Authority may be gone but the work remains
National’s Health Minister Shane Reti has disestablished Māori Health Authority Te Aka Whai Ora under urgency, a move widely condemned by Māori leaders and health representatives. But what is the Māori Health Authority? And what has it done in its 20 months in Northland before its untimely death?
The human and economic costs of Māori health inequities are significant, according to Te Aka Whai Ora, the now-defunct Māori Health Authority.
“Māori die on average seven years earlier than non-Māori. Health inequities between Māori and non-Māori cost New Zealand $1.034 billion per year,” the authority said in its briefing to incoming Health Minister Dr Shane Reti, Whangārei’s MP.
Te Aka Whai Ora was set up to create transformational change in the health system, for the benefit of Māori and the health system as a whole, it said.
Since being established in July 2022, the authority has focused on four areas likely to achieve the greatest health gain for Māori:
● Kahu Taurima / Maternity and early years: Māori have a 4.7 times higher rate of sudden unexpected death in infancy (Sudi).
● Mate Pukupuku / People with cancer: Māori are 60 per cent more likely to die of cancer.
● Māuiuitanga taumaha / People l i ving with chronic health conditions: Māori are 2.3 times more likely to die of diabetes, cardiovascular disease, stroke and chronic obstructive pulmonary disease.
● Oranga hinengaro / People living with mental distress, illness, and addiction: The Māori suicide rate is double non-Māori.
It has also focused on increasing immunisation and, together with Te Whatu Ora, prioritised planned care and reducing rates of ambulatory-sensitive hospital admissions.
The authority has created iwiMāori partnership boards, finding regional and local solutions and services that work for those communities.
What is the Māori Health Authority doing in Northland?
Health inequities for Māori are a huge issue for Northland, where the life expectancy for Māori is among the lowest in the country.
Northland Māori live an average of 73.9 years, 8.8 years less than the average for non-Māori, nonPacific Northlanders, Te Aka Whai Ora reports.
In the north, Te Aka Whai Ora has been working with Te Taumata Hauora o Te Kahu a Taonui - the health arm of the Te Tai Tokerau iwi collective - to establish an Iwi-Māori Partnership Board to find local solutions to the issues.
For Māori health providers such as Whakawhiti Ora Pai, this meant working in partnership, rather than being dictated to, general manager Errol Murray said.
“Since the changes, it has been more of a partnership and working together; working together on outcomes.”
Murray admitted it has also meant more funding for his health service.
“Sad to say, it is about money, but it’s money that we’ve been underfunded all along — it brought a bit of equity.”
The extra funds allowed Whakawhiti Ora Pai to catch up on some building maintenance, upgrade its IT system and employ another nurse on a fixed-term contract, although that contract is now likely to come to an end, Murray said.
These upgrades have benefited all residents at the top of the Far North, not j ust Māori, as Whakawhiti Ora Pai is the only primary health provider north of Kaitāia.
“The 2018 Census of the area showed 52 per cent were Māori and 48 per cent were non-Māori.
“We serve all our community up here, regardless.”
A lack of access means rural people also have poor health outcomes, Murray said.
“It’s distance and the cost of living. Quite often, we’ve got to take the services to the people, rather than getting them to come to us.
“There was a push on mobilising some of our services but I’m not quite sure what that would look like going forward.”
Murray said the greatest concern for Māori health providers now is the lack of a plan going forward.
“The Government is saying that they will provide something better that will provide equity and improve the health outcomes for Māori but they haven’t told us what it is. What’s the plan?”
All Kiwis should have timely access to healthcare, Reti says
Shane Reti, a Whangārei GP, said the Māori Health Authority was not achieving what it was meant to, although expertise from the authority will be retained, including the Iwi Māori Partnership Boards.
“My dream for the health system isn’t about bureaucratic structures and endless plans and reports; it’s about identifying need and responding to it,” he said.
“I want to paint a vision for Māori and all New Zealanders: My vision is that all New Zealanders will have timely access to quality healthcare ... To achieve this, I will be setting clear health targets. These will bring attention, resources and the accountability that’s needed to deliver quality care in a timely manner.”
The Coalition Government believes the health workforce shortages are the biggest hurdle facing the health system, he said.
Reti admitted there was still “more thinking to be done” about health inequality.
“We need to have ways of working that identify and support local solutions to local health challenges.
“That means using data, measuring progress, and working with people who know their communities best.”
"The Government is saying that they will provide something better that will provide equity and improve the health outcomes for Māori but they haven’t told us what it is. What’s the plan?" Whakawhiti Ora Pai general manager Errol Murray