1. Understanding smoking – overview with a Pacific lens Smokefree Nurses Aotearoa Fono, Auckland 2011

2. Population by Ethnicity Auckland Region, 2001 and 2006 Total 2001=1,172,997 Pacific people=139,308 Total 2006=1,319,232 Pacific people=158,871

3. Pacific People by Culture Group Auckland Region Pacific Culture GroupsAuckland region % Samoan87,98745.5% Tongan40,22120.8% Cook Islands Maori34,88718.0% Niuean17,7039.1% Fijian5,8653.0% Tokelauan1,8451.0% Other Pacific5,0462.6% Total Respondents193,554100.0%

4. Ethnic trends in Life Expectancy 1991-2006 MalesFemales Source MoH 2009

5. Potential Avoidable Mortality (PAM) One of the measures to estimate potential to improve health. These causes of death (theoretically) can be avoided by preventive or curative intervention at the individual level. All deaths after age of 75 are considered unavoidable!.

6. Potential Avoidable Mortality (PAM) 3 Auckland DHBs, 2003-2007 PAM Total% Ischaemic heart disease209321.4% Malig neoplasm trachea, bronchus, lung114411.7% Suicide7147.3% Colo-rectal cancer6837.0% Breast cancer6236.4% Diabetes5755.9% Chronic bronchitis and emphysema5665.8% Intracerebral haemorrhage or occlusion4784.9% Motor vehicle crashes4344.4% Lip, melanoma, other skin cancer2402.5%

7. Potential Avoidable Mortality (PAM) Pacific People, 3 Auckland DHBs, 2003-2007 PAM Pacific% Ischaemic heart disease38522.6% Diabetes21212.4% Malig neoplasm trachea, bronchus, lung1619.4% Intracerebral haemorrhage or occlusion1076.3% Breast cancer784.6% Suicide724.2% Chronic bronchitis and emphysema663.9% Nutritional deficits including anaemia603.5% Colo-rectal cancer502.9% Motor vehicle crashes502.9%

8. Cancer Breast cancer commonest cancer for ALL NZ women Lung cancer 8.4% of Pacific female cancer (7% non Maori, non Pacific, 17% for Maori) Beware rise in Pacific female youth smoking rates

9. SOI Purpose Our job is to improve, promote and protect the health of New Zealanders… we will help ensure New Zealanders live longer, healthier and more independent lives. Vision We want New Zealanders to live longer, in better health, with continued and improved independence. We will transform our health and disability system to increase quality and deliver better value for money. Our focus is on reducing waste, and improving systems, processes and culture, in order to: put the wellbeing of New Zealanders at the centre of decision-making support greater clinical leadership improve the integration and co-ordination of services.

11. ‘Ala Mo’ui Vision “Pacific people leading longer, healthier and more independent lives”

12. Service delivery is better, sooner and more convenient for Pacific people The health system is adaptive, innovative and continually improving for Pacific peoples ‘Ala Mo’ui Goals

13. ‘Ala Mo’ui principles Respecting Pacific culture Valuing family Quality healthcare Working together

14. Respecting culture and family Relationships - family based priorities and kinship obligations, reciprocity, custom and group interaction, enduring – lasts over centuries Spirituality – Christian and ancient tapu beliefs coexist, therefore Church and Ministers are key leaders. Role for traditional healing Cultural values and beliefs - dynamic, diverse and evolving Mobility of the Pacific population

15. Quality healthcare Key dimensions of quality - access, equity, cultural competence, safety, effectiveness, efficiency and patient-centeredness - implicit in delivery of health and disability services to Pacific peoples. Quality healthcare at individual, team, organisation and overall system level. Source: Quality dimensions for the New Zealand Health and Disability System in Minister of Health. 2003. Improving Quality (IQ): A systems approach for the New Zealand health and disability sector. Wellington: Ministry of Health

16. Working together Preferred holistic perspectives rather than piecemeal approaches Inter-sectoral development across central and local government - health, social and economic actions Wraparound approaches to service provision, e.g. Integrated Family Health centres, Whanau ora Community development – e.g. Pacific providers

17. HPV Immunisation – at Dec 2010 National Coverage by Ethnicity – (young women born during 1997) - Dose 1 Immunisation coverage by ethnicity: Maori 64% Pacific 76% - target reached All 51% Dose 2 Immunisation coverage by ethnicity is: Maori 61% - target reached Pacific 75% - target reached All 49% Dose 3 Immunisation coverage by ethnicity is: Maori 56% - target reached Pacific 70% - target reached All 46%

19. ‘It takes three’…in a family!

20. Through a consumer’s eyes……..

21. Strong and courageous Leadership for Pacific Health Advocate and apply a Pacific lens to: The systems The networks The pathways The programmes (Prof Sir Muir Gray)

22. Vinaka vakalevu Malo ‘aupito Fa’afetai lava Meitaki maata Faka’aue lahi Fakafetai Thank you