Te H ā o Te Tangata Breathing Easy in Aotearoa Mason Durie Massey University

1. Māori understandings of health and sickness place importance on context 2. The health context is shaped by four Pou Ora, key markers that underly the health-sickness continuum:  Hauora - Compatible environments  Toi Ora – Knowledge transfers  Whānau Ora Empowering relationships  Mauri Ora - Enhanced potential 3. Breathing will be easier when all four Pou are aligned and the human mauri is flourishing.

Rangi and Papa Locked into an embrace that excluded light and life

Rangi and Papa Forced apart by the offspring Forests & birds The elements The seas and waters, fish Crops Ferns Humankind Separation enabled Light and Life

Environmental relationships, the common bonds

 The Whanaunga principle ‘While each species is unique, there is nonetheless a relationship between all species within the natural world. They are linked by time, inter-dependency and common needs.’  The Ahiowhio principle: ‘meaning comes from an outward (centrifugal) flow of energy; life is best understood by the relationships that exist between people and their environments.’

Building relationships An Outward flow of energy People, land, flora, fauna, water, air, cosmos Centrifugal direction Relationships and context are a basis for health Smaller entities make sense when viewed in relationship to larger entities

 ‘Health’ is widely used as a synonym for sickness  ‘Hauora’ has been a common translation for ‘Health’ BUT  Hau = wind, air, human breath, the security of home (hau kainga), fame, and vitality  Ora = safety, satiation, survival, life

 Hauora positions people within a broad ecological context  environments are drivers of health.  The Hauora focus is on:  associations between people with surroundings  reducing risk from external natural and human threats  identifying new and emerging environments

 A Māori world view of connectedness and inter-dependence provides a framework within which Hauora can be understood and its significance to modern times appreciated  The implication is that health is essentially about ‘living in the world’ Human health cannot be fully understood without taking into account impacts from the wider environment

 Global environments  The natural environment  Urban environments  Metropolitan environments  Marae environments  Home environments  Work environments  On-line environments  Whānau environments  Pastoral environments  Horticultural environments  School environments  Roading environments

Toi = knowledge art human origins birthplace Ora =wellness alive safe recovery Toi Ora Wellbeing associated with  Indigeneity  a sense of home  knowledge and information  Creativity

 Health is enhanced by old knowledge, heritage, and remembered ties to an ancestral home  Health is linked to artistic expression, the use of symbols and metaphor derived from cultural experience, and the transfer of knowledge between generations

 Knowledge that is based on past journeys  Knowledge that recalls longstanding world views  Knowledge that can be used for ‘living well’ in the world  Knowledge as a platform for health and wellbeing

Whānau  Kaupapa whānau – group with a common interest  Whakapapa whānau – group who share a common genealogy  Māori families – two- generational household Ora  safety  life  wellness

 Manaakitanga the capacity to care  Pupuri Taonga capacity for guardianship  Whakamana: capacity to empower whanau  Whakatakato tikanga: capacity for planning  Whakapumau tikanga: capacity to transmit culture, knowledge, between & within generations  Whakawhanaungatanga: capacity for reaching consensus

 Interventions can be aimed at:  changing the external impacts on relationships – an ecological approach (e.g. improving housing)  building wh ā nau capacities (e.g. building manaakitanga: capacity to care)

 Whanau self management  Healthy wh ā nau lifestyles  Full wh ā nau participation in society  Confident wh ā nau participation in te ao M ā ori  Wh ā nau economic security  Wh ā nau cohesion

 focus on the whānau as a whole  builds on whānau strengths and increases whānau capacity  six key operational elements: 1. whānau-centred methodologies shaped by the values, protocols and knowledge contained within te ao Maori 2. Intersectoral contributions 3. a primary focus on best outcomes for whānau, through integrated and comprehensive delivery 4. skilled whanau practitioners 5. expertise in whanau dynamics, relationships, aspirations 6. practices that increase whanau skills, knowledge, financial status, and self management (e.g. Online health records)

HauoraCompatible environments Toi OraKnowledge environments Whānau OraNurturing environments

Mauri = a force for life human integrity human spirit human vitality individual uniqueness Ora = alert responsive lively

 Spiritually robust  Culturally engaged  Emotional vitality  Positive thinking  Energetic  Able to participate in activities, events  Sustainable & rewarding relationships

 Spiritually robust  Culturally engaged  Emotional vitality  Positive thinking  Energetic  Able to participate in activities, events  Sustainable & rewarding relationships Mauri Oho Indicators  Inspired  Inspirational  Optimism  Clear thinking  Outward thinking  Moving easy  Breathing easy  Liked  Likeable

 Spiritually robust  Culturally engaged  Emotional vitality  Positive thinking  Energetic  Able to participate in activities, events  Sustainable & rewarding relationships  Cultural & spiritual alienation  Negative emotions  Knowledge gaps  Listlessness  Slow moving  Laboured btreathing  Negative relationships  Social isolation Mauri Noho Languishing

 Spiritually robust  Culturally engaged  Emotional vitality  Positive thinking  Energetic  Able to participate in activities, events  Sustainable & rewarding relationships  Cultural & spiritual alienation  Negative emotions  Knowledge gaps  Listlessness  slow moving  laboured breathing  Negative relationships  Social isolation Mauri Noho Languishing Wairua Hinengaro Tinana Whānau

Creating environments where: the mauri can flourish and breathing is easy Toi Ora Knowledge transfers Intellectual environments Hauora Compatible environments Natural & man- made environments Whānau Ora Empowering relationships Social environments (home, work, leisure)

Hauora Environs Toi Ora Knowledge Whānau Ora Family Mauri Ora Individuals Factors that prevent poor health, disease, sickness Green fields Organic farming Safe & nurturing environs School environs Occupational Health & safety Access to old knowledge Marae experience Exposure to matauranga Turangawaewae Food –Housing – Income Parenting Whānau inclusion Whānau wealth Whānau cohesion Whānau modelling Education Employment Personal resilience & social skills Self determination Exercise, sport, recreation Risk Factors that can lead to disease, sickness Alcohol Housing Ag.-Hort sprays Traffic density Natural & man made disasters Food standards Alienation from heritage, culture, old knowledge. Detached from a past Discrimination, racism, stigma Family dysfunction, child neglect Poverty Violence Cultural alienation Educational failure Physical inactivity Unemployment Lifestyles – tobacco, drugs, alcohol Work stress

‘Breathing Easy’ Environments Personal Environments Natural & Man-made Environments Whānau OraToi OraHauora Internal ‘inner’ environments Family, work, & social environments Heritage & culture Knowledge environments Natural & man-made environments Mauri Ora Family & Social Environments Heritage & cultural environments

The overall challenge for preventing and managing sickness and disease is to create environments where ‘breathing can be easy’ Stay well Kia Ora The Asthma Foundation New Zealand Respiratory Conference 2013

1. Māori understandings of health and sickness place as much importance on context as on individual experience 2. The health context is shaped by four Pou Ora, key markers that underly the health-sickness continuum:  Hauora - Compatible environments  Toi Ora – Knowledge transfers  Whānau Ora - Empowering relationships  Mauri Ora - Enhanced potential 3. Breathing will be easier when all four Pou are aligned and the human mauri is flourishing.