Ao Mai te Rā | The Anti-Racism Kaupapa

The Ministry of Health has outlined a commitment to addressing racism and discrimination in all forms, this is reflected as an outcome in:

• Whakamaua: Māori Health Action Plan 2020–2025
• Ola Manuia: Pacific Health and Wellbeing Plan 2020–2025
• The New Zealand Cancer Action Plan 2019–2029
• Kia Manawanui Aotearoa – Long Term Pathway to Mental Wellbeing.

Eliminating all forms of racism is critical to achieving health equity and the vision of pae ora – healthy futures for all New Zealanders and consistent with upholding our obligations to Māori under Te Tiriti o Waitangi.

About Ao Mai Te Rā

‘Ao Mai te Rā’ means ‘the dawn has come’. It is a reference to Pūao te Atatū which means ‘a new dawn’ and was the government’s first report into racism in the public service.

Ao Mai te Rā is a continuation of the significant work initiated through Pūao te Atatū. It builds on the foundations established and further tailors them to fit our current context in the health system.

Much like the dawn, this kaupapa will usher in a ‘new day’ for health. It will shine light on the dark parts of our system that we aren’t so proud of, those that allow racism and discrimination to flourish.

By illuminating these negative features, we are provided the opportunity to change them. That is what Ao Mai te Rā is about – understanding, uncovering and actively opposing racism in the system and strategising for change. 

Why Ao Mai te Rā is needed

All New Zealanders deserve to achieve their full health potential. However, not everyone has fair access to the factors that contribute to good health and wellbeing. Racism is increasingly recognised as a key determinant of health that results in avoidable and unfair disparities in health outcomes across racial or ethnic groupings.

Within Aotearoa New Zealand, the presence of racism in the health system and its impact on health outcomes has been well evidenced and researched. As kaitiaki of the system, the Ministry of Health has an important role to play in creating an environment where all people can access the health care they need without fear of racial discrimination. This will require courageous leadership, a long-term commitment to change and a shift in the cultural and social norms of the health system.

Ao Mai te Rā is an initiative to support the way the health system understands, reacts and responds to racism in health, this includes identifying and shifting the conditions that hold unfair and unjust health outcomes in place.

Ao Mai te Rā will help us deliver effective and appropriate stewardship of the system, and enable all people, regardless of their ethnicity, to live, thrive and flourish according to their own philosophies and ways of being.

How Ao Mai te Rā will be implemented

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Ao Mai te Rā utilises a design thinking approach and is comprised of two phases that will be implemented over the lifespan of Whakamaua: Māori Health Action Plan 2020–2025. Phase one is a discovery phase focused on understanding the problem of racism and the practical application of anti-racism action in health settings. Key objectives include:

• building collective responsibility for addressing racism at all levels of the system
• building a shared understanding and shared language for what racism is and what effective anti-racism action looks like
• building an evidence-based anti-racism maturity model that supports individuals and institutions to take pragmatic steps towards anti-racism practice.

Phase two is a design and delivery phase focused on supporting individuals and institutions in health settings to take action against racism in the health system. The way we frame and understand the problem of racism and the practical application of anti-racism in phase one will influence how we embed the anti-racism maturity model and the types of anti-racism solutions we develop in phase two.

An overview of phase one of Ao Mai te Rā

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It is important to reflect on where we are now and be guided by evidence and research to inform where we need to be. Establishing a firm evidence base for this work is critical – and better positions the system to design fit-for-purpose anti-racism solutions as part of phase two.

The Ministry has commissioned three literature reviews (discrete components of research) to help discover and understand what racism is and what effective anti-racism action looks like in a health system. The three literature reviews are summarised below.

• An initial (stage one) literature review on the evolution of racism and anti-racism. This literature review explores how understandings of racism and anti-racism have shifted over time, including the various definitions and terminology that have been used. It concludes by offering a set of working definitions for racism and anti-racism that are fit for the Aotearoa NZ health system context.
• A second (stage two) literature review exploring best practice approaches to addressing racism in all its forms. This literature review draws on the anti-racism working definition identified in the stage one literature review and examines the levers necessary to put aspects of the definition into practice. It concludes by offering a set of levers for change necessary for effective anti-racism practice.
• A third (stage three) literature review which examines the key features, characteristics, and utility of an anti-racism maturity model approach. It proposes a model that is centred on a systems-change approach (to help maintain a focus on addressing racism at a system-level, this includes but is not limited to individual behaviour change), overlaid with a critical theory lens (to critically examine and shift the conditions that hold health inequity in place) and maturity model thinking (to highlight a pragmatic pathway for anti-racism progression). 
• A summary paper which summarises insights from all three literature reviews in a way that is brief, accessible and engaging for the health sector and general public. Its primary purpose is to help build a shared understanding of racism and effective anti-racism action in health settings.

The reviews are focused on Māori and Pasifika peoples’ experiences and perspectives of racism and anti-racism. The Ministry of Health acknowledges that racism is not unique to Māori and Pasifika, but these are the two groups most historically affected by racial health inequity in Aotearoa. Getting it right for Māori and Pasifika will ultimately ensure other ethnic groups also benefit.

The Ministry has leveraged the findings and recommendations from the three literature reviews to produce a range of outputs, which: define racism and anti-racism in health, determine a position on racism in health, encourage productive conversations on anti-racism action in health and establish an indicative pathway for anti-racism progression. The outputs are summarised below.

• The formal position statement and working definitions for racism and anti-racism in the Aotearoa NZ health system which draws on the recommended definitions from the stage one literature review.
• The Ao Mai te Rā: Anti-Racism Podcast Series which humanises the issue of racism and its impact on health outcomes and encourages productive conversations about anti-racism action in health settings.
• Whiria te Muka Tangata: the Anti-Racism Systems Change Model (the systems change model) which weaves together the recommendations from the three literature reviews and details a systems-change approach to addressing racism in the health system. The systems change model also includes an implementation guide to support individuals and institutions to better understand where they are now and how they can make progress over time.
• A summary paper on the systems change model which provides a brief and informative overview of the model in a way that is accessible to the general public. It introduces the dimensions and levers and briefly outlines the implementation guide and tools.

The literature reviews and outputs can be read individually or as an integrated portfolio of work for phase one of Ao Mai te Rā. The Ministry anticipates phase two to build on the foundational work established in phase one, this includes testing, refining and embedding the Whiria te Muka Tangata: Anti-Racism Systems Change Model.

Useful links

• Evolution of Racism and Anti-Racism – Lessons for the Aotearoa New Zealand Health System (Stage 1 Literature Review)
• Best Practice Approaches to Addressing Racism – Lessons for the Aotearoa New Zealand Health System (Stage 2 Literature Review)
• Anti-Racism Maturity Models – Lessons for the Aotearoa New Zealand Health System (Stage 3 Literature Review)  
• Summary Paper – Lessons for the Aotearoa New Zealand Health System
• Position statement and working definitions for racism and anti-racism
• Building collective responsibility and ownership for addressing racism (video & podcast series)
• Whiria te Muka Tangata – Anti-Racism Systems Change. A Preliminary Model for the Aotearoa New Zealand Health System
• Whakamaua: Māori Health Action Plan 2020–2025

Questions or comments

We value your thoughts and feedback about Ao Mai te Rā. To contact the Ao Mai te Rā team, please email [email protected]