It has been just over a year since Te Aka Whai Ora, the Māori Health Authority, came into effect and yet as we lead into the election a running theme from some parts of the political sphere is to ask the question "Why hasn't the Māori Health Authority worked yet?" Declaring it a waste of money and that it must be abolished. It took at least 150 years of oppression to accrue the Māori health inequities we experience today. It is laughable to expect a single health entity with a pittance of the health budget to fix 150+ years of inequity in one single year, yet the calls persist.
Māori have always known it was going to require patience and a term vision to unpack and turn around the vast inequities that persist. Our continued support for the reforms is not just because it is what we have long advocated for, but because the lives of whānau Māori depend on it. The reforms are the system reboot we need and that our whānau deserve.
Our organisations, Hāpai te Hauora and E Tipu E Rea Whānau Services work under kaupapa Māori frameworks. Hāpai te Hauora work to the aspiration of Oranga Tangata, Oranga Whenua, which we understand to mean "when our environment is well, so too shall be our people". E Tipu E Rea support mātua taiohi, hapū māmā and pēpi to grow, thrive, and be rangatira within their whānau, hapū, iwi, hapori, across all dimensions of their lives. Many of our people are not well, often because of the environments we live in. A public health approach to understanding the impact of environments is considering where we live, what food and drink we have easy access to, the opportunities for physical activity and how nourished we are by the people, culture, and communities we belong to.
We maintain that our health inequities are a product of colonisation and its associated traumas, which, when coupled with lower socio-economic status and institutional racism, mean Māori are worse off on almost all health and social markers than non-Māori. While we are thrilled at these radical health reforms that seek to disrupt and rebuild a system to improve health outcomes, we are set up to fail unless the other parts of the whole environment - the socio-economic, judicial, and educational systems which feed into it are also addressed.
This month, Hāpai attended a conference for families with FASD (Foetal Alcohol Spectrum Disorder). These are families suffering through the neglect of the Crown, who have been complicit by introducing alcohol with little regulation and not fully acknowledging or addressing its harms. As it happened, Te Aka Whai Ora released a statement that day, announcing a $1.4 million targeted investment into Hauora Māori services to address FASD- this funding recouped from alcohol tax. Simple, logical, and although a small drop in the bucket- groundbreaking, as this was the first time the government had made such a decision. But this announcement was made across a weekend filled with desperate accounts from whānau on there being no pathway and no help with costs for diagnosis, tamariki falling through the gaps of an education system who themselves aren’t adequately informed or supported to teach a tamaiti (child) with neurological impairments. We also heard from despondent grandparents questioning their mokopuna’s future, describing a pipeline to a criminal justice system that sentences rangatahi (young adults) on the principles that they have the comprehension levels to acknowledge the harm caused, to learn from past behaviour and not repeat it.
This is just one very recent example of how investment in health policies has to contend with investment in education, social welfare, criminal justice and housing. It could have been any of the kaupapa we find ourselves advocating, be it drugs, alcohol, smoking, SUDI, gambling, nutrition or physical activity.
E Tipu E Rea Whānau Services work with young Māmā, Pāpā from the ages of 13-30 and their whānau as a wrap-around health and social service. Over the past month we have seen young whānau with pēpi living in cars, young hapū Māmā without maternity care and constant threats of Oranga Tamariki uplifts because of the lack of cross-sectoral understanding of the position our young whānau are in. The Kahu Taurima - Maternity and Early Years funding that is being shared by Te Aka Whai Ora, the Māori Health Authority, means that we are able to create our own initiatives that are tailored to meet the needs of young whānau that we work alongside. It means that we are able to provide maternity care to those who fall through the cracks of our already overstretched health system and it means that we can be innovative in our mātauranga and be trusted to use what we know works in our communities. Research shows what works for Māori works for all and this funding is integral to allowing us to tailor solutions that will bring about positive health and social outcomes.
Working across health for over 20 years we know that positive health outcomes can only be achieved when all of the social determinants of health are addressed for individuals and communities. Te Aka Whai Ora can only be successful if all of its partners are working toward the same goal and at the same pace. We are therefore calling for stronger multi-sectoral, multi-agency partnerships because public health inequities don’t exist in a vacuum and our whānau do not operate in silos.
So this month, as the health of our whānau is kicked around like a political football, Māori health practitioners will be asked by the media on the validity of the Māori health authority. To pre-empt this we need to be clear that re-dredging the prior system that was well documented for its racism and systemic breaches of justice is inconceivable, to do so would be to say that we as a country are aware of the harms we are causing to tamariki and mokopuna Māori, and are therefore complicit in perpetuating these harms. It would be a step backwards in our collective quest to increase the overall health of communities We know too much about how the old system treated our whānau to go backwards.
We should not be asking whether we should scrap the circuit-breaking systemic reforms implemented to address Māori health inequity. Instead, redirect those questions to our partners across education, social welfare, housing and criminal justice and ask why they are not also undergoing reform to address Māori inequities. Until they do join Te Aka Whai Ora and unblock barriers and silos, Aotearoa will never unlock its full potential and a shared vision of all communities thriving.