Ngāti Porou Hauora
posted by Alastair McLean on 4 April 2012
Ngāti Porou Hauora was the Supreme Winner in the 2006 Whānau Ora Awards (and a 2006 Health Innovation Award finalist) with their entry ‘Ngāti and Healthy’ – a project undertaken in collaboration with Otago University’s Edgar National Centre for Diabetes Research and the six East Coast Tairāwhiti coastal communities north of Gisborne, Te Araroa, Tikitiki, Ruatoria, Te Puia Springs, Tokomaru Bay, and Tologa Bay.
The project started in 2003 when Otago University researchers discovered the exceptionally high prevalence of glucose metabolism disorders in these communities.
Around 50 percent of those living in these communities were identified as having insulin resistance, impaired fasting glycaemia, impaired glucose tolerance or type 2 diabetes.
Implementing a diabetes prevention community intervention began in 2004. The focus on key risk factors resulted in a community awareness programme designed to improve nutrition, increase activity and reduce smoking and alcohol consumption. Mobilising communities to take an active role in the design, set up and running of community initiatives was critical.
Programme manager during this time was Terry Ehau. He describes the project as organic, evolving from the flax roots up, and reiterates that mobilising communities is as critical today as it was then when it comes to sustainable community interventions.
‘The real triumph of the project was its effective use of champions,’ he said.
‘On the one hand we had the Ministry championing the project through funding, Otago University championing through knowledge and research and Ngāti Porou Hauora through our clinicians and coordination. But equally important was having our kaiawhina as exceptional champions in the communities where they both lived and worked. Then there were others in the community who stepped up, up-skilled and came on board as champions too – mums, dads, cousins, they became champions as well. We used local people to convey all the key messages. Our posters featured people we all knew. We recruited local celebrities, mobilised gardening and cooking initiatives and got whānau to take ownership of these initiatives.
‘It was classic whānau ora. We had experts and champions, at all levels of the project from whānau to community to clinicians and academics.’
The second-phase of the intervention sought to consolidate work already initiated and to embed the intervention into all parts of the community including workplaces and schools. A process and formative evaluation continues to this day, documenting the programme and gathering feedback from the communities and team to inform the programme.
An international diabetes conference in Wellington in 2008 heard that after the programme's first two years, the number of women aged 25-49 with insulin resistance, the first precursor to type-2 diabetes, dramatically dropped from 38 percent to 25 percent.
General practitioner Dr David Tipene-Leach told the conference that ‘the fact that there has been no increase in diabetes and a reduction in insulin resistance suggests such community-based programmes are effective and worthwhile tools. Marked improvements in levels of exercise and eating habits, and reductions in weight, body mass index and triglycerides, were also observed among women under 50 years’.
Dr Tipene-Leach also told the conference that the better results for women have been attributed to their higher level of participation in community intervention activities than men, something identified in an ongoing evaluation of the programme.
‘Women are braver and more insightful . . . they are more likely to do what is good for themselves and their family.’ (The Gisborne Herald 2 April, 2008)
Terry said that being part of the Whānau Ora Awards in 2006 was invaluable.
‘It was very important to be able to share projects and learn about other initiatives. Taking the project into the mainstream Health Innovation Awards was also exciting. It helped us understand that we were capable of succeeding on a global basis.’
He describes ‘Ngāti and Healthy’ as ‘common sense’ and notes that today it’s the model Ngāti Porou Hauora still uses to address population health issues and deliver primary health services.
Like many remote, predominantly Māori communities health, education, housing and income are a significant part of the environment which impact both positively and negatively on whānau.
Terry believes that effective service delivery to Māori in these environments requires a clear understanding on how continuity, connectivity, culture and change can influence whānau capacity to engage effectively and in ways that promote positive outcomes.
‘The challenge for organisations and whānau is to determine a shared vision, based on high degrees of commitment,’ he said.
‘The challenge for Māori organisations is to recognise and embrace the potential of whānau and to support this by applying frameworks which resonate and appeal to them. It is about shared intentions with whānau and the commitment to work from a platform which is positive and forward looking. It is also about moving to an independence and interdependence model where all stakeholders have an opportunity to contribute and share power.’
Ngāti Porou Hauora is an integrated health, development and support services provider. It is owned by ngā whānau and hapu of Ngāti Porou to provide services, improve health status and increase the life expectancy of all its population. For more information go to: http://ngatiporouhauora.org.nz