Kerekere Elizabeth; Dean JacquiDr ELIZABETH KEREKERE (Green): Kia ora. Thank you for this opportunity to support the Pae Ora (Healthy Futures) Bill. The restructure of our health system is a huge step forward making the wellbeing of all New Zealanders a reality. It was 1985 when the Whare Tapa Whā model of Māori health was first published by Tā Mason Durie. It was a simple yet profound framework four sides of a meeting house each representing one aspect of health: taha wairua—our spirituality our connectedness with all things; our hinengaro—our psychological our mental health; our taha tinana—our physical selves our bodily integrity; and taha whānau—our family health because we are never just individuals. It was a holistic and intergenerational view of health. And of course it's not the only Māori health model that's been developed. A shout-out to the late Dr Rangimārie Turuki Rose Pere for the Te Wheke model which I discovered as a young person and I used for many many years. Te Whare Tapa Whā though is the most enduring model and the most well-known. Many have adapted it for use—and certainly I have as well in my creation of Te Whare Takatāpui" model which is a place of wellbeing for takatāpui people of diverse genders sexualities and sex characteristics.So Te Whare Tapa Whā was an integral part of He Korowai Oranga the Māori Health Strategy when that was first launched in November 2002. It set a new direction back then new and shiny an overarching framework to guide the Government and the health and disability sector on creating better health outcomes for Māori. The initial aim was Whānau Ora—that Māori families would be supported to achieve their maximum health and wellbeing. It was updated in 2014 with "Pae ora – healthy futures". And as they refreshed that strategy so with the foundation of "Whānau ora – healthy families" they added "Mauri ora – healthy individuals" and "Wai ora – healthy environments". And so for us working in the health sector and working in our different ways in the community around health and wellbeing it felt like we had such high hopes but we had so many crushing disappointments. Many of the people in this House have got health backgrounds but you don't need that to know about the huge disparities in Māori health.During the annual review of the DHBs when I was a baby member of the Health Committee and we were inundated with reports from around the country I was horrified to see that in every health condition in every DHB Māori were at the bottom. It was even worse to see that when we were looking at the budgets those DHBs were spending and despite most of them having dedicated strategies in all manner of things going on with a Māori name per health condition per person more money was spent on non-Māori than Māori. And this is the foundation of the struggle to get the last lot of our people vaccinated: that absolute core distrust of a health system that does not look after our people.However—however—this new health system we very much support it. We support its aim to give effect to Te Tiriti o Waitangi the most important evidence of which is the establishment of the Māori Health Authority. It was one of our priorities—Te Mātāwaka our Māori caucus of the Greens—we announced at Waitangi this year because in our consultations with tangata whenua they absolutely confirmed the need for this change but also to make sure that that authority was independent and adequately resourced. It was a stroke of genius to appoint Tā Mason Durie to come back and lead that development of that authority as one of the most trusted Māori leaders we have ever had. But it must be really strange for him to create something 36 years ago—actually created 37 probably before—coming back in the hope that that vision might actually be closer at hand.We note that the Māori Health Authority will commission kaupapa Māori services. So this a big deal alone. As one of many many Māori who have sat on advisory boards in a range of different sectors we know that usually there is no power and there is no money; so this here is a great start. We know that the Māori Health Authority will also co-commission with Health New Zealand and this is important because most Māori don't go to Māori providers. Partly that's because there are so few of them and they are not all over the country but sometimes they choose for different reasons to support their local clinic. And so it really matters how the bulk of the health system is operating and what say the new Māori Health Authority will have over it. Being able to monitor the performance of a system for Māori is one thing but being able to have actual power when you point out that something is wrong—that it actually gets fixed.We note that the new agency will lead systems operations planning commissioning. Together with the Māori Health Authority of course they're going to develop all manner of strategies and plans which is how it should be. We want to make sure that those lead to direct work and that we're not still in a couple of years writing plans and we haven't actually made a change in people's lives. We note that Health New Zealand will also establish localities to plan and commission primary community health services and engage with communities at the appropriate level. Now you could say that locality seems to be very geographically termed. I have suggested to the Minister of Health and the Director-General of Health that we could have a rainbow locality—that even though it would be nationally based it would enable a consistent approach to gender-affirming healthcare for example and to ensure that the things like the atrocious practice of gender normalising surgery on intersex infants never happens in this country again.But we do support also the progressive expansion of the roles and functions of what is now the public health agency to enable it to advise plan and fund evidence-based health promotion services. We support those kinds of services that create supportive physical and social environments and empower communities to identify their own needs and be part of the solution. For this to be a transformational and visionary health system it cannot be that you're just telling people what to do; it is not going to work. People need to be empowered to take control of their own lives and their own bodies and how they look after themselves and given support when they need it.Nicola Willis: Come join the centre right!Dr ELIZABETH KEREKERE: Ha ha! So we think that inside that though there must be a major focus on prevention. We can't just always be dealing with people who are sick and need help right now—we must look after them but let's create a society that emphasises our wellbeing to such a degree that we can rely less and less on a publicly funded health system.Now local democracy is a core value for the Green Party. Our policy is that healthcare professionals service users our communities should be involved in planning and decision making on the issues that affect them. So the proposed replacement of DHB elections with appointed boards—we would still like to learn more about how that will work but we prioritise those population groups with the greatest health needs of course: Māori elderly women children Pasifika refugee and asylum seekers rainbow communities of course people with low economic status people with disabilities and rare disorders. All of this is part of ensuring better health outcomes for all of us. So community engagement particularly as those localities are established and those locality plans are developed the health and disability strategies are created and the code of consumer participation is developed—we want to make sure that those consumer voices are heard.Finally I'll conclude where I started with a vision of health that is holistic and intergenerational because the health sector cannot do it by itself. We note the stated objective of Health New Zealand: to encourage and maintain community participation in health improvement and service planning; to promote health and prevent reduce and delay ill health including by collaborating with other social sector agencies to address the determinants of health. We hope this is indicative of a broader collaborative approach. Whilst this needs to be defined and clarified it's very clear that our people cannot have good health unless they have a warm dry home a safe place to sleep and enough money to live on.Nā reira kua eke te wā kia mārama me whakamana anō hoki te Kāwanatanga ki te tūāpapa o ngā tikanga Māori te tino rangatira me te manaakitanga i raro i te mana o Te Tiriti o Waitangi[Therefore we have come to the time that the Government should be clear and give authority to foundational Māori protocols; self-management and care under the authority of the Treaty of Waitangi.]Accordingly we commend this bill to the House. Kia ora.ASSISTANT SPEAKER (Hon Jacqui Dean): Members the time has come for me to leave the Chair for the dinner break. The House will resume at 7 o'clock this evening.Sitting suspended from 5.57 p.m. to 7 p.m."