Māori involvement in the health sector has a long history, including the appointment of Dr Maui Pomare in early 1900s as the first Māori medical officer of health for the Department of Health. The real growth of Māori participation in the health sector has dramatically escalated however over recent decades.
Prior to 1992, the Area Health Boards were beginning to make concerted efforts to address Māori healthy issues in specific areas such as cervical screening, mental health and in health promotion. At the same time around twenty Māori health providers had been contracted by the Boards to deliver community health services. The development of a Strategic Objective by Government to improve Māori health so that Māori could enjoy at least the same level of health as non-Māori, was inserted into the 1993 legislation. This Objective was to form the basis of much of the growth and development of Māori health initiatives throughout the 1990s.
The legislation was also a spur for the newly formed Ministry of Health, and Hekia Parata and Mason Durie undertook a review of the internal structures of the Ministry. The review recommended that a Māori Health group (larger than the small unit that existed at the time) be established, headed by a manager who reported directly to the Deputy-General. The Māori health branch was eventually established in 1993.
In 1996, Ria Earp was appointed as general manager of the Māori Health branch. A number of internal restructures followed in subsequent years as the Ministry of Health and assumed its current structure. Throughout these reorganisations the position of the Māori Health branch remained in place and in 2000, in preparation for the merger of the Health Funding authority and the Ministry of Health, the Māori Health branch became a directorate, with the Deputy Director-General position secured.
Between 1996 and 2004, the Māori Health team has increased in size and today reflects a much broader management line. Over this period the building of Māori teams within other business units has also occurred and today, for example, Māori Managers also operate in Mental Health, Disabilities, Cervical Screening and Public Health.
Much of the development of Te Kete Hauora must be viewed in the light of the Māori Capacity and Capability Plan that was released internally within the Ministry of Health in 2001. Focusing on the needs of Māori Health, the Plan sought to build Māori management and workforce capacity, and to strengthen the knowledge and awareness of Māori health issues throughout the Ministry. The consultation on the draft of He Korowai Oranga (the Māori Health Strategy) began in the same year, and the key themes would eventually be incorporated into He Korowai Oranga.
Our current legislative position
The current legislation, the New Zealand Public Health & Disability Act 2000 (NZ Legislation website), now incorporates number of significant references in relation to Māori Health. The New Zealand Public Health & Disability Act 2000 requires district health boards to establish and maintain processes to enable Māori to participate in and contribute to strategies for Māori health improvement. These, and related requirements, are imposed in order to recognise and respect the Treaty principles and to improve the health status of Māori.
Section 4 of the Act for example states that:
In order to recognise and respect the principles of the Treaty of Waitangi, and with a view to improving health outcomes for Māori, part 3 provides for mechanisms to enable Māori to contribute to decision making on, and to participate in the delivery of health and disability services.
Part 3 of the Act provides for the establishment of district health boards and sets out their objectives and functions. Of particular relevance are sections 22 and 23 of the Act. Section 22 specifies the objectives of the district health boards.
They include the objective of reducing health disparities by improving health outcomes for Māori and other population groups, and to reduce, with a view to eliminating, health outcome disparities between the various population groups (s 22 (1) (e) (f).
Section 23 sets out the functions of the district health board (‘for the purpose of pursuing its objectives’). Of particular relevance is the requirement to establish and maintain processes to enable Māori to participate in, and contribute to, strategies for Māori health improvement (s 23 (1) (d)).
The New Zealand Health Strategy acknowledges the special relationship between Māori and the Crown under the Treaty of Waitangi (Chapter 3 pp 7–8). The New Zealand Health Strategy also refers to the Māori Health Strategy, which was developed later to provide strategic direction and guidance to the sector in implementing the New Zealand Public Health and Disability Act.
Our current position in health sector policy
While the Government has a duty to govern on behalf of the total population, it also acknowledges that Māori health and disability needs are a responsibility for the whole sector. It also acknowledges that Māori communities should be able to define and provide for their own priorities for health and be encouraged to develop the capacity for delivery of services to Māori communities.
Our position throughout He Korowai Oranga
Initiatives to address Māori health and disability needs in the sector has been based on the three key principles articulated as the Treaty of Waitangi principles – partnership, participation and protection. In He Korowai Oranga (the Māori Health Strategy) these three principles are clearly articulated as follows:
Working together with iwi, hapū, whānau and Māori communities to develop strategies for Māori health gain and appropriate health and disability services.
Involving Māori at all levels of the sector, in decision-making, planning, development and delivery of health and disability services.
Working to ensure Māori have at least the same level of health as non-Māori and safeguarding Māori cultural concepts, values and practices.