Three reasons to be cheerful in spite of difficult year for Māori health

This year has been bleak for Māori health – at a national level anyway.

A combination of the disestablishment of Te Aka Whai Ora, through legislation in February and the first reading of the Principles of the Treaty of Waitangi Bill in November amount to backward steps that seemingly undo progress from decades of Māori health advocacy.

But in thinking about this year, the actions of the Coalition Government or, indeed, any political party, can’t be the full story. Just as Māori health was never the sole domain of a Crown entity – which Te Aka Whai Ora was – so, too, 2024 isn’t only about bad news.

At the risk of toxic positivity (denying any negative feelings in an unhealthy attempt to put a positive spin on everything) here are three highlights for the year: reasons to feel some pride and maybe even some optimism.

As I’m writing this, Te Pāti Māori MP Hana-Rāwhiti Maipi-Clarke is a social media superstar, with estimates of more than half a billion people around the world watching a video of her ripping up the Principles of the Treaty of Waitangi Bill and leading a haka in Parliament.¹

The newly appointed Māori Queen, Kuīni Ngā Wai Hono i te Pō, joined the final day of hīkoi mō te Tiriti in Wellington, one of approximately 40,000 people² walking between Waitangi Park and Parliament to show support for Te Tiriti o Waitangi and opposition to the Principles of the Treaty of Waitangi Bill. Rangatahi were out in force at the hīkoi, and in the past few days I’ve had more conversations about Te Tiriti o Waitangi and the Government with the teenagers in my life than ever before.

This is not a new phenomenon, obviously, with this the latest in decades of Māori protest, resistance and activism, but the visibility and scale of public support this year has been something else – making this a highlight for 2024.

The Waitangi Tribunal has been in the news a lot this year. It has released four reports on contemporary Māori policy issues, including on Oranga Tamariki and the repeal of Section 7A – a provision that imposed specific duties on the chief executive to provide a practical commitment to the principles of the Treaty of Waitangi.

The Waitangi Tribunal has also continued its consideration of claims related to Māori health services and outcomes, with progress on two concurrent stages of its health kaupapa inquiry (known as Wai 2575). The first is a priority inquiry into the disestablishment of Te Aka Whai Ora and the second is the stage two inquiry into Māori disability. Both of these stages of the inquiry are drawing to a close and I’d expect reports in the next couple of months.

There have, however, been some early signs out of the Māori disability phase of Wai 2575, of the impact the tribunal report could make. In particular, the Government has already begun to work with claimants on foetal alcohol spectrum disorder, ahead of a final tribunal report.

For decades, Māori with FASD have been rendered invisible and ignored by our health and disability systems. As claimants told the tribunal back in 2022, FASD often goes undiagnosed for Māori, in part because of the difficulties in accessing specialist services and to get a diagnosis in the first place. Even with a diagnosis, support services that could help those with FASD and their whānau are unavailable – both because FASD rarely meets the criteria for funded disability support services and because the services don’t always meet the needs of Māori individuals and whānau.

Even having these issues highlighted in the semi-public forum of the tribunal has been a sign of progress, but this year there were also other milestones. Māori FASD whānau, experts and advocates have been able to come together under the banner of Te Kaahui Taurikura, the FASD Māori Working Group which was established in August last year.³

Advice to health minister Shane Reti in April signalled the development of a new FASD action plan and highlighted the ongoing development of a comprehensive programme for whānau and caregivers tailored to their cultural and support needs across the spectrum of the condition.⁴ This year also saw the release of new FASD diagnostic guidelines for Aotearoa5 and of new government-funded research.⁶

While there is still a long way to go to give whānau who are impacted by FASD the support they need and deserve, not to mention to change the relationship we, as a society, have with alcohol, the focus on FASD is an early “win” out of the Waitangi Tribunal’s inquiry into Māori disability and hopefully a sign of positive things to come.

I’ve said it before, but it is truly amazing how one of the few things to survive the disestablishment of DHBs was the iwi Māori partnership boards. They were even ramped up to have more of a tangible role, and while this came with additional bureaucratic involvement (it would have been no mean feat to negotiate the establishment of an IMPB with public servants), they have even survived the disestablishment of Te Aka Whai Ora and the pausing of localities.

IMPBs have been set up under the Pae Ora (Healthy Futures) Act 2022 to engage with communities, assess the state of hauora Māori, monitor health sector performance and work with Te Whatu Ora to develop priorities for improving hauora Māori. They will also have a role in commissioning, though exactly what role, remains a bit vague – just like most things with the label “strategic”.

An important function of IMPBs is to ensure Māori voices are heard in decision-making that affects Māori health. How exactly this plays out will vary by rohe (region) but there are positive signs of IMPBs reviewing published research and other evidence to reflect back to whānau what is already known about Māori health locally,⁷ and this will only be strengthened by the recent release of iwi data from the 2023 Census on the Te Whata platform.⁸ Of course whānau voice is also about hearing from whānau directly – not just through survey data or research – and how this develops over 2025 is something to truly look forward to.

On a personal front, this year has also been about reflection – taking time out to regroup after so much change in the Māori health and disability system.

I’d love to tell you this involved a lot of worthy reading, and it has, but it has involved just as much reading about dragon-rider training academies. Which is a reminder, too, that while we might have some causes for optimism there are also lots of reasons why we need to protect our energies for the coming year in whatever way that works for us.

Gabrielle Baker (Ngāpuhi, Ngāti Kuri) is an independent health policy consultant