Celebrating the reforms’ best asset

Even if it does not look exactly as Waitangi Tribunal claimants had hoped, Te Aka Whai Ora is a cause for celebration

Te Aka Whai Ora is here! I have written many times in this column about the steps along the way in establishing a Māori Health Authority, so it is natural that I would want to spend a moment celebrating its formal establishment. It is, after all, a big deal.

The first of July was a busy day for government with the launch of the two new health agencies Te Aka Whai Ora – Māori Health Authority – and Te Whatu Ora – Health New Zealand, as well as Whaikaha – Ministry of Disabled People.

I made time to stream the launch of Te Aka Whai Ora. Initially, I was reluctant because the first page of the agenda showed an all-male panel. (I had naively thought Twitter ridicule had succeeded in eliminating these.)

The second part of the agenda added some gender diversity, so I stopped my eye-rolling. Wāhine Māori have been essential in getting us to this point in our health system’s history.

Fortunately, a pre-recorded video from Professor Tā Mason Durie was shown at the launch, providing a brief history lesson. This was especially important for anyone who thought this had all happened overnight.

Māori have always had our own effective public health systems, but colonisation interrupted and continues to interrupt them. Nevertheless, Māori have continued to assert a place within the Western-style health system we have now, with Māori nursing, as it often does, leading the way since the early 1900s.

The primary roots of a Māori health authority of some kind, though, are found in the 1980s and, in his slides, Tā Mason acknowledged 1984’s Hui Whakaoranga, a national hui focusing on Māori health development, as a particular turning point.

However, as he emphasised, there was a wider context to this. Whenever I look back at what is written about this time, I can’t ignore the role played by the Māori Women’s Welfare League and its research report Rapuora.

That report, also published in 1984, both shed light on the issues of Māori women’s health and introduced Te Whare Tapa Wha as a Māori model of health. The latter has been so prominent in the health sector that barely a day goes by where I don’t see it referenced somewhere, so I am assuming the readers of New Zealand Doctor Rata Aotearoa are familiar with it.

There was also a significant push for a Māori health authority of some kind in the 1990s but, as I have written here many times, I see the biggest push coming from the primary healthcare claimants in the Waitangi Tribunal’s Health Services and Outcomes Kaupapa Inquiry.

When emphasising those claimants, I don’t mean that others were not also advocating for and thinking about a future with Māori in greater control of our health and wellbeing, and our own institutions around health. Of course, they were.

But the Waitangi Tribunal claimants, in holding the Government to account for what they viewed as unfair and unjust implementation of the Primary Health Care Strategy (2001), were tactical in not seeking quick fixes. The claims were not just about seeking compensation (although it is required and remains an issue), they were about creating a different kind of health system, one that would not allow the level of health inequities, lack of Māori engagement, or lack of monitoring that had become features of the Ministry of Health-led, DHB-delivered, arrangements.

The Waitangi Tribunal agreed with the claimants and recommended the Crown look at a stand-alone Māori health authority and mapped out a process to do this. I have been lucky in my mahi to have worked with the primary care claimants and I know the energy, thinking and voluntary labour it took to keeping this on the agenda, especially over the first few months. But the Wai 1315 and Wai 2687 claimants did just that.

At the same time, most members of the Health and Disability System Review Panel were coming to a similar view as the Waitangi Tribunal, recommending a Māori health authority with a full range of powers, including commissioning.

The panel recommended a reduction in DHBs, which eventually led to proposals for Te Whatu Ora to replace all the DHBs.

While establishing Te Whatu Ora and disestablishing DHBs is a big deal, and the implementation process has probably affected employees a lot in recent months – giving them more work and more stress or worry – it is not earth-shattering.

Whether the organisations of our “mainstream” health system are district-level, regional-level or national-level is not new and, since the 1980s, we’ve tried each of these arrangements before with varying success.

What makes this one more exciting is the requirement that Te Whatu Ora work with Te Aka Whai Ora closely and the expectation that it will turn its commitments to achieving equity into meaningful (and effective) action.

So, the best part of the new system, Te Aka Whai Ora exists as of 1 July 2022. The Pae Ora (Healthy Futures) Act 2022 gives it a whole lot of roles and functions that are potentially meaningful, including policy roles, monitoring roles and the ability to commission Māori health services. Even if it does not look exactly as Waitangi Tribunal claimants had hoped, it is a cause for celebration.