Katene Rahui: Estimates Debate — In Committee 
Katene Rahui: Estimates Debate — In Committee 
[Volume:656;Page:5522] 
RAHUI KATENE (Maori Party—Te Tai Tonga) 
: 
 The great poet and philosopher Virgil expressed one of those universal truths that reminds us that health is a basic human right. He said “The greatest wealth is health”. For the Maori Party that wealth will be demonstrated in our people being healthy and living longer. It will be seen in the evidence that whanau Maori have access to quality health-care within a culturally competent health sector. Progress in health will also be evident in the strength of relationships between health professionals and whanau. It is about realising whanau health needs and about enabling whanau to take control of their own health and well-being. 
We come therefore to the estimates for Vote Health with a focus on whanau ora one of the seven priority areas for action identified by this Government. That in itself is a great start. We want to commend the Government on its approach to Influenza AH1N1. The health sector responded swiftly to the threat of swine flu and that was due in many ways to the fact that as a nation we were already well down the track about how to respond to a pandemic as a result of the strategy developed for avian influenza. We want to make particular note on the way in which Maori health providers have responded to the challenge. I am told that Maori providers have accessed Maori resources at a higher rate than general resources which indicates to me that those providers are out there doing the mahi and getting information to our whanau. We endorse the positive comments of the Health Committee on this area and would add only that it will be a great day when we see this same level of commitment and responsibility taken for other areas approaching pandemic proportions such as obesity diabetes management TB or chlamydia. 
The report then drills down into health sector priorities. I want to make it quite clear from the outset that we are concerned at the possible insecurity around future funding. The indication from the Minister of Health that funding may not increase in out-years is concerning as it could cause a significant reduction in outcomes right across the health sector. Although we support the injection of new funds into areas such as hospice care maternity care and Healthy Homes we want to encourage a whole-system approach in which primary health care remains of utmost importance. 
It is our firm belief that high-quality comprehensive primary care makes a significant contribution to whanau ora. We know that improving the physical well-being of an individual will be less effective if it takes place in isolation from his or her whanau. Social cultural economic and spiritual wellness must have equal importance if whanau ora is the goal. Every family must be given the right support to achieve their full potential and to restore their confidence and competence to take back responsibility for achieving whanau ora. Within this we would expect that an integrated approach across the health sector will be the most effective in creating enduring outcomes. 
I want to refer to one of the district health boards within my electorate Capital and Coast District Health Board to demonstrate the local evidence of the importance of an integrated strategy to improve health outcomes. The June 2009 report of  
Primary Health Care in C&C DHB 
 reports that this district health board has some of the lowest avoidable admission rates in the country. The emergency department attendance trends for the primary health organisation - enrolled population including those in most deprived areas have continued to decline since 2005. What is obvious throughout the report is that improved access to primary health care leads directly to lower avoidable hospitalisation reduced emergency department use and improved health outcomes. It does not get much clearer than that. Primary health care works. 
When I look at the select committee report I have to say we share very keenly the concerns around the proposed fee increase and the likely consequence that cost will become a barrier to access. The best information we have comes from the  
RAND Health Insurance Experiment 
. The RAND study was a randomised controlled trial that compared health sector utilisation amongst different groups. It revealed some key findings—namely that fees matter especially at the low end. The study demonstrated that the majority of patients’ responses to user charges occur with small changes. For instance when free health-care was introduced in Britain access increased between 10 and 16 percent. A similar move in Montreal led to a 21.8 percent increase in utilisation. In effect the number of doctor visits increased just over 50 percent more when care was subsidised than for those who paid for all their care. By far the most important finding was that children and low-income earners were more responsive to price changes than adults and higher-income earners. The reduction of the cost barrier has a marked difference in improving access for Maori Pasifika and high-deprivation populations and will remain a key policy principle. Fees matter and what we know already is that even small increases in fees have a disproportionate impact in reducing access for those who need it most. 
Another key area of concern for the Maori Party is around the changes to the Healthy Eating - Healthy Action programme. I want to challenge the misconception that the Fruit in Schools programmes is all about apples and pears. Of course the fruit itself is a vital component of change but the fundamental difference is the energy required to create an integrated healthy school environment. All the fruit in the world will rot if there is not due attention given to health promotion to teaching knowledge and skills to support attitudinal change to improving the social environment of the school and to developing meaningful links throughout the community. A health-promoting school sees the school as part of the wider community. It reaches out to promote the view that being healthy and being able to learn are closely linked. Interventions to promote healthy eating and physical activity to prevent injury and to promote mental health are effective when adopted in the context of a whole-school approach. 
I am aware of some amazing things being done by schools in my electorate to make the difference. A typical example is Te Wharekura o Arowhenua which is part of the Fruit in Schools programme and is a health-promoting school. They run an annual auahi kore iwi challenge which is all about iwi getting together on Waitangi Day celebrating healthy eating physical activity and being Maori. Port Chalmers School has created an edible garden to promote healthy eating while also drawing in the community to focus on their environment. So we were disappointed at the decision to focus on sport and physical activity at the expense of healthy eating and health promotion. 
Finally I want to draw attention to the very positive progress which is described in the select committee report in the work that my colleague Tariana Turia is advancing in whanau ora. Whanau ora is best described as supporting a whanau-centred approach that focuses firmly on the aspirations and priorities as determined by that whanau. It is about being strengths-based enabling whanau to take the lead in managing their own futures. 
In many ways what we are seeking to achieve in whanau ora responds to some of the challenges I have laid out about the decisions made around the allocation of funding priorities in the health sector. A recurrent theme in the discussion of the most effective health investment is the need to sustain support for prevention and public health. Earlier this year Dr Margaret Chan the Director-General of the World Health Organization warned that we must protect health funding during the period of recession realising that in the past social sectors have often been robbed during times of economic downturn. Primary health care must remain a priority if we are serious about health outcomes. We need to protect life and well-being to maintain safety-net programmes to reach the most needy to boost productivity and to remain committed to the view that people are the ultimate target of economic recovery. It makes plain good sense—“The greatest wealth is health”.