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De-estabilishing the Maori Health Authority


All three of the parties who will form the next government have campaigned on disestablishing the Maori Health Authority. What does it even do, and what will happen if it’s scrapped?

It was to be a game-changer that would give Maori a strong voice in the health system.

But nearly 18 months on, the incoming National-led government wants to scrap Te Aka Whai Ora (the Maori Health Authority) saying it hasn’t achieved anything worthwhile in its short existence.

RNZ In Depth te ao Maori journalist Ella Stewart (Ngāpuhi) says the Maori Health Authority was changing the balance of power in the health system.

“Te Aka Whai Ora came into effect in July 1st, 2022. It is the first time in New Zealand that we’ve had a commissioning agency for Maori at that upper central government level with the power to do a whole bunch of things,” Stewart says.

How do they do that? Iwi-Maori Partnership Boards are tasked with speaking to local Maori and Maori health providers about what works best for them, then going back to the Maori Health Authority and asking them to commission certain services.

Despite a report being released that says, among other things, that the role of the boards have lacked clarity, Hikitia Ropata (Ngāti Toa Rangatira, Ngāti Raukawa, Te Āti Awa, Ngāti Porou) chair of the Āti Awa Toa Hauora Partnership Board, says she’s “150 percent” clear about what its tasks are, And she’s calling for the Maori Health Authority to be kept.

The outcomes being promoted for the new Maori Health Authority were to improve Health of Maori. Te Hiringa Hauora thought that cranking up Maori interest in traditional approaches to health care would improve outcomes.

This was based on assertions about the “evils” of colonization and the damage it did to the Maori world view and it seeks to use today’s health money to promote spirituality, cultural identity and whanau development to “decolonize” Maori futures.

There was an idea being promoted that taxpayer money from Vote: Health should be spent on Maramataka Maori, the Maori lunar calendar and forecasting based on the moon cycles, star systems and tides which will lead to an appreciable betterment in Maori mental health.

The truth is that Maori life expectancy in 1840 was about 30 years. Today after all the so-called evils of colonization, education, better food and scientific advances, Maori life expectancy is in the 70s.

As such talk of Maori solutions to health spreads I believe that it’s a reflection on the naivety of the Labour government and Health Minister Andrew Little, who seem to believe in miracles.

The Labour government endorsed the edict from Te Whatu Ora - Health New Zealand in which they introduced an Equity Adjustor Score.

Under this proposal Auckland surgeons are required to consider a patient’s ethnicity alongside other factors when deciding who should get an operation first. As a result, patients are no longer being prioritised on the basis of clinical need, but on race.

Several surgeons have said that they are upset by the policy, which was introduced in Auckland in February and gave priority to Maori and Pacific Island patients - on the grounds that they have historically had unequal access to healthcare.

The “Equity Adjustor Score” aimed to reduce inequity in the system by using an algorithm to prioritise patients according to clinical priority, time spent on the waitlist, geographic location (isolated areas), ethnicity, and deprivation level.

The claim that this has been introduced to reduce inequity in the health system is not, in fact, supported by the data on historical inequality in the access to healthcare. Until now, none of the basic criteria for a systemically racist system have existed in the New Zealand Health Service, but under the Te Whatu Ora proposal which includes their Equity Adjustor Score it has been embedded into our health system.

Under the Code of Disability and Consumer Rights, we have had a health system that legislated for equal services and access for all races, as required by the UN Declaration of Principles on Human Rights, the Declaration of Commonwealth Principles, and the New Zealand Bill of Rights.

Up until the introduction of the Equity Adjustor Score there had not been any discrimination on racial grounds, but with this policy Te Whatu Ora has firmly embedded it into our health system.

Some surgeons have said that the new scoring tool was medically indefensible. They said patients should be prioritised on how sick they were, how urgently they needed treatment, and how long they had been waiting for it - not on their ethnicity.

However, we can look to the past to find a solution that has been proven to work. It’s called parental care and responsibility for the children they produce.

It is a parent’s responsibility to get children vaccinated, introduced to child care, and sent to school. The fact that more than 50% of Maori children on any school day are now truanting from school isn’t the government’s fault: it can be laid squarely at the door of a parent or parents. Sadly, welfare beneficiaries who are paid by the taxpayers to look after their children seem to be at the heart of the problem. Governments can make health services more easily available but in the end, we need to remember that it is parenting that is at fault in most cases.

Labour seemed to prefer to believe that ballooning welfare rolls played no part in “inequitable” health outcomes for Maori. Funny that. I’m old enough to recall that bad Maori health statistics compared with other ethnicities weren’t anything like as common in the era before the introduction of the Domestic Purposes Benefit in 1974.

Maori health leaders have criticized the New Zealand Health System as being systemically racist and that this is the prime contributor to poor Maori health and reduced Maori longevity.

The five most common claims that have been made by them in this regard are as stated below. These have all been fact checked and found to be incorrect. These claims are:

  1. That Maori die seven years earlier than other New Zealanders.
  2. That Maori have poorer health services than non-Maori.
  3. That decolonising the health system will improve Maori health and longevity.
  4. That a primary contributing factor for Maori ill health is “systemic racism”, “white privilege” and “unconscious bias” in the New Zealand Health system.
  5. That non–Maori are not affected by inequitable health provision and services. All the above statements are not correct, as shown by the following facts and evidence.
  6. That Maori die seven years earlier than other New Zealanders.

The data on the life expectancies of people living in New Zealand in 2018 are:

                 Males  Females

Chinese 87.2 90.1 Asian (other) 85.4 88.0 Indian 85.3 85.7 MELAA 82.6 84.7 (Middle Eastern, Latin American, African) European 81.6 85.1 Samoan 77.6 82.2 Pacific 75.9 80.2 (Fijian Tongan, other Pacific) Maori 74.2 78.2

Genetics have been estimated to account for between 7% and 33% of the variance in longevity. The standard accepted figure for this genetic impact is 25% Comparisons of different ethnicities regarding relative life expectancies must take this into account. From the above figures, it can be seen that Maori have the lowest life expectancy. This is accurate. However, it is not accurate to say that Maori die seven years earlier than other New Zealanders as each race in New Zealand has its own genetically influenced life expectancy. That their cousins, the Cook Island Maori, who are genetically very similar, die at around the same age as New Zealand Maori, suggest, but do not prove, that this may be their natural life expectancy. It can be seen for example that Pakeha die nearly six years earlier than Chinese New Zealanders. Using the same logic of the above claim, i.e., that Maori die seven years earlier because of the “systemically racist” Health Service, do we also claim that, as Pakeha are dying six years earlier than Chinese New Zealanders, it is due to a “systemically racist” Health System. The logic is irrational. If genetics are not considered, then mistakes and faulty analysis occurs. This is what has happened here. It is disappointing that the Maori Health leaders who are doctors continue to quote this “fact” when they are all aware of the genetic determinants of longevity. The Next Part of This Article will Appear Next Month

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elocal Digital Edition – December 2023 (#272)

elocal Digital Edition
December 2023 (#272)

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