He Mihi - Ministry of Health NZ · 2014-03-04 · 1 He Mihi Kua tïtaha te ra, kua tü-ä-tö, kei whiti atu te rä ki tua o Täwauwau. E ngä iwi, e ngä reo e ngä whakahuahuatanga

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He Mihi

Kua tïtaha te ra, kua tü-ä-tö, kei whiti atu te rä ki tua o Täwauwau.

E ngä iwi, e ngä reo e ngä whakahuahuatanga maha tënä koutou me o tätouaitua. Kua riro te wehi, kua riro atu ngä körero, kua riro te ihi me te wana, puritiaatu ana e koutou e kui mä e koro mä, i te Pö uriuri, i te Po tangotango. Kua takate rau tau o te tïmatanga o ngä mahi a Ta Äpirana, a Te Rangihïroa, a MäuiPömare, kua neke kë atu i te rima tekau tau o te tïmatanga o ngä mahi häpai i teora a Whina Cooper mä, me Te Roopu Wähine Mäori Toko I Te Ora, e kawe tonunei i ngä mahi toimaha o te hauora. E kimi ana i te ara i haere ai taku pökaitara kite tonga, moe mai e Kui mä e Koro mä i Te Pö.

E te hunga ora, tena koutou i o koutou tini marae kainga, me ä tätou tamarikimokopuna. Tënei te Rangapü Hauora Tümatanui te mihi atu ki a koutou i tetäinga o te pukapuka nei, arä, o Te Matariki.

Kei te maaharahara tonu te Rangapu, otira nga iwi katoa o Aotearoa, ki tö tätouähua i enei ra. I tö rätou na wa, ko te pätai a ngä kaumätua, "Nä te aha i hoki kinoai te puna tangata? Ina hoki, he iwi huanui te iwi Mäori i mua, he iwi uekaha."

I te hurihanga o tërä rau tau he timu te hanga, he timu atu, he timu atu.

Inaianei kua tata te takanga o te rau tau hou. Tirohia te pukapuka nei, me önawhakamarama! Kei konei ngä körero nä koutou i tuku mai, kei konei ngäaureretanga, ngä tangi, ngä nawe päkinini e hëmanawa nei te ngäkau Maori, keikonei hoki nga whainga, kei konei ëtehi o nga huarahi mo äpöpö. Me aro mai kiënei tohutohu. Kua tae noa mai te wä hei whakamana i te kaupapa "Auahi kore"i runga i ö tätou marae, i roto hoki i ö tätou kainga, otira te tini o ngä mahi ewaitohutia mai nei i konei.

Engari kia mataara! Kei tënä whanau kei tënä whänau anö te pütake mai o te ora.Ko tätou katoa ngä poito, kia matariki te taa i te kupenga, kaua e matararahi!"

Tena koutou, tena koutou katoa.

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Foreword

E ka mana, e ka reo, e ka mauka teitei, e ka awakarohirohi tena koutou katoa.E ka mate tautini o te wa haere, haere. Haere i ruka i ka wairua maha o ka tipunakua wehe atu ki te po. Ratou te huka mate ki a ratou, tatou te huka ora ki a tatou,tena tatou katoa.

"Näu te rourou, näku te rourou, ka ora te ta kata"The notion of inclusiveness has guided the Public Health Commission (PHC) inits efforts to meet the special health needs of the Maori and to comply with theCrown's Maori health objective: to improve Maori health status so in the futureMaori will have the opportunity to enjoy at least the same level of health as non-Maori.

He Matariki is a most appropriate title. The first appearance of the star clusterMatariki in the pre-dawn sky heralds the beginning of the Maori year. The sym-bolism of a new era in health management is fitting. It is one in which Maori willaspire to, and achieve, new levels of holistic health. We have long been aware thathealth is a many-faceted pounamu incorporating physical, mental, emotional, spir-itual and whanau elements. The process for compiling He Matariki signals a part-nership concept that augers well for the future health status of te iwi Maori.

Since the publication of JH Pope's treatise in 1883, the ill-health of Maori hasbeen periodically highlighted in research publications. Only in the past two dec-ades have Maori moved towards tino rangatiratanga in health research and inremedial actions to improve the Maori mortality and morbidity rates. Many fac-tors have contributed to a low Maori health status, among them colonialism withits alienation of land, language and culture; a suspicion of the Pakeha healthsystem and a reluctance to seek treatment; a lower level of physical activity thanthat enjoyed by our pre-contact ancestors allied with different foods leading to ahost of problems; and nicotine addiction.

He Matariki is a challenge to all who are concerned for the future wellbeing of teiwi Maori. The PHC's consultation process with Maori is commendable. The nextstage of the process is the effective delivery of health services for Maori by Maori.If this were to occur then He Matariki will have succeeded in moving us forward,in a truly significant fashion, along the path of hauora.

He mihi nui tenei kia koutou, e ka rau rakatira ma.

Erihapeti Murchie QSO, LLD (Hon), JP

Chair, Tokaka Hauora Maori, Public Health Commission

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Contents

Introducing the PHC 4

A Guiding Light 5

What is the Purpose of this Summary? 5

Why a Strategic Plan? 5

How were Maori Consulted? 6

What were the Key Findings? 6

What is Public Health? 7

Where are we Going? 7

What is the Mandate for Good Health? 7

How can we Learn from the Past? 7

When does it all Start? 7

The Plan 8

Improving Whanau Wellbeing 9

Improving Tamariki Wellbeing 12

Improving Rangatahi Wellbeing 14

Improving Pakeke/Matua Wellbeing 16

Improving Kaumatua Wellbeing 17

Maori Purchaser/Provider Development 18

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Introducing the PHC

The Public Health Commission (PHC) was established on 21 June 1993 underthe Health and Disability Services Act 1993 to improve and protect the publichealth and to meet the Crown’s objectives for public health. Setting up a separateagency to deal with public health allows for better planning and co-ordination ofpublic health initiatives. Resources for public health can be explicitly identifiedand key decisions about spending made nationally, with direct accountability tothe Minister of Health.

The PHC’s areas of responsibility include:

λ environmental health (for example, non-commercial shellfish safety)λ food and nutritionλ the prevention and control of communicable diseases (for example, measles,

whooping cough)λ major lifestyle and public health problems (such as tobacco and alcohol)λ the public health needs of Maori and of special groups.

Under the Health and Disability Services Act 1993, the functions of the PHC are:

λ to monitor the state of the public health and to identify public health needsλ to advise the Minister of Health on matters relating to public health, including

(i) personal health matters relating to public health; and(ii) regulatory matters relating to public health

λ to purchase, or arrange for the purchase of, public health services, by means ofpurchase agreements or otherwise ...

The PHC is a Crown entity. It has a seven member Board that is appointed by, andreports to, the Minister of Health. Two members of the Board are of Maori descentnamely, Caren Wickliffe (Ngati Porou) and Heather Thomson (Te Whanau aApanui/Whakatohea). The Board is supported by five standing committees to ad-vise it, one of which is Tokanga Hauora Maori (Maori Health Advisory Commit-tee). The ten member committee is chaired by Dr Erihapeti Murchie (Kai Tahu/Ngati Kauwhata). The Board oversees the work of the PHC secretariat which hasabout 50 staff.

The secretariat consists of five groups, including the Maori Health Group. Therole of the six member Maori Health Group headed by Selwyn Katene (Ngati Toa/Ngati Tuwharetoa) is to provide a focus for Maori health activities through thefull involvement of Maori in the operations of the PHC.

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A Guiding Light

What is the Purpose of this Summary?This summary document is intended as a companion to the full version of HeMatariki: A Strategic Plan for Maori Public Health and is designed to provide, ina condensed form, key information to Maori of the PHC’s strategic direction forimproving and protecting the public health of Maori. It provides a summary ofpublic health goals, objectives, and targets. These recommendations include newinitiatives or improvements in effectiveness and efficiency of established pro-grammes and are based around whanau, tamariki, rangatahi, pakeke/matua, andkaumatua wellbeing, and Maori purchaser/provider development.

Why a Strategic Plan?He Matariki is unique. The decision to develop a three year strategic plan focus-ing specifically on improving and protecting the public health of Maori was con-firmed during consultation undertaken by the PHC early in 1993 on its strategicdirection. This eventually became a requirement for all purchasers of health serv-ices, including the regional health authorities (RHAs), commencing in the 1994-1995 financial year. He Matariki provides an overall framework for advancingMaori public health by addressing particular issues of relevance to Maori. It buildson previous work done by the PHC, and others, and seeks to further develop andset priorities for targets for Maori health. He Matariki is the central part of thePHC’s overall policy advice on Maori health to the Minister of Health in August1994.

How were Maori Consulted?The PHC is committed to ensuring the full involvement of Maori in its operationsconsistent with its statutory duty to consult on matters relating to public healthwith members of the public, those who have an involvement in the provision ofhealth services, and other persons considered appropriate by the PHC.

In September 1993, the PHC developed a first draft consultation document usedas the basis for discussion at two public lifecycle hui. These two hui guided thedevelopment of a second draft strategic plan document of which almost 1,000copies were widely distributed on request. Submissions on the plan could be madein several ways. Many people chose to send in written comments. Still more peo-ple preferred to attend one or more of the hui held to discuss the plan. Twenty-twoadditional hui were held involving several hundred participants by June 1994.Reports of each hui were compiled and returned to participants for verification.The final 24 hui reports and 58 written submissions, from a wide range of indi-viduals and organisations, were then analysed for inclusion into the final draft ofthe plan.

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What were the Key Findings?In summary, there was general support for the recommendations and stated direc-tions. For some people the key issues needing some clarification related to theoverall vision of the PHC, and its role and relationships with other governmentagencies, including the Ministry of Health, Te Puni Kokiri, and the RHAs, alsoiwi, and other Maori groups. An adequate allocation of resources to Maori healthwas considered a vital aspect. Submissions seemed to concentrate on the follow-ing three areas:

λ more emphasis in respect of the practical application of the Treaty of Waitangiλ the development of whanau-focused policies and programmesλ ensuring Maori participation in the purchase and provision of services.

Significantly, many submissions emphasised the positive factors in Maori society,and provided constructive suggestions to seek solutions for improving Maori pub-lic health through recognition of socioeconomic factors. Often there were calls fora restoration of Maori health status. Strengthening the whanau as a pivotal vehi-cle in which to promote sound policies and programmes was frequently stressed.Using whanau members as role models was considered highly appropriate.

What is Public Health?The objective of the PHC is to improve and protect the public health. In the Healthand Disability Services Act 1993, public health is described as relating to thehealth of all of the people of New Zealand, or a community or section of suchpeople. Public health is about taking specific measures to improve the health ofthe community. It means protecting people against ill health and minimising therisk of disease. It means promoting good health. Public health services are con-cerned with whole populations, or population groups such as tamariki, kaumatua,rather than individuals. The quality of public health services affects every minuteof our lives. Such services are responsible for the safety of the air we breathe, thewater we drink, and the food we eat. Other examples of public health servicesinclude promoting immunisation and checking of tamariki for glue ear; ensuringthe safety of non-commercial shellfish from toxins caused by algal blooms; pro-moting healthy lifestyles, that is, smokefree, a healthy, low fat diet and regularphysical activity; and reducing alcohol related harm.

Public health focuses on empowering the whanau to take responsibility for theirown needs. The whanau should provide the necessary cohesiveness and stabilityto meet those needs, and as a support to other societal structures such as hapu andiwi. Public health emphasises the importance of the overall wellbeing and healthstatus of people - tamariki, rangatahi, pakeke/matua, and kaumatua.

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Where are We Going?It is the PHC’s vision to improve and protect the public health of Maori in an openand responsive way, and to ensure the provision of information and advice andprogrammes that enable Maori to lead full and healthy lives. This vision shouldenable all Maori to make individual and whanau-focused choices and to attain anoptimal level of wellbeing commensurate with their social, economic and culturalcircumstances. The fulfilment of this vision will ensure that Maori achieve theirvision of attaining partnership with a Crown entity, consistent with the Treaty ofWaitangi.

What is the Mandate for Good Health?The PHC regards the Treaty as the founding document of New Zealand. The PHCalso acknowledges that it must help meet the public health needs of Maori andaddress the improvement of their health status. The fundamental base of any rela-tionship between Maori and a Crown agent should be the Treaty of Waitangi. TheTreaty is a living document which recognises the special tangata whenua status ofMaori and establishes an ongoing relationship between Maori and the Crown. Itis the intention of He Matariki to promote public health and wellbeing for all,where both Treaty partners have the individual and collective responsibilities toachieve this. The PHC recognises te tino rangatiratanga (self-determination) ofiwi, and appreciates the desire of Maori to control the development and deliveryof public health services to Maori.

How can we Learn from the Past?The PHC acknowledges the valuable contributions that many Maori individualsand groups have made over the years. It intends to build on past achievements.Maori women in particular have played a major role in implementing public healthstrategies for whanau. Much of the history of Maori involvement in health hasbeen in the delivery of public health. Recently, there have been significant im-provements in Maori health status, for example, the size of the Maori populationand life expectancies. He Matariki serves to indicate to Government how its ob-jectives for Maori public health can be achieved, and may be of assistance tohealth workers planning their programmes.

When does it all Start?He Matariki is scheduled for implementation in the 1995-1996 and subsequentfinancial years. It has at least a three year timeframe. However, during the 1994-1995 financial year preparatory work is underway. For example, it is intended toestablish three working groups out of three separate workshops, that is, improv-ing whanau wellbeing, improving tamariki wellbeing, and Maori purchaser/pro-vider development.

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The Plan

This section summarises the Maori public health goals, objectives and targetswhich form the basis of He Matariki: A Strategic Plan for Maori Public Health.For each proposed public health goal, there are objectives. The objectives for eachgoal are not exclusive and may also apply to other goals, but they are consideredto have the highest priority for the particular goal under which they are listed.Targets are framed as outcome, policy, programme, and research and informationrecommendations. There are six goals, thirty-nine objectives and a number oftargets.

The outcome targets will be progressively monitored in Our Health, Our Future,Hauora Pakari, Koiora Roa, the annual report on the state of the public health.The programme targets are progressively built into the purchase and linkage planas funding becomes available. The policy and research and information targetsare incorporated into the work programme of the PHC secretariat.

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Improving Whanau Wellbeing

Maori Public Health Goal 1

To promote a social and physical environment which improves andprotects whanau public health.

Objectivesλ To improve and protect whanau public health by developing strategies to max-

imise the positive effects of whanau development on Maori health.λ To improve and protect whanau public health by developing strategies to re-

duce the impacts of unemployment, inequalities in wealth, housing, transport,and literacy problems on health.

λ To improve and protect whanau public health by developing strategies to im-prove parenting skills and social support for parents and other caregivers.

λ To improve and protect whanau public health by developing strategies to im-prove provision of appropriate primary health care.

λ To improve the health and wellbeing of Maori and reduce the incidence offood-related health disorders by improved nutrition.

λ To optimise the safety of all food eaten in New Zealand.λ To improve the health and wellbeing of Maori by increasing participation in

regular exercise.λ To improve access to, understanding of, and use of information by

Maori to improve and protect whanau public health.λ To reduce the impact of violence on whanau public health.λ To improve and protect whanau public health by developing strategies to re-

duce the adverse impacts of noise, ozone depletion and globalenvironmental conditions, air quality, water quality and safety, and hazard-ous substances on whanau health.

λ To improve and protect whanau public health by developing strategies to max-imise the positive effects of the local social and physical environment on whanauhealth.

λ To improve and protect whanau public health by developing strategies to max-imise the positive effects of workplaces, schools, and marae on whanau health.

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Outcome RecommendationsThese will be progressively monitored in Our Health, Our Future, theannual report on the state of the public health.

λ To reduce the number of Maori women who smoke during pregnancy from66 percent (1992) to 50 percent or less by the year 2000.

λ To reduce the number of all Maori who smoke from 54 percent (1992) to40 percent or less by the year 2000.

λ To increase the consumption of vegetables and fruit so that 75 percent of Maorieat at least five servings each day by the year 2000.

λ To increase the consumption of breads and cereals so that 75 percent of Maorieat at least six servings each day by the year 2000.

λ To decrease the intake of total fat by approximately 20 percent of the totaldietary energy by the year 2005.

λ To decrease the intake of saturated fatty acids plus trans fatty acids to provideno more than 12 percent of the total dietary energy by the year 2005.

λ To increase the number of Maori participating in frequent physical exercise by10 percent by the year 1997.

Further developmental work is required looking at such issues as life expectancyand quality of life and the impact on whanau wellbeing. Listed below are issuesthat could be the focus of further development, but they need to be assessed andmeasured first.

λ Support systems for young Maori parents.λ Antenatal and postnatal education which is appropriate for Maori parents.λ Parenting skills programmes for rangatahi and pakeke/matua.λ Impact assessment of whanau violence on whanau wellbeing and cohesion.λ Reduction in alcohol related harm.λ Improved oral health.λ Iron deficiency/anaemia.λ The impact of unemployment, inequalities in wealth, housing, transport and

literacy problems on whanau wellbeing and cohesion.

Healthy Public Policy RecommendationsThese will be progressively built into the work programme of the PHCsecretariat.

λ That the PHC establishes a working group to develop policy advice on whanaudevelopment as it relates to public health, including policy advice on optionsfor funding and purchasing such initiatives.

λ That the PHC develops national policy advice to improve the public health ofwhanau by reducing alcohol related harm.

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Public Health Programme RecommendationsThese will be progressively built into the PHC’s purchase and linkage plan asfunding becomes available.

λ That the PHC develops a whanau-protection programme which encourageswhanau role models as a means of promoting whanau solidarity andwellbeing.

λ That the PHC continues to purchase national co-ordination of the Maori to-bacco control programme.

λ That the PHC continues to purchase a Maori community injury preventionprogramme that includes an alcohol focus.

λ That the PHC continues to purchase Maori community nutrition programmes.

Research and Information RecommendationThis will be progressively built into the work programme of the PHC secretariat.

λ That the PHC establishes a working group to consider options for the meas-urement and monitoring of whanau wellbeing.

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Improving Tamariki Wellbeing


To improve and protect the health of tamariki.

Objectivesλ To reduce tobacco use, exposure to environmental tobacco smoke, and their

adverse health consequences.λ To protect tamariki from preventable infectious diseases by improving

immunisation.λ To continue the reduction in rates of sudden infant death syndrome (SIDS).λ To reduce death rates and disability from unintentional injuries.λ To reduce death rates, injury and disability from child abuse.λ To reduce hearing loss in tamariki in the under five age group.λ To reduce disability and death rates from asthma.

Outcome RecommendationsThese will be progressively monitored in Our Health, Our Future, the annualreport on the state of the public health.

λ To increase tamariki immunisation coverage to 85 percent by 1997, and to 95percent or more by the year 2000.

λ To reduce the Maori SIDS rate from 6.5 per 1,000 live births (1991) to 4.5 per1,000 or less by 1997, and to 2.5 per 1,000 or less by the year 2000.

λ To reduce hearing loss in children in the under five year age group at schoolentry from 10.5 percent (1991 data) to eight percent or less for Maori by 1995and to five percent or less by the year 2000.

λ The PHC will consult further with Maori working in the areas of child abuseand asthma to ascertain realistic targets. Maori targets for other objectives,for example, hot water injuries and poisoning, will also be developed.

Healthy Public Policy RecommendationThis will be progressively built into the work programme of the PHC secretariat.

λ That the PHC develops policy advice on the prevention of unintentional inju-ries, child abuse, and asthma, among tamariki.

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Public Health Programme RecommendationsThese will be progressively built in to the PHC’s purchase and linkage plan asfunding becomes available.

λ That the PHC continues to work towards comprehensive well child care serv-ices, in the prevention of child hearing loss, SIDS, asthma, and the promotionof immunisation among tamariki.

λ That the PHC purchases a further Maori breastfeeding promotion programme.λ That the PHC purchases a programme developed in collaboration with Maori,

on the prevention of unintentional injuries and child abuse among tamariki.


λ That the PHC establishes a working group to recommend suitable researchand information targets on tamariki health.

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Improving Rangatahi Wellbeing


To improve and protect the health of rangatahi.

Objectivesλ To reduce death rates, injury and disability from road traffic crashes.λ To reduce tobacco use, exposure to environmental tobacco smoke, and their

adverse health consequences.λ To promote responsible sexual behaviour to minimise unplanned pregnancy

and the incidence of sexually transmitted diseases and HIV/AIDS.λ To improve health by reducing alcohol related harm.λ To improve health by minimising harm related to substance abuse.λ To promote mental health and reduce death rates from suicide.


λ To reduce Maori deaths caused by motor vehicle crashes from 84 in 1990 to 64or fewer by 1995, and to 44 or fewer by the year 2000.

λ To reduce Maori hospital admissions caused by motor vehicle crashes from1,612 in 1991 to 1,312 or fewer by 1995, and to 1,012 or fewer by the year2000.

λ To reduce the number of Maori women who smoke during pregnancy from 66percent (1992) to 50 percent or less by the year 2000.

λ To develop in collaboration with Maori, including Te Puawai Tapu, and TeOhu Whakatupu, appropriate targets on unplanned pregnancy for rangatahi.

λ To prevent an increase in the prevalence of HIV infection as indicated bysentinel monitoring and to work in conjunction with Maori, including Te PuawaiTapu, and Te Ohu Whakatupu in establishing realistic STD targets for rangatahi.

λ To develop alcohol, substance abuse, and suicide prevention targets in con-junction with Maori.

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Healthy Public Policy RecommendationsThese will be progressively built into the work programme of the PHC secretariat.

λ That the PHC works in conjunction with Maori in developing policy on STD/HIV/AIDS, substance abuse, and suicide prevention among rangatahi.

λ That the PHC develops in collaboration with Maori, including relevant agen-cies, appropriate policies on the reduction of unplanned pregnancy amongrangatahi.


λ That the PHC develops programmes including family planning, antenatal, andpostnatal health education, in conjunction with Maori working with rangatahion issues of family planning, substance abuse and suicide prevention, oncepolicy is developed.

λ That the PHC works with relevant groups to ensure that antenatal and postna-tal education is appropriate for young Maori parents.

Research and Information RecommendationsThese will be progressively built into the work programme of the PHC secretariat.The PHC has input into the Health Research Council through membership of theCouncil's Priority Planning Advisory Committee.

λ That the PHC works with relevant groups to determine the most appropriatemeans of obtaining information on unplanned rangatahi pregnancies, STD/HIV/AIDS rates, and substance abuse among rangatahi.

λ That the Health Research Council considers giving priority to research intothe use of barrier methods of contraception amongst rangatahi and in particu-lar on whether cost is a factor in the relatively low use of such methods byrangatahi.

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Improving Pakeke/Matua Wellbeing


To improve and protect the health of pakeke/matua.

Objectivesλ To reduce tobacco use, exposure to environmental tobacco smoke, and their

adverse health consequences.λ To improve health by reducing alcohol related harm.λ To reduce illness, disability and death rates from heart disease and stroke.λ To reduce illness, disability and death rates from cancers.λ To promote mental health.λ To reduce disability and death rates from diabetes mellitus.


λ By the year 1995, to reduce the death rate from cervical cancer in Maori womenaged 20 to 69 years by 20 percent; and by the year 2000, to reduce the deathrate by 50 percent or more.

λ Further developmental work is required to produce appropriate targets for heartdisease, cerebrovascular disease, mental health, some cancers and diabetes, inconsultation with Maori.

Healthy Public Policy RecommendationThis will be progressively built into the work programme of the PHCsecretariat.

λ That the PHC works in conjunction with Maori, towards further developingpolicy advice in respect of heart disease and cerebrovascular disease, somecancers, diabetes and mental health among pakeke/matua.


λ That the PHC continues to purchase a Maori “well woman” programme.λ That the PHC works in consultation with Maori on appropriate interventions

to promote a “well pakeke/matua” programme.

Research and Information Recommendationλ No specific recommendation has been identified.

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Improving Kaumatua Wellbeing


To improve and protect the health of kaumatua.

Objectivesλ To maintain and improve mobility amongst kaumatua.λ To reduce death rates and disability from injuries.λ To protect kaumatua from preventable infectious diseases, such as influenza.λ To reduce death rates and disability from depression and promote mental health.λ To reduce disability from incontinence.λ To improve and maintain social support for kaumatua.

Outcome Recommendationλ Further developmental work is required looking at such issues as life expect-

ancy, quality of life, and other specific public health issues.


λ That the PHC establishes a working group, in conjunction with Maori andother relevant agencies, to develop policy advice on kaumatua health, includ-ing mobility, injuries, infectious diseases, mental health, prevention of incon-tinence, and social support among kaumatua.

Public Health Programme RecommendationThis will be progressively built in to the PHC’s purchase and linkage plan asfunding becomes available.

λ That the PHC develops relevant health education materials on mobility, unin-tentional injuries, infectious diseases, mental health, incontinence, and sup-port services, appropriate to kaumatua.


λ That the PHC obtains data on the public health status of kaumatua, the extentto which kaumatua use public health programmes or receive public healthinformation and whether these are of particular benefit to their projected fu-ture needs.

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Maori Purchaser/Provider Development


To improve Maori health status so in the future Maori will have theopportunity to enjoy at least the same level of health as non-Maori.

Objectivesλ To ensure that all services purchased by the PHC are culturally appropriate

and compatible with gains in Maori health.

Outcome Recommendationλ Further developmental work is required looking at such issues as life expect-

ancy and quality of life and the relationship to Maori control over the pur-chasing and delivery of public health services.


λ That the PHC increases the involvement of Maori in purchasing arrangements,subject to satisfactory reviews.


λ That the PHC conducts training hui for new and existing Maori providers.λ That the PHC establishes a national joint venture purchasing arrangement.λ That the PHC establishes a second regional budget holder purchasing arrange-

ment based on the existing arrangement.λ That the PHC publishes a quarterly provider newsletter on Maori health serv-

ices.λ That the PHC explores methods for ensuring the recruitment of Maori to, and

retaining Maori in, public health medicine training.


λ That the PHC, in collaboration with relevant groups, considers public healthworkforce development to identify the extent of the current workforce, itsstrengths, weaknesses and requirements.

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He Mihi

Kua tïtaha te ra, kua tü-ä-tö, kei whiti atu te rä ki tua o Täwauwau.

E ngä iwi, e ngä reo e ngä whakahuahuatanga maha tënä koutou me o tätouaitua. Kua riro te wehi, kua riro atu ngä körero, kua riro te ihi me te wana, puritiaatu ana e koutou e kui mä e koro mä, i te Pö uriuri, i te Po tangotango. Kua takate rau tau o te tïmatanga o ngä mahi a Ta Äpirana, a Te Rangihïroa, a MäuiPömare, kua neke kë atu i te rima tekau tau o te tïmatanga o ngä mahi häpai i teora a Whina Cooper mä, me Te Roopu Wähine Mäori Toko I Te Ora, e kawe tonunei i ngä mahi toimaha o te hauora. E kimi ana i te ara i haere ai taku pökaitara kite tonga, moe mai e Kui mä e Koro mä i Te Pö.

E te hunga ora, tena koutou i o koutou tini marae kainga, me ä tätou tamarikimokopuna. Tënei te Rangapü Hauora Tümatanui te mihi atu ki a koutou i tetäinga o te pukapuka nei, arä, o Te Matariki.

Kei te maaharahara tonu te Rangapu, otira nga iwi katoa o Aotearoa, ki tö tätouähua i enei ra. I tö rätou na wa, ko te pätai a ngä kaumätua, "Nä te aha i hoki kinoai te puna tangata? Ina hoki, he iwi huanui te iwi Mäori i mua, he iwi uekaha."

I te hurihanga o tërä rau tau he timu te hanga, he timu atu, he timu atu.

Inaianei kua tata te takanga o te rau tau hou. Tirohia te pukapuka nei, me önawhakamarama! Kei konei ngä körero nä koutou i tuku mai, kei konei ngäaureretanga, ngä tangi, ngä nawe päkinini e hëmanawa nei te ngäkau Maori, keikonei hoki nga whainga, kei konei ëtehi o nga huarahi mo äpöpö. Me aro mai kiënei tohutohu. Kua tae noa mai te wä hei whakamana i te kaupapa "Auahi kore"i runga i ö tätou marae, i roto hoki i ö tätou kainga, otira te tini o ngä mahi ewaitohutia mai nei i konei.

Engari kia mataara! Kei tënä whanau kei tënä whänau anö te pütake mai o te ora.Ko tätou katoa ngä poito, kia matariki te taa i te kupenga, kaua e matararahi!"

Tena koutou, tena koutou katoa.

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He Kupu Whakataki

E ka mana, e ka reo, e ka mauka teitei, e ka awakarohirohi tena koutou katoa.E ka mate tautini o te wa haere, haere. Haere i ruka i ka wairua maha o ka tipunakua wehe atu ki te po. Ratou te huka mate ki a ratou, tatou te huka ora ki a tatou,tena tatou katoa.

"Näu te rourou, näku te rourou, ka ora te ta kata"Ko te whakauru mai a te Mäori, te tino kaupapa e ärahi ana i te Rakapü HauoraTümatanui, kia tutuki ai öna hiahia hauora motuhake, kia häkai hoki ki tä teKarauna whäi ka, arä, ki te whakapiki i te tü o te hauora Mäori, ä töna wä, kia tüörite ki tërä o Tauiwi.

E tika ana te i koa nei, a He Matariki . Ko te puta ka tuatahi o te hui ka whetu nei ite atatü, he tohu mö te tïmata ka o te tau hou a te Mäori. I könei, e tohu ana i tetïmata ka hou mö te whakahaere i te hauora, e whakataira ka ai kä wawata me käwhakatutukita ka o te hauora katoa o te Mäori. Kua roa nei te wä, a arokä anatätou ki kä ähuata ka maha o tënei täo ka pounamu, te hauora, arä, ki te taha tinana,te taha hine karo, kä kare-a-roto, te taha wairua, me te taha ki te whänau. Ko tetüka ka whakaemi i kä körero kei roto i He Matariki , e tohu ana i te mahi tahita ka,hei whakapai ka ake i te tü o te hauora o te iwi Mäori.

Mai i te puta ka o kä körero a J H Pope (i te tau 1883), kua whakapuakina kämauiuita ka a te iwi Mäori i roto i ëtahi o kä püro ko ra kahau. Otïrä, i kä kahurutau e rua kua hori, kua ara ake te Mäori ki töna tino rakatirata ka i roto i kära kahau hauora, tae atu hoki ki te kaweka o kä mahi whakapai ake i kä päpäta kamate, mauiui hoki. He nui kä pütake kei raro iho te tü o te hauora Mäori, arä, koënei ëtahi: ko te maruta ka o Aotearoa, te karoha ka o te reo me te whenua; ko tetüpatota ka ki te pünaha hauora o Tauiwi, me te kore hiahia ki te kimi rokoä; ko teiti ihota ka o te kori tinana (mena ka whakatauritea ki tërä a ö tätou tïpuna) me käwhakararu hauora ka puta i kä kai rerekë o ënei rä; ko te kahukata ka ki tënei meate kai paipa.

He mätaki a He Matariki , ki a tätou katoa e mäharahara nei mö te ora ka o te iwiMäori i roto i kä rä kei te heke mai. Ka tika, me mihi ki te Rakapü HauoraTümatanui mö tä rätou tüka ka akoako me te iwi Mäori. Inäianei, me aro atu ki tewhäi ka, mä te Mäori te Mäori e whakarato ki kä ähuata ka hauora. Ki tewhakatïnanahia tënei whäi ka, kua whaihua a He Matariki .

He mihi nui tenei ki a koutou, e ka rau rakatira ma.

Erihapeti Murchie QSO, LLD (Hon), JP

Chair, Tokaka Hauora Maori, Public Health Commission

21

Ngä Ihirangi

Ko te Rangapü Hauora Tümatanui 22

He Matariki 23

He aha i tuhia ai tënei whakaräpopotanga? 23

He aha ngä take i whakamaheretia ai ngä kaupapa? 23

Pëhea te akoako a te Rangapü Hauora Tümatanui me te iwi Mäori? 23

He aha ngä körero matua i puta mai? 24

He aha tënei mea te Hauora Tümatanui? 24

E ahu ana tätou ki hea? 25

He aha ngä pütake mö te Hauora? 25

He aha ngä akoranga o mua? 25

Ahea tïmata ai? 25

Ko te Whakamahere Kaupapa 26

Te Häpai Oranga Whänau 27

Te Häpai Oranga Tamariki 30

Te Häpai Oranga Rangatahi 32

Te Häpai Oranga Pakeke/Matua 34

Te Häpai Oranga Kaumätua 35

Te Whanake i te Mäori hei Kaihoko, Kaiwhakarato 36

Nga Kupu Hou I Puta I te Whakamaoritanga o He Matariki 37

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Ko Te Rangapü Hauora Tümatanui

Nö te 21 o Pipiri 1993 i whakatühia te Rangapü Hauora Tümatanui, i raro i temana o te ture (1993) mö ngä ratonga hauora, hauä hoki. Kö töna kaupapa matua,he häpai, he tiaki i te hauora tümatanui me te whakatutuki i ngä whäinga hauoraa te Kawanatanga. Mä te whakatütanga i tëtahi whakahaere hauora motuhake, epai ake ai te whakamahere me te tuitui i ngä kaupapa hauora tümatanui. Katäutohu motuhaketia ngä rawa mö te hauora tümatanui, ka whakatakotohia hokingä whakatau matua e pä ana ki te toha pütea ki te motu whänui, i raro katoa i tearotakenga a te Minita mö te Hauora.

Koianei ngä kawenga a te Rangapü Hauora Tümatanui:λ ko te hauora o te taiao (arä: te ora o ngä mätaitai e kohia ana e te iwi)λ ko te kai me te kai tötikaλ ko te ärai me te tiaki i ngä mate whakawhitiwhiti (përä i te karawaka me te

mare tetekö)λ ko ngä whakararu nui e pä ana ki te ähua noho a te tangata me te hauora o te

porihanga whänui (përä i te kai waipiro me te momi hikareti)λ ngä hiahia a te Mäori me ëtahi atu röpu motuhake e pä ana ki te hauora

tümatanui.

I raro i te mana o te ture (1993) mö ngä ratonga hauora, hauä hoki, koianei ngämahi a te Rangapü Hauora Tümatanui:λ ki te aro turuki i te ähua o te hauora tümatanui, ki te täutohu hoki i ngä hiahia

hauora tümatanuiλ ki te whakaatu ki te Minita Hauora mö ngä kaupapa hauora tümatanui, ko

ënei ëtahi nä:(i) ngä take hauora whaiaro e pä ana ki te hauora tümatanui; me(ii)ngä whakaritenga ture e pä ana ki te hauora tümatanui

λ ki te hoko mai, ki te whakarite hokonga mai ränei, i ngä ratonga hauoratümatanui.

Nä te Karauna te Rangapü Hauora Tümatanui. Tokowhitu kei runga i te poariwhakahaere, i whakatüria e te Minita Hauora, ä, ka tuku pürongo anö ki a ia.Tokorua, he Mäori, ko Caren Wickliffe (nö Ngäti Porou) me Heather Thomson(nö Te Whänau-a-Apanui me Whakatöhea). E rima ngä komiti tohutohu, ko teTokanga Hauora Mäori tëtahi. Tekau ngä tängata kei tënei komiti, ko TäkutaErihapeti Murchie (nö Kai Tahu me Ngäti Kauwhata) te kaiarahi. Ko te poari anöhei whakahaere i ngä mahi a te Rangapü Hauora Tümatanui, me ngä kaimahi 50.

E rima ngä wehenga kaimahi a te Rangapü Hauora Tümatanui, ko te Röpu HauoraMäori tëtahi. Tokoono kei tënei röpu, ko te kaihautü, ko Selwyn Katene (nöNgäti Toa me Ngäti Tüwharetoa). Ko tä rätou mahi, he whakatïtina i ngä kaupapahauora Mäori, me te whakahau kia uru mai te Mäori ki roto i ngä whakahaere a teRangapü Hauora Tümatanui.

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He Matariki

He aha i tuhia ai tënei whakaräpopototanga?Ko tënei te whakaräpopototanga a te pukapuka He Matariki: A Strategic Plan forMäori Public Health . Ko täna, he kawe ki te iwi Mäori i ngä tino kaupapa häpai,tiaki hoki i te hauora Mäori, e whäia ana e te Rangapü Hauora Tümatanui. Kongä körero, he whakamärama i ngä whäinga whänui, ngä whäinga paetae, me ngäwhäinga hua mö te hauora tümatanui. Kei roto i ngä tütohutanga, he kaupapahou, me ngä whakapainga ake i ngä kaupapa türoa, ä, ko te hauora o te whänau,o te tamariki, o te rangatahi, o te pakeke/matua, o te kaumätua, me te whanake ite Mäori hei kaihoko, kaiwhakarato, ngä tino pütake o ënei kaupapa.

He aha ngä take i whakamaheretia ai ngä kaupapa?He tuatahitanga a He Matariki . Mai i ngä akoako i whakahaerehia e te RangapüHauora Tümatanui i te tïmatanga o te tau 1993, i puta te whakatau, ae marika, mewhakamahere ngä kaupapa hauora Mäori. Taro rawa mai, ka tü tënei hei whakatauhere i ngä Rünanga Hauora-a-Takiwä, mai i te tïmatanga o te tau o te tahua 1994-1995. He anga whänui a He Matariki , hei whakamätau i ngä take motuhake e päatu ana ki te Mäori, e kökiritia ai töna hauora. Ka täpirihia ki ngä mahi i mahia ete Rangapü Hauora Tümatanui me ëtahi atu, ä, ko täna, he whakatau i ngä whäingamatua mö te hauora Mäori. Ko He Matariki te wähanga nui o ngä tohutohu iwhakatakotohia e te Rangapü Hauora Tümatanui ki mua i te aroaro o te MinitaHauora i te marama o Here-turi-kökä, 1994.

Pëhea te akoako a te Rangapü Hauora Tümatanui mete iwi Mäori?E here ana te Rangapü Hauora Tümatanui ki te urunga katoa mai o te iwi Mäoriki roto i öna whakahaere. He ritenga ture tënei, arä, me akoako, mewhakawhitiwhiti ki te iwi whänui, ki ngä hunga e whai wähi mai ana ki ngäratonga hauora, me ërä atu tängata e tika ana kia uru mai.

I te marama o Mahuru, te tau 1993, i oti i te Rangapü Hauora Tümatanui, tetuhinga akoako tuatahi, ä, ko tënei te tuhinga arahi i ngä körero whakawhitiwhitii roto i ëtahi hui e rua e pä ana ki te koiora tangata. Mai i ënei hui ka puta tetuhinga tuarua, he tauira whakamahere i ngä kaupapa. Tata ki te 1,000 o ënei katukuna whänuitia ki te motu. He huarahi ruarua i taea e te tangata, röpu ränei tetuku i ö rätou whakaaro e pä ana ki te tauira whakamaheretanga. Ko ëtahi i tukukörero-a-tuhi. Ko ëtahi i tae-a-tinana ki ngä hui i whakatühia hei wähiwhakawhitiwhiti i tënei kaupapa. E rua tekau mä rua anö ngä hui i tü i mua iPipiri 1994, toru rau tängata pea i whai wähi mai ki aua hui. I muri mai i ia hui,ka tuhia he pürongo körero, ka whakahokia ki te iwi hei whakatüturutanga märätou. I tätarihia ënei pürongo hui 24, me ngä körero-a-tuhi 58, kätahi ka tuhia tetauira mahere whakamutunga.

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He aha ngä körero matua i puta mai?I tautoko whänuitia ngä tütohutanga me ngä whäinga i tuhia i roto i ngä pürongo.Otïrä, ko tëtahi take käore i te tino märama ki te iwi, ko te tirohanga whänuiwhakamua a te Rangapü Hauora Tümatanui, me tana pänga atu ki ërä atuwhakahaere Kawanatanga (arä, Te Manatü Hauora, Te Puni Kökiri, me ngäRünanga Hauora-a-Takiwä) tae atu hoki ki ngä iwi, me ngä röpu Mäori. He meanui, me rawaka ngä toha pütea mö te hauora Mäori. Ko te ia o ngä körero i putamai, ko ënei ähuatanga e toru nei:λ me matua whai te whakatinanatanga o te Tiriti o Waitangiλ ko te whänau kei te pokapü o ngä kaupapa me ngä whakahaerenga hauoraλ me whai wähi mai te iwi Mäori i roto i te hokonga me te whakaratonga hauora.

He mea hiringa, he nui ngä whakatakotoranga whakanui i ngä ahuatanga papai iroto i te ao Mäori, ä, he nui hoki ngä whakaaro whaitake, e pai ake ai te hauoraMäori, ötïrä me matua ähukahuka ngä ähuatanga päpori/ohaoha a te Mäori. Henui hoki ngä karanga me whakahoki te tü o te hauora Mäori. He nui ngä körero ekï ana, ko te whakapakari i te whänau te waka hei kawe i ngä kaupapa hauora. Hemea pai, ko ngä tängata tötika nö roto i ngä whänau hei tauira whakakitenga.

He aha tënei mea te Hauora Tümatanui?Ko te whäinga matua o te Rangapü Hauora Tümatanui, ko te häpai me te tiaki i tehauora tümatanui. I roto i te ture mö ngä ratonga hauora, hauä hoki 1993, ko tewhakamärama mö tënei mea te hauora tümatanui, ko te hauora o ngä tängatakatoa i Aotearoa, tëtahi wähanga, häpori ränei o te taupori whänui. Koianei ewhai ake nei ëtahi ähuatanga e pä ana ki te hauora tümatanui:λ ko te whakatü kaupapa e pai ake ai te te hauora o te iwiλ ko te ärai atu i ngä tümomo mate e whakararu ana i te hauora o te iwi, me te

whakaheke i ngä tüpono mateλ ko te whakatïtina i te hauora.

E pä atu ana te hauora tümatanui ki te taupori katoa, ki ëtahi hunga ränei, përä i tehunga tamariki, te hunga kaumätua, käore ki te tangata kotahi. Ko te kounga ongä ratonga hauora, ka pä atu ki te katoa o te wä e ora ana te tangata. Ko ëneiratonga ka tiaki i te hau hä o te tangata, te wai inu o te tangata, me te kai whängaii te tangata. Ko ëtahi atu wähanga o ngä ratonga hauora, ko te whakatïtina äraimate me te ärohi tamariki mö te purakitanga taringa; ko te tiaki i ngä mätaitai kiakore e paihanatia; ko te whakatïtina i ngä ähuatanga noho e ora ai te tangata, aräte kore kai paipa, ngä kai tötika, me te whakakorikori tïnana; ko te whakaheke ingä whakararu ka puta i te kai waipiro.

He mea nui i roto i te hauora tümatanui te whakatau i te mana o te whänau, arä,mä te whänau e kawe te haepapatanga e pä ana ki a rätou anö. Me kaha te tü o tewhänau e taea ai tënei kawenga, me te tautoko hoki i ërä atu hangapori, ko tehapü, me te iwi. Ko tëtahi wähanga nui o te hauora tümatanui, ko te oranga me tetü o te hauora o te iwi, tamariki mai, rangatahi mai, pakeke/matua mai, kaumätuamai.

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E ahu ana tätou ki hea?Ko te tirohanga whakamua, o te Rangapü Hauora Tümatanui, ko te häpai, tiakihoki i te hauora Mäori. Me noho huaki ngä mahi a te Rangapü Hauora Tümatanui,kia tirohia e te iwi, me kätoitoi, me whakarato te iwi Mäori ki ngä tohutohu, mengä whakahaere hauora, e ora ake ai rätou. Me tau atu te mana köwhiri ki ngäMäori katoa. Me whai oranga hoki kia rite ki ö rätou ähuatanga noho, ähuatangaohaoha, ähuatanga ahurea. Ki te whakatutuki tënei tirohanga whakamua, kawhakatinanatia te Tiriti o Waitangi me te wawata nui o te iwi Mäori kia mahi ritetahi me te Karauna.

He aha ngä Pütake mö te Hauora?E whakakoia ana te Rangapü Hauora Tümatanui i te Tiriti o Waitangi hei tüäpapamö Aotearoa. Ka ähukahukatia hoki, me whakarato ngä hiahia o te Mäori, heihäpai i tö rätou hauora. Ko te tüäpapa whakahono i te iwi Mäori me te Karauna,ko te Tiriti o Waitangi. E ora tonu ana te Tiriti, ä, ko täna, ka whakakoia i te manatangata whenua ki te Mäori, ka whakatakotohia te hononga i waenganui i te Mäorime te Karauna. Kei te whakatïtina a He Matariki i te hauora me te oranga tangatamö te katoa, ä, me kawe tënei haepapa e ia taha ake o te Tiriti, me ngä taha e ruae mahi tahi ana. E tautoko ana te Rangapü Hauora Tümatanui i te tinorangatiratanga o ia iwi, me te möhio anö hoki ki tö rätou hiahia, mä te Mäori ehautü, e whakarato ngä kaupapa hauora möna anö.

He aha ngä Akoranga o Mua?E mihi ana te Rangapü Hauora Tümatanui ki ngä tängata me ngä röpu Mäori iwhai wähi mai, i whakapau kaha mai ki ngä kaupapa hauora i roto i ngä tau kuahori. Me äpiti atu ngä mahi a te Rangapü Hauora Tümatanui ki ërä hua i puta ingä tau o mua. Ko te hunga wähine Mäori ngä mea kaha ki te whakatïtina i tehauora Mäori, ki te häpai hoki i te oranga o te whänau. Ko te whakarato i tehauora tümatanui te wähanga nui i whai wähi mai te Mäori i ngä tau ki mua. Inänoa nei, kua ähua piki haere te tü o te hauora Mäori, hei tauira, ko te kake ake ote taupori Mäori me te wä ora o te tangata Mäori. Mä He Matariki e whakaatu atuki te Kawanatanga, me pëhea e whakatïnana ai öna whäinga mö te hauora Mäori.Tërä pea ka äwhina hoki i ngä kaimahi hauora ki te whakamahere i ä rätoukaupapa.

Ahea tïmata ai?Hei te tau o te tahua 1995-1996 a muri ake, ka whakaurua atu a He Matariki kiroto i ngä whakahaere hauora. Mö te toru tau neke atu töna wä. Otïrä, i roto i tetau o te tahua 1994-1995 kua tïmata te whakatakoto i te kaupapa. Arä, kei tewhakatühia kia toru ngä röpu, hei tirotiro i ngä kaupapa häpai i te oranga whänau,hei häpai hoki i te oranga tamariki, me te whanake i te Mäori hei kaihoko, heikaiwhakarato ränei.

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Ko te Whakamahere i te Kaupapa

I roto i tënei wähanga o te pürongo, ka whakaräpopotohia ngä 'whäinga whänui',ngä 'whäinga paetae' me ngä 'whäinga hua' mö te hauora Mäori. Ko ënei heituarä mö He Matariki: A Strategic Plan for Mäori Public Health. Kawhakatakotohia he whäinga paetae mö ia whäinga whänui. Ahakoa ka pä atuënei whäinga paetae ki ëtahi atu whäinga whänui, ka taka ki raro i tërä e tinohängai ana. Ko ngä 'whäinga hua', ngä tütohutanga mö ngä otinga ka puta möngä kaupapa here, ngä whakahaere, ngä rangahautanga, me te mätauranga. Eono ngä 'whäinga whänui', toru tekau mä iwa ngä 'whäinga paetae', me e hia noaake ngä 'whäinga hua'.

Ka aro turukihia ngä whäinga hua i roto i te pürongo Our Health, Our Future,Hauora Pakari, Koiora Roa, te pürongo-a-tau mö te tü o te hauora tümatanui.Ka whakauru haerehia ngä whäinga hua ki roto i te mahere tahua, inä ka wäteamai he pütea. Ko ngä whäinga hua mö ngä kaupapa here, me te mätauranga kataka ki raro i te hötaka a ngä kaimahi a te Rangapü Hauora Tümatanui.

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Te Häpaitanga i te Oranga Whänau

Hauora Mäori, Whäinga Whänui 1

Ki te whakatïtina i ngä ähuatanga päpori, me ngä ähuatanga o te taiao, ekökiri ake ai te oranga whänau.

Whäinga Paetaeλ Ki te häpai, ki te tiaki i te oranga whänau, mä te whakatakoto kaupapa e tino

pä rawa atu ai te whanaketanga i te whänau ki te hauora Mäori.λ Ki te häpai, ki te tiaki i te oranga whänau, mä te whakatakoto kaupapa e

whakaheke ai te pänga o ënei ähuatanga ki te hauora tangata. Arä, ko te koremahi, ko te tökeke koretanga o te whiwhinga pütea, o te wähi noho, me tewaka mauranga, ko ngä whakararu e pä ana ki te pänui pukapuka me tetuhituhi hoki.

λ Ki te häpai, ki te tiaki i te oranga whänau, mä te whakatakoto kaupapa äwhinai ngä mätua, me ngä kaiwhängai, e pai ake ai te tiaki i ä tätou tamariki.

λ Ki te häpai, ki te tiaki i te oranga whänau, mä te whakatakoto kaupapa e paiake ai ngä whakaratonga hauora matua.

λ Ki te häpai i te oranga tangata o te Mäori, ki te whakaheke hoki i ngä whakararuhauora e pä ana ki te kai, mä te whakatïtina i te kai tötika.

λ Ki te mätua whakarite i te ora o ngä kai katoa e kaingia ana i Aotearoa.λ Ki te häpai i te oranga tangata o te Mäori, mä te whakapiki i te whai wähitanga

mai ki te mahi korikori.λ Ki te whakapai ake i te whai wähitanga atu a te Mäori ki ngä mätauranga e

häpai ake ai, e tiaki ai te oranga whänau.λ Ki te whakaheke i te whakapänga atu a te patu tangata ki te oranga whänau.λ Ki te häpai, ki te tiaki i te oranga whänau, mä te whakatakoto kaupapa e

whakaheke ai te pänga atu o ënei ähuatanga ki te oranga whänau. Arä, ko teturituri, ko te paunga o te häora toru me ngä ähuatanga whänui o te taiao, kote kounga o te hau, ko te kounga o te wai, me ngä mea matepä.

λ Ki te häpai, ki te tiaki i te oranga whänau, mä te whakatakoto kaupapa e tinopä rawa atu ai ngä ähuatanga pai o te häpori takiwä , me te taiao takiwä ki teoranga whänau.

λ Ki te häpai, ki te tiaki i te oranga whänau, mä te whakatakoto kaupapa e tinopä rawa atu ai ngä ähuatanga pai o ngä wähi mahi, o ngä wähi mätauranga , ongä marae hoki, ki te oranga whänau.

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Ngä Tütohutanga WhaihuaKa aro turukihia ënei tütohutanga i roto i te pürongo-a-tau mö te hauora tümatanui,Our Health, Our Future, Hauora Pakari, Koiora Roa.

λ Ki te whakaheke iho i te tokomaha o ngä wähine Mäori e kaipaipa ana i te wäe hapü ana rätou, mai i te 66 örau (1992) ki te 50 örau iti iho ränei, a te tau2000.

λ Ki te whakaheke iho i te tokomaha o ngä Mäori katoa e kaipapa ana, mai i te54 örau (1992) ki te 40 örau iti iho, a te tau 2000.

λ Ki te whakanui ake i te kai huawhenua me te hua räkau a te Mäori kia tae ki terima kainga i te rä kotahi mö te 75 örau o ngä Mäori, a te tau 2000.

λ Ki te whakanui ake i te kai paräoa me te pata kai a te Mäori, kia tae ki te onokainga i te rä kotahi mö te 75 örau o ngä Mäori, a te tau 2000.

λ Ki te whakaheke i te kai ngako a te Mäori, ki te 20 örau o te katoa o te püngaokai a te tau 2005.

λ Ki te whakaheke i te kai waikawa matü pühake ki te 12 örau o te katoa o tepüngao kai a te tau 2005.

λ Kia 10 örau te whakanuinga ake i te tokomaha o te Mäori e uru atu ana ki ngämahi korikori a te tau 1997.

Arä kë ake ngä mahi whakahiato kaupapa e pä ana ki te wä me te kounga koiorao te tangata, me te whakapänga atu ki te oranga whänau. Kei raro nei ëtahi atutake hei whakawhanake pea, engari me mätua aro matawai i te tuatahi.

λ He pünaha tautoko mö ngä mätua taiohi Mäori.λ He whakaakoranga mö mua, mö muri hoki i te whänautanga pëpi e rite ana

mö te Mäori.λ He whakaakoranga tuku möhiotanga e pä ana ki te tiaki tamariki.λ He aro matawai i te patu tangata i waenganui i te whänau, ki te oranga me te

piringa o te whänau.λ Ko te whakaheke i te kino e puta mai ana i te kai waipiro.λ Ko te whakapai ake i te hauora-a-niho.λ Ko te hohoretanga rino.λ Ko te whakapänga atu o te kore mahi, o te tökeke koretanga o te whiwhinga

pütea, wähi noho, waka mauranga, me ngä whakararu e pä ana ki te pänuipukapuka me te tuhituhi, ki te oranga me te piringa o te whänau.

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Ko ngä Tütohotanga Kaupapa Here Hauora TümatanuiKa täpiri haerehia ënei tütohutanga ki te hötaka mahi a te Rangapü HauoraTümatanui.

λ Kia whakatühia e te Rangapü Hauora Tümatanui he röpu hei whakatakototohutohu mö ngä kaupapa e pä ana ki te whanaketanga o te whänau me tönahononga atu ki te hauora tümatanui, me ngä tohutohu e pä ana ki te taha tahuahei utu i aua kaupapa.

λ Kia whanaketia e te Rangapü Hauora Tümatanui he tohutohu kaupapa here epä ana ki te whakaheke i te kino ka puta mai i te kai waipiro, e pai ake ai tehauora tümatanui o te whänau.

Ko Ngä Tütohutanga Hötaka Hauora TümatanuiKa täpiri haerehia ënei tütohutanga ki te mahere hokonga a te Rangapü HauoraTümatanui, ina ka wätea mai he pütea.

λ Kia whakatühia e te Rangapü Hauora Tümatanui, tëtahi hötaka tiaki whänaue whakatïtina ai ngä tängata tötika nö roto i te whänau, hei here i te whänau,hei oranga hoki mö rätou.

λ Kia hokona tonutia e te Rangapü Hauora Tümatanui, te tuituitanga i te hötakawhakakore kaipaipa.

λ Kia hokona tonutia e te Rangapü Hauora Tümatanui, tëtahi hötaka-a-häporiärai whara mö te Mäori, kei roto, ko ërä ähuatanga e pä ana ki te kai waipiro.

λ Kia hokona tonutia e te Rangapü Hauora Tümatanui, ngä hötaka-a-häpori ewhakatïtina ai te kai tötika.

Ngä Tütohutanga Rangahau, Mätauranga hokiKa täpiri haerehia tënei ki roto i te hötaka a ngä kaimahi a te Rangapü HauoraTümatanui.

λ Kia whakatühia e te Rangapü Hauora Tümatanui tëtahi röpu hei kimi huarahie aro matawai ai, e aro turuki ai, te oranga whänau.

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Te Häpaitanga i te Oranga Tamariki

Hauora Mäori Tümatanui, Whäinga Whänui 2

Ki te kökiri, ki te tiaki i te hauora tamariki.

Whäinga Paetaeλ Ki te whakaheke i te kainga paipa, te hänga auahi paipa, me ngä whakararu

kino ka puta mai.λ Ki te whakapai ake i te ärainga mate, kia kore ai ä tätou tamariki e pängia atu

e ngä mate hopuhopu.λ Ki te whakaheke tonu i ngä päpätanga mate ohorere a te tamaiti (SIDS)λ Ki te whakaheke i ngä päpätanga mate, me te hauätanga ka puta i ngä whara

pokerehü.λ Ki te whakaheke i ngä päpätanga mate, te wharatanga, me te hauätanga ka

puta i te mahi tükino tamariki.λ Ki te whakaheke i te rongo korenga i roto i te hunga tamariki kei raro iho i te

rima tau te pakeke.λ Ki te whakaheke i te hauätanga me ngä päpätanga mate, ka puta i te huangö.


λ Ki te whakanui ärainga mate tamariki ki te 85 örau a te tau 1997, ki te 95 öraua te tau 2000.

λ Ki te whakaheke i te päpätanga mate ohorere (SIDS) mö ngä tamariki Mäori,mai i te 6.5 mö ia 1,000 pëpi e whänau ora mai ana (1991) ki te 4.5 iti iho möia 1,000, a te tau 1997, ä, ki te 2.5 iti iho mö ia 1,000 a te tau 2000.

λ Ki te whakaheke i te rongo korenga i roto i te hunga tamariki Mäori kei raro ite rima tau te pakeke, i te wä e tïmata ana rätou ki te kura, mai i te 10.5 örau(1991) ki te 8 örau iti iho a te tau 2000.

λ Ka haere tonu ngä akoako a te Rangapü Hauora Tümatanui me ngä kaimahiMäori i roto i ngä kaupapa tükino tamariki, me te huangö, ki te whakatau ingä whäinga tötika. Ka whanaketia hoki he whäinga Mäori mö ëtahi atukaupapa, përä i ngä whara wai wera, me te paihana.

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Ko Ngä Tütohotanga Kaupapa Here Hauora TümatanuiKa täpiri haerehia tënei tütohutanga ki te hötaka a ngä kaimahi a te RangapüHauora Tümatanui.

λ Kia whanaketia e te Rangapü Hauora Tümatanui he tohutohu kaupapa here epä ana ki te äraitanga i ngä whara pokerehü, te tükino tamariki, me te huangöi roto i te hunga tamariki.


λ Kia haere tonu te mahi whakatü ratonga a te Rangapü Hauora Tümatanui möënei ähuatanga, arä, te tiaki i ä tätou tamariki, te ärai i te rongo korenga, temate ohorere (SIDS), te huangö, me te whakatïtina i te ärai mate i a tätoutamariki.

λ Kia hokona anötia e te Rangapü Hauora Tümatanui, tëtahi hötaka whakatïtinai te whängaitanga waiü.

λ Kia hokona mai e te Rangapü Hauora Tümatanui tëtahi hötaka kua ätawhiriwhirihia me te iwi Mäori, e ärai atu ai i ngä whara pokerehü, me tetükino tamaiti, i waenganui i te hunga tamariki.

Ngä Tütohutanga Rangahau, Mätauranga hokiKa täpiri haerehia tënei ki roto i te hötaka a ngä kaimahi a te Rangapü HauoraTümatanui.

λ Kia whakatühia e te Rangapü Hauora Tümatanui tëtahi röpu hei whakatau ingä whäinga rangahau, mätauranga hoki, e tötika ana mo te hauora tamariki.

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Te Häpaitanga i te Oranga Rangatahi

Hauora Mäori Tümatanui, Whäinga Whänui 3

Ki te kökiri, ki te tiaki i te hauora rangatahi.

Whäinga Paetaeλ Ki te whakaheke i ngä päpätanga mate, te wharanga, me te hauätanga ka puta

i ngä tütukinga motokä .λ Ki te whakaheke i te kainga paipa , te hänga auahi paipa, me ngä whakararu

kino ka puta mai.λ Ki te whakatïtina i te whanonga tötika e pä ana ki te onioni, e whakaheke ai

ngä hapütanga käore i äta whakaritea, me te pänga o ngä mate paipai, mateärai kore hoki.

λ Ki te whakapai ake i te hauora, mä te whakaheke i ngä kino ka puta i te kaiwaipiro.

λ Ki te whakapai ake i te hauora, mä te whakaheke i ngä kino ka puta i te hongikäpia.

λ Ki te whakatïtina i te hauora hinengaro, ki te whakaheke hoki i ngä päpätangawhakamomori.


λ Ki te whakaheke i ngä päpätanga mate Mäori ka puta i te tütukinga motokä,mai i te 84 i te tau 1990, ki te 64 iti iho a te tau 1995, ki te 44 iti iho a te tau2000.

λ Ki te whakaheke i ngä päpätanga uru hohipera a te Mäori, ka puta i te tütukingamotokä, mai i te 1,612 i te tau 1991, ki te 1,312 iti iho a te tau 1995, ki te1,012 iti iho a te tau 2000.

λ Ki te whakaheke i te tokomaha o ngä wähine Mäori e kaipaipa ana i te wä ehapü ana rätou, mai i te 66 örau (1992) ki te 50 örau iti iho a te tau 2000.

λ Ki te mahi tahi me Te Puawai Tapu, Te Ohu Whakatipu, me te iwi Mäori, ki tewhakatau whäinga e tötika ana mö te whakaheke i ngä hapütanga käore i ätawhakaritea, i waenganui i te hunga rangatahi.

λ Ki te whakakore i te piki o te päpätanga mate ärai kore e whakaatuhia ana iroto i ngä aro turukitanga, ä, ki te mahi tahi me Te Puawai Tapu, Te OhuWhakatipu, me te iwi Mäori, ki te whakatau whäinga e tötika ana mö tewhakaheke i ngä mate paipai i waenganui i te hunga rangatahi.

λ Ki te mahi tahi me te iwi Mäori ki te whakatau whäinga e tötika ana mö teärainga whakamomori, me ngä kino ka puta i te kai waipiro, me te höngikäpia.

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Ko Ngä Tütohotanga Kaupapa Here Hauora TümatanuiKa täpiri haerehia tënei tütohutanga ki te hötaka a ngä kaimahi a te RangapüHauora Tümatanui.

λ Kia mahi tahi te Rangapü Hauora Tümatanui me te iwi Mäori ki te whakataukaupapa here e ärai atu ai ngä mate paipai, te mate ärai kore, te höngi käpia,me te whakamomori i waenganui i te hunga rangatahi.

λ Kia mahi tahi te Rangapü Hauora Tümatanui, te iwi Mäori, me ngä whakahaeree tika ana, ki te whakatau kaupapa here mö te whakaheke i ngä hapütangakäore i äta whakaritea i waenganui i te hunga rangatahi.


λ Kia mahi tahi te Rangapü Hauora Tümatanui me te iwi Mäori ki te whakatühötaka mö ënei ähuatanga, arä, te äta whakarite whänau, ngä whakaakorangamö mua, mö muri hoki i te whänautanga pëpi, te hongi käpia, me te äraingawhakamomori.

λ Kia mahi tahi te Rangapü Hauora Tümatanui me ërä o ngä röpu e tika ana, kite mätua whakarite, e tötika ana ngä whakaakoranga mö mua, mö muri hoki ite whanautanga pëpi mö ngä mätua taiohi Mäori.

Ngä Tütohutanga Rangahau, Mätauranga hokiKa täpiri haerehia tënei ki roto i te hötaka a ngä kaimahi a te Rangapü HauoraTümatanui. Ka whai wähi atu te Rangapü Hauora Tümatanui ki te KauniheraRangahau Hauora o Aotearoa, mä tëtahi türanga i tö rätou Komiti WhakamahereTohutohu.

λ Kia mahi tahi te Rangapü Hauora Tümatanui me ngä röpu e tötika ana ki tewhakatau huarahi e kohia ai ngä raraunga e pä ana ki te hapütanga käore i ätawhakaritea, ngä päpätanga mate paipai, mate ärai kore hoki, me te hongi käpia,i waenganui i te hunga rangatahi.

λ Kia whakaarohia e te Kaunihera Rangahau Hauora o Aotearoa me tuatahitiangä rangahau e pä ana ki te whakamahi i ngä pükoro ure hei ärai hapü iwaenganui i te hunga rangatahi, ä, ki te whakatau mehemea ko te utu te takekäore e whakamahia whänuitia e rätou.

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Te Häpaitanga i te Oranga Pakeke/Matua

Hauora Mäori Tümatanui, Whäinga Whänui 4Ki te kökiri, ki te tiaki i te hauora pakeke/matua.

Whäinga Paetaeλ Ki te whakaheke i te kainga paipa , te hänga auahi paipa, me ngä whakararu

kino ka puta mai.λ Ki te whakapai ake i te hauora, mä te whakaheke i ngä kino ka puta i te kai

waipiro .λ Ki te whakaheke i ngä päpätanga mauiuitanga, hauätanga, matenga hoki, ka

puta i te mate manawa me te ikura roro .λ Ki te whakaheke i ngä päpätanga mauiuitanga, hauätanga, matenga hoki, ka

puta i te mate pukupuku .λ Ki te whakatïtina i te hauora hinengaro .λ Ki te whakaheke i ngä päpätanga hauätanga, matenga hoki, ka puta i te mate

huka.

Ngä Tütohutanga WhaihuaKa aro turukihia ënei tütohutanga i roto i te pürongo-a-tau mö te hauora tümatanui,Our Health, Our Future, Hauora Pakari, Koiora Roa.λ Ki te whakaheke i te päpätanga mate ka puta i te mate pukupuku o te waha

whare tangata i roto i te wahine Mäori i waenganui i te 20 me te 69 tau tepakeke, mä te 20 örau a te tau 1995, mä te 50 örau nui atu, a te tau 2000.

λ Me haere tonu ngä akoako me te iwi Mäori, e kitea ai ngä whäinga hua tötikamö te mate manawa, te mate romohä, te mate hinengaro, ëtahi o ngä matepukupuku, me te mate huka.

Ko ngä Tütohotanga Kaupapa Here Hauora TümatanuiKa täpiri haerehia tënei tütohutanga ki te hötaka a ngä kaimahi a te RangapüHauora Tümatanui.λ Kia mahi tahi te Rangapü Hauora Tümatanui me te iwi Mäori ki te whakatau

kaupapa here, e ärai atu ai te mate manawa, te mate romohä, ëtahi o ngä matepukupuku, me te mate hinengaro i waenganui i te hunga pakeke/matua.

Ko Ngä Tütohutanga Hötaka Hauora TümatanuiKa täpiri haerehia ënei tütohutanga ki te mahere hokonga a te Rangapü HauoraTümatanui, ina ka wätea mai he pütea.λ Kia hokona tonutia e te Rangapü Hauora Tümatanui tëtahi hötaka 'oranga

wahine' mö te Mäoriλ Kia mahi tahi te Rangapü Hauora Tümatanui me te iwi Mäori ki te whakatïtina

i tëtahi hötaka 'oranga pakeke/matua'.

Ngä Tütohutanga Rangahau, Mätauranga hokiKäore kau he tütohutanga motuhake i könei.

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Te Häpaitanga i te Oranga Kaumätua

Hauora Mäori Tümatanui, Whäinga Whänui 5Ki te kökiri, ki te tiaki i te hauora kaumätua.

Whäinga Paetaeλ Ki te pupuri, ki te whakapai ake i te koringa i waenganui i te hunga kaumätua.λ Ki te whakaheke i ngä päpätanga mate ka puta i ngä wharanga.λ Ki te tiaki i ö tätou kaumätua kia kaua rätou e pängia ki ngä mate hopuhopu e

taea te ärai atu, përä i te mate rewharewha.λ Ki te whakaheke i ngä päpätanga mate, hauä hoki, ka puta i te pouri rawatanga ,

ä, ki te whakatïtina i te hauora hinengaro.λ Ki te whakaheke i te hauätanga ka puta i te mimi turuturu.λ Ki te pupuri, ki te whakapai ake i ngä ratonga tautoko i ö tätou kaumätua.

Ngä Tütohutanga WhaihuaMe haere tonu ngä mahi titiro ki ngä take nei, arä, te roanga o te koiora tangata,te kounga o te koiora tangata, me ëtahi atu take hauora tümatanui.

Ko Ngä Tütohotanga Kaupapa Here Hauora TümatanuiKa täpiri haerehia tënei tütohutanga ki te hötaka a ngä kaimahi a te RangapüHauora Tümatanui.λ Kia whakatühia e te Rangapü Hauora Tümatanui, te iwi Mäori me ëtahi atu

whakahaere tötika, tëtahi röpu hei whakatakoto tohutohu kaupapa here mö tehauora kaumätua. Me whai wähi hoki ënei ähuatanga nei: te koringa, ngäwharanga, ngä mate hopuhopu, te hauora hinengaro, te ärainga mimi turuturu,me ngä ratonga tautoko i ö tätou kaumätua.

Ko Ngä Tütohutanga Hötaka Hauora TümatanuiKa täpiri haerehia ënei tütohutanga ki te mahere hokonga a te Rangapü HauoraTümatanui, ina ka wätea mai he pütea.λ Kia whanakehia e te Rangapü Hauora Tümatanui he rauemi mätauranga tötika

mö te koringa, ngä wharanga pokerehü, ngä mate hopuhopu, te hauorahinengaro, te mimi turuturu, me ngä ratonga tautoko e tika ana mö ö tätoukaumätua.

Ngä Tütohutanga Rangahau, Mätauranga hokiKa täpiri haerehia tënei tütohutanga ki te hötaka a ngä kaimahi a te RangapüHauora Tümatanui.λ Kia whäia e te Rangapü Hauora Tümatanui, he raraunga whakaatu i te tü o te

hauora tümatanui o te hunga kaumätua, te urunga mai o te hunga kaumätua kiroto i ngä hötaka hauora tümatanui, me tö rätou whai wähitanga atu ki temätauranga hauora, ä, ki te whakatau hoki mehemea e hängai ana te whai huao ënei ähuatanga ki ö rätou hiahia mö ngä tau e heke mai ana.

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Te Whanake i te Mäori hei Kaihoko,Kaiwhakarato

Hauora Mäori Tümatanui, Whäinga Whänui 6Ki te whakapai ake i te tü o te hauora Mäori, kia örite ki tërä o Tauiwi i rotoi ngä tau kei te heke mai.

Whäinga Paetaeλ Kia hängai tötika ngä ratonga katoa e hokona ana e te Rangapü Hauora

Tümatanui ki ngä tikanga Mäori, me te whakapiki haere i te tü o te hauoraMäori.

Ngä Tütohutanga Whaihuaλ Me haere tonu ngä mahi titiro ki ngä take nei, arä, te roanga o te koiora

tangata, te kounga o te koiora tangata, me te hononga ki te mana Mäori mö tehokonga mai me te whakahaere i ngä ratonga hauora tümatanui.

Ko ngä Tütohotanga Kaupapa Here Hauora TümatanuiKa täpiri haerehia tënei tütohutanga ki te hötaka a ngä kaimahi a te RangapüHauora Tümatanui.λ Kia whakanuia ake e te Rangapü Hauora Tümatanui te whai wähitanga mai a

te Mäori ki roto i ngä whakaritenga hoko, Ka arotakengia tënei ähuatanga.

Ko Ngä Tütohutanga Hötaka Hauora TümatanuiKa täpiri haerehia ënei tütohutanga ki te mahere hokonga a te Rangapü HauoraTümatanui, ina ka wätea mai he pütea.λ Kia whakahaerehia e te Rangapü Hauora Tümatanui he hui whakangungu i

ngä kaiwhakarato hauora Mäori, ngä mea hou, ngä mea türoa hoki.λ Kia whakatühia e te Rangapü Hauora Tümatanui tëtahi whakaritenga hoko

mö te motu whänui.λ Kia whakatühia e te Rangapü Hauora Tümatanui tëtahi whakaritenga-a-takiwä

tuarua mö te hokonga a ngä kaipupuri pütea, kia rite ki ngä whakaritenga e tüana inäianei.

λ Kia täia e te Rangapü Hauora Tümatanui tëtahi pürongo ia hauwhä o te tau,ko te kaupapa, ko ngä ratonga hauora Mäori.

λ Kia tühurangia e te Rangapü Hauora Tümatanui ngä huarahi e uru ai te Mäori,e noho pümau ai te Mäori ki roto i ngä whakangungutanga rongoä hauoratümatanui.

Ngä Tütohutanga Rangahau, Mätauranga hokiKa täpiri haerehia tënei tütohutanga ki te hötaka a ngä kaimahi a te RangapüHauora Tümatanui.λ Kia tirohia tahitia e te Rangapü Hauora Tümatanui me ëtahi atu röpu e tötika

ana, te whanaketanga i ngä kaimahi hauora, ki te täutohu i te ähua o ngäkaimahi o näianei, ngä painga, ngä mea käore i te tino pakari, me ngä hiahiamö ngä rä kei te heke mai.

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Nga Kupu Hou I Puta I TeWhakamaoritanga o He Matariki

ahurea culture

akoako consultation

aro matawai assessment

aro turuki monitor

arotake review

ähukahuka recognise

ärohi check/examine

haepapa responsibility

hangapori societal structures

häpori community

hohoretanga deficiency

hongi käpia substance abuse

hötaka programme

huangö asthma

ikura roro stroke

mate hopuhopu infectious disease

kai tötika nutrition

karawaka measles

kätoitoi responsive

kounga quality

mare tetekö whooping cough

mate ärai kore HIV/AIDS

mate paipai STD

mate pukupuku cancer

mate romohä cerebrovascular disease

matepä hazardous

mimi turuturu incontinence

hauora-a-niho oral health

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pata kai cereals

päpätanga rate

päpori society

pokerehü unintentional

porihanga whänui wider society

pouri rawatanga depression

purakitanga taringa glue ear

pünaha system

püngao energy

rawaka sufficient/adequate

rongo korenga hearing loss

tau o te tahua financial year

tauira whakakitenga role model

täutohu identify

te paunga o te häora toru ozone depletion

te tü o te hauora Mäori Maori health status

tökeke korenga inequality

tui tui co-ordination

tüäpapa foundation

tühura explore

tümatanui public/open

tütohutanga recommendations

waikawa matü pühake saturated fatty acids

whakakoia affirm

whakamahere plan

whakamomori suicide

whakangungu training

whakatïtina promote/encourage

whanake develop

whanonga behaviour

whäinga hua outcome targets

whäinga paetae objectives

whäinga whänui goals

Documents

He Mihi - Ministry of Health NZ · 2014-03-04 · 1 He Mihi Kua tïtaha te ra, kua tü-ä-tö, kei whiti atu te rä ki tua o Täwauwau. E ngä iwi, e ngä reo e ngä whakahuahuatanga