Where do the parties stand? Addressing Māori health inequity

On 1 July 2022, the Pae Ora (Healthy Futures) Act came into effect. This followed the findings of the Inquiry WAI 2575 that the Crown had breached the Treaty of Waitangi by failing to administer and implement the primary health care system to actively address persistent Māori health inequities and failed to give effect to the Treaty guarantees of tino rangatiratanga (autonomy, self-determination, sovereignty and self-government). ¹

The Health and Disability System Review, which also informed the legislation, recommended system-level changes that would be sustainable, lead to better and more equitable outcomes for all New Zealanders and shift the balance from treatment of illness towards ensuring health and wellbeing.

The Pae Ora Act “…requires the Minister, the Ministry and all health entities to be guided by the health sector principles, which among, other things, are aimed at improving the health sector for Māori, and improving Māori health outcomes: and establishes the Māori Health Authority and sets out its objects and functions…”.

The health system changes under Pae Ora have the potential to make lasting difference to Māori access to health services and the quality and safety of those health services, aiming to improve health outcomes for Māori.  As Associate Professor Jason Gurney and Professor Jonathan Koea have pointed out, the marked disparities in Māori health have persisted for over 100 years within the previous single health authority system. A new path forward is needed that gives Māori greater say (rangatiratanga) in shaping their health. They concluded that “Te Aka Whai Ora—the Māori Health Authority—should not be scrapped before it has had a chance to work.” ²

The future of the Māori Health Authority

Our first question to the political parties asked:

• Will your party retain and/or strengthen the Māori Health Authority/Te Aka Whai Ora?

The responses from the parties are summarised in the Table below (see the Appendix for the full responses).

In their responses, Labour, the Greens and Te Pati Māori stated they would retain Te Aka Whai Ora. Labour referred to its actions while in government, establishing Te Aka Whai Ora, saying it would continue to support the entity. However, it was silent on whether it would strengthen the agency. Both the Greens and Te Pati Māori were of the view that the agency needed to be given much more power and resources. The Greens stated that the agency needed more resource to enable it to have an equal footing with the other major health organisations: Manatu Hauora and Te Whatu Ora. Te Pati Māori identified that it would allocate 20% of the Heath Budget through the agency.

ACT stated that it would abolish Te Aka Whai Ora. National also implied this, albeit saying it would replace it with “a strong Māori Health directorate within the broader Ministry of Health.”

Table 1: Political party policies on the future of Te Aka Whai Ora (Māori Health Authority) (Party responses in alphabetical order)

Political party	Summary of response (see Appendix for the full response)	Favoured retaining and/or strengthening the Māori Health Authority/Te Aka Whai Ora?
ACT	Believes an equitable health system is directed at those individuals in the greatest need, especially where health resources are limited.	No. Will abolish
Green	Outlined its commitment to providing support for hauora Māori, recognising the existing health disparities and the responsibility to provide funding to address this.	Yes.
Labour	Referred to its actions in government creating Te Aka Whai Ora/The Māori Health Authority as a significant step towards tino rangatiratanga in health and living up to the Crown’s obligations to Māori under Te Tiriti o Waitangi.	Yes. Pledged to continue support for the authority and the rest of the health system to improve Māori health outcomes and reduce inequities.
National	Believes that we don't need two systems to deliver public services. We will implement a single system that has enough innovation in it that can deliver for people on the basis of need.	No. To be replaced by “a strong Māori Health directorate within the broader Ministry of Health”. Believes the Māori Health Authority is “simply more bureaucracy that actually won't lead to better outcomes.”
Te Pāti Māori	Outlined how it had campaigned strongly on the introduction of a Māori Health Authority. But cautioned it needed to be given much greater power.	Yes. Says it will allocate 20% of the Health Budget for Māori health initiatives, and much of this would be through Te Aka Whai Ora.

 

Policies to improve Māori health and equity

The second question asked political parties:

• Expand on what measures your party will introduce to improve Māori health and equity.

The responses from the parties are summarised in the Table below (see the Appendix for the full responses).

The Greens were the only party to attempt to address the unequal distribution of the social determinants of health – by raising the need to address poverty and increase incomes.

Labour again pointed to their efforts over the last three years but provided little detail on what they proposed to do if they became the next government. 

Te Pati Māori response was light on detail and focused on whānau ora and legislating to support the continuation of the models’ implementation. It also referred to action to improve access to cancer treatments, dental care and mental health care. 

The response from National has not deviated from previous stated directions ie, care closer to home, devolution of responsibility to iwi and Māori providers, support for those who are doing a good job and self-accountability. 

ACT was focused on targeting health services based on health need including variables such as age and socio-economic background. It appeared to ignore the fact that ethnicity plays a significant role in access criteria, deprivation, quality of care and health outcomes.

Table 2: What the political parties would do to improve Māori health and equity (parties listed in reverse alphabetical order)

Political party	Summary of response (see Appendix for the full response)	Comment
Te Pāti Māori	Significantly increase funding to Whānau Ora and give Whānau Ora greater autonomy and legislative protections to reflect its independent mana and status. The response also covered significantly expanding services covered by the public health system, such as cancer treatments, dental care and mental health care.	One of the only responses to raise the issue of Whānau Ora – which encompasses supporting families within the community context.
National	Believes in devolved care for Māori, not centralised care. Will boost Iwi providers who are doing a good job of reaching the local community. Will devolve autonomy closer to the home and closer to the hapu and will have key health targets.	Continued on the path of devolution of responsibility.
Labour	Referred to its actions in government including a funding boost for Māori primary and community healthcare providers as part of $71.6m in commissioning investments by Te Aka Whai Ora. Investing in kaupapa Māori mental health providers through initiatives like Access and Choice	The response provided little detail on what they will do if they become the next government.
Green	Committed to prioritising population groups currently experiencing inequitable outcomes, including Māori and Pasifika within the health system, and addressing determinants of health disproportionately impacting Māori and Pasifika by boosting incomes.	One of the few responses to consider the role of low incomes in driving inequities.
ACT	Argues the health system should be focussed on the health needs of the person rather than solely their identity and resources directed at people that have higher risk factors, such as socio-economic background, age, etc.	Ignores the role that ethnicity plays in Māori health (see Introduction).

Comment

It is disquieting to note that all of the political parties’ responses to addressing the enduring and unacceptably large inequities that Māori experience appear to be very light on detail. They also did little in the way of linking wider social determinants of health to what policies they would put in place to improve Māori health (an exception was the Greens which discussed improving incomes).

While Labour as Government has put in place significant health sector changes aimed at, among other things, addressing inequities for Māori, it is also disappointing that their election statements are largely silent on further actions.  

Both ACT and National have articulated statements that are very much aligned to their ideological positions. While there is some potential merit in National’s view of enhancing successful local iwi-based delivery of healthcare – it is problematic that there is no role for distinct central Māori leadership in healthcare (other than the weaker former approach of a Māori directorate within the Ministry of Health).

Te Pati Māori are proposing a substantive injection of funding to Te Aka Whai Ora but as with the Greens have been light on what health policies or actions will be put in place to effect lasting change.

In summary, over the last two decades New Zealand has had a health system that was required to address and reduce health inequities for Māori, and that aim has been repeated more recently in Pae Ora (Healthy Futures) Act 2021. While this survey shows some progressive responses from some political parties – they were all rather light on detail and two would wind back a key new feature: Te Aka Whai Ora. 

Author details
Teresa Wall (Te Rarawa, Te Aupōuri) – Māori Health consultant. Former Deputy Director-General Māori Health.

 

Appendix: Full responses from the five political parties to the survey

The questions we posed were:

Responses below (as provided by 6 July) are in randomised order.

Green Party

Question 1 (retaining the Māori Health Authority)

Yes - The Green Party is committed to providing support for hauora Māori, recognising the existing health disparities and the responsibility to provide funding to address this. We believe needs and preferences of Māori whānau, from the beginning to the end of life, must be recognised and respected in the delivery of health services.

Question 2 (measures to improve Māori health and equity)

1. Empower and resource Te Aka Whaiora (the Māori Health Authority) to work in an equal relationship with the Ministry of Health and Te Whatu Ora (Health New Zealand) to improve outcomes for whānau, hapū, iwi and hapori.

2. Prioritise population groups currently experiencing inequitable outcomes, including Māori and Pasifika, within the health system, as part of ensuring equal health outcomes for all. To achieve this, we’ll require Public Health Organisations to develop and report on plans to proactively improve their services to under-serviced populations.

3. Address the determinants of health disproportionately impacting Māori and Pasifika, including by boosting incomes. We’ll end poverty for all families through a base payment of $385 a week for everyone out of work, and an $135 a week top up for sole parents. This will replace Jobseeker, the Student Allowance, and Sole Parent Support - with full individualisation; and universal eligibility. We will transform Working for Families by creating a Family Tax Credit of $215 a week for the first child and $135 a week for subsequent children. We will also introduce a tax-free threshold so that the first $10,000 earnt is tax-free. This will result in everyone earning $125,000 and under getting a tax cut.

Te Pāti Māori

Question 1 (retaining the Māori Health Authority)

Te Pāti Māori campaigned strongly on the introduction of a Māori Health Authority and we are glad that the government adopted the idea. However, it needs to be given much greater power and resource. We would allocate 20% of the Health Budget to by Māori, for Māori health initiatives, and much of this would be through Te Aka Whai Ora. 20% reflects an equity-based proportion based on population and need.

Question 2 (measures to improve Māori health and equity)

Te Pāti Māori would significantly increase funding to Whānau Ora and give Whānau Ora greater autonomy and legislative protections to reflect its independent mana and status. We would also significantly expand services covered by the public health system, such as cancer treatments, dental care and mental health care.

Labour Party

Question 1 (retaining the Māori Health Authority)

The health system must work in true partnership with Māori to improve services and achieve equitable health outcomes. That’s why our Labour Government has made substantial progress in furthering Māori health equity during our time in government. The creation of Te Aka Whai Ora/The Māori Health Authority was a significant step towards tino rangatiratanga in health and living up to the Crown’s obligations to Māori under Te Tiriti o Waitangi. We will continue to support Te Aka Whai Ora, community health providers, and the rest of the health system to improve Māori health outcomes and reduce inequities.

Question 2 (measures to improve Māori health and equity)

Last November, we welcomed a record funding boost for Māori primary and community healthcare providers as part of $71.6m in commissioning investments by Te Aka Whai Ora. This funding includes $13 million for contract increases with Māori primary and community providers and $11.7 million to support innovation and ensure diverse whānau voices inform the design and provision of healthcare. In mental health too, we must address health inequity. That’s why it’s important we invest in kaupapa Māori mental health providers through initiatives like Access and Choice. Through this programme, almost 53,000 sessions have been delivered, and more than 4,000 people were seen in December alone. Many of these services simply didn’t exist before this Government’s Wellbeing Budget in 2019.  

ACT Party

Question 1 (retaining the Māori Health Authority) and Question 2 (measures to improve Māori health and equity)

An equitable health system is directed at those individuals in the greatest need, especially where health resources are limited. ACT will abolish the Maori Health Authority. The health system should be focussed on the health needs of the person rather than solely their identity. Health resources should be able to be better directed at people that have higher risk factors, such as socio-economic background, age, etc.

National Party

Question 1 (retaining the Māori Health Authority)

National believes that we don't need two systems to deliver public services. We will implement a single system that has enough innovation in it that can deliver for people on the basis of need.
By the Māori Health Authority’s own admission, they don’t expect to see any benefits for Maōri for at least five years – that is not good enough.
The Māori Health Authority is simply more bureaucracy that actually won't lead to better outcomes. We should have a strong Māori Health directorate within the broader Ministry of Health.

Question 2 (measures to improve Māori health and equity)

National believes in devolved care for Māori, not centralised care. National will work closely with iwi and community groups. Where iwi providers are doing a good job of reaching the local community, National will boost them up so they can continue.
National will devolve autonomy closer to the home and closer to the hapu and will have key health targets and will hold ourselves accountable.