Recover the Man

How to keep Māori men living longer and healthier lives is the focus of a pioneering national coalition. Adrienne Rewi talks to some of the people at the forefront of that movement.

Rugby league legend Tawera Nikau gets his blood pressure checked at the Tāne Ora Māori men's health hui by Stewart Eadie from the National Heart Foundation.

Stress, alcohol, poverty, cigarette smoking, racism and role confusion are just some of the factors that feed into Māori men having an average life expectancy of less than 69 years old.

On top of that, Māori men experience a high burden of disease compared to other ethnicities in Aotearoa.

However a new era is being heralded with Tāne Ora: the first National Māori Men's Health Conference, which was staged in Blenheim in June.

Conference chair Joe Puketapu (Te Āti Awa) has spent the past 23 years working in Māori health. He says the conference more than achieved its goal of providing a forum for Māori men to express their views.

As he leans back in his chair at the Blenheim offices of Te Hauora o Ngāti Rarua Ltd, where he is co-general manager, Puketapu talks about an exciting future for Māori men.

"The conference was designed to be thought-provoking and to provide opportunities for us to discuss priorities and issues. We wanted it to challenge Māori men to expand their thinking, to think more widely about how we can work towards achieving Tāne Ora.

"Our aim is to raise the profile of Māori men's health and wellbeing and to develop strategies that will lead to a significant improvement of the whānau ora o ngā tāne Māori.

"The forming and mandating of the National Māori Men's Health Coalition at the conference is a terrific first step towards that." As head of the newly-formed coalition, Puketapu is keen to see Māori men becoming part of the solution rather than being continually criticised as being the problem.

"I think the main issue has been a lack of recognition of the needs of Māori men," he says. "While there have been numerous initiatives to ensure the health of women and children, there is now an imbalance in terms of resources available to men. "Now it's time for our men to stand up and develop solutions to their health problems. We want to take more control of the health of our future.

Puketapu says the role of the national health coalition is to advance the development of Māori men's health at a political level and to ensure it is high on the health agenda. The Tāne Ora Conference had guest speakers including Ngāi Tahu's Tā Tipene O'Regan and former rugby league star Tawera Nikau (Tainui).

The conference was born out of a 2007 survey of Māori men's health needs in Te Tau Ihu (Nelson, Marlborough, Tasman), commissioned by Te Hauora o Ngāti Rarua and undertaken by Melissa Cragg of Karake Consultancy, Blenheim. Research included a sample population of 41, a questionnaire, a literature review, a series of consultation hui held across the region and a focus group to oversee the survey.

Cragg says it was the first time a regional approach had been taken to this type of study.

"While there were some unique characteristics particular to this region, the overall survey validated much of a previous national health survey. Figures for the top of the south were better than the national figures, but the disparity between Māori and non-Māori was still very evident.

"For example, the life expectancy for Māori males in the Nelson- Marlborough region is 73.5 years compared to the national figure of 68.6 years, but the figure for non-Māori is 76.1 years regionally and nationally."

She says the main causes of death among Māori men are cardiovascular disease, diabetes/obesity and cancer.

In terms of cancer, non-Māori go to their doctors earlier, can be treated and often survive, according to Cragg. But the trend for Māori is they are reluctant to go to the doctors and by the time they do, it is often too late for life-saving treatment, and they receive palliative care instead.

Cragg says Māori men often don't feel comfortable going to the doctor and generally don't form strong relationships with a single doctor.

Tiri Manahi (Ngāi Tahu/ Ngāi Tūāhuriri) and Joe Puketapu (Te Āti Awa).

"A lot of Māori men also felt that doctors didn't understand them and what it means to be Māori."

That observation is supported by Tahu Potiki Stirling (Ngāi Tahu/Te Whānau-a-Apanui/Ngāti Porou/Ngāti Whātua), who is the Pouārahi Rōpū (team leader) for Ngā Ratonga Hauora Māori, Canterbury District Health Board.

"If you look at all the deaths we've had from 2000-2004, you can see that Māori men are the highest in all age categories, but I don't believe that's because Māori men are sitting at home and not wanting to see a doctor or attend clinics. It's more about what we are doing to provide a service suited to Māori men and how we are encouraging them to come to us.

"Accessing medical services is an ongoing issue for Māori across the board and that comes down to a complex set of cultural issues – housing, unemployment, justice and education," says Stirling. "The mere fact that the median salary for Māori is $20,000 is a contributing factor; that's often not enough to include visits to doctors or specialists."

He points to a 2006 national study into racial discrimination that found 34 per cent of the Māori respondents had experienced some type of racial discrimination.

The Self-reported racial discrimination and deprivation: effects on Māori health study concluded that interpersonal and institutional racism contributes to health inequalities between Māori and European New Zealanders, and that future interventions and policies should address the health effects of racism. The groundbreaking study was led by Dr Ricci Harris (Ngāti Kahungunu, Raukawa, Kāi Tahu), who was subsequently nominated for the Lilly Medal for health research.

"Māori currently make up only about two per cent of the health workforce [at CDHB]," says Stirling. That's an improvement over even 10 years ago when there were very few Māori working in health, but ideally we would like to increase that to seven per cent wherever possible. We need to make contact with our Māori patients, converse with them and find out what's going on for them if we are to connect them to health services in a meaningful way." Creating a model of togetherness for Māori men will be the key to getting more involvement and participation in addressing their health issues, he says. He would like to see the Māori Women's Welfare League referenced as a model.

"The Māori Women's Welfare League has created an excellent environment for women to come together and discuss issues and develop ideas and strategies to meet the needs of Māori women. Men need to look at that model as a way of developing and determining our own health future. It's all about raising and promoting our profile.

"We've only had a few lonely voices in the past, but the numbers are becoming bigger and stronger every year. Tāne Ora was evidence of that."

Since the conference, Stirling has organised meetings with Christchurch Māori men with the aim of establishing a regional group. He says the response has been "fantastic" and that many of the men are excited by the idea and keen to participate.

"If we look back there's always been a lot of talk about Māori men being a warrior race, but we were also hunters and gatherers. We knew where all the food was and we knew the right time to collect it. We knew our role.

"Modern society and the urbanisation of Māori have confused and undermined that role for many men. Many are now in a situation where they are unemployed and because their wife is working, they are doing the cooking and child minding. That has created a number of issues around wellness and mental health in our men.

"Stress is a huge silent killer for Māori men. The responsibility for providing for whānau is a huge expectation and equally, if that ability to provide is taken away, it creates personal and family stress.

"I'm a great believer in the fact that our emotional health can affect our physical health. A significant part of that is our spiritual health, our wairua. Through my observations in working with Māori men, I have noted that some are able to rise above insurmountable odds to live quality lives while others give up and die in a short amount of time.

"If we look back there's always been a lot of talk about Māori men being a warrior race, but we were also hunters and gatherers. We knew where all the food was and we knew the right time to collect it. We knew our role. Modern society and the urbanisation of Māori have confused and undermined that role for many men."

Tahu Potiki Stirling (Ngāi Tahu/Te Whānau-a-Apanui/ Ngāti Porou/Ngāti Whātua)

Spiritual health is about self-confidence and self-awareness, he says. "The body has ways of showing us when something is amiss and some men are not picking up on these. Others are, but they're choosing to ignore the signs in the hope that whatever it is will go away.

"Women are far more aware of their bodies than men," says Stirling.

Aroha Reriti-Crofts (Ngāi Tahu/Ngāi Tūāhuriri) is general manager of the kaupapa Māori health and education provider Te Puawaitanga ki Ōtautahi Charitable Trust. She also has a long association with the Māori Women's Welfare League (she joined in 1968, served as Ōtautahi branch secretary in the 1970s and was elected national president in 1990).

Three years ago she established Healthy Day at the Pā at Tuahiwi Marae. "We have a nurse who comes to check our blood pressure, blood sugar levels and respiratory levels, and we have a wide variety of others who come along for a kōrero with the kaumātua on some health issue. It's become a monthly social event. Everyone brings along enough kai for two, not 22, and it's having a very positive effect on people monitoring their health.

The day includes tai chi, kapa haka, and painting. Reriti-Crofts says there have been all sorts of positive spinoffs. "There is such a lot of camaraderie between us. It's like one big whānau, and there's no reason why Māori men can't create the same sort of thing."

At the Tāne Ora Conference, Reriti-Crofts presented a paper entitled The Men in My Life. It was a personal account of the illnesses and health tragedies that have affected five generations of men in her family.

"I was a sickly child, and I've seen a lot of illness among the men in my whānau, so I'm keen to work towards Māori being healthier. I don't need Māori to live to a hundred, but I'd rather we be healthy and fit while we are alive."

Puketapu says if Māori men better understand themselves as men in relation to the bigger scheme of things, they will have better relationships with their women and whānau.

"We need to recognise that there are two parts to man – our taha tāne or hunter, gatherer, protector side, which we have spent all our time developing our behaviour around, and our taha wahine part, which is our caring and nurturing side.

" I've seen a lot of illness among the men in my whānau, so I'm keen to work towards Māori being healthier. I don't need Māori to live to a hundred, but I'd rather we be healthy and fit while we are alive."

Aroha Reriti-Crofts (Ngāi Tahu/Ngāi Tūāhuriri)

"Historically, Māori men were always the caregivers, the nurses, the midwives but as time has gone by, that role has been taken away from us and given to Pākehā. We've experienced years of imbalance around our understanding of who we are as men. This is an opportunity for us to say there is a better way and that some of the traditional things in our culture are valid and important to us as men and to our health and wellbeing."

Cragg says the Te Tau Ihu survey results substantiate that. "One of the recommendations of the survey was the notion of holding consultation hui or regional wānanga more regularly so that Māori men can get together to discuss issues and ideas and provide positive role models for youth.

"There's a real need for mentoring programmes and good Māori male role models. Being a good man and a good father is strongly connected to that sense of self-identity and being Māori," says Cragg. "Unfortunately many Māori men have become dislocated from their tribal base, so it is important that any health initiatives for Māori men take a holistic approach to wellbeing."

Puketapu adds that Māori men need to be challenged about some of the things that have occurred.

"We do need to come together to encourage each other and raise issues … but it is important not to generalise. We have single Māori men, married and divorced. We have gay Māori men and Māori men in gangs and in prisons.

"One size does not fit all. We need to look at developing a range of ways of tackling the health issues and not assume everyone fits into one category."

Puketapu says one thing Tāne Ora highlighted was the lack of available forums for Māori men to get together – "places where men can be men without having the interruptions of women and day-today life – places beyond the pub where the sole aim is to get pissed before rolling home".

He cites the example of The Men's Shed in Picton. Tiri Manahi (Ngāi Tahu/Ngāi Tūāhuriri), now living in Picton, is a member of The Men's Shed. Organised by REAP in Blenheim, it now has around 20 members aged 60 and over, and Manahi says everyone enjoys going along.

"We have an excellent workshop and members can participate in building or crafts. We're also restoring a clinker boat at present. It's the sort of group that gives people choice and it can become a vehicle for delivering health messages.

"I was a commercial pilot for 30 years, and health checks were an integral part of my working life, so that hasn't been an issue for me. But I do know that many men won't go to the doctor unless they're almost dying.

"The good thing about men's groups is their ability to break down barriers, says Manahi. "I keep reasonable health but I do have my own health issues and I'd be keen to join a men's health group. It's in a non-threatening situation like that, that you soon discover you're not the only person with problems."

In Christchurch, Stirling is keen to act on early momentum in the move to right Māori men's health issues.

"We need a broad approach to reviving Māori men's health – everything from developing men's self-esteem and wairua to re-teaching them how to grow vegetables and look after chickens in the back yard.

"We need to look at diet, exercise and general well-being from a holistic point of view. The good news is Māori men are adept at networking. And we Māori have some very good communication systems in our radio and television networks and our publications, and that will be vital in setting up good regional groups that our men will be interested in and passionate about being involved in. "Tāne Ora was a fantastic hui and the Mokowhiti Consultancy (whose owners are of Ngāi Tahu and Ngāti Rarua descent) did a marvellous job of the conference organisation. I'm very pleased that I was part of it and that I had the opportunity to put ideas to the group.

Puketapu says the National Māori Men's Health Coalition has earmarked the setting up of local groups as a key priority. He adds that at these early stages it is important to develop a robust structure to carry the organisation and its members into the future.

"We also need to look at how we will develop our membership, and we're looking at how we can encourage the Ministry of Health to get behind the establishment of a national health programme for Māori men which can be executed at a local and regional level." The coalition has also established a website, www.taneora.co.nz. An important step now is finding the money to fund the coalition and its work, says Puketapu.

"On a formal level we hope to have the coalition fully underway within the next two years so it can be launched at the next Māori Men's Health Conference in 2011 (at a venue yet to be decided). "What is most important is that we begin the dialogue, that at every level we begin taking responsibility as men for the future our own health. Things like alcohol and smoking have caused havoc with our health, and once you start losing your health, you lose your mana."