1. Tiriti o Waitangi Principles and Culture and Health Care (adapted)

2. “Colonisation is the historical process by which Western societies have occupied and exploited other territories and societies” (McLennan, Ryan & Spoonley, 2004:218)

3. Treaty of Waitangi Act 1975 Royal Commission on Social Policy 1988 Identified the following principles as particularly relevant to a discussion on health PARTNERSHIP PARTICIPATION PROTECTION (Mitchelson, E. 2012)

4. Partnership Implies an association of equals Many Iwi (tribes) entered into partnerships with Health Authorities, now District Health Boards - constitutional symbolism whereby the two partners to the Treaty work together to realize mutually acceptable goals

5. Participation Refers to Maori involvement in a particular health activity or sector. e.g. nursing, medical school, clinical psychology, social work Refers to involvement in policy development Active leadership role in defining health needs and then organising health services (Mitchelson, E. 2012)

6. Protection Refers to the State’s policies and programmes to guarantee Maori the same ‘rights and privileges’ as other New Zealanders Includes proactive measures to promote health and prevent illness (Mitchelson, E. 2012)

7. Application in the provision of services Kia Ora Hauora is a national Māori workforce development programme that aims to support whānau and students to enter into a health study pathway He Korowai Oranga: Māori Health Strategy sets the overarching framework to guide the Government and the health and disability sector to achieve the best health outcomes for Māori Whanau Ora

8. What about Maori health today Significant disparities continue to exist between Māori and non- Lower life expectancy than non-Māori Higher rates of psychiatric illnesses Higher rates of all cancers, leading cause of death and illness Increasing rates of suicide, especially among youth Lower educational achievement High rates of imprisonment (50% of prison population) Higher rates of cardiovascular disease yet lower rates of interventions Poor access to services (M Hopkinson, 2013)

9. Considerations for the health care worker …. ? Commitment to principles in the provision of health care Awareness and sensitivity What about Te Reo ?

10. Maori health Model The Māori philosophy towards health is based on a wellness or holistic health model. For many Māori the major deficiency in modern health services is taha wairua (spiritual dimension). The four cornerstones (or sides) of Māori health are whānau (family health), tinana (physical health), hinengaro (mental health) and wairua (spiritual health). Te Whare Tapa Wha Model http://www.health.govt.nz/our-work/populations/maori-health/maori- health-models http://www.health.govt.nz/our-work/populations/maori-health/maori- health-models

11. Te Whare Tapa Whā: Mason Durie http://www.health.govt.nz/our-work/populations/maori-health/maori-health-models http://www.health.govt.nz/our-work/populations/maori-health/maori-health-models

12. In the provision of care..…… DHB Māori Health Plans and Health Needs Assessments DHBs are required to improve the health of Māori and reduce health disparities for Māori compared to other population groups in New Zealand. Māori health providers service distinguished by the kaupapa and the delivery framework which is distinctively Māori (not exclusive to Maori)

13. Maori have…….. Survived more than two hundred years of colonisation Shown remarkable resiliency in the face of extreme adversity and dispossession of land Made significant contributions to the societies and cultures of which they are a part Shown that there are viable alternatives to the dominant Western paradigm that prevails today (Hopkinson, 2013)

14. Links to practice Meeting the needs of Māori Cultural safety Can apply to all people

15. Part 2 Culture and health

16. Culture and Health - Cultural Safety Cultural Safety has its origins in the field of nursing education. [1] The concept originated at a nursing leadership hui in 1989 (Wikipedia, 2014; NCNZ, 2011) [1] cultural safety is met through actions which recognise, respect, and nurture the unique cultural identity of Tangata Whenua, and safely meet their needs, expectations, and rights The right to have one’s culture expressed through practices that do not put peoples cultural values and beliefs at risk (Wepa, 2005) Care that respects and safeguards cultural needs of clients (Scott, 2011 P. 84) - requires that you understand that culture is a major aspect of most peoples lives and that as a carer you are obliged to assist your client in a way that is culturally appropriate for them ( Scott et al, 2011 P.84 ) (NCNZ, 2011)

17. Unsafe cultural practice comprises any action which diminishes, demeans or disempowers the cultural identity and wellbeing of an individual. (Wikipedia, 2013; NCNZ, 2011)

18. Culture and Health Cultural sensitivity and awareness

19. Aotearoa New Zealand A bicultural nation – relates to TOW A multicultural nation – actual population Ethnically diverse – Auckland the most diverse (1:4 Asian, NZ Herald, Mar 4 2014) Auckland City 59.3% European 10.7% Maori 23.9 percent of New Zealand's Māori population usually live in Auckland Region. Stats (2013) 14.6% Pacific Peoples 23.1% Asian (NZ Census, 2013) http://www.stats.govt.nz/Census/2013-census/profile-and-summary- reports/quickstats-about-a- place.aspx?request_value=13170&tabname=Culturaldiversity http://www.stats.govt.nz/Census/2013-census/profile-and-summary- reports/quickstats-about-a- place.aspx?request_value=13170&tabname=Culturaldiversity

20. Culture Shock The feelings of disorientation and stress that people may experience when they enter an unfamiliar cultural setting. There may be feelings of incompetence, fear and loneliness. Everyday life becomes unpredictable

21. Ethnocentrism The tendency to evaluate other cultures in terms of one’s own and to conclude that the other cultures are inferior.

22. Culture and Health In all human societies, beliefs and practices relating to health and illness are a central feature of the culture. The role of culture is influenced by economic and social factors. Cultures are not homogenous, there may be marked differences among members.

23. As HCW we need to be aware of… How individuals in a particular culture perceive health How individuals/people perceive and react to illness and pain The types of health care they turn to Particular Health Practices and beliefs about e.g. wellness; food and nutrition; birth and death;

24. Aware of the variety of people who people turn to The popular sector - includes individual, family, social, and community networks. The folk sector - traditional healers or complementary/alternative therapists The professional sector - any organized professional health group: nurses, doctors, physiotherapists, psychologists. Cultural support groups e.g. DHB Maori and Pacific support groups; Asian support service Language interpreter service

25. Things to consider for those working in health care The role of culture must be seen in its particular context. In understanding health and illness it is important to avoid ‘victim blaming’ Influence of culture may be misinterpreted by health professionals Remember the iceberg model……………….and work with your client to understand their needs/beliefs etc Culture includes, but is not restricted to, age or generation; gender; sexual orientation; occupation and socio-economic status; ethnic origin or migrant experience; religious or spiritual beliefs; and disability (Wikipedia, 2013)

26. Culture and communication Metge wrote about ‘Talking past each other’ What does this mean to you? -Not understanding communication rules -Leads to misunderstanding/misinterpretation -Review Guidelines (Wolgin, Smith & French, 2012) p.87

27. References Burnard, P. Gill P. (2009) Culture, communication and nursing. Pearson: UK. Crisp, J. Taylor, C. (2009) Potter & Perry’s Fundamentals of Nursing. Mosby/Elsevier: Aus Donatelle, R. (2011) Health the basics: Green edition. Pearson: CA. Durie, Mason (1999), ‘Te Pae Mahutonga: a model for Maori health promotion’, Health Promotion Forum of New Zealand Newsletter 49, 2-5 December 1999. Durie, M (1998) Whaiora. Oxford univ Press: NZ. Galanti, G. (2008) Caring for Patients from Different Cultures. (4 th ed). Univ of Pensylvannia Press: PA. Higgs, J. Titchin, A. Practice Knowledge and Expertise in the health professions (2001). Butterworth Heinemann: US. Hopkinson, M (2013) Presentation ‘Culture and health’ HCW Course Metge, J (1978) Talking Past Each Other: Problems of Cross-cultural Communication. Victoria Univ Press. Mitchelsen, E. (2012) The Treaty of Waitangi: An introduction. Presentation for HCW Course New Zealand Nursing Council, 2011. Guidelines for cultural safety, the Treaty of Waitangi and maori health in nursing education and practice Scott, K. Webb, M. Sorrentino, S. (2011) Long-term Caring (2 nd ed.) Elsevier: Aus. Smith, L. (2008-12) Cultural safety & Culture and Health presentations Nursing in Aotearoa & HCW Courses Wepa, D. (ed.) (2005) Cultural Safety in Aotearoa NZ. Pearson: Auck. Wolgin,F. Smith, K. French, S. (2012) Pearsons’s Nursing Assistant Today. Pearson: US. Retrieved from http://www.health.govt.nz/our-work/populations/maori-health Retrieved from: 14.1.14 http://nzcurriculum.tki.org.nz/Curriculum-resources/NZC-Updates/Issue-16-January-2012/Treaty-principles-Participation