This section was co-written with DRUA, Le Va, and Tupu Services in 2023.
While often grouped together, Pasifika refers to several different groups – each with their own culture, language, and history. Values of fa‘aaloalo (respect), alofa (love), vā fealoa‘i (collective relationships), and tautua (duty) are common across many Pasifika cultural groups, with some differences in how they apply to everyday life.
Pasifika people in Aotearoa are strongly connected to family and communities in the Pacific Islands. That means that conversations about harm reduction in Aotearoa cannot be disconnected from conversations in the wider Pacific region. Space to talanoa (talk) about alcohol and other drugs and explore ways to prevent health, social, and legal harms in a by Pasifika for Pasifika context is needed. This is an international conversation, respecting the similarities and differences in the Pacific Islands and Aotearoa contexts.
Policy-level changes to reduce harm from substances require engagement from communities. However, the methods used to engage communities often do not result in effective engagement with Pacific communities. Meaningful engagement of Pacific communities, particularly those who have experience of substance use, is essential to ensure what is put in place reflects the needs of the community.
Implementation of a harm reduction approach in service delivery
“Cultural engagement is important to ensure successful Pacific outcomes are achieved and that is very important and critical. What does that look like in practice?
With Mapu Maia, the ability to implement a harm reduction approach in both prevention and in intervention is the key to ensure elements of keeping the vā, providing key information, psychosocial messaging, and implementing clinical interventions through family-centred and strengths-based care are what we found to be key to achieving the outcomes for our Pacific clients and their aiga. We developed integrated service delivery whereby clinicians have dual community-based roles. Their dual roles enable the team to engage in the community, build rapport and trust, deliver prevention programmes as well as clinical interventions through a cultural lens.
By integrating public health and clinical practice to deliver prevention and primary healthcare services [we provide] a seamless and integrated service which makes sense for the service user and their family.”
Pesio Ah-Honi, Chief Executive Officer of Mapu Maia and Co-Chair of DRUA]
Key considerations:
- The conversation that families, villages, and communities have about alcohol and other drugs is changing across generations. It was commonly seen as inappropriate to use these substances and abstinence was seen as the goal. Many families are now talking about and encouraging actions that reduce the potential of harm from some substances that are more commonly used, such as alcohol and nicotine. For example, some families have experienced this as a shift from conversations being stopped with “don’t drink” messages to having more space to say that ideally people would not drink, but if they do, they should drink at home, not drive, drink non-alcoholic drinks as well, and eat food.
- People born in Aotearoa navigate many different cultural, situational, and peer influences. These younger generations may need different information, tools, and support than older generations. This information, tools, and support needs to be provided in a way that takes into account that younger generations will be part of families, churches, and communities who may not understand the context in which young people grow up in Aotearoa.
- Space for conversations about how potential health, social, and legal problems from drugs could be prevented need to happen in a culturally appropriate way. These topics are taboo, and respect for the vā (the space or relationship that connects people with each other, the environment, and time) is essential. These conversations will need to happen over time, providing space for the nuance of the situation to enter the discussion appropriately.
- A person’s wellbeing is interconnected with their family, culture, environment, time, and their health (spiritual, physical, and mental). Models of wellbeing, such as the Fonofale and Fonua models, can help a person reflect on their situation and what actions they can take to improve their wellbeing.
- Focus on creating a space for conversation where there is no judgement and feelings of shame can be removed. Shame is a major factor that prevents people talking about alcohol and other drug use, looking for information, or getting support. The process of warmly welcoming, removing shame, and connecting is often an important component of nurturing the vā in Pasifika addiction services.
- Families care for each other and do not turn family members away when there are problems. Often, families will try to address a situation themselves, and many families have found their own pragmatic solutions that prevent or reduce problems. Sometimes families do this without speaking to the places that they would usually be connected to and supported by, such as church, because they fear being judged or ostracised. That can be isolating, and strains their connection to the community around them. It can also mean that people only reach out for information or support when there are no other alternatives or when pressures are extreme (e.g., from involvement of Oranga Tamariki or police, or when there are extreme health problems).
- Families can feel like they have failed to care for their family member if a family member goes to hospital or a residential programme.
- Health and social services have an important role to play to share accurate information and provide space for conversations that a person may not be able to have with other people in their lives. These conversations should:
- Take into account family, cultural, and religious contexts. Some conversation areas are seen as especially taboo (e.g., talking about putting drugs into genital areas) and need extra care when talking about them in a health setting.
- Aim to protect the safety of the person, their family, and their community.
- Provide accurate information about ways to prevent risk and problems.
- Health and social services should not turn people away from information or support because the person does not want to reduce or stop their use.
- A person’s family or partner can be powerful agents of change. They are also going through their own journey and need access to information, tools, and support to have conversations with alofa.