The new coalition government has pledged to dismantle Te Aka Whai Ora, the Māori Health Authority.
Doing so, says Lady Tureiti Moxon, will dismantle an organisation that is now reducing bureaucracy for Māori health providers, and improving service for Māori patients.
Lady Tureiti runs Te Kōhao Health in Hamilton and was on the establishment board of Te Aka Whai Ora. Here, she explains how the authority came into being, and why it must remain to finish the job it was set up to do.
Te Tiriti o Waitangi guaranteed tino rangatiratanga (self-determination: chiefly rule) to iwi Māori. It is the founding document of our nation. Those who think that the Tiriti provision of kāwanatanga (governance: the structure of government) ceded full sovereignty to 2,000 Englishmen who were here at the time are completely wrong.
In the current political 100-day coalition action plan, Te Tiriti o Waitangi has been defined in a way that favours the Crown, and action to assimilate and neutralise all forms of rangatiratanga.
As Ned Fletcher has shown in his 2023 book The English Text of the Treaty of Waitangi, this is a misreading of the founding document of our country.
The Treaty is to be understood according to the principal purpose of establishing government over British subjects for the protection of Māori. The effect of the Treaty in English was to set up an arrangement similar to a Federation, in which the sovereign power did not supplant tribal government . . . It was conceived, written and affirmed in good faith. (pp529)
The Waitangi Tribunal and Wai 1315
The Waitangi Tribunal was established in 1975 and is a permanent Commission of Inquiry. It makes recommendations on claims brought by Māori relating to legislation, policies, actions or omissions of the Crown that are alleged to breach the promises made in the Treaty of Waitangi. Its main purpose is to:
“. . . ensure that both parties to it would live together peacefully and develop New Zealand together in partnership. The Treaty does this by assuring Māori that their interests will be protected and confirming citizen equality.”
In 2005, the claim Wai 1315 was taken to the Waitangi Tribunal by four Primary Health Organisations (PHOs) in relation to inequitable funding for Māori PHOs.
Those PHOs were Toiora PHO (Kirikiriroa/Hamilton), Te Kupenga o Hoturoa (Tāmaki Makaurau/Auckland), Ngā Matapuna Oranga (Tauranga) and Te Kupenga o Hoturoa (Ngāti Pikiao Rotorua). Ngā Matapuna Oranga is the only PHO to survive today.
In 2018, evidence from Māori PHOs and other Māori health providers was finally heard before the Waitangi Tribunal in Stage 1 of the Hauora Wai 2575 claims, at Turangawaewae in Ngāruawāhia.
The claimants who led this were Taitimu (Timi) Maipi, Janice Kuka, Hakopa Paul and me, along with Wai 2687 claimants from the National Hauora Coalition, Henare Mason and Simon Royal.
The Hauora Report Wai 2575
In 2019, the Hauora Report was released. It recommended the establishment of an independent Māori Health Authority. The principles of Te Tiriti o Waitangi were articulated in the report as:
- The guarantee of tino rangatiratanga (self-determination)
- Equity (equitable health outcomes)
- Active protection
The state of Māori health
There are widely documented different levels of health for people in Aotearoa, which is unfair and avoidable. There are clear ways the system has failed to look after Māori:
- Māori die on average seven years earlier than non-Māori.
- Māori die at twice the rate as non-Māori from cardiovascular disease
- Māori tamariki have a mortality rate one-and-a-half times the rate of non-Māori children
- Māori are more likely to be diagnosed and die from cancer.
The Waitangi Tribunal found that our primary healthcare legislation and policies breach Te Tiriti o Waitangi and fail to care for Māori health and wellbeing.
Health and Disability Systems Review 2020
In 2020, the Health and Disability Systems Review by Heather Simpson and others also recommended the establishment of a Māori Health Authority. These and the other health reforms were accepted by the former Minister of Health, Andrew Little.
The review confirmed that Aotearoa has:
- Unacceptable Māori health inequities
- Institutional racism
- General health systems that have not improved Māori health outcomes
- Approaches to design, purchasing and contracting of health services that have worsened inequity.
The Pae Ora (Healthy Futures) Act 2022
In 2021, Te Aka Whai Ora and Te Whatu Ora were established and in the following year on July 1, 2022, the Pae Ora (Healthy Futures) Act 2022 came into force. The claimants worked hard to have the principles of Te Tiriti included in the legislation and to protect the Māori Health Authority.
Te Aka Whai Ora
In my view, Te Aka Whai Ora has done more for Māori Health equities in the last two years than any other government department has achieved in the last 150 years, simply because it is focused on Māori health outcomes, commissioning for services, innovation, workforce development and capacity-building.
It is a breath of fresh air to work with people who are committed and aligned to the same values and vision as those of us who work on the frontline. Their priorities are where the greatest needs are:
- Kahu Taurimu, a child’s first 2,000 days
- Oranga Hinengaro, mental wellbeing and addictions
- Māuiuitanga Taumaha, long-term conditions
- Mate Pukupuku, cancer
From a service provider perspective, Te Aka Whai Ora has brought most of our health contracts together under one contract manager with whom we have a direct relationship. This has created less bureaucracy. It has made communication and reporting so much simpler.
Our contracts in some cases have been extended to three years, which is easier to manage. Previously, under the district health boards, we were contracted on a year-by-year basis.
For those in rural communities, Te Aka Whai Ora has been able to build the capacity of service providers where there is little or no community access to health services. These communities are often overlooked, in terms of their ability to even get to a healthcare facility, in places where a hospital and transport is often unavailable.
Te Aka Whai Ora has enabled us to build a more seamless and cohesive service through Kahu Taurima, which brings together a team of midwives, a paediatrician, registered nurses, a counsellor, a clinical pharmacist and Whānau Ora wraparound services, to support mothers and their babies until they are five years old. Anyone who has had a baby in their home will know just how difficult it can be raising a child when you are sleep-deprived. It’s even worse if you are raising a baby on your own. By providing a more seamless and cohesive service within our communities, we are better able to pick up on any issues and needs of the whānau early, and to support them to meet those needs.
Workforce development for our non-regulated staff is another area of growth across the health sector, enabled by Te Aka Whai Ora. This has allowed us to train seven rongoā practitioners in our first intake, a huge learning experience for them all. We have had a further nine staff undertake the First Line Management Level 4 training at WINTEC, and 13 of our staff are currently undertaking Mahi a Atua training in Gisborne with Mark and Di Kopua.
The health reforms were about creating transformational change so that everyone received the health services they needed in a fair and equitable system. Despite all the hard work it took to establish Te Aka Whai Ora — setting up and appointing a governance board, chief executive, executive team, the Iwi Māori Partnership Boards, as well as employing staff, undertaking community consultations, and branding — all in order to bring about transformational change — this government has decided to scrap it.
There was no consultation undertaken with iwi as Te Tiriti partner. They are winding back the last 10 years of hard-fought recognition. The implementation of these anti-Māori policies is a breach of Te Tiriti o Waitangi.
Colonisation and racism are alive and well, and policies are being pursued to make Māori invisible, and create an illusion that we all equal. These anti-Māori policies are detrimental to the health and wellbeing of our country. The rhetoric that Te Aka Wai Ora is raced-based and that Aotearoa should return to what we had before —“one health system for all” — is wrong. That system failed Māori before, and it will fail Māori again.
Te Aka Whai Ora is already cutting through a huge amount of bureaucracy and is more aligned to the needs of Māori. It needs to remain to finish the job it was set up to do.
The government needs to be reminded that iwi and Māori are partners under Te Tiriti, and they need to honour that with the respect and mana it deserves.
Our future generations need to grow up in a country that treats everyone with dignity and protects them from further breaches of Te Tiriti o Waitangi.
Ka whawhai tonu mātou, āke ake ake.
Lady Tureiti Moxon is chairwoman of the National Urban Māori Authority and managing director at Te Kōhao Health and was a member of the establishment board of the Māori Health Authority.
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