OPINION
Despite two major health reviews revealing the extent of health inequity for Māori in Aotearoa, a survey of political parties shows many are light on detail on how they will address the issues. Māori health consultant Teresa Wall analyses the results of the Public Health Communication Centre (PHCC) election survey questions on improving Māori health equity.
Political parties are not going into the 2023 election blind to the detail of the harm of Māori 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 NZ.
These changes were informed by evidence. Firstly, by the findings of the Inquiry 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 Māori 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 Māori faced inadequate access to health services, poorer quality of care, and a failure of health services to improve outcomes for Māori, all of which contribute to the persisting inequities in health outcomes for Māori.
The health system changes under Pae Ora have the potential to make lasting difference to Māori access to health services, the quality and safety of those health services aiming to improving health outcomes for Māori.
As Associate Professor Jason Gurney and Professor Jonathan Koea have pointed out, the marked disparities in Māori health have persisted for over 100 years within the previous single health authority system. A new path forward is needed that gives Māori greater say (rangatiratanga) in shaping their health. They concluded that “Te Aka Whai Ora—the Māori Health Authority—should not be scrapped before it has had a chance to work.”
The future of the Māori Health Authority
Our first question to the political parties asked: Will your party retain and/or strengthen the Māori Health Authority/Te Aka Whai Ora?
In their responses Labour, the Greens and Te Pāti Māori 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 Pāti Māori 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 Pāti Māori identified that it would allocate 20 per cent of the heath budget through 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 Māori health directorate within the broader Ministry of Health”.
Policies to improve Māori health and equity
The second question to the political parties asked: Expand on what measures your party will introduce to improve Māori 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 Pāti Māori response was light on detail and focused on whānau 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, ie. care closer to home, devolution of responsibility to iwi and Māori 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 Māori 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 Māori health (an exception was the Greens which discussed improving incomes).
While the Labour as Government has put in place significant health sector changes aimed at, among other things, addressing inequities for Māori, 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 that there is no role for distinct central Māori leadership in healthcare (other than the weaker former approach of a Māori directorate within the Ministry of Health).
Te Pāti Māori are proposing a substantive injection of funding to Te Aka Whai Ora but as with the Greens have 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 Māori, and that aim has been repeated more recently in 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.
For the full report go to https://www.phcc.org.nz/briefing/where-do-parties-stand-addressing-maori-health-inequity
Teresa Wall (Te Rarawa, Te Aupōuri) – Māori health consultant. Former Deputy Director-General Māori Health.