Series Classification: G (General Programmes)
Emma spends lockdown at Auckland hospital, and sees how government action on COVID-19 underlines the lack of urgency when it comes to Māori health.
By Gabrielle Baker
Getting Better consulting producer Gabrielle Baker (Ngāpuhi, Ngāti Kuri) is a public policy and Māori health expert whose focus is on creating a just and effective health system. Here she reflects on hope, worry, and the prospect of a “new normal” after COVID-19.
During alert level four, most of us were unsettled in some way. And for many of us, the Covid-19 pandemic brought with it the added worry that Māori would be left irreparably harmed.
The worry was built on whānau stories of the 1918 Influenza pandemic, which saw the death rate for Māori approximately seven times as high as it was for non-Māori and decades of research on health inequity in Aotearoa which show across almost every health and disability indicator the health system does less well for Māori than it does for Pākehā.
Recently, Dr Melissa McLeod wrote, with a group of other leading Māori health researchers about the increased risks of Covid for Māori. This includes an increased risk of getting Covid and worse outcomes from Covid, not to mention the wider reaching consequences beyond the virus itself, like rising unemployment. All of these concerns were occupying many of our thoughts during alert level four and, in my case at least, driving us to distraction.
“Whatever it is, coronavirus has made the mighty kneel and brought the world to a halt like nothing else could. Our minds are still racing back and forth, longing for a return to “normality”, trying to stitch our future to our past and refusing to acknowledge the rupture. But the rupture exists. And in the midst of this terrible despair, it offers us a chance to rethink the doomsday machine we have built for ourselves. Nothing could be worse than a return to normality.”
When I read these words from Arundhati Roy’s in April, I got to take a moment out of the worries to be a little hopeful. At some point beyond the state of emergency, would we have a once-in-a-generation chance to create a new normal and leave behind the stale ideas in the health system that disproportionately impact Māori whānau, people with lived experience of disability, takatāpui and rainbow communities, refugee and migrant families, and many poorer communities?
The fact that Covid is currently managed in Aotearoa, has meant that much of the worry has naturally subsided, leaving room for optimism. This was amplified when the Government released the Health and Disability System Review final report in June. This 18-month, expert-led review had been touted as once in a generation. The timing seemed set to usher in genuine change.
But the thing is with something as ambitious as resetting the health and disability system: it is hard. And for my money, to be any good the review must balance expert views with a full expression of Te Tiriti o Waitangi obligations. The Health and Disability System Review Panel report (almost universally referred to as the Simpson Review, in honour of the review panel’s Chair, Heather Simpson) makes a suite of recommendations to “confront many of the inequities the system has perpetuated over the years.” It does this by creating more central government agencies and fewer regionally based organisations. There are sensible enough recommendations that funding should actually include factors that relate to inequity, and there is acknowledgement that institutional racism needs to go.
The Simpson Review also recommends the establishment of a Māori health authority that would be largely advisory.
The Review made this recommendation in conflict with an alternative view held by its Māori expert advisory group, and against the views of more than half of its panellists. In a nutshell, the alternative view is: the Māori health authority needs a substantial commissioning (or funding) function to have any substantial impact.
Having a panel so publicly disagree on a core recommendation is extraordinary. So, unsurprisingly it has dominated media coverage that might otherwise have focused on whether or not the proposals were Treaty-compliant. That also means we have not had as much of a chance to ask the bigger questions of how Māori will be involved in decision-making and partners in the new future when all governance appointments are made by the Minister of Health, or whether the recommendations might have the (unintended?) consequence of the Crown creating an agency to become its own Treaty partner.
In light of all this, it is fair to say my sense of hope gets challenged. And ironically, while managing Covid means there is room for optimism, it also means there is room for the status quo. Alert level one is so similar to the old normal that fewer and fewer people are talking about a new normal and the sense of urgency subsides.
But there should be a sense of urgency when it comes to Māori health.
Across this series of Getting Better, we can hear examples of a health system that isn’t designed for Māori, letting us all down.
We can also see statistics that tell us things like Māori life expectancy is seven years lower than it is for non-Māori and know that on every level this is unjust and unfair and needs to be changed, urgently.
The Waitangi Tribunal’s 2019 report Hauora has hinted at how we might start this change. Māori self-determination and mana motuhake must be embedded in the design, delivery and monitoring of services, equity should be stated as the unabashed goal of everything we do in the health and disability system which also means ensuring equity for groups of Māori the government has particularly failed (such as those with lived experience of disability). We should also not shy away from challenging the constructed boundaries between what is and is not the business of health, regardless of whether it is delivered by ACC, Corrections, Oranga Tamariki or Kāinga Ora.
As we are barrelling towards a general election we have a moment where there will be wider discussions about change. Some issues will be seen as urgent – worthy of party policy and confidence and supply agreements. Māori health should be one of them. If we have learned anything from our experience of Covid, it’s that we can do things we had never imagined. I hope that supports us to imagine a new, Treaty-based, normal.
Noelle McCarthy and John Daniell are award winning writers who make podcasts that connect with audiences, exploring complex subjects in an accessible, entertaining way. Their backgrounds are in journalism and broadcasting, having worked across radio, TV, print and online at a variety of media outlets in New Zealand and Europe, including Noelle’s longtime association with RNZ. They set up Bird of Paradise in 2017. Their last project was The Service, a podcast co-production with RNZ in June 2020.