We challenge, Hon Dr Reti, to do what is right and include ethnicity, as a variable, in equitable healthcare
Te Kāhui Hauora Māori, a collective of primary health care providers, is laying down a challenge to the Minister of Health to issue a counter directive informing the health sector it must consider ethnicity, as a variable, in equitable healthcare.
A directive, which includes ethnicity, will ensure fair and robust needs based provisions for individual care, services and health contracts everyone can use to guide their equity work, says Ora Toa Director of Health Michael Rongo.
“It will meet the Government’s objectives, and continue decades of work already undertaken to improve equitable health outcomes for Māori, Pasifika people, and all other ethnicities which suffer from certain health conditions, of which ethnicity, is one of the determining factors.”
The wero, or challenge, to Hon Dr Shane Reti was laid down following the latest Government directive from the Public Services Minister Nicola Willis to remove, or justify using, ethnicity in needs based service provisions in every public agency including health.
“Ethnicity is a need. It is a determinant of health and therefore a need which impacts outcomes for patients,” says Top of FormTaima Campbell, Chief Executive Hauraki PHO.
“If the Crown does not recognise ethnicity in public services we run the risk of blowing out inequities, which will again, disproportionately harm Māori people, their children and whānau, our communities, and Aotearoa in general,” says Campbell.
“It is unfair, and unjust. It is also not the behaviour of fair minded Kiwis. This is not who we are as a nation.”
Equity guardrails against higher taxpayer costs, more sickness, and premature deaths
In New Zealand, Māori are sicker, dying younger and prematurely, more than any other ethnic group. Māori children are disproportionately represented in social situations such as poverty in greater numbers than any other ethnicity, leading to higher rates of preventable health conditions and death.
Last week was Mental Health Week, a time to reflect on the mental health of all Kiwis. Māori are overrepresented across every condition, particularly rangatahi, New Zealand’s future leaders and 20 per cent of the workforce by 2040.
It is why Te Kāhui Hauora Māori (TKHM) is extremely concerned about recent developments and challenged the Health Minister to do what is right by providing a fair and just counter directive to the policy set down by the Minister of Public Services.
TKHM includes: the Hauraki PHO, National Hauora Coalition, Ngā Mataapuna Oranga, Ngāti Porou Hauora, and Ora Toa. Te Kāhui Hauora Māori delivers whānau-focussed hauora outcomes while maintaining autonomy as individual organisations improving the health and social outcomes of Māori, and all New Zealanders.
“We also challenge Dr Reti to consider the decades of clinical evidence and overwhelming research to continue using ethnicity, as one of many variables, to determine equitable healthcare initiatives and services,” says Rongo.
“Equity guardrails against higher taxpayer costs, more sickness, and premature deaths. Why would the Government conceive that taxpayers would agree to widening inequity gaps, by removing ethnicity as a factor?”
Ethnicity is not a proxy for need but it is a determinant of health
TKHM agrees with Hon Nicola Willis who said in her public service directive ethnicity is not a proxy for need. However, unlike Minister Willis who told public servants to consider all other variables before ethnicity, and to justify its use, TKHM believes ethnicity is equal to all needs based factors.
A holistic approach to healthcare is important because it targets and considers everything in a person’s life which could be impacting their health, such as the environment, family dynamics, socioeconomic status, etc.
Minister Willis also mentioned in her directive one of the reasons why she has legitimised removing ethnicity from contractual services is the perception of discrimination.
“Trying to improve equity isn’t a form of discrimination,” says Campbell. “The Government seems determined to conflate needs and rights to justify its many policies to remove race based, evidence based initiatives, particularly focused on Māori. It’s unconscionable.”
TKHM agrees with the positioning of Māori, and other high needs groups in health plans
For the past 24 years much has been done to ameliorate health inequities for all New Zealanders. Although Māori health statistics are dire, they have improved over time but more can be done.
Hon Dr Reti has laid out his plans for the health sector through the Government Policy Statement on Health 2024-27. In it he prioritises improving outcomes for all New Zealanders and high need populations such as Māori, Pacific peoples, disabled people, women, and people living rurally.
He sets out how those priorities will be achieved in Māori health by shifting decision-making closer to people and communities, and involving them in the design and delivery of services.
The Minister also outlines five priority areas; access, timeliness, quality, workforce, and infrastructure. In his access priority he lays out 20 expectations which include working with Iwi Māori Partnership Boards to ensure primary and community care services are increasingly tailored to better respond to the needs of Māori.
Time to hui with all Māori primary healthcare representatives and the Minister of Health
In light of the new public service directive the challenge remains, says TKHM, the Hon Dr Reti needs to inform the health sector to use ethnicity equally with other variables in assessing needs.
“We look forward to engaging with Hon Dr Reti in the future to discuss our challenge to him further, kanohi ki te kanohi, face to face, and to support his efforts to improve outcomes for everyone,” says Campbell.
“We are proposing a hui to gather all Māori primary healthcare representatives with the Minister to openly discuss the future of Māori health.
“Let us work together, the Crown and Māori, to remove barriers so all New Zealanders are equal.”
For further information or interview requests, please email: communications@ngatitoa.iwi.nz
References:
Waitangi Tribunal WAI2575: Hauora: Report on Stage One of the Health Services and Outcomes Kaupapa Inquiry (July 2019)
https://waitangitribunal.govt.nz/news/report-on-stage-one-of-health-services-and-outcomes-released/
Indigenous adaptation of a model for understanding the determinants of ethnic health inequities (2022)
Racism is an important determinant of health (2023). Ministry of Health, NZ Health Survey
Hauora Māori – Māori health: a right to equal outcomes in primary care (2024)
Achieving Equity (last updated 8 August 2024). Te Whatu Ora Health NZ
https://www.tewhatuora.govt.nz/corporate-information/about-us/achieving-equity
Government policy statement on health 2024-27 (30 June 2024)
https://www.health.govt.nz/publications/government-policy-statement-on-health-2024-2027
Press release Hon Nicola Willis 13/09/24 plus links to Cabinet Circular, Minute and Paper
https://www.beehive.govt.nz/release/need-and-value-forefront-public-service-delivery