The purpose of this chapter was to provide an understanding of child health and wellbeing from a number of perspectives to provide a synthesis that would inform the testing and validation of the CHQNZ.
While many themes were identified during the analysis of the key person interviews, their relative contribution to understanding health and wellbeing and a child health questionnaire was not immediately clear. However when considered in concert, they present a framework on which to link factors that were identified during the key person interviews. Te Aho Tangata was the sum of these themes and not an easily identified thread in its own right. Contributing to Te Aho Tangata the following were identified whenu (treads) - mana whenua, kawa, tikanga, hauora and ngā tangata tika ki te tēpū. The whenu are interwoven and characterise the Aho Tangata – child health and wellbeing. Connecting the whenu are sub-themes that merge in differing context to form patterns, each pattern a distinct representation of the status of the child that extends beyond accepted definitions of health or wellbeing. Some of these patterns may equate with the scales and domains of the CHQNZ while others perhaps describe the context in which the CHQNZ must function, and perhaps capture.
With each whenu is a process that in conjunction with the features identified in this chapter informed a process to produce a desired outcome. For example, tikanga and kawa (in the section on Whanaungatanga – Relationships, see p. 118) were themes that emerged during the interviewing. Strongly associated with kawa was education and how teaching te reo Māori was supported at home (see p. 127). For this thesis, this validated the decision to provide in te reo Māori the information that went home that was consistent with the school environment.
Mana Whenua
Mana whenua is the status a person or people have in connection with the land. In terms of tamariki Māori their status in terms of mana whenua is determined by birthright validated by whānau and the law. Later in life this status may change but for tamariki Māori mana whenua is one of the features of whānau. Strongly associated with mana whenua was the notion of whānau – being born, and being born into group that identifies as Māori and has connections with other whānau by land (whenua), ancestry (whakapapa) and by deed (marriage). The time of whānau, the birth of a baby, was the time when the care of the baby was determined by nominated whānau members. The adults charged with raising the child were selected in the best interests of the child, and in the past this relationship building had the additional benefit of maintaining whānau connections and access to whānau resources. Maintaining access to traditional whānau resources is less often practiced now, although language and culture are now critical resources for today’s tamariki Māori. The notion of whangai (open adoption) is still a feature of whānau
development. Whangai is the gifting of a child for the mutual benefit of whānau and the child -the re-integration of whānau by the process of whangai. Whakapapa characterises the connections between people, though generations and across generations. Whakapapa is the science of tracing the connections between people through time and across the world and is best expressed in te reo Māori. For a child the notion of mana whenua places the child at the nexus of whakapapa, whenua and whangai. Associated with children and mana whenua is tikanga, another whenu identified from the key person interviews.
Tikanga
How the rules that framed the welfare and safety of children were applied emerged as theme when the response of ‘The Welfare’ was recalled. Although most welfare issues were associated with the care and protection of children, tikanga also included the terminology used by public servants and health professionals, how the rules were applied as well as the assistance offered by Government agencies. The key
informants explained that safety required an understanding of the whānau, the child’s history, and connections and accountabilities with other people. When ‘The Welfare’ intervened it was often to provide help to the disadvantage of tamariki Māori, ignoring the wishes of whānau and the outcome was at the expense of the
whānau. The key informants indicated that the Government was required to seek additional support and help in order to maintain the best interests of tamariki Māori. The Government had excluded Māori from this vital role and new resources were put in place to improve the responsiveness of DSW. An outcome of the
investigation led by the Ministerial Advisory Committee on a Māori Perspective for The Department of Social Welfare was a set of 13 recommendations. Sadly with the loss of many of the leaders within the Department of Social Welfare, the death of the principle advocate and a lack of qualified human resources within the department, the initiative was lost. Tamariki Māori were at risk from unresponsive Government agencies a decade later and a new investigation was launched. This subsequent investigation by Judge Michael Brown illustrated the limited degree to which the Department and later Ministry had not addressed the needs of tamariki Māori. A new Minister and Cabinet took up the recommendations of Judge Michael Brown and further changes to the way services are provided for tamariki Māori were put in place. The re-emergence of te reo Māori provided a new pathway for biculturalism, and with this a new appreciation of the rules by which care for tamariki Māori will be undertaken.
Kawa
The rules and guidelines that influence the inter-relationship between people were seen as an important issue for tamariki Māori. Whether it was to celebrate the birth of a child at home, formal occasions on the marae, or the family group conference, kawa and knowing the kawa was not only important for determining the needs of tamariki Māori, but also in responding. The strength of kawa is how well it is understood and having the requisite skills to act appropriately. Assessing needs and responding to need can best be done by learning from role models, being formally instructed and reinforced through practice –a good education. In terms of child care and protection the emergence of the practice of the Family Group Conference (FGC) was a change of kawa for the relevant Government agencies who use the FGC to draw upon the resources of the whānau. Kawa and tikanga are strongly connected and the bonds between the two are reflected in the behaviour and cohesiveness of the parties with an interest in the child, and their ability to work together to ensure the child’s potential is not compromised. An ability to converse in the language of the whānau, te reo Māori was an important skill for many of the Māori Affairs
Welfare Officers until the DMA was disestablished in 1981. The re-emergence of te reo Māori in the delivery of services for children and whānau may strengthen whānau approaches to the care of tamariki Māori and make explicit the use of kawa whose understanding is shared by the whanau and ‘The Welfare” alike.
Hauora
The focus on the material needs of children was associated strongly with the health and wellbeing of tamariki Māori. Good housing, sufficient food and health care were required to maintain good child health and well being. The inter-relationship between the many determinants of child health and wellbeing is an emerging science. The determinants identified by key informants included housing,
availability of healthcare, religious values and spiritual intervention, demarcation of risk and safety, and sustenance. The influence the Government of the day has on many of the determinants is necessarily indirect. The Government has an indirect role in the care in protection of children until a child is assessed to be at risk. Given the measures to determine risk are related to the immediate physical and emotional wellbeing of the child the Government has less influence because it is reliant of the child’s caregivers for preventing harm to the child and early warning when such harm appears. The child’s caregiver(s) status if questioned is determined by the Court guided by legislation including the Guardianship Act and the Children, Young Persons and Their Families Act.
The inter-relationship between determinants and health is generally accepted, however the people who deliver these services, who determine need and priorities, do not seem to be as well inter-connected because important services such as child and maternity care remain outside the Primary Healthcare Organisation structure and registration for the Immunisation Register is voluntary meaning there is no oversight of the delivery of this health service to children. Agencies have acted almost independently and sometimes counter to the interests of the child. Health inequalities for tamariki remain a durable feature of their health and well-being, and few if any tamariki Māori specific strategies or tools are available to fill the
information void. Surrounding the little information that is available are ‘joined up strategies’ to share this information in a manner and avoid the needs of tamariki Māori falling into the silos that Recommendation 13 of Puao Te Ata Tū was made to avoid. The monitoring framework established by the Ministry of Social Policy as
part of the Social Report goes some way to an inter-sectoral approach but the delivery against these indicators remains slow if change in these indicators is an effective measure of progress. A feature of the approach taken with the Social Report is to get some of the right people around the table.
“Ngā tangata tika ki te tēpu” was a phrase often used by Mr. John Grant to
characterise the consultation process adopted by DSW as a result of Puao Te Ata Tū. Mr. Grant recalled the benefits and risks of consultation that included not getting to the issue because the information and advise being provided did not reflect the needs of the people. The history of consultation prior to Puao Te Ata Tū featured an absence of Māori, therefore some advice was an improvement. After Puao Te Ata Tū, DSW and later most other Government Departments and Ministries struggled to get advice because of a lack of information and suitably skilled advisors. The information has taken time and resources to collect but now it is possible to build a picture of the health and well being of tamariki Māori. Most of the measures and sources of information are proxy measures whose interpretation may not reflect the needs of tamariki Māori. Getting the right people around the table, ngā tangata tika ki te tēpū, would now include Māori and the advice would be informed by tamariki Māori. A strategy used during the inquiry led by John Rangihau was to talk with Māori, hear what they had to say, and report it in a manner that could be retold with Māori present to see the response to their wishes.