The Asthma Foundation New Zealand Respiratory Conference 2013

1. TeHāo TeTangata Breathing Easy in Aotearoa The Asthma FoundationNew Zealand Respiratory Conference 2013 Mason Durie Massey University

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

3. Pou Ora 1: Hauora Compatible Environments Rangi and PapaLocked into an embrace that excluded light and life

4. Ki teAoMārama • 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

5. Environmental relationships, the common bonds Whanaungatanga

6. Rangi & Papa Environmental Impacts • 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.’

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

8. Hauora & Health • ‘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

9. Hauora as an ecological concept • 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

10. Hauora & Connectedness • 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

11. Complex Environments - easy and not-so- easy breathing for Kiwis • 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

12. PouOra 2 ToiOra Knowledge Transfers Toi = knowledge art human origins birthplace Ora = wellness alive safe recovery • ToiOra • Wellbeing associated with • Indigeneity • a sense of home • knowledge and information • Creativity

13. ToiOra • 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

14. ToiOra is about • 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

15. Pou Ora 3: Whānau Ora Empowering Relationships • Ora • safety • life • wellness Whānau • Kaupapa whānau –group with a common interest • Whakapapa whānau –group who share a common genealogy • Māori families – two-generational household

16. Whānau capacities • 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

17. Whānau interventions • Interventions can be aimed at: • changing the external impacts on relationships – an ecological approach (e.g. improving housing) • building whānaucapacities (e.g. building manaakitanga: capacity to care)

18. Whānau Outcome Goals • Whanau self management • Healthy whānau lifestyles • Full whānau participation in society • Confident whānau participation in te ao Māori • Whānau economic security • Whānau cohesion

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

20. Towards Flourishing • Hauora Compatible environments • ToiOra Knowledge environments • WhānauOra Nurturing environments

21. PouOra 4 MauriOra Enhanced Potential Mauri = a force for life human integrity human spirit human vitality individual uniqueness Ora = alert responsive lively

22. Mauri Oho A Flourishing Mauri • Spiritually robust • Culturally engaged • Emotional vitality • Positive thinking • Energetic • Able to participate in activities, events • Sustainable & rewarding relationships

23. Mauri Oho Indicators Mauri Oho Flourishing • 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

24. MauriNohoLanguishing Mauri Oho Flourishing • Cultural & spiritual alienation • Negative emotions • Knowledge gaps • Listlessness • Slow moving • Laboured btreathing • Negative relationships • Social isolation • Spiritually robust • Culturally engaged • Emotional vitality • Positive thinking • Energetic • Able to participate in activities, events • Sustainable & rewarding relationships

25. MauriNohoLanguishing Mauri Oho Flourishing • Cultural & spiritual alienation • Negative emotions • Knowledge gaps • Listlessness • slow moving • laboured breathing • Negative relationships • Social isolation • Spiritually robust • Culturally engaged • Emotional vitality • Positive thinking • Energetic • Able to participate in activities, events • Sustainable & rewarding relationships Wairua Hinengaro Tinana Whānau

26. The Challenge Creating environments where: the mauri can flourish and breathing is easy ToiOra Knowledge transfers Intellectual environments WhānauOra Empowering relationships Social environments (home, work, leisure) Hauora Compatible environments Natural & man-made environments

27. Some implications for prevention of disease & the management of disease

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

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

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