Jacinda Ardern speaks at Te Whare Runanga in 2018. Photo by Phil Walter/Getty Images

Dr David Galler: My wish for Waitangi

The author and intensive care specialist on why he’s hopeful the prime minister will this week make a transformational announcement on Māori health.

Maybe it was no coincidence that the country’s new cancer control agency, Te Aho o Te Kahu, released its first report in the week leading up to the commemorations at Waitangi. The report, released Tuesday morning, shows Māori are still twice as likely as non-Māori to die from the disease, despite cancer survival rates for all ethnicities improving over the last 20 years.

Sadly, this poor outcome for Māori suffering from cancer is mirrored by a high prevalence and poor outcomes from many other debilitating conditions for Māori – conditions that carry a massively high human cost and create tragic reverberations across society more broadly. This has been the case for a long time and nothing will change until we recognise that simply tinkering with different elements in the long chain of events leading to these outcomes will never be enough. Instead what is required is transformational change, predicated on agreed outcomes and to which we are prepared to reconfigure all our resources

The cumulative burden of this ongoing tragedy for Māori has many corrosive dimensions: racism, colonisation, a lack of basic ethics, poor value and so much more. But right now I believe we are at a tipping point such that society and this government are no longer willing to see this continue. Maybe it is not coincidence that in parallel with this change in sentiment, our tolerance for the status quo in how we respond to the climate emergency has run out too.

I am optimistic that this second term of a majority Labour government will be characterised by seeing things as they truly are, calling out what is no longer acceptable and putting plans in place to deal with them comprehensively.

I am optimistic that this week at Waitangi we will hear an announcement to establish a new Māori health authority that will have full commissioning powers – or, as the authors of the “alternative view” in the Simpson review of the health and disability system put it, provide a vision of the future that gives practical expression of Te Tiriti o Waitangi principles, rangatiratanga and mana motuhake, through Māori commissioning roles that are embedded throughout the health system. This cannot simply be an exercise where one layer of bureaucracy – a Māori health directorate – is replaced by another, a Māori health authority.

Yes I am an optimistic person, but not blindly so. Never before have the stars been so well aligned to make the bold changes necessary to address what must be addressed. We have a new second term majority government led by a prime minister with more political capital than anyone ever before in her position; an obvious burning desire for change; a well thought out solution supported by Māori articulated by the authors of the “alternative view”; an influential and well informed champion in the form of the associate health minister Peeni Henare; and a powerful and articulate Māori caucus.

We can look also to Aotearoa’s amazing achievement in delivering demographic proportionality of graduation from medical school – we are the first place in the worldwide to do that, providing evidence that equity is achievable (and health workforce equity is part of that) – and the evidence of success from abroad, notably in Alaska, as a result of the devolution of health services in 1997 to the indigenous people there. That act of devolution was truly transformational, leading to drastically improved health outcomes for indigenous people, infants, children and adults were drastically improved. Today in Alaska, new and innovative ways of reaching people are continually being devised. The state boasts the most effective telehealth system in the world and now its model is informing improvements in service delivery to all manner of populations, all over the world. It’s an example that should provide Aotearoa with enormous confidence that we can achieve similar results.

As it was for the Alaskans, the change I’m hoping for would be nothing less than a restoration of sovereignty to Māori in the crucial area of healthcare. It will restore to Māori the power and ability to organise, purchase and deliver services in ways that are appropriate for them and which will ultimately improve their health outcomes in a similar way. This has to happen if we truly want to see better health outcomes for Māori.




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