Pacific Health and Wellbeing Strategic Plan for the Greater Wellington Region 2020 to 2025 - Wairarapa ...

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Pacific Health and Wellbeing Strategic Plan for the Greater Wellington Region 2020 to 2025 - Wairarapa ...
Pacific Health and
Wellbeing Strategic
Plan for the Greater
Wellington Region
2020 to 2025
Pacific Health and Wellbeing Strategic Plan for the Greater Wellington Region 2020 to 2025 - Wairarapa ...
Talofa lava
           Samoan

                                      Kia Orana
                                            Cook Island

Ni Sa Bula Vinaka
                             Fijian

                                      Malo e lelei
                                                Tongan

Malo Ni
    Tokelaun

                        Fakalofa lahi atu
                                              Niuean

Talofa koutou
                    Tuvalu

                                          Mauri
                                              Kiribati
Pacific Health and Wellbeing Strategic Plan for the Greater Wellington Region 2020 to 2025 - Wairarapa ...
Contents | 3

CONTENTS
 4      Foreword
 5      Our commitment
 6      Introduction
 7      Key strategic directions
 8      Our vision for Pacific peoples in the Greater Wellington Region
10      Principles of Pacific health care delivery across the 3DHBs
11      System enablers and pillars of systems change
12      So’oso’o le upega framework for guiding this plan
13      Our strategic priorities and measuring progress
14      Priority one: Pacific child health and wellbeing
18      Priority two: Pacific young people
22      Priority three: Pacific adults and ageing well
26      Priority four: Pacific health workforce and Pacific providers and non-governmental organisations
30      Priority five: Social determinants of health
34      Priority six: A culturally responsive and integrated health system
38      Appendix

ACKNOWLEDGEMENT
We wish to acknowledge the invaluable contributions of all those who provided input in to the
development of the Pacific Health and Wellbeing Strategic Plan for the Greater Wellington Region
2020 to 2025. In particular, our gratitude is extended to the Pacific communities who supported the
development of this plan by contributing their voices, stories, ideas and insights as well as our
provider community and DHB staff across the Greater Wellington region. We were delighted at the
response we received from communities and the interest there is to improving Pacific health outcomes.
Pacific Health and Wellbeing Strategic Plan for the Greater Wellington Region 2020 to 2025 - Wairarapa ...
4 | Pacific Health and Wellbeing Strategic Plan for the Greater Wellington Region 2020 to 2025

    FOREWORD

    It is our privilege to present the Pacific Health                        There are many health challenges facing our Pacific
    and Wellbeing Strategic Plan for the Greater                             communities. The priorities and strategies identified
    Wellington Region 2020 to 2025 for the Capital                           in this plan represent the key touch points that
    & Coast, Hutt Valley and Wairarapa District                              we believe will enable us to leverage improved
    Health Boards (3DHBs). This plan represents the                          outcomes as efficiently and effectively as possible.
    blueprint for meeting the changing needs of Pacific                      These priorities are as follows:
    individuals, families and communities over the
    next five years.                                                         1. Pacific child health and wellbeing
                                                                             2. Pacific young people
    This plan outlines the 3DHBs strong commitment                           3. Pacific adults and ageing well
    to improving the health and wellbeing of Pacific                         4. Pacific health workforce & Pacific providers/
    people. Pacific peoples do not always enjoy the                             non-governmental organisations
    same access, service experiences and health                              5. Social determinants of health
    and wellbeing outcomes as non-Pacific peoples.                           6. A culturally responsive and integrated health
    This plan recognises that we need a specific and                            system
    targeted approach to redressing inequities that exist
    within our health system. We believe that a core                         The above strategies do not cover all possible
    role of district health boards is to apply the revenue                   approaches to reducing health inequalities, but
    they receive to provide the best health care services                    rather the emphasis is on priorities where there
    that are culturally responsive to the needs of our                       is good reason to believe action by the 3DHBs
    Pacific populations.                                                     and its partners outside of health will lead to the
                                                                             attainment of better health and wellbeing outcomes
    We acknowledge that a range of factors such                              for our Pacific peoples.
    as education, housing, income, employment
    and social policies have a significant impact                            The 3DHBs are committed to implementing this
    on achieving better health outcomes for Pacific                          Pacific health and wellbeing strategic plan and
    peoples. We also recognise that we are operating                         we look forward to continuing to work with the
    in an increasingly complex and challenging health                        Pacific communities, partners and stakeholders to
    environment, with competing financial pressures                          achieving equity in access and, most importantly,
    and health interests, emerging health technologies                       equity in health outcomes for Pacific peoples and
    and pharmaceuticals, shortages in the health                             communities.
    workforce, and changing demographics.

    To this end, improving Pacific peoples health is not                                         David Smol
    only a mandate of the three district health boards,                                          Board Chair
                                                                                                 Capital & Coast District Health Board
    but it should be everyone’s business.
                                                                                                 Hutt Valley District Health Board

    Our vision for Pacific peoples is empowered
    and enabled Pacific peoples living longer quality                                            Sir Paul Collins
                                                                                                 Board Chair
    lives, supported by a culturally responsive
                                                                                                 Wairarapa District Health Board
    health system.

                                                                                                 Fa’amatuainu Tino Pereira
                                                                                                 Chair
                                                                                                 3DHB Sub Regional Pacific
                                                                                                 Health Strategic Group
Pacific Health and Wellbeing Strategic Plan for the Greater Wellington Region 2020 to 2025 - Wairarapa ...
Our commitment| 5

OUR COMMITMENT

Pacific health and improving equity of health           This plan has been developed in partnership with
outcomes is everyone’s responsibility and a key         the 3DHB Sub Regional Pacific Health Strategic
priority for our district health boards. Illustrating   Group, and reflects our joint commitment to
our commitment to this is our Pacific Health            accelerate Pacific health gain and achieve health
and Wellbeing Strategic Plan for the Greater            equity for Pacific peoples.
Wellington Region 2020 to 2025, which will
be incorporated into our day-to-day work as we          Our goal requires a collaborative effort and
take a whole-of-system approach to ensure the           robust leadership across the health system.
priorities in the plan are achieved.                    With demonstrated commitment and shared
                                                        accountability, the reality of better health
The plan provides the 3DHBs with a guiding              outcomes for all Pacific peoples will be realised.
framework, enabling us to improve and sustain
the development and delivery of health services
                                                                     Fionnagh Dougan
to Pacific communities. It is our collective                         Chief Executive
responsibility to ensure that this work makes a                      Capital & Coast and Hutt Valley
positive difference in the heath of Pacific peoples                  District Health Boards
in our Greater Wellington Region.
                                                                     Dale Oliff
                                                                     Chief Executive
                                                                     Wairarapa District Health Board

                                 Malu i pu’ega -
                         To lend aid in the undertaking
                                                                   Samoan proverb
Pacific Health and Wellbeing Strategic Plan for the Greater Wellington Region 2020 to 2025 - Wairarapa ...
6 | Pacific Health and Wellbeing Strategic Plan for the Greater Wellington Region 2020 to 2025

    INTRODUCTION

    This Pacific Health and Wellbeing Strategic                                                        community by Pacific providers, for example,
    Plan for the Greater Wellington Region 2020                                                        Pacific nurse-led services (Vaka Atafaga Nursing
    to 2025 represents the beginning of a new way                                                      service, Pacific Health Service Hutt Valley Primary
    of approaching service design and delivery for                                                     nurses and Thriving Cores Well Child Service,
    Pacific families and communities and builds on the                                                 Pacific Navigation Services, Pacific churches and
    progress of previous plans:                                                                        community leaders to name a few.

    •    Pāolo mo Tagata o le Moana HVDHB                                                              Unfortunately, Pacific peoples health, as measured
         & WrDHB Pacific Health Action Plan                                                            by most major indicators of health, still remains
         2015–2018                                                                                     poorer when compared to non-Pacific. Whilst many
                                                                                                       of the barriers Pacific peoples face such as cost, are
    •    Toe timata le Upega CCDHB Pacific Health
                                                                                                       shared with other groups in the Greater Wellington
         Action Plan 2017–2021
                                                                                                       Region, there are issues that are unique to Pacific
                                                                                                       peoples. Differences in health outcomes confirm
    This plan adopts a human rights based approach
                                                                                                       that there are also issues for specific groups within
    to health. There is a growing body of evidence
                                                                                                       Pacific communities.3
    confirming that health services reflect the dominant
    economic or cultural group. Consequently, in
                                                                                                       We are determined to build on the achievements
    practice, Pacific communities do not receive
                                                                                                       particularly focusing on programmes and
    equitable care.1 Varying degrees of social isolation,
                                                                                                       services that address health inequity and reduce
    acculturation, the impact of migration, and different
                                                                                                       discrimination. This will be done by advancing
    views of illness between Pacific communities
                                                                                                       strategies that support locally developed solutions,
    all impact on the ability to provide services that
                                                                                                       cultural and collaborative models of health care
    appropriately meet needs.2 Across the Greater
                                                                                                       that support individuals and families from a holistic
    Wellington Region we are committed to ensuring
                                                                                                       perspective and tailored to meet local need across
    policies, programmes and services provide a
                                                                                                       the Greater Wellington Region.
    level playing field and equal opportunities for
    best health possible for Pacific peoples regardless
                                                                                                       We recognise that many other organisations outside
    of age, gender, ability, religious beliefs or social
                                                                                                       of the health sector hold the levers to progress
    economic backgrounds.
                                                                                                       health outcomes. Inter-professional and
                                                                                                       inter-disciplinary teamwork, partnering across
    We acknowledge the gains and milestones reached
                                                                                                       health service providers and cooperation across
    in the last five years, with some improvement
                                                                                                       sectors, as well as including the voices of Pacific
    in access and interaction of Pacific peoples
                                                                                                       peoples, families and communities opens the way
    with the health system, partnerships across the
                                                                                                       for new and collaborative partnerships for shared
    health sector, AND innovations delivered in the
                                                                                                       solutions and innovative planning.

    1.   Southwick, M., Kenealy, T. Ryan, D. (2012). Primary Care for Pacific People: A Pacific and Health System Approach. Wellington: Pacific Perspectives.
    2.   ibid
    3.   Southwick, M., Kenealy, T. Ryan, D. (2012). Primary Care for Pacific People: A Pacific and Health System Approach. Wellington: Pacific Perspectives.
Pacific Health and Wellbeing Strategic Plan for the Greater Wellington Region 2020 to 2025 - Wairarapa ...
Key strategic directions|7

KEY STRATEGIC DIRECTIONS

This plan applies a Pacific approach and lens to      3. Strengthening accountability and performance
the strategic directions outlined in key strategic       monitoring across the health system – to
documents that guide our response to improving           hold ourselves liable and answerable to
the health and wellbeing of the Pacific communities      ensuring we are doing more than enough to
in the Greater Wellington Region. These include:         achieve equitable health outcomes for Pacific
                                                         peoples through consistent reporting and
•   CCDHB Health System Plan 2030                        measuring progress.
•   HVDHB Vision For Change 2017–2027
•   WrDHB Well Wairarapa – Better Health for All      4. Building the Pacific workforce – strengthening
    vision 2017                                          Pacific health providers providing sustainable
•   3DHB Sub-Regional Disability Strategy                resources for long-term, rather than short-term
    2017–2022 Enabling Partnerships:                     funding.
    Collaboration for effective access to health
    services                                          5. Inclusiveness – ensuring that Pacific disabled
•   Ministry of Health Ola Manuia Pacific Health         children, youth and adults and their families
    Plan 2020–2025                                       are also at the centre of service and programme
•   Faiva Ora National Pasifika Disability Plan          decision-making and are not left behind.
    2014–2016                                            Recognising that those with a disability may
•   The Child and Youth Wellbeing Strategy 2019,         have extra barriers to overcome in accessing
    Department of the Prime Minister and Cabinet         health services than most.
•   PHARMAC Pacific Responsiveness Strategy
    2017–2026                                         6. Robust evidence base – implementing and
•   Minister of Pacific Peoples Priorities               investing in what is already working and
•   Whānau Ora commissioning                             building evidence through research, monitoring
                                                         and evaluation.
The key strategic directions:
                                                      7. Integrated planning – strengthening integrated
1. Equity – advancing decisions, solutions and           planning and service delivery and accelerating
   innovations that eliminate health inequalities        the shift of services closer to home.
   for Pacific peoples.
                                                      8. Culturally responsive services – developing and
2. Collaboration – strengthening partnerships            sustaining culturally safe and competent health
   including integrated planning and service             services and work settings including elimination
   delivery with both health and non-health              of racism and developing strategies to mitigate
   partners across different sectors and Pacific         negative attitudes and behaviours.
   communities.
Pacific Health and Wellbeing Strategic Plan for the Greater Wellington Region 2020 to 2025 - Wairarapa ...
8 | Pacific Health and Wellbeing Strategic Plan for the Greater Wellington Region 2020 to 2025

    OUR VISION FOR PACIFIC PEOPLES IN
    THE GREATER WELLINGTON REGION

                  “
                  Our Pacific peoples are
                  empowered and enabled
                  to live longer quality lives,
                  supported by a culturally
                  responsive health system.

                                                                                                 ”
Pacific Health and Wellbeing Strategic Plan for the Greater Wellington Region 2020 to 2025 - Wairarapa ...
Our vision | 9
Pacific Health and Wellbeing Strategic Plan for the Greater Wellington Region 2020 to 2025 - Wairarapa ...
10 | Pacific Health and Wellbeing Strategic Plan for the Greater Wellington Region 2020 to 2025

    PRINCIPLES OF PACIFIC HEALTH CARE
    DELIVERY ACROSS THE 3DHBS
    In the development of this plan, it is important to                  The five key principles:
    foreground Pacific peoples as diverse with unique
    values, cultural intelligence, social capital, differing                   FAMILY
    languages and lived experiences. ‘Pacific peoples’                         Family underpins identity, genealogy,
    is an umbrella term used to describe a population                          relationships and a sense of belonging for Pacific
    made up of 16 distinct and diverse cultures of                             peoples. It lies at the heart of who Pacific
    peoples from Melanesia, Polynesia and Micronesia.                          peoples are as every Pacific person belongs to
    In the Greater Wellington Region the seven largest                         an aiga or kainga.
    ethnic groups are Samoan, Tongan, Cook Island
    Maori, Niuean, Fijian, Tokelauan, Tuvaluan.4                               ENVIRONMENT
                                                                               Built and natural environments are important
    By making this the focal point, we commit as                               to Pacific peoples. Their connectedness and
    district health boards to ensure that Pacific people                       experiences of both plays a huge role in the
    are actively involved in co-designing services and                         holistic approach to health and wellbeing.
    programmes that help address difficulties based
    on “one size does not fit all” due to the growing                          SPIRITUAL
    diversity of Pacific peoples and their ability to                          Churches have historically played a crucial role
    access quality and responsive services. We are                             in the lives of Pacific peoples, providing spiritual
    putting a stake in the ground and acknowledging                            guidance with values such as faith, integrity,
    that as navigators of this wide ocean that we                              truth and trust. Churches are still an integral
    call the health system, we owe it to our Pacific                           part of Pacific communities and their everyday
    communities and other indigenous ethnicities to                            lives.
    reconstruct a system that they can voyage through
    without difficulty.                                                        RESPECT
                                                                               Showing respect when relating to one another
    We have chosen five key principles or values                               is an important aspect for Pacific peoples right
    common across Pacific cultures that are weaved                             from an early age. This includes respect towards
    through this plan, and will guide our work                                 older people, people in positions of authority,
    alongside the input of Pacific communities                                 each other, women and children.
    through community leaders, churches, providers
    and others.                                                                CULTURE
                                                                               Cultural diversity such as the different
                                                                               languages, ethnicities, gender, generational
                                                                               issues (New Zealand-born and Pacific-born),
                                                                               religion, and sexual orientation influences how
                                                                               Pacific peoples view and respond to health
                                                                               services. This diversity is also evident and seen
                                                                               in individuals and family practices, behaviours,
                                                                               understanding and responsiveness to the world
                                                                               around them.

   4.   Statistics New Zealand, 2018.
System enablers and pillars of systems change | 11

SYSTEM ENABLERS AND PILLARS
OF SYSTEMS CHANGE

                Build new and strengthen existing partnerships and networks with multiple
PARTNERS AND    organisations, Pacific communities and individuals. Leverage off strengths and
NETWORKS        skill sets of different organisations. Also look at new partnerships to create a
                shared sense of ownership and responsibility to deliver the best services for
                Pacific peoples.

                The way we commission services and invest will be more intentional and
COMMISSIONING   targeted. We will explore re-commissioning identified services run by the
                DHBs into the community. System funding should also be aligned, sustainable
                and equitable to ensure resources are distributed to scaling up and supporting
                programmes that are already working and meet the needs of the Pacific
                community. For instance, initiatives that are run in the community by Pacific
                providers or faith-based Pacific organisations. In addition, priority activities
                are explicitly outlined in contracting work to ensure a strong equity focus for
                Pacific peoples.

                Leverage off the influence we have to accelerate and progress change at
INFLUENCE AND   not only at policy, planning, service and programme levels locally, regionally
ADVOCACY        and nationally.

                We have access to the technology, evidence-based data and resources that
ICT AND         can be used and shared across to our primary care and community-based
KNOWLEDGE       partners to ensure decision making, investments and design processes. We
RESOURCE        will look at building and strengthening community infrastructure.

                We have a mandate to create a culturally sensitive work environment that
DHBS AS AN      entices and supports employees to feel and be their best. In addition, we can
EMPLOYER        influence creating a work environment that a Pacific skilled workforce want to
                be a part of and attracts.
12 | Pacific Health and Wellbeing Strategic Plan for the Greater Wellington Region 2020 to 2025

    SO’OSO’O LE UPEGA FRAMEWORK
    FOR GUIDING THIS PLAN

    The plan adopts a well used and known Pacific                            By using this framework, we acknowledge that the
    framework to illustrate how the 3DHBs are going                          cultural wisdom of Pacific peoples still defines and
    to work with its partners collectively to achieve                        shapes how information is processed, harnessed
    better health and wellbeing outcomes for Pacific                         and acted out. Therefore, meaningful and
    peoples. Upega (fishing net) is a Samoan fishing                         respectful relationships with the community are
    proverb and so’oso’o means connect. So’oso’o                             imperative to the design and implementation of this
    le Upega therefore means to connect (so’oso’o)                           plan. This ensures that the Pacific communities we
    other agencies to health and vice versa so that the                      serve are not just passive beneficiaries of services
    Pacific families we serve are being provided the                         but are stewards and managers of their own health
    best services that support them to address issues                        care and management.
    that have an impact on their health and wellbeing.
    By being purposeful and intentional in drawing on
    the knowledge, expertise and understanding of the
    Pacific communities to partner with the 3DHBs to
    bring about much needed and sustainable changes
    across areas of need in the health system.

                                                                                                        EMPLOYMENT
                                                                                                        AND INCOME
                                                                   G
                                                                  IN
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                                                                                                  ION
                                                                                         EDUCAT
                                         EN PHY
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                                                                                                     SOCIAL
                                                                                                  ENVIRONMENT

                                                                              E
                                                                            UR ITY
                                                                        U LT NT
                                                                       C IDE
                                                                          D
                                                                       AN
Our strategic priorities and measuring process | 13

OUR STRATEGIC PRIORITIES AND
MEASURING PROGRESS

Our six strategic priorities as identified and   These strategic priorities and priority actions,
informed by the Pacific communities are:         activities and performance indicators with
                                                 accompanying budgets will be embedded into
1. Pacific child health and wellbeing            the Annual Plan and existing performance and
                                                 accountability mechanisms of each district health
2. Pacific young people
                                                 board. Indeed, accountability and responsibility
3. Pacific adults and aging well                 towards reporting against this plan and achieving
4. Pacific health and disability workforce       measurable outcomes for Pacific peoples should be
   and Pacific providers/non-governmental        the responsibility of all levels of management.
   organisations
                                                 We know we have been successful when we see
5. Social determinants of health                 improvements in the following six priority actions:
6. Culturally responsive and integrated system

                          Takanga etau fohe -
                    Working together in harmony will
                    ensure success for our community
                                                                 Tongan proverb
14 | Pacific Health and Wellbeing Strategic Plan for the Greater Wellington Region 2020 to 2025

                                                PRIORITY ONE

                  Pacific child
                  health and
                   wellbeing
Priority one | 15

Our goal is to give Pacific children                       diabetes and having heavier babies. Pacific children
                                                           aged 0–14 years, also make up 55% of CCDHB
and their families the best possible
                                                           children, 33% of the Hutt Valley and 12% of
start in life and ensure they meet key                     Wairarapa who live in the most deprived areas.
childhood developmental milestones
through culturally responsive and safe                     Most ASH presentations of Pacific children to hospital
services and support.                                      were for asthma, dental conditions, gastroenteritis/
                                                           dehydration, upper respiratory tract infections and
                                                           cellulitis across the three DHBs. There also remains
RATIONALE                                                  a disparity in the percentage of Pacific children being
With a fast growing young population, Pacific              caries free by the age of five, higher rates of obesity
children, their families and support networks will         or overweight, and Pacific children turning 1 year old
benefit from early fanau-centred health and wellbeing      were less likely to have had all their scheduled core
interventions that are culturally sensitive, community     checks than children of other ethnicities, excluding
determined, partnerships driven and system enabled.        Māori. For Wairarapa Pacific children, 70% had
The early years and, in particular, the first 1,000 days   received all their core checks, 57% of Hutt Valley
of life is a crucial time and a window of opportunity      Pacific children and 69% of Capital & Coast Pacific
whereby efforts need to be concentrated to enable the      children.
best start to life for our Pacific children.
                                                           Efforts should be focused on the provision of
                                                           culturally responsive maternal health services that
WHAT THE DATA TELLS US                                     support healthy pregnancies and delivered close
                                                           to and in people’s homes and in the communities.
Latest data tells us that children aged under 15 years
                                                           We want to see easy access and better engagement
make up 33% of the Wairarapa Pacific population,
                                                           in reproductive, perinatal, antenatal and postnatal
29% in the Hutt Valley and 27% for Capital & Coast
                                                           services for Pacific mothers.
DHB. And that over 60% of the Pacific population
in the Greater Wellington Region are now
                                                           In addition, we need to progress health services
New Zealand born. There have been improvements
                                                           support and care that focus on good nutrition
in health outcomes as evidenced by a decrease in
                                                           and physical activity, smoking cessation, positive
Ambulatory Sensitive Hospitalisation (ASH) rates for
                                                           parenting, immunisation, warm homes, mental health
Hutt Valley and Capital & Coast Pacific children in the
                                                           and wellbeing of parents are crucial for healthy
last 5 years. There is increased newborn enrolment
                                                           physical and social development.
with a general practice and community oral health
service. There are improvements in immunisation
                                                           Certainly approaches that focus on the strengths
rates, an increased percentage receiving WellChild/
                                                           of Pacific families with a spotlight on parents, a
Tamariki Ora core checks in their first year and B4
                                                           mother’s overall wellbeing, focus on the role of
School checks by the time they are four years old.
                                                           grandparents, strengthening communities and
                                                           empowering families economically, socially and
However, despite improvements in health we are also
                                                           educationally will provide environments and
seeing higher rates of caesarean for Pacific mothers,
                                                           foundations that bring up strong, healthy Pacific
lower uptake of antenatal or postnatal maternity
                                                           children. Research and literature affirms that if
services, pregnant Pacific mothers registering and
                                                           we focus our efforts on fanau-centred approaches
seeing a Lead Maternity Carer in their first trimester,
                                                           that provide support, and work with families and
and increasing complexities due to gestational
                                                           what they care about in their homes, our young
                                                           children benefit.
16 | Pacific Health and Wellbeing Strategic Plan for the Greater Wellington Region 2020 to 2025

    We want the Greater Wellington Region to be one                           •    Primary Health Organisations (PHOs) and
    of the best places in New Zealand to raise healthy,                            Pacific providers
    thriving Pacific children. These actions will focus                       •    Well Child tamariki Ora (WCTO) providers
    on supporting timely and quality access to health                         •    addressing causes and issues with ASH
    care and advocating and influencing early childhood                       •    mental health and wellbeing
    development initiatives in other sectors like education                   •    cross agency collaborations and integrated
    and social services. We will also be specifically                              partnerships to address social determinants
    focused on working collaboratively to improve access                           of health
    and engagement of Pacific families with:                                  •    childhood obesity-focused initiatives
                                                                              •    good oral health
                                                                              •    breastfeeding rates
                                                                              •    smokefree and warm, healthy homes.

                 Ia ifo le fuiniu i le lapalapa -
     As to each coconut leaf belongs to a cluster of young
         nuts, so each individual belongs to his family
                                                                                                               Samoan proverb
Priority one | 17

             PRIORITY ONE:                                                                                                                                                KEY FOR
                                                                                                                                                                                                                 Partners and networks

                                                                                                                                                                                                                 Commissioning

             Pacific child health and wellbeing
                                                                                                                                                                          SYSTEM ENABLERS
                                                                                                                                                                                                                 Influence and advocacy
                                                                                                                                                                          Note: Targets will be set using
                                                                                                                                                                          national targets or to improve on      ICT and knowledge resource
                                                                                                                                                                          current performance. Targets will be
                                                                                                                                                                          incorporated into DHB annual plans.    DHBs as an employer

                                                      Goal 1: To give Pacific children and their families the best possible start in life
System enablers                    Actions to achieve this outcome                                How will we know there’s been improvement?                                                Measures of improvement

                                                                                         •   Increased uptake and improved access of Pacific mothers to
                                                                                                                                                                  •    Percent of Pacific pregnant women registered with a Lead
                                                                                             antenatal and postnatal maternity services.
                  1. Support family-centred initiatives to reach pregnant mothers,                                                                                     Maternity Carer within the first trimester of pregnancy.
                                                                                         •   Responsive child health, oral health and disability support services
                     parents, babies and families.                                                                                                                •    Percent of Pacific mothers using antenatal services.
                                                                                             wrapped around to support the needs of Pacific mothers and
                                                                                                                                                                  •    Percent of Pacific mothers rating services as meeting their needs.
                                                                                             children.

                                                                                         •   A decrease in avoidable hospital admissions for Pacific children.
                                                                                                                                                                   •   Rate of ASH for children aged 0–4 years (per 100,000 people).
                  2. Collaborate with appropriate stakeholders to promote safe           •   Increase the number of Pacific children living in healthy homes
                                                                                                                                                                   •   Percent of Pacific babies living in smokefree households at 6
                     environments for bringing up Pacific children including warm            that are warm and smokefree.
                                                                                                                                                                       weeks old.
                     homes, smokefree homes, good nutrition, safe sleeping, reducing     •   Improved Pacific provider system integration and coordination
                                                                                                                                                                   •   Rate of hospitalisations potentially related to housing conditions
                     smoking and alcohol consumption.                                        between the community, across primary, secondary, and tertiary
                                                                                                                                                                       per 1,000 population for children under 15 years age.
                                                                                             care providers and other sector partners.

                                                                                         •   Strengthened approach through inter-agency partnerships to            •   Percent of Pacific infants fully or exclusively breastfed at 3
                  3. Work with relevant stakeholders to develop targeted initiatives
                                                                                             address timely access to maternity services and birthing options.         months.
                     campaigns that focus on increased rates and duration of
                                                                                         •   Strengthen Pacific breastfeeding services, and child immunisation     •   Percent of Pacific children fully vaccinated at eight months old,
                     breastfeeding and immunisation uptake for Pacific children.
                                                                                             services.                                                                 two years old and five years old.

          Goal 2: Ensure Pacific children meet key childhood developmental milestones through culturally responsive and quality services and support

                                                                                         •   Increase in children receiving all their core checks.                 •   Percent of Pacific children accessing Well Child/Tamariki Ora
                  4. Leverage existing Well Child/Tamariki Ora services and Pacific-
                                                                                         •   Better collaboration between Well Child/Tamariki Ora services             services and completing core checks.
                     specific Well Child services and partnerships and build up these
                                                                                             through collective programmes and projects developed across the       •   Percent of eligible Pacific children receiving and completing B4
                     providers to reach the most vulnerable families.
                                                                                             health system.                                                            School Checks.

                                                                                         •   Increased knowledge and understanding of parents and caregivers
                  5. Work collaboratively with Bee Healthy regional screening services       of healthy foods to nourish young children.                           •   Percent of Pacific children (0–12) enrolled in Community and DHB
                     and key stakeholders on projects and initiatives to improve         •   More Pacific children with healthy teeth.                                 oral health services overdue for their scheduled examinations.
                     coverage of screening and preventative oral health interventions.   •   Increase in number of children receiving their annual dental          •   Percent of Pacific children caries free at 5 years and 12 years old.
                                                                                             examinations.

                                                                                         •   Strengthen support for initiatives that address family violence and
                                                                                                                                                                   •   Number of referrals to relevant services during discharge planning.
                  6. Work collaboratively with key stakeholders to reduce the rates of       work with relevant stakeholders on preventative measures.
                                                                                                                                                                   •   Number of inter-agency collaborations with the DHB to support
                     family violence in Pacific communities.                             •   Increased role of health services through inter-agency
                                                                                                                                                                       Pacific families and ensure they access the right services.
                                                                                             collaborations to support Pacific families.
18 | Pacific Health and Wellbeing Strategic Plan for the Greater Wellington Region 2020 to 2025

                                               PRIORITY TWO

             Pacific young
                people
Priority two | 19

Pacific young people have timely                            we are seeing a rise in mental health issues, suicide
                                                            attempts, sexually transmitted infections, smoking,
access to services and programmes
                                                            preventable injuries, obesity and family violence.
that enables them to grow into healthy                      Our young people identified during the consultations
adults and lead productive lives.                           the close link between mental health and the result
                                                            of identity crises, poverty, lack of culturally sensitive
RATIONALE                                                   health care models, stigmatisation and discrimination.

Pacific young people growing up in the Greater              Tackling the risk factors associated with these issues,
Wellington Region are contributing positively to their      alongside sufficient investment to advancing progress
families and society and are progressing well in many       made in some areas and investment in new and
areas. However, with the majority now classified as         innovative ways to support our young people to thrive
New Zealand born and identifying with more than             is our goal. Particularly given that across the Greater
one ethnicity, our Pacific young people still face issues   Wellington Region in the next 10 years most of the
that previous generations may not have experienced          Pacific population growth will be in the age groups
due to exponential social, technological, economic,         15–29 years, an 8% increase.5
cultural and educational changes over the years.
                                                            We know that youth is a key transitional period
                                                            in the life of a young person where they make
WHAT THE DATA TELLS US
                                                            decisions around relationships, career pathways,
Various school-based health services are provided in        and responsibilities alongside rapid brain and body
low decile colleges, teen parent units and alternative      transformations. Research and the data tells us that
education centres delivered by Regional Public              enabling environments that foster healthy behaviours,
Health, VIBE, Evolve and some specific DHB health           resilience and confidence of young people puts
services across the region. Doctors and nurses provide      them in good stead to transition into adulthood.
students with advice, treatment and referrals to other      The research and data also tells us that Pacific
services on problems including general health, sexual       young people still face obstacles more so than other
health, and mental health. They also provide routine        ethnicities due to socio economic and educational
health assessments to Year 9 students. Based on the         disadvantages, inter-generational suffering and
most recent data available for the 2017 calendar            prejudice to name a few. We heard from our young
year, in Wairarapa 27 Pacific students were seen            people that they want to contribute to policies and
by school-based health services (79% of eligible            programmes that impact on them given the right
students) and had on average two visits. Hutt Valley        support and opportunities to do so. Sport, music
school-based health nurses saw 133 Pacific students         and the arts are some of the areas they identified as
(28% of eligible students) who had on average two           having a significant impact in promoting a sense of
visits. One hundred Pacific Year 9 students in Hutt         wellbeing for them.
Valley received a routine health assessment. Capital
& Coast school-based health nurses saw 589 Pacific          In light of this, the following actions will be taken
students (94% of eligible students) who had on              to ensure we are supporting Pacific young people to
average almost two visits.                                  strengthen their resilience, address mental health and
                                                            wellbeing, establish the right support networks, and
Even though we see improvements and the                     improve their sense of belonging, problem-solving
availability of youth-centred health services and           skills, and strong connection to culture and family.
programmes targeted to our young people in schools,

5.   3DHB Pacific Plan Data sets 2019.
20 | Pacific Health and Wellbeing Strategic Plan for the Greater Wellington Region 2020 to 2025
Priority Two | 20

             PRIORITY TWO:                                                                                                                                              KEY FOR
                                                                                                                                                                                                               Partners and networks

                                                                                                                                                                                                               Commissioning

             Pacific young people
                                                                                                                                                                        SYSTEM ENABLERS
                                                                                                                                                                                                               Influence and advocacy
                                                                                                                                                                        Note: Targets will be set using
                                                                                                                                                                        national targets or to improve on      ICT and knowledge resource
                                                                                                                                                                        current performance. Targets will be
                                                                                                                                                                        incorporated into DHB annual plans.    DHBs as an employer

       Goal: Pacific young people have timely access to services and programmes that enables them to grow into healthy adults and lead productive lives
System enablers                    Actions to achieve this outcome                                How will we know there’s been improvement?                                              Measures of improvement

                                                                                                                                                                 •   Percent of age-standardised rate of overweight and obesity in
                  1. Support and strengthen initiatives that encourage Pacific young
                                                                                                                                                                     Pacific aged 15+ years.
                     people to adopt healthy lifestyles, make informed choices about     •   More Pacific youth are making healthy lifestyle choices.
                                                                                                                                                                 •   Percent of Pacific young people accessing sexual and reproductive
                     sexual health, smoking, and risk-taking behaviours.
                                                                                                                                                                     health services either through GPs or youth-specific services.

                                                                                         •   Increased number of Pacific young people engaging with              •   Percent of eligible Pacific young peoples accessing community
                  2. Accelerate strategies and innovations that focus on Pacific young       programmes and initiatives such as the Piki free youth mental           Youth mental health services (primary services).
                     people’s mental health, self-harm and violence.                         health services, YouthQuake, community driven mental health         •   Percent of Pacific young people accessing suicide prevention and
                                                                                             programmes and others.                                                  self-harm education services and support.

                  3. Leverage technology to promote health messages and campaigns        •   Pacific young people receive and respond to health messages on      •   Percent of age-standardised rate of overweight and obesity in
                     that reach and resonate with Pacific young people.                      media that they use often.                                              Pacific aged 15+ years.

                  4. Strengthen and promote partnerships with youth specific health,     •   Increased access to health and disability services that are youth   •   Percent of Pacific students seen by school-based health services.
                     social and educational service providers.                               centred.                                                            •   Percent of Pacific Youth seen at youth health services.

                                                                                                                                                                •    Percent of Pacific young people involved in DHB and primary care
                  5. Implement leadership programmes that encourage the                  •   Number of collaborations with identified colleges and high schools
                                                                                                                                                                     relevant consumer and health steering groups.
                     participation of Pacific young people in dialogue and decision-         to promote health as a career but also to collaborate on health
                                                                                                                                                                •    Percent of scholarships offered for relevant Pacific young people to
                     making opportunities and activities to enhance their health.            promotion initiatives driven by Pacific young people.
                                                                                                                                                                     complete health related studies at universities and polytechnics.
22 | Pacific Health and Wellbeing Strategic Plan for the Greater Wellington Region 2020 to 2025

                                            PRIORITY THREE

                        Pacific
                      adults and
                      ageing well
Priority three | 23

Pacific adults and older people are                       Amendable mortality rates for Pacific are also high,
                                                          particularly for people under the age of 75 due to
actively engaged in their health care,
                                                          causes that could have been prevented through
and live productive, active, culturally                   treatment or better safety precautions. The causes
secure and quality long lives.                            of death include injuries, suicide, cancer and
                                                          cardiovascular disease. Over the 5 years from 2011
                                                          to 2015, there were 176 preventable deaths in
RATIONALE                                                 Capital & Coast Pacific peoples and 71 Hutt Valley
                                                          Pacific peoples. The standardised rate of amenable
Healthy Pacific adults and older people contribute
                                                          mortality is higher for Pacific than non-Māori
positively to their families, churches, work places
                                                          non-Pacific people in Capital & Coast and Hutt Valley.
and society overall. Our Pacific elders play a crucial
role as the custodians of traditional wisdom to help
                                                          Based on coroner’s information on suspected
sustain cultural traditions, languages and practices,
                                                          suicides, over the four years from 2014/15 to
through passing on of knowledge, customs and
                                                          2018/19, 5% of Hutt Valley deaths were Pacific
generational blessings across generations. They are
                                                          peoples, 7% of Capital & Coast and none of the
cultural champions that need to be engaged to ensure
                                                          deaths in Wairarapa were Pacific peoples.
there are appropriate cultural approaches to health
and wellbeing.
                                                          There is also an increasing trend of individuals
                                                          suffering from multiple chronic conditions and
A social wellbeing survey undertaken by Statistics
                                                          this impacts on the quality of life of the individual
New Zealand in 2017 highlighted that Pacific adults
                                                          and family due to complications from having more
reported higher levels of wellbeing despite challenging
                                                          than one long-term condition. This is despite
socio economic situations. The life expectancy of
                                                          improvements in treatments, management and access
Pacific adults has also increased showing that Pacific
                                                          to clinical care services, wrap around programmes
adults and older people are living an extra 7–8 years
                                                          and services that support and encourage the adoption
when compared to 20 years ago.
                                                          of healthy lifestyles and focus on addressing social
                                                          determinants of health.
WHAT THE DATA TELLS US
                                                          Therefore, we need to provide holistic and appropriate
Data across the two Primary Health Organisations          health promotion, prevention efforts and education
and the three DHBs in the Greater Wellington Region       to improve the health literacy of Pacific adults
show that Pacific peoples have high rates of health       and older people. We want to make sure that Pacific
care utilisation, accessing their general practices       adults and older people are ageing well and accessing
3.5 times more than others.                               the appropriate services including aged care facilities
                                                          and palliative care services, to maximise their
Pacific adults and older people continue to be high       independence and reducing the burden of health
users of health services, and are still more likely to    problems and disabilities.
suffer and die prematurely from chronic diseases
such as diabetes, heart disease, respiratory illnesses,
stroke, cancer, obesity and high rates of avoidable
ambulatory hospital admissions compared to others.
Based on the NZ Health Survey standardised
rates, 92% of Pacific adults in Capital & Coast are
overweight or obese and 89% of Hutt Valley Pacific.
This is similar to all Pacific in New Zealand.
24 | Pacific Health and Wellbeing Strategic Plan for the Greater Wellington Region 2020 to 2025

                      Fakamalolo ke he tau amaamanakiaga,
                        ke mafola ai e tau matakainaga -
                           Strengthen all endeavours
                         and the community will benefit
                                                                                                  Niuean proverb
Priority three | 25

                                                                                                                                                                                                                      Partners and networks

             PRIORITY THREE:                                                                                                                                                  KEY FOR
                                                                                                                                                                              SYSTEM ENABLERS
                                                                                                                                                                                                                      Commissioning

             Pacific adults and ageing well
                                                                                                                                                                                                                      Influence and advocacy
                                                                                                                                                                              Note: Targets will be set using
                                                                                                                                                                              national targets or to improve on       ICT and knowledge resource
                                                                                                                                                                              current performance. Targets will be
                                                                                                                                                                              incorporated into DHB annual plans.     DHBs as an employer

        Goal: Pacific adults and older people are actively engaged in their health care, and live productive, active, culturally secure and quality long lives
System enablers                    Actions to achieve this outcome                                   How will we know there’s been improvement?                                                 Measures of improvement

                                                                                                                                                                       •   Percent of eligible Pacific women (25–69 years old) completing
                                                                                                                                                                           cervical screening.
                                                                                                                                                                       •   Percent of eligible Pacific women (50–69 years old) completing
                  1. Work in partnership with key stakeholders to increase and
                                                                                       •       More Pacific peoples participate in bowel, breast and cervical              breast screening.
                     encourage participation in screening programmes (cervical, bowel,
                                                                                               screening programmes for early diagnosis of cancer.                     •   Percent of eligible Pacific population (60+) completing bowel
                     breast and other cancers) and cessation support (smoking and
                                                                                       •       Pacific peoples receive cancer treatment sooner.                            screening testing.
                     drugs).
                                                                                                                                                                       •   Percent of Pacific patients who receive their first cancer treatment
                                                                                                                                                                           (or other management) within 62 days of being referred with a
                                                                                                                                                                           high suspicion of cancer.

                                                                                           •   Increased support and uptake of risk assessment, and early
                                                                                               intervention programmes for
                                                                                                                                                                       •   Percent of Pacific adults with diabetes who have completed their
                                                                                                • diabetes checks
                                                                                                                                                                           annual review.
                  2. Continue to improve system-wide health service delivery with               • cardiovascular disease
                                                                                                                                                                       •   Percent of the eligible Pacific population assessed for
                     targeted activities specifically aimed at chronic disease treatment        • respiratory disease
                                                                                                                                                                           cardiovascular disease risk.
                     and prevention.                                                            • smoking
                                                                                                                                                                       •   ASH rate for Pacific adults aged 45–64 (per 100,000 people).
                                                                                                • high blood pressure.
                                                                                                                                                                       •   Percent of unfilled prescriptions at pharmacy.
                                                                                           •   Increased access to medications and pharmaceuticals by
                                                                                               decreasing the number of prescriptions unfilled due to cost.

                                                                                                                                                                       •   Percent of Pacific peoples registered under the long term
                                                                                                                                                                           conditions programme attending 100% of appointments and
                  3. Implement prevention, health education and promotion
                                                                                           •   Reduced ASH rates and Pacific peoples admitted to hospital due              getting necessary care.
                     programmes that draw on Pacific traditional wisdom, languages
                                                                                               to complications from chronic conditions.                               •   Percent of Pacific peoples with diabetes aged 15–74 years
                     and cultural strengths to address risk factors and treatment.
                                                                                                                                                                           enrolled with a PHO whose latest HbA1c in the last 12 months
                                                                                                                                                                           was
26 | Pacific Health and Wellbeing Strategic Plan for the Greater Wellington Region 2020 to 2025

                                             PRIORITY FOUR

           Pacific health
           and disability
            workforce
            and pacific
             providers
            and NGOs
Priority four| 27

The Pacific health workforce and                                                               WHAT THE DATA TELLS US
providers have the capabilities,                                                               The Central Region District Health Boards Pacific
resourcing, aspirations, organisational                                                        Workforce Report6 as at 30 June 2019 identified
structures, professional opportunities                                                         that across the Wellington Sub Region, the Pacific
and potential to lead, support and                                                             workforce was spread across with the highest
                                                                                               reported proportion of Pacific peoples in the care
contribute to achieving positive health                                                        and support occupation group with 20% in Capital &
and wellbeing outcomes for Pacific                                                             Coast, 2% in Hutt Valley and 0% in Wairarapa. This
peoples.                                                                                       was followed by those working in corporate, admin
                                                                                               and other, nursing, and with the lowest proportions in
                                                                                               midwives, resident and senior medical officers.
RATIONALE
                                                                                               Across the Central Region, the proportion of Pacific
The importance of building and maintaining a                                                   staff with more than two years of accrued annual
qualified Pacific health and disability workforce                                              leave was typically lower than the proportion of all
alongside investment in strengthening Pacific                                                  employees with this level of accrued leave, with no
providers is crucial to closing the gap in addressing                                          Pacific staff in the midwifery, resident medical officer
the health inequalities that exist for Pacific peoples.                                        or senior medical officer occupation groups reportedly
A qualified Pacific health workforce with cultural                                             accruing more than two years of annual leave.
understanding and who are well versed in the cultural                                          A cause for concern was the reported number of sick
nuances of Pacific people will improve and strengthen                                          leave hours taken between April and June 2019,
our ability to provide a culturally responsive health                                          as a proportion of total paid hours, was typically
system that benefits the communities we serve to                                               higher for Pacific employees than the rate across all
engage them to become good and better stewards of                                              DHB employees.
their own health and wellbeing.
                                                                                               The exceptions are the midwifery and resident and
We want to ensure our current and future workforce                                             senior medical officer groups, but this may be linked
is diverse and have the right skills and qualifications                                        to the low numbers of Pacific employees in these
to deliver and provide continued improvement across                                            occupations.
all parts of the health sector. In addition, funding
investments and commissioning of services are                                                  One of the limitations is that the data sets obtained
directed and help build up Pacific providers with                                              does not include the Pacific workforce in primary and
proven success in providing services that meet the                                             community health care. The DHBs’ workforce also
needs of Pacific peoples.                                                                      has an ageing Pacific health workforce.

Investing resources and funding into growing the                                               Certainly in the Greater Wellington Region the
Pacific health and disability workforce and providers                                          forecast for the Pacific population is that there will
will enable the district health boards to close the gap                                        be persistent inequities, increased demand on health
and make a difference in achieving optimum health                                              services, increased social isolation with volumes of
for vulnerable groups such as Pacific peoples in the                                           older people with complex health and social needs.
Greater Wellington Region.

6.   TAS Central Region District Health Boards Dashboard Pacific Workforce Report June 2019.
28 | Pacific Health and Wellbeing Strategic Plan for the Greater Wellington Region 2020 to 2025

    A strong focus should be on investing now and
    making it a priority to grow the Pacific health
    workforce, to meet the impact and increase in
    demand of the changing Pacific demographics. It
    will support an ageing workforce who are small in
    numbers and who are feeling the weight of supporting
    older people with long-term conditions and other
    health issues affecting our Pacific populations.

    Pacific providers and NGOs in the community are
    small; we aim to support them by building their
    capacity further at all levels to collaborate (especially
    with other providers) as a key way to improve the
    range, access and cultural appropriateness of services
    to Pacific communities.

                        E rima te’arapaki te aro’a, te ko’uko’u
                                te utuutu, ‘laku nei -
                        Under the protection of caring hands
                        there’s a feeling of love and affection
                                                                                                  Cook Island proverb
Priority Four | 28

              PRIORITY FOUR:
                                                                                                                                                                                                                    Partners and networks
                                                                                                                                                                            KEY FOR                                 Commissioning
                                                                                                                                                                            SYSTEM ENABLERS

              Pacific Health and disability workforce
                                                                                                                                                                                                                    Influence and advocacy
                                                                                                                                                                            Note: Targets will be set using
                                                                                                                                                                            national targets or to improve on       ICT and knowledge resource
                                                                                                                                                                            current performance. Targets will be

              and pacific providers and NGOs
                                                                                                                                                                            incorporated into DHB annual plans.     DHBs as an employer

Goal: The Pacific health workforce and providers have the capabilities, resourcing, aspirations, organisational structures, professional opportunities and potential
                             to lead, support and contribute to achieving positive health and wellbeing outcomes for Pacific peoples
 System enablers                    Actions to achieve this outcome                                   How will we know there’s been improvement?                                              Measures of improvement

                                                                                             •   Number of recruitment policies reviewed and updated accordingly.
                                                                                                                                                                  •      Percent of innovative interventions to improve health workforce
                   1. Influence HR recruitment policies and processes across the             •   Increased number of Pacific skilled workforce being interviewed
                                                                                                                                                                         retention and recruitment.
                      3DHBs to improve Pacific employment opportunities including                for positions and employed within the district health boards in
                                                                                                                                                                  •      Number of Pacific staff employed in DHBs.
                      increasing number of Pacific on shortlisting, interview panels,            different areas.
                                                                                                                                                                  •      Percent of Pacific nurses, vaccinators and nurse prescribers
                      steering groups and governance.                                        •   Strong pathways in place for mentoring and leadership trainings
                                                                                                                                                                         completing training.
                                                                                                 for the current workforce.

                   2. The 3DHBs and PHOs demonstrate their commitment to funding
                      and supporting “Pacific by Pacific” Pacific health service providers
                                                                                             •   Review commissioning and contracting processes within the
                      in the community and recognise the crucial part they play within                                                                               •   Percent of Pacific by Pacific health and disability service providers
                                                                                                 DHBs ensure Pacific providers are funded, utilised and resourced
                      the health system and the achievement of health outcomes.                                                                                          supported.
                                                                                                 to support primary and secondary care to reach and serve Pacific
                                                                                                                                                                     •   Number of Pacific provider forum meetings.
                                                                                                 peoples.
                   3. Strengthen and support Pacific health providers and align their                                                                                •   Percent of Pacific providers reporting positive and good support
                                                                                             •   Pacific provider forum in the Greater Wellington Region established
                      work with general practices and hospital services, with a focus on                                                                                 from the DHBs.
                                                                                                 and supported.
                      health care homes and integrated family health centres in primary
                      care and the community.

                   4. Increasing and attracting our Pacific workforce by targeting           •   Number of Pacific students showing interest in undertaking health
                                                                                                                                                                     •   Number of scholarships funded and cadets placed.
                      students via formal education settings, such as secondary schools          studies.
                                                                                                                                                                     •   Number of Pacific graduates employed in the health workforce
                      and tertiary institutions. This pipeline needs to be socialised as     •   Number of cadetships and relevant health scholarship
                                                                                                                                                                         (allied health, doctors, nurses, health promoters, etc).
                      well with the education sector.                                            programmes in place.

                   5. Focus on Pacific trained health professionals with overseas training •     Increase the Pacific health and disability workforce by focusing
                                                                                                                                                                     •   Percent of Pacific health staff registered with professional
                      and qualifications and the pathways for qualification in the NZ            on supporting Pacific trained health professionals to complete NZ
                                                                                                                                                                         associations and councils.
                      health system.                                                             required registrations.
30 | Pacific Health and Wellbeing Strategic Plan for the Greater Wellington Region 2020 to 2025

                                               PRIORITY FIVE

               Social
           determinants
             of health
Priority five | 31

A health system in the Wellington                                                 valuable insight on how the social determinants
sub region that is aligned and better                                             of health impact on their health and wellbeing.
                                                                                  Most importantly, the feedback highlighted what
connected to housing, education,                                                  we need to prioritise to improve the health and
employment, social services and other                                             wellbeing of our Pacific peoples across Wellington,
sectors to address environmental,                                                 the Hutt Valley and Wairarapa.
social and economic inequities to
                                                                                  It is well known that income is associated with
achieve better health outcomes for
                                                                                  health and wellbeing. Families on low incomes
Pacific peoples.                                                                  may struggle to pay all their bills, which can cause
                                                                                  stress and tension within a family. The rise in
Culturally sensitive models of care are                                           housing costs in recent years, in particular, has
used and integrated into health care                                              put many families under financial strain – with a
                                                                                  significant proportion of their income having to be
to educate and promote strategies to                                              spent on rents or mortgages. This may mean they
enable the best possible mental health                                            are unlikely to afford items and activities that can
and wellbeing for Pacific peoples.                                                have a positive impact on health and wellbeing.

                                                                                  These may include, for example:

                                                                                  •   healthy foods, like fruits, vegetables and milk
RATIONALE                                                                         •   team sports and other outdoor activities
The health and wellbeing of our Pacific                                           •   school outings and events
communities is heavily influenced by the underlying                               •   joining and participating in local cultural or
social determinants of health. These include                                          religious groups, hobby groups, or clubs
housing and employment, health behaviours,                                        •   appropriate clothing and bedding
clinical care and the physical environment.                                       •   travel or holidays
                                                                                  •   electricity for heating
                                                                                  •   household items to help keep homes warm and
WHAT THE DATA TELLS US                                                                dry, like heaters, curtains, draft stoppers and
A higher proportion of Pacific peoples are living                                     insulation.
in more deprived areas according to the NZ
Deprivation Index. Based on the 2013 Census                                       Of course, low income will also impact on a
population, 51% of Capital & Coast Pacific people                                 family’s ability to pay for health care, including
were living in the most deprived areas, 40%                                       regular check-ups and care when they are unwell.
of Hutt Pacific peoples and 36% of Wairarapa
Pacific peoples.                                                                  Employment helps to raise a family’s income,
                                                                                  which can help pay for activities and items
Research suggests that only about 20% of a                                        that improve health and wellbeing. However,
person’s health is determined by access to health                                 employment can take a parent’s time away from
care. The other 80% is determined by health                                       their family – especially if they are having to
behaviours and the social and environmental                                       work more than one job, or work at nights and
conditions where they live, work and play. The                                    weekends, to make ends meet. Time away from
feedback from our Pacific peoples provided                                        their family while working can also have a negative
                                                                                  impact on wellbeing.

7.   https://www.health.govt.nz/publication/health-and-independence-report-2017
32 | Pacific Health and Wellbeing Strategic Plan for the Greater Wellington Region 2020 to 2025

    Many Pacific families told us that both employment
    and income affect their health and wellbeing in                          Income support was especially needed for Pacific
    different ways. Often, both parents were working                         families after a baby is born, for the first 12 months
    and the family still did not have enough money                           of the infant’s life. During this time finances are
    coming in to meet all their ongoing bills and                            particularly stretched because the family will lose
    household costs. Sometimes they had more than                            the income of one parent. Additional income during
    more job and were working different shifts and at                        this time would also relieve financial stress and
    weekends. Pacific young people would also often                          help the family support the baby during this critical
    be working to help support their family. Some                            period in a baby’s life.
    said that they would often settle for less when
    interviewing for jobs.                                                   As expected, we were told that low income affects
                                                                             the ability of Pacific peoples to access health
    We were also told that many Pacific peoples are                          care. They told us that many are not having regular
    not aware of the Government support available.                           check-ups with their general practice due to
    When they do seek support, many felt the process                         the costs.
    was administratively burdensome, intrusive, and
    took away their dignity. The process involved
    too much paperwork and forms, and having to
    ‘prove’ they had low incomes. We were told that
    many Pacific peoples felt judged and humiliated
    by the process.
Priority Five | 32

              PRIORITY FIVE:
                                                                                                                                                                                                             Partners and networks
                                                                                                                                                                      KEY FOR                                Commissioning
                                                                                                                                                                      SYSTEM ENABLERS

              Social determinants of health
                                                                                                                                                                                                             Influence and advocacy
                                                                                                                                                                      Note: Targets will be set using
                                                                                                                                                                      national targets or to improve on      ICT and knowledge resource
                                                                                                                                                                      current performance. Targets will be
                                                                                                                                                                      incorporated into DHB annual plans.    DHBs as an employer

Goal: A health system that influences and is aligned to housing, education, employment, social services and other sectors to address inequities and achieve better
                                                               health outcomes for Pacific peoples
 System enablers                    Actions to achieve this outcome                                  How will we know there’s been improvement?                                         Measures of improvement

                   1. Strengthening partnerships through inter agency networks to
                      influence and advocate for Pacific communities with housing
                      organisations, Ministry of Social Development, Ministry of Pacific
                      Peoples, Ministry of Education, Pasifika Future, local councils and                                                                      •   Number of Pacific children enrolled in an ECE.
                      other stakeholders and leverage off programmes.                       •   Connected and influential health system to social, economic,   •   Percent of Pacific students achieving NCEA level 1,2,3.
                                                                                                education and other sectors.                                   •   Percent of Pacific families accessing whanau ora services and
                   For example:                                                         •       Improved access to ECE for Pacific children.                       support.
                   • accessing benefits, housing, income support, disability allowances •       Increased number of Pacific young people achieving NCEA        •   See measures for
                   • access to ECE, improved literacy, retention rates, pass rates New          qualifications.                                                    • Reducing avoidable hospitalisations
                       Zealand Certificate of Educational Achievement (NCEA) and                                                                                   • Improving outcomes for people with long term conditions
                       increased number of Pacific students
                   • improve response and prevention of family violence, safe guarding
                       children and women

                                                                                                                                                               •   Rate of ASH for children aged 0–4 years and adults aged 45–64
                                                                                                                                                                   (per 100,000 people).
                   2. Work closely with local councils, Kāinga Ora and key stakeholders
                                                                                            •   Increased number of Pacific families accessing warmer, drier   •   Percent of Pacific babies living in smokefree households at 6
                      to advocate and influence decision-making that will improve
                                                                                                homes leads to a reduction in avoidable hospitalisations.          weeks old.
                      healthy housing for Pacific peoples.
                                                                                                                                                               •   Rate of hospitalisations potentially related to housing conditions
                                                                                                                                                                   per 1,000 population for children under 15 years age.

                   3. Reductions in reported police investigations of family violence       •   Decreased number of reported police investigations of family   •   Rate of Pacific reporting being victims of violence by family
                      involving Pacific families.                                               violence.                                                          member to police per capita.
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