Self-determination at the heart of new Māori Health Authority
Wednesday, 21 April 2021
Since the beginning of the 20th century, Māori have been calling for a by Māori, for Māori approach to health services. Now, tino rangatiratanga or self-determination for Māori is on the horizon. National Correspondent Florence Kerr explains.
Ka pū te ruha, ka hao te rangatahi – when the old net is cast aside, the new net goes fishing.
The old health system is gone, dismantled by the government to be replaced by something new, streamlined and centred on fixing systemic issues for all New Zealanders and health inequities for Māori.
On Wednesday, Health Minister Andrew Little announced the creation of an independent Māori Health Authority that will have commissioning powers, and make joint-decisions alongside the newly created, centralised agency called Health NZ.
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The Government will also abolish all 20 district health boards to set up Health NZ, to oversee four new district health areas.
The Māori Health Authority comes almost two years after a damning Waitangi Tribunal report outlined systemic racism and the consistent failure of the Crown in the care and wellbeing of Māori.
It’s also a year since the Heather Simpson’s Health and Disability review panel made its comprehensive recommendations including a Māori Health Authority. However, there was a split in the panel and Expert Māori Advisory Group who believed Simpson had not gone far enough. They put forward an alternative view of what an independent Māori Health Authority should be. It’s the alternative view the government had endorsed in its health system changes.
On average, Māori die seven years younger than non-Māori, a fact health experts say is a result of inequities in the system caused largely by institutional racism.
The claimants that sparked the tribunal inquiry, health experts, iwi Māori and the Crown are now tasked with building the new model from the ground up with whānau at the heart of it.
Simon Royal the chief executive of the National Hauora Collective, and one of the two main tribunal claimants, says the authority was a long time coming.
“The crucial question is, ‘what is the changed experience for whānau in this new infrastructure coming into place? If it doesn't change that experience it will all just be a bureaucratic exercise and there's no one in this room that I am in that wants that,” he said.
“What our whānau can expect is better access to a wider range of services to whānau in their own locality, so we don't have to travel far for treatment. There is going to be a greater emphasis on improving the use of technology, digital mobile services, locality planning, and developing new workforces and less complexity in the way the health system appears to Māori.
“There's a lot more work to do around whānau engagement and that whānau voice being amplified into the health system and how we respond to it. The interest of whānau are being placed at the centre rather than professional workgroups, and stakeholders.”
Primary health workers at the coal face across the country say the Māori Health Authority is desperately needed.
Albie Laurence, CEO of Ngāi Tahu owned Te Kāika Hauora in Dunedin said getting rid of the old system will have a positive impact on Māori health outcomes.
“Primary health organisations are good at some stuff, namely looking after the health of a ‘general’ population in the middle class, but when it comes to our vulnerable communities of Māori and Pasifika, they have spent a lifetime being underserved,” said Laurence.
“We spend too much time at the moment working hand in hand with whānau, only for our ideas to then get lost in the tangle of red tape in middle management. The urgency of the needs for our local whānau is out of step with a system designed to move slowly.”
The authority has been welcomed by Kaikohe-based iwi health provider Te Hau Ora o Ngāpuhi chief executive Te Ropu Poa.
“It's courageous and bold. The minister acknowledges the health system has failed the minority groups in our country,” she said.
“We have the opportunity now, with the establishment of a Māori Health Authority, to ensure that the health system delivers in improved outcomes for Māori.”
She would like the new authority to deliver on priorities where Māori have poor outcomes, such as increasing screenings for pancreatic, bowel, prostate and cervical cancer.
National Party health spokesperson Dr Shane Reti, a medical doctor in Northland and former member of the Northland DHB, has condemned the new authority calling it separatist, echoing the sentiments of his leader Judith Collins.
Reti believes Māori do not need their own health authority, instead, there needed to be a better framework for Māori health within the one system.
“It's not explicitly bad, it's whether it is the best framework to deliver the aspirations of Maori for their hauora,” Reti said.
“The question I'm raising is that the framework that has been put forward where there are potentially two separate health systems in New Zealand, where there will be competition for workforce, where there will be competition for funding. This is not generally what International Health Systems seeking to be the best and high performing do.”
Reti acknowledged that changes are needed because statistics showed the status quo was not working for Māori.
He said even if the authority did work in fixing Māori health inequities, National would still abolish it if it came into power.
“I would congratulate any progress that they could make and look at how that was done, what parts were the most effective, but we would still be of the view that would then need to be brought back into one system.”
Associate Health Minister Peeni Henare said he couldn't care less for National’s “regressive politics”.
He said it’s important to remove the many barriers for Māori seeking medical treatment in a system that hasn’t treated them well, and to highlight inequities for non-Māori to understand.
Henare said Dr Reti was his family doctor when he was growing up, and they know each other well.
“While I respect his expertise and his knowledge, in this case, he has it wrong. The evidence is overwhelming, and I'm proud of what this government has decided to do about it.”
Henare said he was ecstatic to create change that would see Māori reclaim their health and strike balance for what has been an inequitable system for Māori.
The Māori Health Authority is autonomous, he said, but also sits within the wider health structure. It is unique, he says.
“That has been the overwhelming evidence from clinicians, practitioners, and our whānau, including those who presented to the Waitangi Tribunal for Wai 2575 that it must be independent. We're committed to that.
“The second part of it, is it must also have influence and levers within the broader system … So it's important that the Māori Health Authority continues to drive policy and decision-making in an integrated health model in order to serve Maori interests with respect to health.”
Bay of Plenty District Health Board's first Māori chairperson Sharon Shea said the announcement of the Māori Health Authority will be a game-changer if it is implemented well.
Shea said the partnership between the authority, the Ministry of Health, and Health NZ will create a whole system change that has never been seen in New Zealand before.
“The Māori Health Authority will innately know and understand the healing power of tikanga, the healing power of karakia, waiata, wai, you know, all of those beautiful aspects of our culture,” Shea said.
“That will be promoted as an opportunity for us to be able to access a wide range of kaupapa Māori services that we've never seen before in the history of the New Zealand health system. It's exciting if we can fulfil the promise.”
Shea was also the chair of the Expert Māori Advisory Group that advised the Health and Disability Review panel.
One of the original tribunal claimants, Waikato kaumātua Taitimu Maipi said the government had recognised the need to establish an independent Māori Health Authority.
“This is the first time I have ever supported a government initiative, as I have always opposed and protested anything that has come from out of this building [parliament],' he said.
“After all these years I see some hope in [the] government announcement, but our challenge will be to keep the government to task, which was always the aim to achieve mana Māori motuhake in Hauora.”
Minister Henare expects the Māori Health Authority will be setup by July 2022.
Additional reporting by Denise Piper and Hannah Martin.