Health statistics for Māori men paint a "pretty bleak picture" about the state of healthcare in New Zealand, a doctor says.
Māori men are still dying much younger than any other group of New Zealanders. Their life expectancy is just 73 years compared to 80 years for non-Māori men.
In a special episode of The Hui focussing on Māori men's health, Jordan Te Whaiti-Smith of the Medical Research Institute says the inequities they face begin much earlier than people may expect.
"It's a pretty bleak picture… I think it starts preconception, in utero," Dr Te Whaiti-Smith told The Hui on Monday.
"Before you've even thought about it, there's a predetermined pathway for Māori, and tāne Māori specifically. Unless we can intervene really, really early on, it's a bleak picture."
Also appearing alongside Dr Te Whaiti-Smith on The Hui's panel was immunologist Anthony Jordan, Health Te Rūnanga o Ngāti Whātua director Boyd Paratene, and Māori Council executive director Matthew Tukaki.
Dr Jordan says the problem lies in not just what they do, but also in "winning back the hearts and minds" of those who need help reengaging with the health system.
"This isn't about treating disease at the end of the road, it's about promoting from that first interaction wellbeing throughout life. That requires a lot of cross-sector engagement to be able to promote health as a focus," he says.
But he adds people have stood by watching the divergence of health data showing Māori are behind.
"Māori men are lagging the most. And what have we done?
"We've just continued to watch something as a natural evolution of something without saying, 'What are the determinants of this?'"
Tukaki, who had a heart attack seven years ago, says he's more conscious of his mortality than ever before. His dad died at 46 years old from an aneurysm, and now Tukaki has reached age 46 too.
"For me, I'm probably in that band of Māori males in our middle years who are confronted by going to the GP," he says.
"We know there's something wrong with us, we know something's not quite right, but there's something inside of us that says, 'ka pai, we'll just wait until we're taken out by the ambulance.'"
This mentality among Māori males is something that needs to change, he adds.
According to Paratene, another thing that needs changing in the health system isn't just creating equal access for Māori, but changing how that help is delivered given the outcomes are inequitable. The amount of "bias and resources" that need to be dedicated to Māori to make up the difference hasn't been measured yet, he adds, and making up that difference between Māori and Pākehā isn't the end goal, it's the start goal.
"We've had this announcement about the Māori Health Authority. These are all really good things for Māori health, but I see the Māori health sector running itself ragged trying to fix [things]," he says.
When asked if the disparity in health outcomes between Māori and non-Māori is "blatant racism", Dr Jordan believes that, at some level, it is.
"You're ignoring the reality, so whether or not that's a challenging or confronting thing to hear, when you ignore the reality of something that exists, it is racism."
Dr Te Whaiti-Smith says he agrees, but people shouldn't run away from "the big r-word".
"Even if patient A who's Māori and patient B who's non-Māori come in at the same point in their lives, they get treated differently in the health system, and that is the bottom line."