Pae Ora firmly states that it will eliminate them. Now that's a big ask. It was always going to be difficult complicated and messy. However transformational change can only happen with a vision and the Greens certainly envisage a health system that is based on Te Tiriti o Waitangi but it ensures that no matter the ethnicity or cultural background of a person no matter their age or address no matter their disability no matter their sexuality gender or sex characteristics they have access to the healthcare they need when they need it and where they need it.During the many times I've spoken in this House on COVID-19 orders and bills I expressed concerns that people who died of COVID seemed to be more important than people who died for any other reason. There's still daily reporting in the national news but only for COVID people not for cancer not for rare diseases not for family violence and not for suicide. In the year ended December 2020 there were 32613 deaths in this country an average of over 89 people every single day. In 2021 34932 more an average of 96 people every day. A few made the news but most went unremarked mourned by their family and friends but not the nation. Some of those deaths were because the treatment they needed was not available in this country or not funded by Pharmac. Some were because their treatment was delayed and appointments were missed to make way for COVID because of the chronic shortage of nurses and specialist healthcare professionals. Some were because they lived rurally or had disabilities that meant that healthcare was not accessible for them. We can do better and we absolutely should because not dying is a very low bar in developed countries such as ours. Many people would just like to live without pain with access to the diagnosis healthcare and medication they need.We support the locality plans because they enable local voices that operate within communities in a way that works for them. I totally agree with my colleagues who've said people in Wellington should not be telling anybody else in the country what to do. However for me I've always had a concern that it's very easy to just duplicate the way that things have operated because we still have the same hospitals in the same places. We are still going to have mostly the same staff offering pretty similar services to what we have in the regions and locally.So for me the national strategies then have to be key. We support the production of the hauora Māori the Pacific health and disability outreach strategies that were already in the original legislation. We shout out to the Gender Justice Collective who advocated for years and have successfully achieved a women's strategy being included with those. And as my colleague Deborah Russell has said and my colleague Matt Doocey there were many many other strategies that several of us advocated for that came out of the submissions. So I reiterate: the mental health rural rare diseases rainbow medicines and there were many more. My concern and what is not in the legislation at all is how do those connect together? It doesn't exist yet because we cannot get rid of the postcode lottery until those things are woven together and until that happens we can't make any of this vision come true.To conclude I want to just acknowledge that there's two terms that are appearing in New Zealand legislation for the first time in the Pae Ora bill. The first is lived experience". It puts into law and acknowledges that people who have experience are actually critical for officials to listen to when decisions are being made. This is a core part of how our health system should be working. They should not be discounted because they don't have a degree. They certainly have a degree in what's wrong with them or what's going on with their own health and it's such a huge resource in the generosity of all those people that have to through their own experience educate everybody around them. The fact that it's baked into this I'm very very very very pleased with.The second—and although I've failed so far I'm going to keep trying to get a rainbow strategy added to the list. The second term that's been added is "takatāpui". I'm particularly proud of that because it's saying again that there are particular experiences that people have in different communities in this country that are not experienced by anyone else and so they have particular expertise and particular knowledge that is essential for the decisions that are being made about them. In the Greens we call that appropriate decision-making both of those terms.We have high hopes for this restructure. We are also realising that there is a lot more work to do. I would like to see much greater clarity on how those locality plans work with the national strategies and how many aspects of this will roll out to actually get to that vision that we're talking about. However thank you again for all the work that has gone into this and all of the officials who make us look good on these committees. We commend this bill to the House. Kia ora."