John Tamihere reminds us of the ways in which Maori are disadvantaged in our current health care system. Each one of his examples in his Herald article strikes home as a real failure. They resonate with me, both as an academic who has studied health services and health policy for a long time, and as a current elected member of the Auckland District Health Board (ADHB).
The argument John makes is a powerful and persuasive one, but, from my experience of the ADHB, one could largely have substituted Pasifika for Maori and come up with a similar story of failure and disadvantage in the health care system. That is why the senior management and planning staff at the ADHB, with the support of the Board, have developed an equity agenda that encompasses both Maori and Pasifika, on the reasoning that these two groups share not dissimilar circumstances of disadvantage.
Then, to draw a fuller picture, one should also include those in the bottom two quintiles of our socio-economic structure, regardless of ethnicity. Those in that demographic are severely disadvantaged in similar ways, regardless of ethnicity. That is why DHBs have a special loading in their allocation from the Population-based Funding Formula that takes account of the proportion of their population that is in that demographic, alongside Maori and Pasifika. Overall, then, this is a story about people with limited voice and power trying to get a system to respond to their needs, and with the system trying through a number of mechanisms to respond.
Our welfare state system, inclusive of health and social policy, designed in the 1930s, operates on the principle that people in need, regardless of ethnicity and socio-economic status, should be served according to their requirements, whether that need be housing, income, education, or, in this case, health care.
The problem is that the system continues to fail in many of these respects, and Maori, among others, have borne the brunt of that. Let us remember that we are just emerging from the aftermath of a decade in which more state houses were sold than were built, benefit levels remained mostly unadjusted, low-decile schools didn’t get the support they needed, and the funding of the health care system was steadily eroded.
In other words, while the concerns of Maori are long-standing, they have also been exacerbated in the period since the Global Financial Crisis by a failure to maintain key features of the pre-existing social contract between the State and citizens.,
The Treaty of Waitangi governs the relationship between Maori and other New Zealanders. In the design and delivery of and access to health services, it must be taken into account. The Government’s proposed health changes are a chance to rectify the failures in health care, for Maori and or others who are disadvantaged. Maori will be the vanguard of the change through the Maori Health Authority, but let the kaupapa be one of “leave no one behind”, “levelling up”, and “lifting all boats”.
The coalition of those who support the public health system can at times be fragile. Removing Maori from that coalition weakens it. For example, Ngati Whatua appear to have given up on the failings of the current system by signing up for comprehensive private insurance cover. That is understandable in the circumstances, but Maori leadership on the wider equity agenda across our health and social services is vital. That way we support not ‘separatism’, but solidarity and unity. We are all in this together.
Elected Member, Auckland District Health Board
and Emeritus Professor of Population Health and Social Science,
University of Auckland