‘^{How is that a thing?’ - The persistent life expectancy gap that must come down}

Health targets

While not yet an official target, Manuel’s commitment to a meaningful reduction within five years is significant.

Health targets have been hotly debated.

Last year, Health Minister Andrew Little established a new Health System Indicators framework, which replaced National Health Targets. The previous targets had been created under the National-led government in 2007.

A suite of new targets is due to be outlined for the new health bodies - Te Whatu Ora and Te Aka Whai ora - early in 2023.

Manuel told RNZ targets used previously “don't work”.

“I'm really happy to go on record and say that, simply because if you set a target, you have to be able to address that when you don't reach the target what does it actually mean?

“So we've had national targets over the years in all kinds of domains, health, education, you name it, they don't necessarily lead us toward it.”

Auckland University of Technology Professor Jacquie Kidd (Ngāpuhi) said targets were necessary in order to make health services and health professionals accountable.

“But what we don't want is for those targets to be their final aspirations because that's really limiting,” Kidd said.

Targets needed to encourage a holistic approach, she said. 

“I think one of the things that Māori health professionals have been arguing is that focusing on numbers misses the context.

“We're still looking in that holistic space about what a health target would look like for a flourishing community. So what are the steps that need to happen in order to empower that community to have control of their own well-being. Those targets become really useful in terms of whānau being able to see a difference for themselves. It's not just about systems tracking numbers.”

The broad reach of inequality

The life expectancy gap between Māori and non-Māori may be the most telling indicator of all.

According to the latest available data from 2019, life expectancy at birth for Māori men was 73.4 years compared with 80.9 years for non-Māori men. For Māori women, it was 77.1 years, compared with 84.4 years for non-Māori women.

That seven-year gap was one of the reasons the Government set up the Māori Health Authority, whose job will include commissioning services and achieving equitable outcomes for Māori.

At the current rate of progress, however, it will be more than a century before Māori and non-Māori have an equal life expectancy, a study by the Association of Salaried Medical Specialists found last year.

The stubborn gap is the result of a wide range of inequities across society, Kidd said.

“At every single step of our life course and at every step of our engagement with the health sector, there are disparities.

“And what happens is those disparities become cumulative. Over time, it results in not only dying seven years earlier, but it also means that we tend to be sicker prior to passing away.”

Kidd, who is the Associate Head of the School for Māori advancement Clinical sciences at AUT, said racism is a big barrier standing in the way of Māori living longer. 

“There is the story of one kuia who sat for four-and-half hours in a clinic room on those horrible hard chairs because when her name was called out to go to attend her appointment, it was so badly mispronounced that she didn't understand it. ... Nobody checked on her in that time. That's what racism looks like. Racism looks like sending fewer Māori for diagnostic tests and having delays in being diagnosed with cancer.

“It is scary. It's demoralising. Why would you put yourself through dealing with people who don't even want to try and pronounce your name correctly? Much less understand what you need to tell them about your health.”

Lives cut short

Graham King (Ngāti Tai) was diagnosed with type 2 diabetes when he was 35. Now in his sixties, he said living a longer and healthier life is important so that he can be around for his mokopuna. 

His father died of type 2 diabetes-related complications, as did his grandmother. He knows the reality of Māori lives being cut short. If you visit his family urupā, he said, you’ll see that a lot of his tūpuna died young. 

“The system has shown that it doesn't work for Māori, but we’ve got to be the ones to stand up because we’re Tangata Whenua.

“I want to make sure that [my grandchildren] get the best out of me and the only way to do that is to make sure that you look after yourself a little bit better than before. They sort of inspire you to stop smoking. ‘Should you really be eating that cake?’ and stuff, you know? That's one of the motivations to stay healthy for me.”