Political parties have an opportunity to agree that the health system has an obligation to respond to the pressing health needs of Māori, with the aim of equally good health outcomes for Māori and Pākehā. What if, ask Professor Peter Crampton and Shelley Campbell, they gave Te Aka Whai Ora a chance to succeed?
The election is still too close to call but there seems to be a clear choice on the cards regarding the approach New Zealanders want to take towards race relations, Te Tiriti partnerships and how we get to fixing the significant inequities that have existed for Māori and Pacific people for decades.
Let’s not underestimate the consequence of the political choice we are about to make. The prize is social cohesion where we all benefit from improving the lives of those who need it most in this country.
The attack politics of pre-election rhetoric will always be accepted to a point by New Zealanders, but eventually voters will tire and turn to leaders who have detailed solutions and offer hope of a better future.
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On the back of Covid, global challenges and multiple adverse weather events at home, the ground has never been more fertile for aspirational well-informed health leadership. If we are looking for role models, look no further than community leaders from Northland through Auckland to Coromandel and Gisborne who stood up during the toughest days of the recent cyclone and storms.
In seeking votes, the centre-right parties seem to be appealing to fears held by some older Pākehā New Zealanders on matters such as co-governance and prioritisation of scarce resources with the underlying message – you will miss out.
It’s worth noting that New Zealanders under the age of 30 tend not to have the same fears or concerns around te reo, Te Tiriti or partnership. They have lived and been educated through different times, when learning things Māori is an advantage and makes New Zealanders unique and exceptional on the world stage.
An example of how these debates play out concerns the future of Te Aka Whai Ora (the Māori Health Authority). While many people who work in the health system—nurses’ and doctors’ groups and the like—have stated their strong support for Te Aka Whai Ora, both the National and Act parties have said that they will scrap the fledgling agency if they form the next government. Déjà vu, we have been here before.
The future of Te Aka Whai Ora may not be front of mind for some voters, but the question remains—what if this works, what if Te Aka Whai Ora is the game changer we have all been looking for? To help with answering this question, we make three observations.
The first observation is that the majority of New Zealanders place great value on the public health system and its ability to meet the needs of all people and communities in a way that reflects our deeply-held value of fairness.
The health system is under pressure. There is no denying it is a stressed and under-resourced system. But New Zealand’s health workforce is highly-trained, highly-skilled, dedicated and extremely hard working.
Most of us rely on the health system when we have concerns about our health and when we have a health crisis. Dress it up however you like though, the experience of Māori within the system just isn’t as good as the experience of Pākehā. The extensive health problems experienced by Māori are a product of large, slow-moving factors such as racism, cultural marginalisation, loss of land and language, and poverty.
How does this play out? Māori die on average about seven years earlier than Pākehā, and for key diseases like cancer they are 20 percent more likely to get some cancers but 60 percent more likely to die from them. Something doesn’t add up.
There is a mountain of data to illustrate this point and health planners and leaders in nearly all fields of health care are aware of these facts. So, in response, the system is attempting to take more responsibility for its poor performance by strengthening its own capacity to respond differently.
In the context of a single, coherent health system for all people and communities, Te Aka Whai Ora places Māori expertise right at the centre of the system within a bespoke Crown entity focused on delivering health outcomes for Māori that are similar to those for Pākehā.
Replacing this with a one-size-fits-all operating model based largely on political philosophy would benefit those who are already privileged by existing political, financial, health and social systems, with the likelihood that the health inequities between Māori and Pākehā will grow.
Our second observation is that New Zealanders have a long history of embracing innovation and a number 8 wire mentality. Te Aka Whai Ora is an example of focused responsiveness, adaptability and innovation.
Our health system has a duty to understand and cater to the particular health needs of different patients and communities, and to empower communities to lead their own solutions. There are countless examples of the system’s willingness to address the needs of different groups, be they rural communities, older people, children, people with mental health problems and so on.
It is necessary that the health system respond to the health consequences that beset Māori communities with fresh thinking, home-grown models and innovative solutions. Te Aka Whai Ora is one such solution.
While on its own it is not a silver bullet, it does substantially increase the capacity of the health system to respond to the health challenges Māori communities face including in ways that are culturally nuanced and tailored to Māori contexts. We believe this is evidence of a growing and increasingly sophisticated willingness of the system to design its services in response to different contexts.
Observation number three is the purely practical matter of the time it takes to see results from turning the ship around. A large-scale re-organisation of the health system, such as the current transformation process, is a long-haul journey.
Setting up new organisations such as Te Whatu Ora (Health New Zealand) and Te Aka Whai Ora takes a huge amount of effort and we should not expect to see immediate and dramatic results from either of these brand-new agencies within a year. This is a five-year change runway with at least two years before we will start to see a cohesive sector-wide approach.
Our view is that it is misleading to claim that if we haven’t seen results in the first year, the new agencies have failed. Given the amount of thought, effort and expense that has gone into setting up the largest Crown entity ever, these new organisations need a chance to succeed. In reality, the health sector is very fragile and resilience plus appetite for reform of reforms is likely to be low. Even if it wants to, a new government will struggle to turn the health reforms off or around; the changes have gone too far and are embedded in legislation that would take a great deal of effort and expense to change.
And so we find ourselves asking – what if Te Aka Whai Ora were to succeed? What if all political parties agreed a commitment to fairness means that the health system has an obligation to respond to the pressing health needs of Māori, with the aim of equally good health outcomes for Māori and Pākehā.
History shows that not all approaches in the past have been successful at narrowing the gap between the haves and have nots, and in this election there is a clear ‘do it to or do it with’ strategic trade-off, with Te Aka Whai Ora intending to improve Māori health outcomes taking a ‘do it with’ approach. Let’s give it the time and support it needs to succeed.
Professor Peter Crampton (Pākehā) is a public health researcher at the University of Otago. He served on the Health and Disability System Review, which advocated for the development of a Māori health authority. He is a member of the board of Te Tāhū Hauora (Health Quality and Safety Commission) and is a member of the Public Health Advisory Committee.
Shelley Campbell (Ngāpuhi, Ngāti Hine) served on the Health and Disability System Review which advocated for the development of a Māori health authority, and is the CEO of the Wise Group. She is a lecturer for Ngā Manukura (Clinical Leadership training programme for Māori Nurses and Midwives) and for the Leadership for Māori in Public Health programme.