Health leaders call for kaupapa Māori-led initiative across agencies to help fix inequities

Almost six months ago, the Government announced its new health system.

District health boards (DHBs) were gone and in their place was Health New Zealand, which would work alongside two other new organisations, the Māori Health Authority and the Ministry of Disabled Peoples.

One of their collective aims was to deliver better health outcomes for Māori and address longstanding inequities. 

But Māori health leaders now say that while the creation of the Māori Health Authority will help them achieve that goal, it isn't enough on its own - they need more say across the entire health system.

"The status quo does not work," Dr Lynne Russell, a senior research fellow at Victoria University, said.

"It has not only not worked, it has damaged our people, it kills our people. And here is an opportunity right now to make a difference, but it is going to take bravery."

Primary health care is overseen by Te Whatu Ora - Health New Zealand, but now 27 Māori health leaders said the Māori Health Authority needs more say in primary health care or what goes on in hospitals and doctor's clinics.

The health leaders told researchers they need kaupapa Māori-led initiatives across all health agencies to help fix inequities.

"They said to us about how to do it differently is to prioritise mātauranga Māori, to prioritise our knowledge and how to best care for Māori, so that the health outcomes that we have at the moment are not repeated, so we don't see the terrible statistics that we see in healthcare," Dr Russell said.

Some Māori health statistics include:

  • Māori die on average seven years earlier than non-Māori
  • Māori die at twice the rate as non-Māori from cardiovascular disease
  • Māori tamariki have a mortality rate 1.5 times the rate of non-Māori children
  • Māori are more likely to be diagnosed and die from cancer.

The mental health system is failing Māori too. They are more likely to be undiagnosed, over-medicated, imprisoned, or left in seclusion.

Psychiatrist Diana Kopua said the system is racist on both a one-to-one level and a system-to-one level.

"Practitioners who think they know what's needed and none of them look at the inequity for Māori and all of them think when we are talking about racism, we are talking about interpersonal racism, as opposed to institutional racism," Kopua said.

She said institutional racism is rooted so deeply in our society that both the patient and psychologist can be unwitting victims of it.

"When you connect the whakapapa of racism and how that has indoctrinated all of us, our mindsets, the way we think about ourselves, and you see that problem continuing through the practitioner, sharing a knowledge system that perpetuates racism - when that happens to you, you're trapped," Kopua said.

She and her tohunga husband Mark Kopua have developed their own mental health treatment programme using Māori creation stories as a form of healing.

So far they've trained almost 500 practitioners across Aotearoa and are moving away from the labels of Western medicine and the stigma of them.

"We have been told that the problem might be a depressive disorder, it could be a psychotic disorder, it could be anxiety disorder and all these terms are just descriptions," she said.

A more Māori approach is to reconnect to whakapapa - or ancestry - in an attempt to discover identity and find cultural relevance. And instead of a one-on-one consultation, the whānau is also in the room taking part in the treatment.

"Taking the approach that is whānau-centred, that is wellness-focused and is aspirational, as opposed to sickness-focus on the individual - that's the kind of transformational approach," Dr Russell said.

That's the kind of approach the 27 Māori health leaders surveyed want to be introduced throughout our primary health care.

Because, as the ministry said six months ago at the launch of Te Whatu Ora, a health system that does better for Māori, does better for all.

On Sunday, a Te Whatu Ora spokesperson said they acknowledge Dr Russell's research and welcome the information and insights provided by studies. They said research like this helps inform their thinking and approach as they work alongside Te Aka Whai Ora - Māori Health Authority and the Ministry of Health.

"The reforms have provided an opportunity to ensure that the services we deliver place whānau at the heart of the health system and improve equity and outcomes for them by implementing service change and innovation," the Te Whatu Ora spokesperson said.

"This is just the start of the journey as we re-set the foundations of our health system to unify health service delivery and deliver joined-up quality care for generations to come.

"The plan outlines what we will do differently over the next two years to build the foundations of a sustainable, unified health system that better serves our communities - better supporting and growing the healthcare workforce, including increasing Māori health professionals, addressing the current inequities - including supporting Te Aka Whai Ora to expand kaupapa Māori - and addressing the many other barriers that Māori experience to accessing care."

The spokesperson said the health system change means ensuring people can access the support and care they need, where and when they need it, and in a way that works for them.

"It means not just treating an illness, but ensuring that all well-being needs are met, by ensuring people have access to healthy food, safe housing, employment, education, and are part of supportive communities," they said.

"Taking a community-focused approach, through newly established localities, means looking at the big picture, working collaboratively, and coming up with local solutions. Iwi Māori partnership boards have a significant voice in supporting the establishment of localities."

Health leaders call for kaupapa Māori-led initiative across agencies to help fix inequities