A new system

Ka Mua, Ka Muri

Kia Tu, Kia Ora

Our future is linked to our past,

When we stand tall, we will flourish

He mihi atu tenei ki a koutou, i roto i nga āhuatanga o te wa.

In 2022, the health system for Aotearoa was radically changed. An Act of Parliament in 2021, Pae Ora Healthy Futures provided for the cessation of District Health Boards and a reduced role for the Ministry of Health. The Act also provided for the establishment of two major entities: Whatu Ora (New Zealand Health Authority) and Te Aka Whaiora (Māori Health Authority). Both would report directly to the Minister of Health rather than to the Ministry.

Under the new system there has been a strong emphasis on access to primary health care, a more integrated arrangement, and timely access to secondary treatment and care. Embedded in the reforms there is also recognition of Māori health as key to a more equitable society. The provision of appropriate health care that has regard for Māori culture, whānau realities, and socio-economic circumstances, is part of the overall aim. To strengthen that aim, Iwi Māori Partnership Boards have been established across the country, largely to advise Te Aka Whaiora.

A history

A Māori Health Authority is not without a history. More than a 100 years ago the Health Act 1920 saw the establishment of a Division of Māori Hygiene, headed at by Te Rangi Hīroa; he established a Māori Advisory Committee to provide advice to the Department of Health. But his efforts to give stronger voice to the Committee were thwarted and in 1927 he resigned. A few years later the Committee was disestablished. In that same decade Te Puea Herangi unsuccessfully sought approval for a hospital to be established on the Turangawaewae marae. Her argument was Māori would do better in a caring and familiar environment.

A decade later, in 1937, the Te Arawa Women’s Health League, Te Ropu o te Ora was established at Tunohopū. The aim intention was to support Māori women and children who were unwell and to facilitate access to health services. Te Ropu o te Ora remains an integral part of the current health system through Tipu Ora and Manaaki Ora.

The mid-1940s saw the return of the Māori Battalion to Aotearoa. The significance of an indigenous battalion was widely recognised nationally, and internationally, and confirmed the view of Sir Apirana Ngata that Māori contributions were stronger when they were based on Māori leadership and Māori understandings. Later, in 1949, Tipi Ropiha became under-secretary for Māori Affairs. He was the first Māori to head the department and was to hold the position for 9 years.

Then in March 1951, the Maori Womens Welfare League was established. Whina Cooper was the chair and Mira Szászy secretary. By September 1951, 187 branches were operating. A decade later in 1960, a Māori Health Conference was convened by the Director General of Health (Dr Turbott). It concluded that Māori health disorders could not be separated from socio-economic factors and health gains would come from education, housing, and better economic circumstances. In that same decade the Māori Community Development Act 1962 established the New Zealand Māori Council as a national pan-Māori link with Government.

The 1970s witnessed a number of protests all demanding greater recognition of Māori land: the 1975 Land March, the Bastion Point protest, and the Ragland Golf Course protest. Then in the 1980s there was a strong call for action to establish Māori-led initiatives in health. Tainui piloted the first Māori health organisation (Raukura Hauora o Tainui) in 1983, and in 1982 Māori staff at Tokanui (Mental) Hospital had opened a new ward specifically for Māori staff, Māori patients and their whānau. The Hui Whakaoranga, a large national Māori Health Conference in 1984, endorsed Māori initiatives for health (Te Wheke, Whare Tapa Wha), and also advocated a ‘by Māori for Māori’ approach with Māori health providers. Direct funding by Government was advocated: ‘give us the money and we will do the job’.

In the following decade the Runanga Iwi Act 1991, provided for Iwi to establish their own forms of governance and service. Similarly, the Hospital and Health Services (HHSs) Health and Disability Services Amendment Act 1998, separated funding from the provision of existing services and enabled Māori health services to operate as independent agencies. Kaupapa Māori Organisations (KMOs) soon flourished.

In 2005, the National Iwi Chairs Forum was established and in 2009 two health related Waitangi Tribunal Treaty claims were heard (Wai 1315 and Wai 2687). The decade after (2010) saw the establishment of Whānau Ora, a Maori health and wellbeing movement built on mātauranga Māori and transcending a range of socio-economic sectors. Later (2019), the Health Services and Outcomes Inquiry was launched (Wai 2575) and in the same year the Pomare Day address focused on the possibility of a Māori Health & Wellbeing Authority with commissioning agencies, a whanau centred approach, the delivery of health and social services, health promotion and prevention, located in Te Ao Māori, and a future focus.

A new direction

Finally in 2022, and despite the Covid pandemic, the new Heath System was implemented comprising Whatu Ora, Te Aka Whaiora, and the Iwi Māori Partnership Boards.

Te Aka Whaiora is also known as the Māori Health Authority and has a particular focus on a nation-wide Māori health and wellbeing strategy. But because it is directly responsible to the Minister of Heath it is essentially a Crown agency. That does not necessarily reduce its impact but does distance it somewhat from a Treaty of Waitangi understanding of Māori authority. In contrast the Iwi Māori Partnership Boards (IMPB) are grounded in te ao Māori and IMPB leaders are part of a wider national network of Māori leadership that includes Iwi leaders, the Māori Womens Welfare League, the New Zealand Māori Council, the Whānau Ora Commissioning Agencies, and the Māori Wardens. Along with those other institutions, the IMPBs could become an integral part of a wider pan-Māori affiliation for the future – a Māori Health Authority?

In any event, because of their close connections to community, and to whānau, IMPBs can be expected to offer advice to Te Aka Whaiora that resonates with Māori and has the potential to lift Māori health and wellbeing to new heights. It is a contemporary initiative that is built on a century old Māori commitment to healthy whānau – oranga tangata.

Conflicts of interest

The author declares no conflicts of interest exist.