Amicus Curiae: Keep Politics Out of It – How Māori Health is Being Held Back by Those Meant to Be Improving It
The author acknowledges that she is Pakeha and does not wish to speak over Māori voices. If you have any issues with the content of this article, she invites you to please contact her.
Several high-profile individuals have recently expressed concerns that the New Zealand health system is actively “failing Māori”, despite provisions in both legislation and Ministry of Health policy documents meant to avoid exactly that. The CEO of Te Whānau O Waipareira Trust, John Tamihere, asserted that there was “institutional racism” within the health system, whilst Dr Rawiri Jansen, chairman of Te Ora (Māori Medical Practitioners’ Association) has spoken of having to manoeuver around public servants who would hinder Māori-targeted medical programmes. Institutional (or systematic) racism is largely agreed to be “requirements, conditions, practices, policies or processes that maintain and reproduce avoidable and unfair inequalities across ethnic groups.” On that note, Dr Jansen concluded that the legislation and policy meant to address inequities in Māori health was being “undermined by bureaucratic interference that is motivated by political considerations rather than medical ones.”
In response to Mr Tamihere and Dr Jansen’s concerns, the Minister of Health elected to give no oral or written comment. The Ministry’s written statement accepted it “didn’t always get it right”, but drew attention to its recent revision of the Health Strategy 2000 policy document.
The key stipulation contained within the New Zealand Public Health and Disability Act 2000 is that the legislation should work to “to reduce health disparities by improving the health outcomes of Māori and other population groups.” Furthermore, the New Zealand Health Strategy 2000 emphasised the importance of addressing health inequities, and directed that the Ministry and District Health Boards (“DHBs”) would achieve this by:
- Identifying “community-driven initiatives that are achieving results or that have the potential to do so;
- Adapting policies, programmes and funding to support successful community initiatives;
- Implement programmes to reduce health inequalities;
- Support provision of/by Māori for Māori services”;
- And engaging in the fulfilment of other relevant objective.
There is also a specific Māori Health Strategy – He Korowai Oranga – that is aimed toward Pae Ora (healthy futures). He Korowai Oranga continues to identify four pathways in implementing strategy:
- “supporting whānau, hapū, iwi and community development;
- supporting Māori participation at all levels of the health and disability sector;
- ensuring effective health service delivery;
- working across sectors.”
The Health Strategy recognised the ‘te whare tapa whā’ health model of 4 dimensions that, when equalised, impact upon wellbeing: te taha wairua (spiritual); te taha hinengaro (mental and emotional); te taha whānau (family and community), and te taha tinana (physical).
The 2016 revision also included an action needed for enabling Māori to contribute to decision making on health and disability services and participate in the delivery of these services.
Based on Tamihere, Jansen and Dr Heather Came’s statements to Radio NZ, it would appear that neither set of objectives set by the Health Strategy or He Korowai Oranga have been met. Rather, their implementation appears to have been obstructed. DHBs were singled out in needing to consider He Korowai Oranga in “planning and meeting statutory objectives and functions for Māori health”, though Jansen asserts a demonstrable failure by those bodies to meet these legal obligations. The Ministry acknowledged that some gains had been made towards health equity, but recognised there was still significant differences. For example, Māori life expectancy is significantly lower than non-Māori, whilst the former has higher comparative mortality rates and illness/injuries.
With this year’s Health Strategy revision now superseding the 2000 version, many of the same issues are again present, with publicised submissions also giving an insight into how those affected view the health system. A summary of submissions disclosed a recurring theme concerning the Treaty of Waitangi/Te Tiriti o Waitangi, with submissions identifying a need for the “strategy to show more culturally appropriate ways to address health problems that affect Māori (in particular tangata whenua and tikanga-based principles in health care).” Further submissions from Māori suggested that equity in health outcomes had not yet been achieved, and that current services fail to integrate the Māori wellbeing approach into the Strategy, with the Pakeha ‘disease model’ still the overriding authority.
The concerns brought up by the aforementioned individuals and professionals are not new in origin. A conclusion of institutional and interpersonal racism impacting upon Māori health and treatment has been drawn by numerous sources, particularly since Mason Durie’s Whaiora. Racism and discrimination breach not only the Treaty of Waitangi but also basic human and indigenous rights, and the elimination of these must therefore be prioritised and accomplished in order for any real change to occur in the field of Māori health.
It is clear that reducing inequities in Māori health is a multifaceted issue that requires multiple problem areas to be addressed – funding, quality of care, access to health care and a lack of ‘best practice’ and Māori practitioners. Nonetheless, the public health sector must absolutely recognise the shared concerns of Māori professionals and academics that institutional racism and politics are obstructing gains in this area, and it must actively take steps to combat that. Such steps may include actively creating and maintaining relationships with Māori stakeholders, taking on board their feedback and priorities, and making clear commitments to addressing health inequities and Te Tiriti. The Ministry has legal and political obligations to do so, and the consistent research affirming these findings show how significant of an issue this is. AUT health researcher Dr Heather Came summarily identified the wider societal benefits of doing so, that given even further weight to the need for change:
"If you lift up the health of the most vulnerable you lift up the health of everybody. That's exactly where you should be investing, into targeted public health interventions. It will be the most efficient in terms of health gains and the most cost-effective. It's ineffective and it's not cost-effective to allow health inequalities to flourish.”
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