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Introduction: Cultural Competence, Legislation and Māori History: Video Transcript

Kia ora tatou. Welcome to this on-line foundation course in Cultural Competency. My name is David Jansen and I am a General Practitioner working in Auckland.

Kia ora tatou, nau mai haere mai. My name is Leonie Matoe and I lead the nutrition and physical activity team at Te Hotu Manawa Māori in Auckland.

Health practitioners want to make a positive difference and contribute to the improved health of our patients. This on-line course is designed to provide you with the foundation skills to begin your cultural competence journey: and has been developed especially for the New Zealand health workforce

This module briefly outlines the background and context for this cultural competence foundation programme.

It is not our intention to try to make you experts on legal matters, but I want to quickly cover the NZ Public Health and Disability Act 2000, the Health Practitioners Competence Assurance Act 2003, and the Health and Disability Commissioner Act 1994.

The Health Practitioners Competence Assurance Act 2003 requires that health practitioners observe standards of cultural competence that are set by responsible authorities – such as the Pharmacy Council, the Podiatrists Board, the Nursing Council or the Medical Council. In recent years many health practitioner regulatory authorities have published standards for cultural competence. Sometimes these cultural competencies are embedded within the broader clinical competencies, and sometimes the cultural competencies are stand alone. As a health practitioner, registered with one of the regulating authorities covered by the Act, we are required to meet the standards set by our relevant authority.

The Health and Disability Commissioner Act 1994 established the role of the Health and Disability Commissioner. The Act also prescribed the code of rights which came into effect 1 July 1996 (http://www.hdc.org.nz/the-act–code/the- code-of-rights). Many aspects of the code are relevant to cultural competence. The Health and Disability Commissioner has discussed cultural competence in detail. A brief review of the code identifies that:

Right 1 part (3) of the Code gives every consumer the right to be provided with services that take into account the needs, values, and beliefs of different cultural, religious, social, and ethnic groups, including the needs, values, and beliefs of Māori.

The Commissioner in 2002 Mr Ron Paterson stated that, “as Commissioner, I actively seek to ensure that Māori access the Code, that the Commissioner’s office reflects its commitment to the principles of Te Tiriti, and that the rights of Māori consumers are promoted and protected.” Mr Paterson noted that the Code sits alongside the Treaty “as a means of achieving oranga through the empowerment of Māori consumers.”

Mr Paterson further identified that Right 4 part (3) gives every consumer the right to have services provided in a manner consistent with his or her needs, and Right 4 part (4) ensures that services are provided in a manner that minimises potential harm to a consumer and optimises the quality of life.

Under Right 4 part (5), every consumer has the right to co-operation among providers to ensure quality and continuity of services. This right includes instances where the consumer is receiving services from providers with quite different thinking on what is appropriate care for the consumer. A consumer may choose to see both a tohunga (Māori healing specialist) and a conventional practitioner – interaction and co-operation between each provider assists to facilitate a co-ordinated approach to the consumer’s care.

Right 5 gives all consumers the right to effective communication in a form, language and manner that enables the consumer to understand the information provided. This places an obligation on the provider to ensure that information being communicated can be understood.

Right 5 part (2) states that every consumer has the right to an environment that enables both consumer and provider to communicate openly, honestly, and effectively.

Right eight states that every consumer has the right to have one or more support persons of his or her choice present.

Further detail is available from the Health and Disability Commissioner website http://www.hdc.org.nz

The NZ Public Health and Disability Act 2000 established District Health Boards, and requires District Health Boards in exercising the specified Treaty of

Waitangi obligation, to ensure that Māori can participate in decision-making and the development and design of health strategies. The Act is also very explicit that District Health Boards have responsibilities to provide health services for and improve the health of the people resident in their respective districts and address the health disparities between Māori and other New Zealand citizens.

This course on cultural competence is not exclusively about Māori, we acknowledge the genuine and broad application of cultural competence to the diverse cultures resident New Zealand. It is also completely appropriate that we maintain a focus on Māori culture and Māori health – recognising Māori as tangata whenua, the indigenous people of this land, and recognising that Māori people have the greatest health disparities across a wide range of health indicators. The module on Māori people, health and history will take you a little bit further into this discussion.

So that is a brief overview of the background regarding legislation and regulations. And it is significant internationally as to where that places the New Zealand public health system. Many people would advocate that New Zealand is leading the world in some aspects of identifying and protecting the rights of health consumers. But this course doesn’t need to convince you one way or the other, this background is part of the context for developing and providing this course to you.

We have also provided throughout this course some of the research and some of the evidence about cultural competence in health. Much of the literature comes from international studies and other jurisdictions.

Finally, note that this course is an introductory programme. Each of you will need to meet the standards and requirements of your registration authority. Your registration authority will have specific requirements, perhaps regarding how to record your professional development programme activities in cultural competence or continuing education requirements. Where possible this course will provide you with the appropriate credits or documentation for the work that you do during this course, in a form that meets the requirements of your registration authority.

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