Parties pressed on approach to Ma¯ ori health
Despite two major health reviews revealing the extent of health inequity for Ma¯ ori in Aotearoa, a survey of political parties shows many are light on detail on how they will address the issues. Ma¯ ori health consultant Teresa Wall analyses the results
Political parties are not going into the 2023 election blind to the detail of the harm of Ma¯ ori health inequity or what should be done. Two major reviews have led to the Pae Ora (Healthy Futures) Act 2022, which came into effect on July 1, 2022, signalling substantial changes to the health system in Aotearoa New Zealand.
These changes were informed by evidence. Firstly, by the findings of WAI 2575 that the Crown had breached the Treaty of Waitangi by failing to administer and implement the primary healthcare system to actively address persistent Ma¯ ori health inequities. Also, the Crown had failed to give effect to the Treaty guarantees of tino rangatiratanga (autonomy, self-determination, sovereignty and self-government).
The Health and Disability System Review, which also informed the legislation, recommended system level changes that would be sustainable, lead to better and more equitable outcomes for all New Zealanders, and shift the balance from treatment of illness towards ensuring health and wellbeing.
The reviews had laid out starkly that Ma¯ ori faced inadequate access to health services, poorer quality of care, and a failure of health services to improve outcomes for Ma¯ ori, all of which contributed to the persisting inequities in health outcomes for Ma¯ ori.
The health system changes under Pae Ora have the potential to make a lasting difference to Ma¯ ori access to health services, to the quality and safety of those health services and to improving health outcomes for
Ma¯ ori.
As Associate Professor Jason Gurney and Professor Jonathan Koea have pointed out, the marked disparities in Ma¯ ori health have
persisted for over 100 years within the previous single health authority system. A new path forward is needed that gives Ma¯ ori greater say (rangatiratanga) in shaping their health. They concluded that “Te Aka Whai Ora — the Ma¯ ori Health Authority — should not be scrapped before it has had a chance to work”.
The future of the Ma¯ ori Health Authority
Our first question to the political parties asked: will your party retain and/or strengthen the Ma¯ ori Health Authority/Te Aka Whai Ora?
In their responses, Labour, the Greens and Te Pa¯ ti Ma¯ ori stated they would retain Te Aka Whai Ora. Labour referred to its actions while in government, establishing Te Aka Whai Ora, saying it would continue to support the entity. However, it was silent on whether it would strengthen the agency. Both the Greens and Te Pa¯ ti Ma¯ ori were of the view that the agency needed to be given much more power and resources. The Greens stated the agency needed more resource to enable it to have an equal footing with the other major health organisations: Manatu Hauora and Te Whatu Ora. Te Pa¯ ti Ma¯ ori identified that it would allocate 20 per cent of the heath budget to the agency.
Act stated that it would abolish Te Aka Whai Ora. National also implied this, albeit saying it would replace it with “a strong Ma¯ ori health directorate within the broader Ministry of Health”.
Policies to improve Ma¯ ori health and equity
The second question to the political parties asked: expand on what measures your party will introduce to improve Ma¯ ori health and equity.
The Greens were the only party to attempt to address the unequal distribution of the social determinants of health (those are all the factors that impact our health such as housing, employment, etc) by raising the need to address poverty and increase incomes. Labour again pointed to their efforts over the last three years but provided little detail on what they proposed to do if they became the next government.
Te Pati Ma¯ ori’s response was light on detail and focused on Wha¯ nau Ora and legislating to support the continuation of the models’ implementation. It also referred to action to improve access to cancer treatments, dental care and mental healthcare.
The response from National has not deviated from previous stated directions: care closer to home, devolution of responsibility to iwi and Ma¯ ori providers, support for those who are doing a good job, and self-accountability.
Act was focused on targeting of health services based on health need, including variables such as age and socio-economic background. It appeared to ignore the fact that ethnicity plays a significant role in access criteria, deprivation, quality of care and health outcomes.
Comment
It is disquieting to note that all of the political parties’ responses to addressing the enduring and unacceptably large inequities that Ma¯ ori experience appear to be very
light on detail. They also did little in the way of linking wider social determinants of health to what policies they would put in place to improve Ma¯ ori health (an exception was the Greens which discussed improving incomes).
While the Labour Government has put in place significant health sector changes aimed at, among other things, addressing inequities for Ma¯ ori, it is also disappointing that their election statements are largely silent on further actions.
Both Act and National have articulated statements that are very much aligned to their ideological positions. While there is some potential merit in National’s view of enhancing successful local iwi-based delivery of healthcare, it is problematic there is no role for distinct central Ma¯ ori leadership in healthcare (other than the weaker former approach of a Ma¯ ori directorate within the Ministry of Health).
Te Pa¯ ti Ma¯ ori is proposing a substantive injection of funding to Te Aka Whai Ora but, as with the Greens, has been light on what health policies or actions will be put in place to effect lasting change.
In summary, over the last two decades New Zealand has had a health system that was required to address and reduce health inequities for Ma¯ ori, and that aim has been repeated more recently in the Pae Ora (Healthy Futures) Act 2021. While this survey shows some progressive responses from some political parties, they were all rather light on detail and two would wind back a key new feature: Te Aka Whai Ora.
i For the full report go to https://www.phcc.org.nz/ briefing/where-do-partiesstand-addressing-maorihealth-inequity
The Public Health Communication Centres has approached all parties on other topics such as food marketing. health transport, drinking water, vaping, how to seal with disasters, meningococcal disease: https://www.phcc.org.nz/ briefing