HOW DO ELECTION PROMISES STACK UP AGAINST MĀORI ASPIRATIONS FOR HEALTH? Professor of Māori Health at Auckland University of Technology (AUT), Denise Wilson, looks at how far policies targeting Māori will go towards improving Māori health equity and outcomes.
Election 2020: party policies
- Māori leadership and autonomy in health
- Māori health services
- The Māori health workforce
Māori health: the big picture
- The three biggest challenges to Māori health in 2020
- Government interventions that could make a real difference to Māori health
Election 2020: party policies
Māori leadership and autonomy in health
Election 2020 | Three parties (Labour/Green/Māori) have proposed to establish a Māori health agency or authority, to incorporate the principles of Te Tiriti and matauranga Māori into the health system, increase Māori leadership and control in commissioning health services for Māori.
Q: What government intervention is needed to put Māori at the centre of decision-making? Is a Māori health agency or authority a good move? Who should lead it? What is window dressing and what is meaningful change?
A: (Professor Denise Wilson) – The New Zealand Health and Disability System Review recommended the establishment of a Māori health authority, although members of the review panel indicated that the recommendations did not go far enough.
The current health and disability system continues to fail many Māori in multiple ways – that is, having equitable access to the determinants of health (education, housing, employment, and income), and access to quality health services that are timely, safe and free of bias and racism.
Without a doubt, Māori must lead the design and management of a Māori health agency or authority, with the support of government. A Māori health authority needs to be about rangatiratanga and mana Motuhake. Despite previous governments’ intentions and interventions, we have not seen appreciable gains in health equity for Māori. And Māori can no longer afford to wait for the government to get it right.
We have evidence that the system fails our people, and more window dressing will maintain the status quo. Nothing is stronger than the fact that Māori are more likely to have serious preventable health conditions, and more likely to be hospitalised or die as a result. The reality is that Māori die on average seven years earlier than those who are not Māori.
Incorporating Te Tiriti o Waitangi and mātauranga Māori into the health system enables Māori to focus on wellbeing and health equity for Māori. However, this requires the government to clarify its role as a Te Tiriti partner and share the necessary resources to enable Māori to lead a health and wellbeing plan, for Māori.
During the COVID-19 lockdowns, Māori overwhelmingly demonstrated that when the government offered Iwi, hapū and hapori (community) providers high-trust contracts, they worked to anticipate and respond to the needs of whānau.
Māori health services
Election 2020 | There is strong support for Whānau Ora. Three parties (Labour/National/Māori) have indicated ongoing support or increased funding for the indigenous health initiative. National’s Māori-specific health policies focus entirely on Whānau Ora, including a review of its commissioning model. While the Green Party has taken a more general approach, to increase funding to Māori and Pasifika community health providers.
Q: What government intervention is needed to improve health services for Māori? Is the focus on Whānau Ora too narrow? Are any opportunities or challenges being overlooked?
A: (Professor Denise Wilson) – It is pleasing to see that Labour, National and the Māori Party have all proposed the continuance of Whānau Ora. Whānau Ora positions whānau at the heart of decision-making about wellbeing and draws on the collective strengths and capabilities of the whānau as a whole. It moves away from individual-focused, disease and illness oriented approaches to health.
While Whānau Ora is a successful approach, there is a need for government to also consider its role in supporting Iwi and tāngata whenua providers – particularly those that improve whānau wellbeing, but are underfunded or not funded at all.
The Māori Party has also indicated they would issue ‘a health card for all Māori for purchasing health services’, which expands on Whānau Ora by providing Māori with greater choice and control over the health services they require. Such a policy is pleasing to see, although whānau may require support in determining the services they need. Whānau Ora has navigators already embedded in this approach, to support whānau to be able to make these decisions about their wellbeing.
Māori have a higher mortality rate for cancer that is associated with delays in diagnosis and treatment. So, it is a positive move by the Māori Party to ‘allow Māori to access cancer screening earlier’. We know that Māori are likely to die at a younger age, so where the evidence supports earlier screening, this seems like a logical suggestion.
The Māori health workforce
Election 2020 | It appears that only two parties have Maori-specific policies to address the health workforce. The Green Party has proposed scholarships and professional development for Māori seeking management roles in health. While the Māori Party aims to progress pay negotiations for Māori nurses.
Q: What government intervention is needed to develop Māori leadership and the Māori workforce in health?
A: (Professor Denise Wilson) – These are both important areas that require attention. Pay equity for Māori nurses is long overdue. It is incomprehensible that Māori nurses pay is dependent on the work setting, even if they are similar roles.
However, these policies do little about progressing the long-standing issue of insufficient Māori in the health workforce. It is well established that culturally and ethnically matched health professionals and users improve health outcomes.
Despite decades of successive governments acknowledging the need to increase the Māori health workforce, little has changed. There needs to be a purposeful strategic approach to Māori health leadership and workforce development, that is monitored in terms of recruitment, retention and the cultural safety of workplace settings.
We know what the problems are – sub-standard experiences of education; equity issues around access to necessary resources for studying (such as computers, internet access and a quite space in work); retention in both education and practice, fuelled by racism and bias in teaching and curricular content; the lack of monitoring education and practice providers; and few development and leadership opportunities for Māori.
Māori health: the big picture
Q: What is the big picture? Where does Māori health sit in relation to poverty, housing and education?
A: (Professor Denise Wilson) – All people living in Aotearoa should be able to enjoy healthy lives and live to similar ages. But that is not the case for Māori. They are more likely to die earlier than their New Zealand European counterparts from non-communicable diseases, like diabetes and cardiovascular disease. As a result, Māori are often cast in a negative light, regardless of their potential and positive contributions to society.
Health is complex and not merely about something we do or don’t do. Poverty, sub-standard housing and lower levels of education are intertwined. Education is crucial for employment and income. For instance, the better our employment prospects, the better our income is likely to be, and the more likely we can live in a warm dry home and have security over healthy food.
Q: What are the biggest challenges to Māori health in 2020?
A: (Professor Denise Wilson)
1. Being able to access health services, diagnostic tests, interventions or treatment in a timely manner.
2. The lack of tāngata whenua wellbeing services that are informed by mātauranga Māori and designed to meet the needs of whānau.
- Institutional and interpersonal bias/racism that leads to non-responsive health services for Māori.
Q: What government interventions could make a real difference to Māori health?
A: (Professor Denise Wilson)
1. Address child poverty with greater urgency. The evidence is unequivocal that growing up in poverty, even for short periods, has lifetime impacts on education, social and health outcomes. It is a pathway to premature chronic illness and death.
2. Listen and act on recommendations from Māori health experts and leaders about improving Māori health equity and outcomes. Continuing with the same interventions, even if packaged differently, will only yield more of the same. Māori know what is needed to improve the health and wellbeing of whānau, yet we continue to have the same conversations year after year.
- Create a purposeful strategy aimed at education and practice to increase the Māori health workforce, monitored by a multidisciplinary team of Māori health experts in partnership with government. We cannot underestimate the value of having someone who looks like you in the health setting.
Denise Wilson (Ngāti Tahinga, Tainui) is a Professor of Māori Health. She is the Director of the Taupua Waiora Centre for Māori Health Research and Associate Dean for Māori Advancement at Auckland University of Technology (AUT). Her research and publications focus on Māori and indigenous health, health service engagement, health workforce development, cultural responsiveness, and family violence.