He Korowai Oranga - Māori Health Strategy

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Date of Publication: November 2002 It is also available as a PDF file to download or print.
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Te Ara Tuawha - Pathway Four
Working across sectors

This pathway directs the health and disability sector to take a leadership role across the whole of government and its agencies to achieve the aim of whanau ora by addressing the broad determinants of health and organising services around the needs of whanau rather than sectors or providers.

Effective development and care of whanau should take economic and social situations, cultural frameworks, values and beliefs into account. It should acknowledge whanau rights to high-quality and safe health services.

Prerequisites to improved whanau ora include:

• affordable, appropriate, available and effective education, income and housing

• affordable, appropriate, available and effective health and disability services

• ability to participate in te ao Māori

• ability to participate in New Zealand society as a whole

• a healthy environment.

Barriers to addressing these prerequisites include:

• unsafe working conditions with little job control

• unemployment

• inadequate housing

• crime

• high disparities in income and wealth

• unfavourable economic conditions

• violence

• discrimination

• institutionalised racism.

The work of other sectors impacts on the health of whanau, and the Ministry of Health is developing practical advice to other sectors on how they can contribute to reducing inequalities.

This advice will include:

• working intersectorally

• collecting ethnicity data

• best practice in relation to population groups

• behavioural risk factors

• social and economic determinants of health (eg, housing and education).

Improvements in whanau ora may also lead to positive outcomes for whanau in other areas, such as education and employment.

Te Ara Tuatahi (whanau development) is about supporting whanau to identify their own strengths and fostering the conditions required to build on those strengths. Te Ara Tuawha (working across sectors) is about government sectors and DHBs working together to address the wider determinants of Māori health and to co-ordinate the delivery of services to whanau to complement whanau, hapu and Māori community development.



Encouraging initiatives with other sectors that positively affect whanau ora

Objective 4.1


Whanau ora and public health

Health must be pursued in the context of the community in which whanau live. Fostering and protecting the conditions that will encourage health and wellbeing is a primary focus of the public health sector.

Public health – or population health, as it is sometimes called – is about promoting wellbeing and preventing ill health before it happens. It aims to improve the health of populations, not just treat disease, disorders or disabilities at an individual level. The aim is to have many people participating in preventive measures for health gain.

The public health sector plays a part in ensuring the safety of the air we breathe, the water we drink and the food we eat (Ministry of Health 1997). Public health is most evident when public health sector workers take a lead role in disease prevention, health promotion and health protection.

Examples include:


Tamariki ora (Well child) services (including immunisation and oral health)

In 2001, over 250 health providers delivered outreach immunisation services nationally. Most Māori providers and general practices help facilitate access to services, and a range of mobile community-based providers also carry out vaccinations.


Tobacco control programmes

Public health has a variety of tobacco control programmes, including media campaigns and enforcing smokefree legislation. For Māori the Aukati Kai Paipa pilot programmes advocating smoking cessation for Māori women was completed in 2001. Initial results are positive compared to other national and international campaigns, and over 3000 Māori women enrolled to quit smoking. Another 345 Māori community health workers were trained in the use of smoking cessation guidelines.


Non-communicable disease prevention

Public health instigates services such as breast and cervical screening and services to protect against chronic diseases such as heart disease, stroke and diabetes (in all of which Māori experience higher rates of mortality and morbidity than non-Māori).

The public health sector encourages and supports work by the personal health and disability support sectors as well as public health work undertaken by individuals (eg, doctors and pharmacists), and other sectors such as Local Government, Social Policy, Transport, Conservation, Environment and Housing.


Hauora taiao – environmental health

Protecting Papatuanuku (mother earth) and Ranginui (sky father) and the realm of Tangaroa (seas) from the effects of toxins and pollution is an important feature to protecting the health and wellbeing of the whanau.

Māori views on hauora taiao (environmental health) have been recognised in legislation (eg, the Resource Management Act 1991). These views are also reflected in public health initiatives. Public health helps to create healthy physical, social, and cultural environments. Supportive environments and strong, active communities play an important part in the health of individuals and whanau.

It is important for the Ministry of Health and DHBs to ensure that Māori views to protect and restore te taiao (the environment) are included in such initiatives, as well as involving whanau, hapu, iwi and Māori communities in the design and planning of such initiatives.


Implementing intersectoral initiatives

The Ministry of Health and DHBs will work to engage other government agencies to implement specific whanau ora initiatives and community-based strategies.

Working across sectors seeks to improve whanau and Māori health by:

• ensuring that other sector agencies take into account the health impact of their activities, and then develop initiatives which positively affect whanau ora

• improving co-ordination between health and other service agencies where those agencies have a shared interest in whanau wellbeing and improved social outcomes

• fostering service integration based on the needs of whanau.

Whole of government approach

Iwi and the Government are working on initiatives to develop a ‘whole-of-government approach’ to services (eg, housing initiatives). Appropriate consultation with Māori, whanau, hapu, iwi and Māori communities is an important part of this development. DHBs need to be informed on such initiatives and consider how they might contribute to such developments.

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