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Image: Bianca Cross
Image: Bianca Cross

OPINIONĀteaJuly 4, 2022

A landmark day for Māori health

Image: Bianca Cross
Image: Bianca Cross

As a Māori health activist, I’m thrilled by how far we’ve come. I’m also wise enough to know health inequities are far from solved.

Friday July 1, 2022 was the day when Pae Ora (Healthy Futures) Act came into effect and Te Aka Whai Ora – the Māori Health Authority – became a real thing. This is the first time we have had a standalone Māori Health agency at a central government level with the power to do a whole lot of things including purchasing Māori health services and monitoring performance of the publicly funded health system.

Māori whānau, hapū, iwi and communities have been arguing for control over our own health and wellbeing since “western” ideas about health were first introduced to Aotearoa. But the push for something like a Māori Health Authority with the ability to commission or buy health services dates to the early 1990s. Such calls continued through the health reforms of the early 2000s, leading to Māori primary health care groups putting together claims to the Waitangi Tribunal in 2005 that highlighted how, despite lots of aspirational statements, the government’s health system was not actually working for Māori.

These Treaty claims were not heard substantively until 2018, but as it happens this was exactly the right time for change. The hearings coincided with a “once in a generation” review of the health and disability system led by Heather Simpson and led to significant debate around the idea of a separate Māori heath entity. Following that review, a Māori Health Authority became government policy, and the rest is history.

In acknowledgement of the kaimahi Māori who have been advocating for 30 years or more for this day to come, the best thing I can do is to be thrilled about how far we have come and positive for the future. And the worst thing I could do is think that the job is done, and Māori health inequities are “solved”.

When I’m celebratory, I think about how Te Aka Whai Ora has a set of legislated functions that allow it to both set a path for the health sector to do better for Māori, to directly fund services for Māori and to monitor the publicly funded health system in relation to Māori health.

When I’m hopeful for the future, I think about the difference this could make to the health and wellbeing of Māori, especially the groups of Māori who have been made invisible by the old ways of doing things. This includes tāngata whaikaha Māori, Māori with lived experience of disability, who have been ignored in so much of our health sector policy, funding and planning due largely to the complementary and intersecting powers of racism and ableism. The establishment of Te Aka Whai Ora is an opportunity to champion and support tāngata whaikaha Māori communities to be part of deciding what health or wellbeing services they need. It is also a chance to do away with some of the unfair and unjust rules around funding and could mean, for example, Māori who are recovering from stroke and under 50 years old can access at least the same range of supports non-Māori recovering from stroke over 65 years old do.

When I’m hopeful, I also think about Māori provider development. I say this knowing that the key to health and wellbeing isn’t about the number of providers, it’s about Māori whānau, hapū, iwi and communities being able to do what’s best for ourselves. But when we do need to access health services, we deserve to have the option of accessing these services from Māori health providers. The budget this year gave me a glimmer of hope in this regard too, because for the first time since 1997 the Māori Provider Development Fund (which was previously administered by the Ministry of Health and is now the responsibility of Te Aka Whai Ora) saw an increase in funding. While in reality this funding does only a little more than restoring the fund’s purchasing power (so it can buy as much today as it did in 1997), it is still a sign that we are moving in the right direction.

Photo: Getty Images

But all of this is only “in the right direction” and not at all “job done”. While it sets up a system that has potential to improve Māori health and wellbeing outcomes and allow us to break from some of the old ways of doing things that have not served Māori, it is not exactly a health system set up to honour Te Tiriti o Waitangi, to be anti-racist and pro-equity from the outset.

The first thing many proponents of a Māori Health Authority wanted to see was for the authority to be independent, under Māori leadership and control. But from the time it became government policy it was clear the intention was for it to still be a government entity of some kind, answerable to a minister.

Te Aka Whai Ora was established with its own bespoke legislation, so it isn’t exactly like every other government entity. But it certainly isn’t a Māori organisation. A fear I have is that the idea of government entities working together (in this case Te Aka Whai Ora, Te Whatu Ora – Health New Zealand – and the Ministry of Health) is confused with Te Tiriti o Waitangi partnership. At its most banal level this would mean things like other government agencies meeting with Te Aka Whai Ora staff and reporting it in cabinet papers as consultation with Māori (which is very easy for me to imagine, having spent nearly two decades reading cabinet papers). More fundamentally it could prevent meaningful partnerships developing between Māori groups (especially those not part of the formal structures of Te Aka Whai Ora or with members on its board) and the Crown when it comes to health.

The next thing proponents of a Māori Health Authority wanted was assurance that it would have a decent budget, with arguments floating around (including in the Waitangi Tribunal) that this should start at 15% of Vote Health and grow from there. Having looked at Budget 2022 I can tell you this is not, in fact, the starting point. It is much lower than that.

A mega budget from day one can be a double-edged sword, and you need significant organisational capacity (i.e. lots of highly skilled staff) to be able to spend 15% of Vote Health, so I understand why Te Aka Whai Ora has a more manageable budget initially as it sets up its systems and processes and builds its teams. However, with ministers at the launch being clear about their hopes and expectations for the new organisation, the budget needs to increase swiftly. Otherwise, it will be the agency with the least funding but highest expectations to “solve” the persistent health inequities between Māori and Pākehā that have marked (and marred) the district health board era.

So where does this all leave me? On balance, I’m choosing to be incredibly proud of what Māori advocacy and health expertise has achieved in creating the conditions for a Māori Health Authority. I am also excited to see how Te Aka Whai Ora develops over its first year, knowing that there will be opportunities for it to show it can make tangible and meaningful impacts on Māori health outcomes even in this short space of time. If they’ll allow a suggestion, they could start by focusing on the inexcusable health inequities for tamariki Māori when it comes to childhood vaccination rates.

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Rereata Makiha (Image: Tina Tiller)
Rereata Makiha (Image: Tina Tiller)

ĀteaJuly 2, 2022

Should Aotearoa ditch the four seasons?

Rereata Makiha (Image: Tina Tiller)
Rereata Makiha (Image: Tina Tiller)

Winter, spring, summer and autumn aren’t relevant to our environment, says Rereata Makiha of Te Māhurehure, Te Aupōuri and Te Arawa. The renowned astronomer and authority on maramataka tells Te Kuru o te Marama Dewes why.  

We all look forward to summer, when the environment warms up and we enter the festive season. Those terms, the festive season and even summer, were introduced to this country along with the western Gregorian calendar that follows the sun and 365-day year.

Rereata Makiha says the introduced seasons of winter, spring, summer and autumn aren’t relevant to our environment.

“We need to get rid of summer, winter, autumn, spring because it’s in the northern hemisphere, it’s koretake, it doesn’t work down here, never has,” says Makiha.

This might sound extreme to someone who has only known one system of time and relies on the western system for orientation, which is most of us today here in Aotearoa.

It wasn’t always this way and pre-contact, Māori had our own system of time which informed our practices.

We’re learning more about it now with the normalisation of traditional Māori lunar-stellar calendar and narratives being driven by the national recognition of Matariki and its alignment with the maramata as the celestial marker of the Māori new year.

The milestone has seen a reinvigorated uptake of mātauranga Māori within communities around the country. Our people are connecting back to their land, waterways, forests and oceans through the maramataka and aligning planting and harvesting to the ways of our ancestors.

Naturally the next step, after becoming intimately familiar with the maramataka and our stars, is to identify and understand the Māori phases of the year.

It’s important to know, because the current sun-based calendar and seasons don’t move with the environment.

“On the first day of December they say ‘the first day of summer’ when we’re almost at the third phase of summer,” says Makiha.

There are seven kaupeka to the summer phase, all with different names and different signs that reveal when they’re active. Unlike the maramataka, which repeats its cycles, the kaupeka aren’t fixed.

A maramataka dial (Supplied by Ayla Hoeta and Rereata Makiha)

Maramataka generally have either a 28-day or 30-day cycle, while some tribes have a 30-day cycle and add one day. Explained in Living by the Moon by Te Whānau a Apanui elder Wiremu Tāwhai, this is done through observation of the moon, where if the moon phase has 31 days, an extra day is acknowledged that month.

“There are six winter phases. When the first winter wind blows, which has a specific name, it’s a sign that we’ve entered that phase. At that time, the taiao starts to shut down. That’s the easiest phase to detect because when you wake up and you have to boil your jug to defrost the windscreen, you know you’re in Te Kōkota,” says Makiha.

“The third phase is usually around mid-July and then we go into the Takurua phases, so the higher Takurua rises, the warmer it gets. Then we head back into those phases of summer, when the red berries ripen in the ngahere, all of those little tohu tell us we’re in it, and it’s usually about the end of July, going all the way through to about April again next year,” says Makiha.

He points out that other iwi have variations which are tied to their geographic location. Further to the south in colder climates, near the Maniapoto and Tūwharetoa areas, some tribes recognise eight phases of summer.

“Our sign for the longest phase of summer is the flowering of the puawānanga. Here in Hokianga they flower a month before Te Arawa and about six or seven weeks before Taranaki,” says Makiha.

The puawānanga flowering  (Photo: Leonie Hayden)

The stars are connected to the maramataka in multiple ways, with some stars signalling the Māori months of the year and others tied to the phases.

“When Rēhua rises in the face of the sun, it triggers the flowering of the pōhutukawa and the rātā,” says Makiha.

“It happens here around the 4th or 5th December, at half past five in the morning. That’s how precise you can get it. So if you had a marker tree outside your whare, you’d see them, those little red filaments bloom.”

Acknowledging our legacy of migration, he points out that a lot of our knowledge transcends the 1,000-plus years we’ve been here in Aotearoa, expanding back through time across the Pacific to Hawai’i.

In Hawai’i, they call the pōhutukawa “lēhua”, which is Rēhua to us. To Kānaka Māoli in Hawai’i, when the star Lēhua rises in the east, the lēhua tree flowers, hence the name. That’s indigenous knowledge, from generations and generations of observing the taiao.

The pōhutukawa in bloom

Makiha says that following the maramataka and knowing these signs of the environment was a way of life.

“You couldn’t get your maramataka wrong otherwise you’d go hungry, because you’d miss the migration of the fish, you’d miss the migration of the tuna, you’d miss the kai in the ngahere, you’d miss the tāwhara, the pātangatanga, all that kai, if you haven’t got your maramataka right.”

The key to the maramataka in the time of our tīpuna is that it was based on kai, Makiha says. Through colonisation, that knowledge is no longer practised as widely as it once was, although to say it was lost is to disqualify many communities and knowledge holders who continue maramataka practices.  

“We’re lucky today because we don’t have to be so accurate, because we can go down to the supermarket. If you were growing up in a world that relied completely on your understanding of the taiao and all around when to get kai, when the kai was available, when it’s fat, when is the fish running, when is the tuna going to move, that’s what the old people had a reliance on the use of the maramataka and timing of the taiao so you could survive, and if you didn’t, mate koe – you would die,” says Makiha.

Freshwater Eel, colour. Anguilla reinhardti (Steindachner)

He reiterates that having things like “the first day of spring” as September 1 every year, following the Gregorian calendar, doesn’t help us align with our environment.

“Can you go over and tell those daffodils that flowered in July to go back to sleep?” asks Makiha.

By following such a rigid system of time, we are imposing a human construct on the shifting phases of nature that distances ourselves from intimately knowing and living within our environment, the way our Māori ancestors did.

“The phases of summer and winter are linked with the stars. The moon, however, is cyclic in its calendar,” says Makiha.

This alludes to the holistic worldview encapsulated in mātauranga Māori, developed over centuries through observation, trial-and-error experimentation, living at a time where their lives depended on it.

“People need to understand that the Gregorian calendar is based on the sun, it doesn’t align to the lunar calendar. So when they’re promoting the first day of September as the first day of spring, those of us who live by the maramataka think, ‘what a dumb bloody calendar that is’, that’s why our kids are kūare to the taiao,” says Makiha.

Rereata Makiha in an episode of Waka Huia (Image: Supplied)

In an ongoing effort to upskill and enable his communities, Makiha has been sharing his knowledge around the stars and the maramataka with rangatahi in Te Taitokerau.

He is also helping to inform various communities in the efforts of ecosystem restoration, which he says needs to be decolonised and looked at from a Māori perspective that revolves around the phases of the year.

“I’m serious about this planting willy-nilly along our waterways and calling it restoration. A lot of the rākau they’re using is mānuka, which is OK, but they need to be pushed back from the waterways. What you need along waterways are plants that are going to support fish life, ocean life, bird life,” says Makiha.

Within oral literature there are lessons on what the canopy should be, says Makiha, emphasising that ngahere should be restored to the canopy that are suited for those different seasons.

“Imagine if you’re planting, you have to have kai for all the phases of summer and winter. How the hell are you going to support a whole environment just by planting mānuka? Tell me that. This is where someone needs to just get a good kick up the ass,” says Makiha.

As someone who has spent decades learning, understanding and educating others on the environment, he doesn’t hold back when exposing the knowledge gap that exists between theory and practice.

“You get 100% for planting natives, rawe, planting a rākau, you get 100 points for that, good on you. It’s not about that, it’s about particular and accurate about what we should be putting along those waterways in this awa restoration.

“If you don’t have food for manu in all those six phases of summer and seven phases of winter, then what the hell are you doing? That’s why these kaupeka are important,” says Makiha.

The connection between understanding the various phases of summer and winter and environmental restoration is one of those seemingly obvious yet not quite understood perspectives.

“The way we’re restoring ngahere needs a big shake-up, we should be leading that conversation, not letting Pākehā scientists do it,” says Makiha.

For Makiha, he will continue to observe, learn and educate, while advocating for mātauranga Māori to be normalised for the benefit of all and, most importantly, our environment.


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