Rhys Jones: Taking a sovereign stance

Rhys Jones is one of the growing number of Māori health professionals who’ve lost patience with the mainstream health system which, despite the stats, keeps behaving as if it knows, much better than Māori, what’s best for Māori health. Here he outlines to Dale some of his thoughts on that issue.

 

Kia ora, Rhys. I know you have a Ngāti Kahungunu whakapapa but, in your full name, Rhys Griffith Jones, there’s just a hint of some Welsh ancestry, isn’t there? 

Yes. There’s Welsh heritage from Evan, my dad. His father was a Jones and his mother was a Griffith. On the Jones side, there’s a strong English connection, and Scottish too. 

Then, through my mother, Michele, we affiliate to Ngāti Kahungunu from Wairoa. But we also trace our whakapapa back to a number of the iwi and hapū from up around there, including Te Aitanga-a-Māhaki, Tūhoe, Whakatōhea — and no doubt others that I’m not so familiar with. 

But the four of us kids all had Welsh names inflicted on us because our parents liked Welsh names. My brothers are Bryn and Carwyn, and our sister is Rhiannon.

Bryn is also a doctor and he does a variety of work aimed at equitable Māori wellbeing. Carwyn is an associate law professor at Victoria University in Wellington and was recently one of the negotiators for the settlement of our Treaty claims in Wairoa. 

Rhiannon is a dietitian and works as a Māori health academic at the University of Otago and the University of Auckland — and she’s loving being a māmā to Manaia who was born in August.

And where were you living as youngsters? 

We were city kids. We grew up in Taradale, in Hawke’s Bay. Mum and Dad were Napier people. They met at Colenso High School, in Napier. And, from there, my dad went to the University of Canterbury, and did teacher training in Christchurch where Bryn and I were born. 

Then my dad got a teaching job in Whakatāne, at Trident High School for a couple of years and next in Hawke’s Bay at Taradale High School, where he spent most of his teaching career.

He taught maths, statistics and physics for many years. That wasn’t just at high schools, including St Joseph’s Māori Girls’ College and Te Aute. But he was also a teacher at EIT, the Eastern Institute of Technology. 

Michele, our mum, has done various jobs over the years, more recently in Special Education. She’s had a soft spot for working as an early intervention teacher, and using the “Incredible Years” programme in her work with tamariki and whānau Māori. 

As kids we were part of a loving whānau. Not a lot of material things, but plenty of aroha. And our family was unusual in that Mum and Dad had a no-violence kaupapa. We were never hit — which was quite different from the way many children were raised in the 1970s.

How about your links in those days with your Māori whānau? And with te reo Māori?

We had really close links with our Māori whānau in Napier, and with our extended whānau in other places, but we weren’t really connected with our marae, Tākitimu, in Wairoa. That engagement has come about more recently. 

I didn’t grow up speaking Māori. My reo journey didn’t really begin until I got to high school.  We had a close family friend, Jenny Cracknell, who was a Māori language teacher in Napier. During my teenage years, we’d kōrero, so I owe a huge debt of gratitude to her and others who helped me with this kaupapa. I also did te reo Māori at high school, and I followed up through various courses and wānanga.

As a young fulla, did you have medicine in mind as a career?

I wasn’t one of those young people who’d always wanted to be a doctor. But I had an affinity for maths and the sciences — and I’d been thinking about options like engineering. But medicine began to appeal to me because it’s more people-oriented. And I managed to get into the medical programme straight out of high school. 

Going to med school in Auckland was a big culture shock for me. There I was moving from small-town Hawke’s Bay and into the big smoke — and coming into a class where lots of the students were from the top city schools like Auckland Grammar, King’s, and Epsom Girls’. I felt quite intimidated and I took a while to realise I had just as much right to be there as anyone else.

How did things roll after med school? Where did life take you?

When I graduated, I moved back to Hawke’s Bay for my junior doctor years. I went down there with Jo, my girlfriend who’s now my wife. We’d been in the same class at med school and started going out in our fourth year. 

I worked in Napier Hospital and Jo worked in Hastings Hospital before the two were amalgamated in Hastings. It was great working in Napier Hospital because it was relatively small and it was a tightknit community, where you got to know everyone. 

Then, when we’d saved up a bit of money, Jo and I went off to the UK on a working holiday. I did a number of locum type jobs, but then I got a six-month position as a junior doctor in paediatrics which was one of my strong interests. 

When we came back in the late ‘90s, I worked as a paediatric registrar, just doing locum work, and I enjoyed that. But eventually, I decided that public health was the specialty for me. 

That was for a number of reasons, including that I was mostly working out at Middlemore Hospital and seeing a lot of Māori and Pacific children coming in. 

Many of those I saw were from whānau who were living in very difficult circumstances. And their illnesses were often the result of social problems like poverty and poor housing. Being a bit idealistic at the time, I thought there had to be a better way to approach these issues, rather than just waiting for children to come into hospital and then us trying to deal with their ill-health. 

There was some satisfaction, though, in seeing them respond to the medical care — and, in the vast majority of cases, then seeing them go home a few days later much, much better. And the gratitude from the parents and the whānau was incredible. So, I really enjoyed that aspect of the role. 

But I also saw that this was almost like a conveyor belt. Or like the ambulance at the bottom of the cliff, to draw on a cliché. 

So, from there, I applied to get into the public health training programme. That’s something that most people haven’t known much about until Covid-19 happened and we started seeing Ashley Bloomfield leading the Ministry of Health response. And we’ve had other public health physicians also being quite vocal in the media and providing advice around how we should manage the pandemic. 

The first part of the public health training programme that I did, was based in what was then the Department of Māori and Pacific Health at the University of Auckland. And, after I finished my training, I ended up going back there as a lecturer. 

That department has been separated out and I now work in Te Kupenga Hauora Māori, the Māori Health department. Pacific Health has its own identity as a section in the School of Population Health. So, from the time I finished my public health training, I’ve been working mostly in academia at the University of Auckland.

During this time I was also fortunate to be awarded a Harkness Fellowship in Health Care Policy, which I did in 2005, 2006. Jo and I lived in Boston, in the US, for a year with our then one-year-old twin boys, Kahu and Māhaki. I was based in the Department of Health Care Policy at Harvard Medical School, where I studied ways to reduce racial and ethnic disparities in health care.

You’ve already referred to the societal influences on ill-health that, too often, haven’t been factored in. If we look back a generation, there was a one-size-fits-all approach. But we know that there are a number of factors that lead to Māori and Pasifika ill-health. 

A lot of conventional medical training has been focused on the immediate risk factors and causes that are driving people towards poor health. But doing the Master of Public Health programme helped me appreciate that there’s a much bigger picture, and how there are bigger forces that shape population health. And, for me, that was a life-changing part of my career. 

If you educate people about the risks of continuing to smoke and put in place smoking-cessation programmes, you can see that those efforts are important. But they ignore the fact that smoking is related to poverty and education and a whole range of things that we call the “social determinants” of health. 

And, among them, is colonisation — and not just colonisation in a historical sense but also the systemic racism which comes from the colonisation, and how different sectors of our society fare, that shapes our health risks. 

It’s been frustrating, even infuriating, at times, that there’s been a widespread view that the medical needs of Māori and Indigenous peoples are accommodated through mainstream resourcing. There’s been a pushback, though, from our people, in the last 20 or 30 years, seeking a by-Māori, for-Māori approach. Yet it feels like there’s an unwillingness by mainstream, by politicians and by the medical fraternity, to share power, responsibilities, and resources. What do you think needs to happen to remove some of those barriers?

Any move to try and assert mana motuhake, to achieve sovereignty in any field, immediately pushes up against the existing power structures. And, whenever those systems and structures are threatened, you get that pushback. 

And, just to give a recent example, we’ve seen that pushback in the Ministry of Health’s response to the calls for the bowel screening programme to be extended for Māori to start at a younger age. The unwillingness to follow the expert advice on that issue is because it’s seen as “preferential treatment for Māori”. And there’s great reluctance on the part of mainstream organisations to support any action like that. 

So we see resistance to any initiatives that are challenging to those who are doing well in the current system — or that are challenging white privilege. Calls, for example, for a Māori Health Authority are resisted. There is no interest in making space for a separate or parallel structure where Māori would be planning and funding the health services to meet their needs. 

There’s always been resistance to those kinds of initiatives, because they threaten the existing power dynamic. And government agencies and various ministries seem to think that part of their role is to uphold their colonial power. 

So we end up seeing the privileged holding on to their privileges — and the country carries on with racist policies that produce inequitable outcomes for Māori.

Is one of the options for Māori not to look towards Wellington but to concentrate on finding our own ways to improve our health? How can we become better at helping ourselves?

That’s definitely the way that we need to be thinking. We can’t rely on the Ministry of Health or the district health boards, to be making Māori health a priority. So we need to take that sovereign stance of defining what we need and then working to achieve that. 

Some of the initiatives, like Māori health providers, are essential. Community food gardens on marae are another worthwhile move. Those and many other initiatives can be effective ways of reclaiming sovereignty over aspects of our lives and taking some of the control into our own hands. And the great thing is that they can provide not only health benefits but also environmental, cultural, social, economic benefits as well. 

What we need is more than just support from government and from our mainstream health agencies. They should also step out of the way and help remove the barriers that are blocking our ability to assert tino rangatiratanga.

Not everyone factors in environmental matters when they’re studying health, but you’re one who’s done so. How are we tracking here? 

A significant part of my work has been advocacy around hauora o te taiao. Not just human health, but putting that in the broader context of the health of our environment, our taiao. It’s become clear to me that a lot of the challenges we’re facing with health inequity are intertwined with the challenges we’re facing with environmental and ecological collapse. 

They’re all driven by colonialism and capitalism. We’ve seen the impact of the extractive approach that came with colonialism. It has resulted in a major alienation of land as well as the degradation of our natural environment and ecosystems. And that has flowed through into poor health outcomes for our people. 

Climate change is a particular and growing problem. That’s going to be a major driver of health outcomes and how we respond to that will be critical. But, if we can address climate change from a Māori perspective, we can come up with some solutions that aren’t just a slightly greener version of the status quo. 

Instead, they can be about fundamentally transforming our systems and our society into a way that is more consistent with Indigenous principles and with the values of living in a healthy relationship with the natural world. 

And it’s only once we get to that point that we’ll truly start to address the climate crisis — and not just the climate crisis, but all the other environmental and global ecological issues that we’re facing. Like the loss of biodiversity and ocean acidification. 

This year, you were a recipient of the Ako Aotearoa teaching excellence awards — and one of five winners in the Māori kaupapa category. Congratulations. But I wonder if you’d outline what kaupapa Māori teaching means to you.

It means taking a decolonising approach to teaching and learning. It’s about recognising that our health professions and the culture of the New Zealand health system are grounded in colonial ideas, values, and practices. And those things contribute to the ongoing health inequities that we see, and the denial of Māori rights to health.

We can’t just tack on a Māori health curriculum. We need to engage at a fundamental level with our health professional education programmes and institutions. We need to change the whole learning environment and create a health system that is anti-racist and pro-equity.

One of my main kaupapa is engaging students in a mana-enhancing way. When you’re talking about colonisation, white privilege and ethnic bias, students can often feel like they’re being blamed — especially Pākehā students.

So I avoid a blaming approach, which can lead to disengagement from learning. Having said that, in teaching about Māori health we still need to challenge students. If we’re not getting people out of their comfort zones, we’re never going to get the transformation that’s required. 

What sort of responses do you get from your students, particularly the Pākehā ones?

You get a range of responses on a continuum from deeply engaged and supportive of the kaupapa to full-on resistance. But we need to expect this and not blame individuals for the ways in which society has conditioned them, and the narratives they’ve been exposed to as they’ve been growing up. And we need to learn how to work with students at all points on the spectrum if we’re to build a culturally safe health workforce. 

That’s an interesting kōrero. But, finally, let’s hear something about your life outside of work. Like being a dad as well as having a liking for grunge-metal music.

Well, yes, I do have musical tastes that go across a whole range of genres. I enjoy my music. I learned the piano when I was young, and then taught myself the guitar. And I like having a bit of a strum every now and then. 

And, as for family, Jo and I have three boys, the twins who are now 16, and our pōtiki, Tamatea, who’s 13.

I enjoy doing as much as I can with the boys. Like coaching their football teams over the years. I played football when I was younger and it’s lovely to see them enjoying the game. I also used to do quite a bit of mountain biking and, for a while, I used to take part in the Iron Māori events. Nowadays, I use my bike to get around pretty much wherever I can. It’s great to have some exercise like that built into your daily routine. 

I also hear you’re a fantastic cook and make an amazing spaghetti bolognese.

Well, my dad was a role model in sharing the cooking and other domestic duties. And I’ve tried to carry that on and not just stick to the traditional gender roles at home. So, yeah, when it comes to cooking, there are a few decent meals that I can whip up. Putting kai on the table is pretty important when you have three teenage boys in the house. 

Is there anything else you’d like to add?

What’s been important for me in the course of my career has been the influence and support of wāhine Māori. Especially in health, their influence has been a feature, like in our department, Te Kupenga Hauora Māori, where I’m one of the few males. 

It’s often like that when you go to hui where there’s a health kaupapa. You’ll find that it’s wāhine who are doing the heavy lifting — and they’re there in big numbers. 

So, I want to mihi to people like Papaarangi Reid, who’s my boss, and many, many others who have paved the way, and who carry the kaupapa of health for our people.

 

(This interview has been edited for length and clarity.)

© E-Tangata, 2020