Give me words that walk the talk

Talk about dynamic! Now Te Tiriti is signed with Māori and Pasifika?

It’s not enough for legislation, strategies, organisations and leaders simply to proclaim that something is important. They must show us that it is.

This is a common theme in my writing but, recently, I have been thinking about the tension involved in finding words that will compel action but not sound like empty rhetoric.

Ministers and drafters of the Pae Ora (Healthy Futures) Bill must have grappled with this tension when preparing a clause on Te Tiriti o Waitangi as part of this legislation, which sets up the latest health system reforms.

The New Zealand Public Health and Disability Act 2000 was pretty ho-hum when it came to Te Tiriti and was roundly criticised by the Waitangi Tribunal in 2019.

Fortunately, this also meant there was a lot of advice to draw on.

The legislation could have included a wide-ranging requirement, as recommended by the Waitangi Tribunal – that is, it could have said: “This Act shall be interpreted and administered so as to give effect to the principles of the Treaty of Waitangi.” Instead, the legislation spells out exactly how it “honours” Te Tiriti. This includes:

• adopting health sector principles (aimed at improving the health sector for Māori and improving hauora outcomes for Māori)
• establishing a Māori Health Authority, a Hauora Māori Advisory Committee and creating meaningful roles for iwi Māori partnership boards
• requiring development of a Hauora Māori Strategy and a Government Policy Statement with priorities for hauora Māori
• requiring Health New Zealand to have systems and processes in place to ensure capacity and capability to understand Te Tiriti o Waitangi
• requiring the Māori Health Authority to have systems in place for engaging with Māori.

The positive of this approach is that it sets out tangible ways for the new health system to give effect to Te Tiriti obligations.

However, these tangible ways are all very procedural. Having processes for involvement of Māori, adopting principles aimed at improving Māori outcomes, and ensuring policies are developed, may be preconditions necessary for having a health system that honours Te Tiriti o Waitangi, but they shouldn’t be mistaken for actually honouring Te Tiriti.

Therefore, the negatives of the clause include that it attempts to limit the application of Te Tiriti to procedural matters rather than, say, substantive achievement of equitable outcomes.

Restricting Te Tiriti o Waitangi obligations to a set of procedural steps is an extension of stating it is important and, knowingly or not, believing the mere act of claiming importance is the end of your obligations.

And it’s in this context that I’m raising my eyebrows at the term “Treaty dynamic framework” that keeps popping up in health sector documents and discussions with colleagues – especially when the framework is used to describe the new health entities’ obligations, when those obligations are already spelled out in legislation and in Waitangi Tribunal judgements.

Part of my concern is a bit superficial; I can’t get over how it sounds like outrageous jargon. And that is from someone who uses jargon too much.

But, when I look at what the framework is, I have concerns too. The framework comes from the Health Promotion Agency – more recently, Te Hiringa Hauora/ Health Promotion Agency.

With a reference group made up primarily of non-Māori who were mostly employed by the Crown, the agency developed a framework after a series of hui in 2020.

The result was a document that aims to provide “practical ways of being Tiriti-dynamic, achieving equitable health outcomes for Māori and Pasifika, and augmenting community wellbeing”.

Talk about dynamic! Now Te Tiriti is signed with Māori and Pasifika?

I, too, expect a health system that achieves equitable outcomes for Pasifika peoples, but not in a way that denies what Te Tiriti o Waitangi is about.

The steps the document sets out are fine but, again, procedural, and include power-sharing between Māori and the Crown, ensuring equitable resourcing for Māori providers, and using robust data.

This takes us no further towards honouring Te Tiriti o Waitangi than what is in the pae ora legislation, nor does it provide more tangible steps for the sector than the Waitangi Tribunal did in 2019, when articulating the principles of Te Tiriti o Waitangi that it sees as applicable to primary care.

So what is this framework’s value and why do we keep hearing about it? Honestly, I don’t know. I do know, however, there is a risk it will be used to demonstrate that the health sector (especially officials in the Ministry of Health and Health NZ) are committed to Te Tiriti – because they have a framework they can point to.

Pointing to the framework could become the main “action” they are committing to. The aim being, of course, that the pressure to do anything differently for Māori dissipates.

How, then, to articulate a meaningful commitment to Te Tiriti o Waitangi, without empty rhetoric, when even a framework that sounds formal can be toothless and tend to protect the status quo?

While I don’t know the answer to this one, either, I know we can collectively do better.

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