We have come too far to not go further; We have done too much to not do more
Health equity for Māori has been a long-standing goal for our people. COVID-19 has exposed already glaring disparities in both Māori health outcomes and Māori influence within health system operations. With the establishment of a Māori Health Authority (MHA), Māori will hold more power than they’ve ever had in the health system since the arrival of Pakehā. Still, questions arise regarding how much influence the Māori health authority will really hold.
The implementation of the role is important for the future of the health care system in Aotearoa and students who choose it as a career. The Waitangi Tribunal has acknowledged the need for a clear understanding of what the MHA is, how much power the MHA will possess, the funding behind it, and who will ultimately be accountable. As our people look towards a more equitable health care future with the implementation of an MHA, we cannot be complacent. The MHA is a step forward, but it alone is not enough to fix the effects of decades of institutionalised, systemic racism and colonisation. Although this is a significant step In the right direction regarding health for our people, we need to keep pushing towards more substantial change. It will be of no surprise that the initiative will face opposition of every kind during the integration process, and policymakers will try to minimise our influence.
One of the roles the MHA holds is that it is an agent of Tino Rangatiratanga (self-determination in design delivery of Hauora Māori), but right off the bat, there are details that raiseconcerns. A momentous announcement was the introduction of the Pae Ora (Healthy Futures) Bill. Within this Bill, there is a bewildering clause that attempts to limit the application of Te Tiriti o Waitangi to only a few Māori clauses. The Bill then states that some of its principles to engage with Māori “don’t apply to all the health sector agencies”. It makes it clear that the Minister of Health has an ultimate say on what the MHA can do.
A new type of entity has been made to decide who sits at the table. But this entity and its decisions rest with the government. An example includes the decisions on board appointments (and board firings) which currently sits with the Minister of Health. An entirely new entity with more Māori control was proposed, but officials declined as they saw this idea as “not reflecting Te Tiriti partnership and accountability”, as it “gives the Crown little assurance about the capabilities of the crown to discharge their functions”. From this statement, it is clear the Crown places its power above its commitment to Te Tiriti. Any attempt to fix this broken system is met with opposition from those who only seek power for themselves.
Our people need to have a say in how the authority is operated. This allows the authority to be governed by and for Māori. The Tribunal is hopeful that an arrangement that upholds Tino Rangatiratanga can be made. But certain situations have put doubts in our minds. The COVID-19 pandemic has shown how inequitable our health system is for Māori, and the Ministry has not helped Māori primary health intrusions enough during this time. During the pandemic, it has been increasingly hard for Māori health care providers to gain the necessary data on Māori health statistics from the Ministry.
Moving towards and investing in Māori health approaches fixes many negative health outcomes for our people. This includes investment in Māori primary health care. By looking at COVID-19 equity data sets, we see the discrepancies. Halfway through the Delta outbreak, Māori infection rates reached 50% of all new cases despite being only 15% of the population. But the most infuriating statistic is that Māori made up 40% of the deaths during Delta. If the MHA is not put in a position to make real change and is not financially backed, then the current institutions that fail our people will continue to exist without alternatives.
Time will tell whether the MHA is set up to meet complete Māori health equity goals. Our people have struggled for too long and fought too hard to stop fighting for our right to heal. The Poutama pattern that accompanies this piece symbolises the various levels of learning and intellectual achievement but also the steps in which Tāne-te-wānanga ascended to the topmost realm in his quest for superior knowledge. For us here, they represent the steps towards total health equity for our people to not only survive but heal. Whether the MHA has the necessary power to make a change or not, we will continue to fight until Māori health frameworks are fully ingrained into the New Zealand health system, and Māori health outcomes improve. We have come too far to not go further; we have done too much, to not try and do more.