Treaty of Waitangi

Examining racism in NZ’s health system

The disparity between Māori and non-Māori health is at the centre of a Waitangi Tribunal hearing this week.

Two similar claims will be heard in stage one of the Tribunal’s Health Services and Outcomes Inquiry at Tūrangaewae Marae in Ngaruawahia. Both claimant groups are focused on issues within primary care - the first place people seek medical help.

The claimants say inequity and institutionalised racism exist in the current primary health system.

Te Kōhao Health managing director Lady Tureiti Moxon said currently Māori lives are seven years shorter than the lives of non-Māori.

“Māori are twice as likely to face discrimination in health, Māori are less likely to be referred for diagnostic tests, Māori children are over two and a half times as likely to have unfilled prescriptions due to cost and Māori are more than twice as likely to die from preventable diseases.”

Moxon has been waiting 13 years for the claim she is involved in to be heard after negotiations with the government did not reach a satisfactory conclusion.

"What we saw then continues now - the system is not meeting the needs of Māori."

She is part of a group of managers and governors of Māori Primary Health Organisations (PHO) and providers. Her group believes primary healthcare is not sufficiently contributing to the achievement of Māori health equity.

“Our Wai claim has been 13 years in the waiting after first filing back in 2005 in response to the Government’s Primary Health Care Strategy. What we saw then continues now - the system is not meeting the needs of Māori. The inequalities that exist between Māori health and the health of others is a national outcry for our people and our nation.”

The group is seeking an apology and repayment of $348 million, representing 16 years of underfunding of Māori PHOs and providers as well as legislation for primary health care which meets the principles of the Treaty of Waitangi.

It also seeks ongoing funding for Māori primary health, to be controlled by Māori and an independent Māori Health Commissioning Agency.

The second claimant group seeks similar outcomes. Autonomy over healthcare, as well as public policy change to ensure there is resource to improve Māori health outcomes.

“The ultimate solution lies in constitutional reform based on Te Tiriti o Waitangi that entrenches equity of outcome and Māori participation in achieving this,” said Simon Royal, chief executive of the National Hauora Coalition.

PHOs were introduced in the 2000s. They were aimed at offering community-led healthcare where prevention as well as treatment could be achieved. Funding was given based on PHO members, not appointments.

The Māori Primary Health Organisations & Providers group claim this funding model was not adequate for Māori PHOs, where members were often in poorer health and more expensive to look after than those of an average practice.

The idea that half the cost of an appointment would come from members was also problematic for Māori PHOs according to the group who say those members who could afford to pay anything for appointments, could only afford to pay a small amount.

The claim says the amount carried by Māori PHOs and Providers is $21.77 million a year, equating to $348 million since 2002.

Only four of 14 Māori PHOs remain. Others have amalgamated or been forced to close.

Judge Stephen Clark is the presiding officer for the week-long hearing which commences today. Joining several Māori health experts giving evidence is a health expert from Alaska, who has experience in indigenous-led health solutions. Former cabinet minister John Tamihere will also give evidence.

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