The Asthma FoundationNew Zealand Respiratory Conference 2013

Te Hā o Te TangataBreathing Easy in Aotearoa

Mason DurieMassey University

The Main Points

1. Māori understandings of health and sickness place importance on context

2. The health context is shaped by four Pou Ora, key markers that underly the health-sickness continuum: Hauora - Compatible environments Toi Ora – Knowledge transfers Whānau Ora Empowering relationships Mauri Ora - Enhanced potential

3. Breathing will be easier when all four Pou are aligned and the human mauri is flourishing.

Pou Ora 1: Hauora Compatible Environments

Rangi and Papa

Locked into an embrace that excluded light

and life

Ki te Ao Mārama

Rangi and Papa

Forced apart by the offspring

• Forests & birds• The elements• The seas and waters, fish• Crops• Ferns• Humankind

Separation enabled

Light and Life

Whanaungatanga Environmental relationships, the common bonds

Rangi & Papa Environmental Impacts

The Whanaunga principle‘While each species is unique, there is nonetheless a relationship between all species within the natural world. They are linked by time, inter-dependency and common needs.’

The Ahiowhio principle:‘meaning comes from an outward (centrifugal) flow of energy; life is best understood by the relationships that exist between people and their environments.’

Hauora as a Centrifugal Spiral Ahiowhio Wharite

Building relationships

An Outward flow of energy

People, land, flora, fauna,water, air, cosmos

Centrifugal direction

Relationships and context are a basis for health

Smaller entitiesmake sense when viewedin relationship tolarger entities

Hauora & Health

‘Health’ is widely used as a synonym for sickness

‘Hauora’ has been a common translation for ‘Health’

BUT

Hau = wind, air, human breath, the security of home (hau kainga), fame, and vitality

Ora = safety, satiation, survival, life

Hauora as an ecological concept

Hauora positions people within a broad ecological context environments are drivers of health.

The Hauora focus is on: associations between people with

surroundings reducing risk from external natural and

human threats identifying new and emerging

environments

Hauora & Connectedness

A Māori world view of connectedness and inter-dependence provides a framework within which Hauora can be understood and its significance to modern times appreciated

The implication is that health is essentially about ‘living in the world’

Human health cannot be fully understood without taking into account impacts from the wider

environment

Complex Environments - easy and not-so- easy breathing for Kiwis Global environments The natural environment Urban environments Metropolitan

environments Marae environments Home environments Work environments On-line environments Whānau environments Pastoral environments Horticultural

environments School environments Roading environments

Pou Ora 2 Toi Ora Knowledge Transfers

Toi = knowledgearthuman originsbirthplace

Ora = wellnessalivesaferecovery

Toi Ora

Wellbeing associated with Indigeneity a sense of home knowledge and

information Creativity

Toi Ora

Health is enhanced by old knowledge, heritage, and remembered ties to an ancestral home

Health is linked to artistic expression, the use of symbols and metaphor derived from cultural experience, and the transfer of knowledge between generations

Toi Ora is about

Knowledge that is based on past journeys

Knowledge that recalls longstanding world views

Knowledge that can be used for ‘living well’ in

the world Knowledge as a

platform for health and wellbeing

Pou Ora 3: Whānau Ora Empowering Relationships

Whānau

Kaupapa whānau –group with a common interest

Whakapapa whānau –group who share a common genealogy

Māori families – two-generational household

Ora safety life wellness

Whānau capacities Manaakitanga

the capacity to care Pupuri Taonga

capacity for guardianship Whakamana:

capacity to empower whanau Whakatakato tikanga:

capacity for planning Whakapumau tikanga:

capacity to transmit culture, knowledge, between

& within generations

Whakawhanaungatanga: capacity for reaching

consensus

Whānau interventions

Interventions can be aimed at:

changing the external impacts on relationships – an ecological approach

(e.g. improving housing)

building whānau capacities

(e.g. building manaakitanga: capacity to care)

Whānau Outcome Goals

Whanau self management Healthy whānau lifestyles Full whānau participation in society

Confident whānau participation in te ao Māori

Whānau economic security Whānau cohesion

Whānau Ora Approach focus on the whānau as a whole builds on whānau strengths and increases whānau

capacity six key operational elements:

1. whānau-centred methodologies shaped by the values, protocols and knowledge contained within te ao Maori

2. Intersectoral contributions

3. a primary focus on best outcomes for whānau, through integrated and comprehensive delivery

4. skilled whanau practitioners

5. expertise in whanau dynamics, relationships, aspirations

6. practices that increase whanau skills, knowledge, financial status, and self management (e.g. Online health records)

Towards Flourishing

Hauora Compatible environments

Toi Ora Knowledge environments

Whānau Ora Nurturing environments

Pou Ora 4Mauri Ora Enhanced Potential

Mauri = a force for life human integrity human spirit

human vitality individual uniqueness

Ora = alert responsive

lively

Spiritually robust Culturally engaged Emotional vitality Positive thinking Energetic Able to participate

in activities, events Sustainable &

rewarding relationships

Mauri Oho A Flourishing Mauri

Spiritually robust Culturally engaged Emotional vitality Positive thinking Energetic Able to participate

in activities, events Sustainable &

rewarding relationships

Mauri Oho Flourishing

Mauri OhoIndicators

Inspired Inspirational Optimism Clear thinking Outward thinking Moving easy Breathing easy Liked Likeable

Spiritually robust Culturally engaged Emotional vitality Positive thinking Energetic Able to participate

in activities, events Sustainable &

rewarding relationships

Mauri Oho Flourishing

Cultural & spiritual alienation

Negative emotions Knowledge gaps

Listlessness Slow moving Laboured btreathing

Negative relationships

Social isolation

Mauri Noho Languishing

Spiritually robust Culturally engaged

Emotional vitality Positive thinking Energetic Able to participate

in activities, events Sustainable &

rewarding relationships

Mauri Oho Flourishing

Cultural & spiritual alienation

Negative emotions Knowledge gaps

Listlessness slow moving laboured breathing

Negative relationships

Social isolation

Mauri Noho Languishing

Wairua

Hinengaro

Tinana

Whānau

The Challenge

Creating environments where: the mauri can flourish and

breathing is easy

Toi OraKnowledge transfers

Intellectual environmen

ts

HauoraCompatible

environments

Natural & man-made

environments

Whānau OraEmpowering relationships

Social environments

(home, work, leisure)

Some implications for prevention of disease & the management of disease

HauoraEnvirons

Toi OraKnowledg

e

Whānau Ora

Family

Mauri Ora Individual

sFactors that prevent poor health, disease, sickness

Green fieldsOrganic farmingSafe & nurturing environs School environsOccupational Health & safety

Access to old knowledgeMarae experienceExposure to matauranga Turangawaewae

Food –Housing –Income Parenting Whānau inclusion Whānau wealthWhānau cohesionWhānau modelling

EducationEmploymentPersonal resilience & social skillsSelf determinationExercise, sport, recreation

Risk Factors that can lead to disease, sickness

Alcohol Housing Ag.-Hort spraysTraffic densityNatural & man made disastersFood standards

Alienation from heritage, culture,old knowledge.

Detached from a past

Discrimination, racism, stigmaFamily dysfunction, child neglectPovertyViolence

Cultural alienationEducational failurePhysical inactivityUnemploymentLifestyles – tobacco, drugs, alcoholWork stress

‘Breathing Easy’ Environments

Personal Environments

Natural & Man-made

Environments

Whānau Ora Toi Ora Hauora

Internal‘inner’

environments

Family, work, &

socialenvironments

Heritage & culture

Knowledgeenvironments

Natural &man-made

environments

Mauri Ora

Family & Social Environments

Heritage &cultural environments

The overall challenge for preventing and

managing sickness and disease is to

create environments where ‘breathing

can be easy’

Stay well

Kia Ora

The Asthma FoundationNew Zealand Respiratory

Conference 2013

The Main Points

1. Māori understandings of health and sickness place as much importance on context as on individual experience

2. The health context is shaped by four Pou Ora, key markers that underly the health-sickness continuum: Hauora - Compatible environments Toi Ora – Knowledge transfers Whānau Ora - Empowering relationships Mauri Ora - Enhanced potential

3. Breathing will be easier when all four Pou are aligned and the human mauri is flourishing.