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Pacific Health and Wellbeing Strategic Plan for the Greater Wellington Region 2020 to 2025
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
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.
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
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
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.
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.
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.
”
Our vision | 9
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
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ANOur 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 proverb14 | Pacific Health and Wellbeing Strategic Plan for the Greater Wellington Region 2020 to 2025
PRIORITY ONE
Pacific child
health and
wellbeingPriority 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 proverbPriority 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
peoplePriority 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 wellPriority 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 proverbPriority 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
was26 | 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 NGOsPriority 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 proverbPriority 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 healthPriority 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-201732 | 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.You can also read
