In June 2022, the small nation of New Zealand had 20 District Health Boards—elected bodies that decided what happened in a defined geographic area.
One served a population of 32,550 people, while another looked after 628,770. Arbitrary lines on a map had led to a top-heavy, inefficient, and mostly ineffective system. And so on July 1, they disappeared, to be replaced by two new national bodies created after months of planning and consultation.
Te Whatu Ora (Health NZ) was responsible for delivering services to almost everyone, but alongside it sat Te Aka Whai Ora (the Māori Health Authority), charged with providing culturally appropriate care to Māori people and, it was hoped, closing the gap between health outcomes for Māori and others.
Less than two years later, Te Aka Whai Ora is gone. The Bill to disestablish it passed through its first two readings yesterday and third reading today, under urgency.
A Different Dream: Minister
Health Minister Shane Reti defended the speed and lack of consultation around the change, saying it was a “narrow bill” that “was canvassed at length on the campaign trail.”In introducing the Bill, he tried for a conciliatory approach, saying: “While the particular version of the dream that the Māori Health Authority laid out is coming to an end today, I want to paint a different dream, one that will be outcomes-driven, providing greater devolved decision-making that will deliver care as close to the home and the hapū [small community] as possible.
“There is organisational expertise in the Māori Health Authority, and I want to retain that. I say to Māori Health Authority staff to please join me, guide me, and help us together to row a different waka [canoe] towards better health outcomes. This bill enables that.”
Opposition parties, however, weren’t placated by the minister’s assurances, and an emotional debate followed.
Labour’s Willow-Jean Prime, who is from the same tribe as Dr. Reti, said her anger at the government was matched by sadness that one of her relatives was leading the bill in the House.
‘Excuse Us ... For Dying Earlier’: Māori Party
Te Pāti Māori co-leader Debbie Ngarewa-Packer said Māori were clearly seen as “expendable”.“From day one, you have carried on the kōrero [conversation] that this is a two-tier system based on race … Well, excuse us. Excuse us for having to have a separate need to be able to have our wellbeing addressed because we are dying earlier than everyone else.”
Māori children have a mortality rate one-and-a-half times the rate of non-Māori children; Māori die at twice the rate of non-Māori from heart disease; and Māori die on average seven years earlier than non-Māori.
Green MP Hūhana Lyndon described the move as the “recolonisation of ... Māori” and warned there was “a strong feeling ... that we’ve been ripped off by this government.”
Many MPs focused on the lack of clarity over what will replace the authority and how Māori will be treated under the new system.
Little Detail
On Feb. 27, Dr. Reti avoided reporters’ questions on the shape of the new system by saying he liked oratory and “adding context and contour to the statements I’m going to make.”But his subsequent speech delivered very little detail.
All that is clear so far is that funding for Māori health will remain the same, and Te Aka Whai Ora’s staff and functions will transfer mostly to Health New Zealand, with a few to the Ministry of Health.
