16 Jun 2020

Autonomy the solution to Māori health - Janice Kuka

From Checkpoint, 6:12 pm on 16 June 2020

Not ambitious or empowering enough - that's a Māori health advisor's diagnosis of a new government report into revamping the health system.

The report recommends setting up a new independent Māori health authority that would advise the Health Minister on eradicating inequality in the system, identifying problems, developing and testing solutions.

But as it stands, the authority would then work with another new agency - Health NZ and DHBs - when it came to commissioning kaupapa Māori services.

Janice Kuka, managing director of Bay of Plenty Māori health provider Nga Mataapuna Oranga, told Checkpoint the proposed changes "never quite reached the mark."

She wants to see a a standalone Māori authority that commissions on behalf of Māori services, "for them, designed by them."

"We believe that if you want true equity and a better Treaty of Waitangi relationship, which in turn improves Māori health, it needs to be standalone.

"We realise there needs to be a direct relationship but it still falls under an advisory category. It still talks about supporting Māori workforce development, supporting Māori provider development programmes, advising alongside the new Health NZ structure.

"Where's the sovereignty? Because really we're still there helping other agencies make decisions that we are unable to make for ourselves.

"It's like the Crown again saying, 'help me to help you'. Same old line, but you're not involved in the final decision.

"It's limited, has a limited budget. It should have gone further."

Kuka said the question around health for Māori needs to be asked: "What are the solutions for Māori? Quite often we rush off too quickly to look at medical treatment without taking time to say what is best for this individual who presents continuously at our clinics, then in turn what embeds good health for them as a whānau.

"They need to see the framework, the services framed in a culture they understand. They need to understand we have a different way of speaking. Right now we have GP clinics, but when the Māori whānau comes out of visiting a nurse or doctor, [they can have] a totally different view of what the doctor said. So it's cultural.

That doesn't mean only Māori can treat Māori, she said. "We call it kaupapa - the cultural nuances so they understand the dos and don'ts of communicating with Māori.

"There's more involved in just giving medication or making sure you can get an appointment."

She thinks the biggest threat to Māori health is "not allowing us to move through to our own solutions and keeping us bound to a model that is so outdated, that doesn't work anymore, and not allowing us to say we can do it.

"I've been in health for 30-odd years now, seen I don't know how many different types of configurations of health. And it's the same thing, we tend to tinker. In some ways this is a higher level of tinkering, getting nearer where we probably want to go. Starting to agree with us on what makes us unwell.

"But unfortunately they never then hand us the power to say, and this is the solution to us getting equity and improving our health."