Opinion: Fairness is one of our cornerstone national values, right? Fair go, level playing field, and so on.
And yet, when it comes to Māori health outcomes, some of us seem willing to tolerate outcomes a long way from fair. A Māori child born today will be more likely to go on to have a stroke, renal disease, type-2 diabetes, a mental health disorder, and develop cancer. If they do develop cancer, they are less likely to survive. These outcomes are not down to bad luck or bad choices, they are down to a history that has left many Māori with limited access to the resources needed to support a healthy life and wellbeing.
When a Māori child lives, on average, nearly eight years less than a Pākehā child, that is not a lifestyle choice. It is the consequence of institutional racism.
Today, the Public Health Advisory Committee, which I chair, published its position statement on Equity, Te Tiriti o Waitangi, and Māori Health.
It sets out these stark health inequities in our society, their origins, but also the solutions.
Public health is concerned with patterns of health and illness, what causes these patterns and, crucially, what action is needed. Health services are important, of course, but most of the ‘determinants of health’ lie outside the health sector, and include affordable and healthy food, space and time for physical activity, access to education, a warm and dry home, a way to get around, and a secure job with fair pay.
When population groups start off with big disadvantages, treating everybody the same can never create the level playing field required for fair outcomes
The reality is these resources are spread unevenly across our society, with Māori among the least likely to have access to what they need. Much of this disparity can be explained by rates of poverty, with about a quarter of Māori living in the most extremely deprived decile compared with about five percent of Pākehā. A child who lives in a damp and cold home with less access to healthy food is more likely to get sick, less likely to have the means or time to access treatment when they do get sick, and more likely to miss school more as a result. It’s worth pointing out that, in common with indigenous people around the world, this relative poverty is the result of colonisation.
But the health gap for Māori cannot be explained by poverty alone. Even among the most socio-economically advantaged fifth of New Zealanders, the death rate for Māori remains higher than for non-Māori. So this reflects not only a material gap, but a society that is simply better at meeting the needs of Pākehā than Māori. The consequences for Māori health are predictable, unfair and unjust. But they are not inevitable.
There’s a cartoon you may have seen on social media platforms that portrays kids of different heights trying to look over a fence. If all the kids are given a box that’s big enough for the tallest kid to be able to see over, the shortest kids still won’t be able to; they need a bigger box. When population groups start off with big disadvantages, treating everybody the same can never create the level playing field required for fair outcomes.
Te Tiriti o Waitangi sets Māori apart from other groups that experience unfair health outcomes. Everyone is entitled to a fair go, but only Māori also have the promises made to them through Te Tiriti. Equal access to the determinants of good health is a fundamental human right, supported by the United Nations Human Rights Framework and protected under international law. Under Te Tiriti o Waitangi, the Government is also obliged to act where Māori are disadvantaged. By these measures, our country’s enduring health inequities are a breach of people’s human rights and the Treaty.
As much as they are an obligation, the principles of Te Tiriti set out by the Waitangi Tribunal are also a pragmatic guide to addressing unfair health outcomes across Aotearoa.
In practice, honouring Te Tiriti means Māori can exercise self-determination over the design, delivery and monitoring of health care services (Tino rangatiratanga).
It means being committed to achieving fair health outcomes for Māori and providing active support for that.
It means providing for and resourcing kaupapa Māori services and ensuring all health services are provided in a culturally appropriate way.
And it means treating Māori as a partner in designing and delivering health solutions.
Te Tiriti offers a valuable guide for enabling a society that delivers a long and healthy life for all New Zealanders. That comes down to supporting people to design and deliver the solutions that work for their communities. We would benefit from more of that approach in every part of society. It’s often said that if we can ensure that services will work for Māori, they will work for everyone. Having a wider range of service approaches available can only be a good thing. Services that understand individual people are part of families, and that health needs are not separate from other needs, are at the heart of the whānau ora approach, and it’s great to see people from all ethnicities recognising the power and effectiveness of these kaupapa Māori services.
We are lucky to have a unique resource in Te Tiriti of Waitangi, grounded in our history and identity. We need to embrace and use it to help close the gap and improve the health and wellbeing of all New Zealanders.
Kevin Hague is chair of the Public Health Advisory Committee. The Committee provides independent, expert advice to the Government on public health, and today published its position statement on Equity, Te Tiriti o Waitangi, and Māori Health. The other members of the Committee are Beverly Te Huia, Associate-Professor Sir Collin Tukuitonga, Associate-Professor Jason Gurney, Professor Peter Crampton and Associate Professor Ruth Cunningham.