Keep imagining, one day Māori will see equitable outcomes

The Waitangi Tribunal imagined a health system that honoured Te Tiriti o Waitangi principles

Having made Māori health policy my career, you would almost be forgiven for thinking that my interests tended towards the bleak. Looking across the history of New Zealand, health policy has rarely done well by Māori. And looking across the past decade, doing “Māori health policy” has necessarily required a focus on data that reveals how much the public health system has failed its Māori citizens, not to mention its Te Tiriti o Waitangi obligations.

However, the truth is that doing Māori health policy properly is – at its heart – about imagination. Imagining what is possible, imagining a better way of doing things, imagining what it would be like if major changes were made, imagining a different constitutional relationship between the Crown and Māori, and also (admittedly) sometimes imagining all the things that could go wrong and trying to cut them off at the pass.

“After all, a small taste of the light can lead to that most dangerous of emotions. Hope”. (Said by Lady Whistledown in the latest series of TV show Bridgerton, set in an imaginary regency England.)

For most of the past seven or so years, the health system has – to some extent – rewarded imagination. The Health and Disability System Review imagined different health sector structures. The Waitangi Tribunal imagined a health system that honoured Te Tiriti o Waitangi principles. Both were acted on to some extent by the previous Government. But, as the actions taken around Māori health have been diluted by changes in government policy during the past six months, it is hard not to question why every step forward seems to come with a step backwards.

As Rebecca Kiddle (Ngāti Porou, Ngāpuhi) says in an essay, titled “Colonisation sucks for everyone”, the answer is “easy peasy: colonisation squashes creativity”. In her essay, Dr Kiddle emphasises that by ignoring or devaluing indigenous knowledge, everyone loses out on possibly world-changing solutions for everything from addressing climate change to designing effective mental health services.

In the same short volume, Imagining Decolonisation, ¹ an essay by Ocean Ripeka Mercier (Ngāti Porou) reminds us that the everyday and ongoing impacts of colonisation are not accidental. Colonisation has assigned some things value, and robbed others of the same thing. When a policy proposal is too edgy – or imaginative – colonisation is part of what prevents it being successful by demanding a return to “right” the upside-down world that values differences.²

The counter to this is re-indigenisation or decolonisation (these are different concepts but for the purposes of this column let’s just see them as similarly concerned with challenging the status quo). These approaches have explicitly been pursued by Māori health advocates, scholars, providers, practitioners, communities, whānau, hapū and iwi over the past seven years. But as the opportunities to engage over policy changes have disappeared (eg, the lack of public consultation over tobacco law changes because of coalition agreements) it feels increasingly hard, not to mention frustrating, to stay the course towards decolonisation. That doesn’t mean we should give up though.

I have been nostalgic over the past few months, recalling a period from 2019 to around 2021, when much of my time was spent imagining how a fundamentally different health system could work for Māori. This work grew out of the Waitangi Tribunal’s Hauora: Report on Stage One of the Health Services and Outcomes Kaupapa Inquiry recommendation that the Wai 2575 claimants and the Crown work together to explore the feasibility of a Māori health authority. The tribunal’s recommendation, which was a response to the claimant’s calls for a distinctively Māori entity with funding and policy functions, captured public imagination in a way that even I hadn’t expected – especially since it had been talked about for decades before the recommendation, in a way that at times must have felt like shouting into the void.

Like all good creatives, everyone involved in the discussions over this period came to the table(s) with different ideas of what could or should work. They were, however, united in a desire for the Crown to recognise its own limitations in “doing” Māori health, and to step aside so that Māori could make decisions over what was most important to us. And what was more, this imagination was rewarded through legislation, setting up Te Aka Whai Ora – the Māori Health Authority. While the new entity didn’t look exactly like anything the Māori individuals and groups doing the imagining had come up with, it was still what Lady Whistledown might describe as a small taste of the light.

And, as Lady Whistledown says, hope is a dangerous emotion. Both because it can lead to a desire for something much better, and because when hopes are dashed you can feel a bit despairing.

Dr Mercier has words for those of us feeling a bit hopeless though: “We live in a settler-colonial society which incessantly reminds us of its presence. The work of decolonising thought, knowledge, methods, pedagogies, and all the rest, goes against the grain. It is an uphill hike. As with weaving, if decolonisation work stops, the work unravels”.¹

In other words, easy peasy: keep imagining.

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