GUEST BLOG: Ian Powell – Maori child health inequities reinforces case for the Maori Health Authority in New Zealand’s health system

Research over many years has identified serious longstanding health inequities for tamariki (Māori children). This has been both reinforced and updated by new recently published research by the Universities of Auckland and Otago.

These latest findings were reported in Te Ao Māori News on 25 January: Māori children suffering most from health inequities.

Research findings

The research found that Māori children are unable to engage with primary healthcare, outpatient care, medicines and laboratory investigation to the same degree as non-Māori. Consequently the finding that tamariki have higher rates of avoidable hospitalisations and deaths than other children is no surprise.

The Royal New Zealand College of General Practitioners has rightly called for urgent action to reduce these health inequities. Also rightly, it notes that the findings are neither new nor surprising. With precision the College concludes that this lack of newness and surprise in the findings is exactly the problem. The College has got it in one.

Health inequities go beyond primary care and access to general practice. It is also hospitals. This is confirmed by the invaluable New Zealand Health Survey which the Ministry of Health publishes annually.

Invaluable and revealing annual New Zealand health survey

The 2019-20 survey revealed that Māori adults had the highest prevalence of not being able to book an appointment at their usual general practice within 24 hours.

When access to general practice is delayed or blocked due to factors such as cost and social determinants of health, this has harmful flow-on effects for the whole whānau. General practitioner diagnosis is also crucial for Māori to access hospital care.

Getting function and form right

Two things become clear from various research findings, including the most recent discussed above, over Māori health inequities. First, there is no one-size-fits-all solution to address them. If there was then it would have been found by now.

Second, despite best endeavours, at a national level the structure responsible for addressing them was not fit-for-purpose. In terms of the critical relationship between function and form in health systems, the function was identified (health inequities) which then led on to consideration of the form (structure).

This is where Te Ake Whai Ora (Māori Health Authority) comes in. The Heather Simpson led review of the health and disability system recommended in 2020 the establishment of such an authority but limited to an advisory role.

However, the review’s final report also included a section by dissenting review members recommending a much stronger role for the authority. Ironically they were the majority but, as Simpson was reported as saying, the majority position does not mean that it is the review’s position (at least, I opine, not a review chaired by her).

Andrew Little deserves credit for establishing Te Ake Whai Ora

To his credit (and it is the only thing I will give him credit for as health minister) Andrew Little supported the review’s ‘majority’ position. He then proceeded to progress it through Parliament as an important part of the Pae Ora Act, which took effect on 1 July 2022.

Māori Health Authority: objectives and functions

Under the Act the objectives of the Authority are to:

• ensure that planning and service delivery respond to the aspirations and needs of whānau, hapū, iwi, and Māori in general;
• design, deliver, and arrange services; and
• promote Māori health and prevent, reduce, and delay the onset of ill-health for Māori.

These three objectives are followed by several functions which include:

• jointly developing and implementing a New Zealand Health  Plan with Health New Zealand;
• owning and operating services;
• improving service delivery and outcomes for Māori at all levels of the health sector;
• collaborating with other agencies, organisations, and individuals to improve health  and wellbeing outcomes for Māori and to address the wider determinants of health  for Māori;
• providing accessible and understandable information to Māori  on the performance of the publicly funded health sector;
• commissioning kaupapa Māori  services and other services developed for Māori;
• reviewing locality plans developed by Health New Zealand;
• undertaking and promoting public health  measures, including commissioning services to deliver public health programmes;
• providing policy and strategy advice to the Minister of Health on matters relevant to hauora Māori;
• designing and delivering programmes for the purpose of improving the capability and capacity of  Māori health providers and workforce; and
• undertaking and supporting research.

The nonsense of separatism

These objectives and functions give Te Ake Whai Ora considerable power and influence at various levels in the health system in order to address the difficult and complex challenge of Māori health inequalities.

Power and influence is in how Māori healthcare and wellbeing are planned, designed, developed and delivered. This includes its own direct role in ‘hands-on’ delivery. Further, beyond diagnosis and treatment, there is a strong population health emphasis which is essential for medium to long-term Māori health planning.

The opposition to the Māori Health Authority is based on an opportunist argument of separatism; that is, a second separate health system is being established for Māori. This opposition is primarily from the National, Act and NZ First parties, although the far right is also in this chorus singing from the same tuneless song sheet.

Within the spectrum of what might constitute nonsense, this separatism argument is at the extreme end of nonsensical. At best it is a misleading soundbite.

Much of the focus of Te Ake Whai Ora is in communities and with primary care where many Māori organisations are already active. The expression ‘by Māori and for Māori’ is commonly used and has been uncontentious for both National and Labour-led governments.

Riana Manuel, Chief Executive, Te Ake Whai Ora

The purpose of Te Ake Whai Ora is to build on this in order to sharpen and enhance the capacities and capabilities required to address Māori health inequities. This is not separatism in community based healthcare. Nor is it establishing separate hospitals for Māori (critical mass alone makes this a nonsense).

Instead, creating the Authority is about adjusting structures to better align with the diversity of health statuses which include significant and disproportionate disadvantages.

An additional moral in the story

Establishing the Māori Health Authority is a good example of form following function. It is unfortunately that in much of the Government’s other health restructuring, form comes first leaving function to be poorly thought-out

The Simpson review (both its ‘official’ and ‘majority’ positions) envisaged that the Authority’s  work would be supported by district health boards. This would have been invaluable because of their focus on and experience with the healthcare needs of their geographically defined populations.

DHBs would have been an excellent resource for the Authority to draw upon. Their abolition has meant that this has been hugely downgraded by a much more vertical structure.

This thoughtlessness will make Te Ake Whai Ora’s effectiveness more difficult to achieve. It already has enough difficulties with things it has no control over such as external social determinants of health. While this is no reason for not trying, it is a pity nevertheless.

 

Ian Powell was Executive Director of the Association of Salaried Medical Specialists, the professional union representing senior doctors and dentists in New Zealand, for over 30 years, until December 2019. He is now a health systems, labour market, and political commentator living in the small river estuary community of Otaihanga (the place by the tide). First published at Otaihanga Second Opinion