I feel like I am on the frontline. Not the one with the doctors and nurses and the protective PPE gear and the swabbing and injecting. But a public health, evidence-based, equity focused, Treaty frontline.
It’s scary here. Every day, I have to stop my tears from overwhelming me.
I am a public health physician and an associate professor in Māori Health at the University of Auckland. I have trained in epidemiology and I am immersed in health equity research. I can see and inherently know the terror being unleashed on my people. And I am deeply concerned.
I want you to make sound, evidence-based judgements. I want you to live up to your Treaty responsibilities. Even the 3 Ps — partnership, participation, and protection — would be something right now. But I’m not seeing that. Not when it comes to Māori health equity.
How did you decide that stealing tūpāpaku (shrouded in PPE alien uniforms) from the arms of their loved ones would ever be an acceptable approach? How could you not scientifically determine the real risk of whether or not a tūpāpaku is contagious? Or whether the risk of multiple “bubbles” can be managed by funeral directors?
How could you not — especially when we are now managing the risk of shopping for food or getting some exercise?
As a public health physician, I would never support actions that would increase the spread of infection. But scientific evidence tells us that the deceased body is not contagious.
The key risk is that the tūpāpaku or the coffin could act as a surface where roimata, hupe and saliva may transmit the virus between mourners. But this can be managed under strict conditions that Māori — arguably all — funeral directors are adamant they can provide.
This means that viewing at funeral homes doesn’t require being restricted to only “the deceased’s bubble”. Lifting that restriction doesn’t raise the risk of transmission. It may require managing numbers from any one bubble, or separating multiple bubbles from immediate whānau.
The point is, it’s entirely possible to give grieving whānau the dignity of a modified tangihanga while also maintaining safety from Covid-19.
So your mixed messages and unevidenced-based decision-making are disappointing. I expect much better. In the opinion of our pre-eminent indigenous rights lawyer Moana Jackson, the originally released tangihanga guidelines were “an assault on our people”.
I agree with him. Tangihanga processes, the ability to farewell a loved one, is at the core of Māori society and wellbeing. It’s as important as putting food on the table. It’s as important as obtaining one’s medications. In short, it’s an essential activity within Māori society. So why are you not reflecting this in your decision making?
Is it because you’ve assumed that we are on the margins, something to be managed — as opposed to being at the centre of your thinking, values and actions?
I can’t wait for the answer. But I know (as do many others) that you are falling short on taking a Māori worldview to your decision making. You are falling short on making logical, evidence-based decisions.
How you have addressed tangihanga advice is just a start. I have more concerns and so do my Māori health colleagues.
We need high-quality ethnicity data to understand how this pandemic will affect Māori. We need data about the testing, treatment and healthcare for Māori. We need this data to monitor your actions — and to avoid inequities worsening.
That’s another significant concern. As you fight Covid-19, you are justifiably pulling back on treatments for other chronic diseases, like chemotherapy and radiotherapy — and are having to reduce access to business-as-usual healthcare services.
It’s just that my people are the ones most likely to be affected by these actions, given our disproportionate level of cancer, diabetes, and cardiovascular and respiratory disease (to name a few).
This now puts us at an increased risk of death, both from Covid-19 and potentially from these other conditions.
You need to ensure that the existing barriers to healthcare access are removed for Māori so that we don’t suffer more, so that we’re protected from experiencing worse outcomes than those around us.
This includes you having an equity lens at the core of the values behind any decision-making tool you develop — to help clinicians decide who gets the ventilator when our intensive care units become too full to cope.
These are difficult, complex and ethical decisions that are hugely influenced by the underlying values and assumptions that are used.
So, with respect for everything you’re facing, please take a moment to stop and realign yourselves to health equity and your Treaty responsibility to uphold the indigenous rights of Māori.
That means more than one Māori expert on a committee. It requires an “all of government” response that can action an equity-based, Treaty-focused approach to every little decision you make and promote.
It may slow you down and it may be inconvenient. But I know that it is needed. And I know that you can do it.
Let Aotearoa show the world how indigenous rights and health equity can be meaningfully upheld and respected as we face this crisis together.
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