Health leaders say the current system is failing Māori and are calling for a Māori-led agency to turn it around.
On average, Māori die seven years earlier than non-Māori. They are twice as likely to die from cardiovascular disease or heart failure, and one and a half times more likely to die from stroke or cancer than non-Māori. Rheumatic heart disease rates are five times higher and twice as high for diabetes.
"If these problems were for the majority population, we'd be doing something about them," said Lady Tureiti Moxon, managing director of primary health organisation Te Kōhao Health Ltd.
Moxon presented evidence last week in the first stage of the WAI 2575 Health Services and Outcomes Waitangi Tribunal hearing at Tūrangawaewae marae, in Ngaruawahia.
There have been more than 200 claims for the inquiry, which has been split into three stages. The first stage had been focusing on claims from Māori primary health organisations and providers in claim WAI 1315, and the National Hauora Coalition in WAI 2687.
Claimants from both groups say institutionalised racism and inequity are at the heart of the disparities in outcomes, and they want Māori at the forefront of a new system based on mana motuhake, or self-determination.
Moxon, presenting on behalf of WAI 1315, lodged her claim 13 years ago, yet said the issues facing Māori remained the same.
"Diabetes is at epidemic proportions, with four times more Māori having to have limbs amputated. Is there an outcry? No, we just let the inequalities carry on, getting bigger and bigger. But it is time for a change."
Contributing to the disparities in health statistics, Māori were twice as likely to experience discrimination in health and were three times more likely to receive differential treatment to non-Māori as a result of discrimination.
In the 2000s, PHOs were introduced, allowing community-led healthcare, with funding provided for them based on members, rather than appointments. Māori groups established their own PHOs as a means to take control of their healthcare and turn around the inequality.
However, claimants have said the funding model was not adequate for Māori PHOs, where members were often in poorer health, making it more expensive to look after than those of an average practice. Māori PHOs also received less than 2 per cent of health funding overall.
As part of their claim, Moxon's group sought an apology, and repayment of 16 years of underfunding, estimated at $348m.
They also sought a legislated mechanism for providing primary health care for Māori by Māori, and ongoing funding, controlled by Māori, and an Independent Māori Health Commissioning Agency.
"The primary health system has to change, in a way that Māori can determine our own future: for Māori, by Māori," Moxon said.
"We want our own primary health system, to be able to run it ourselves, to focus on the services we need, so it is not always at the whim of the politics of the day."
In their evidence, the group referred to an indigenous Nuka system of care established in Alaska.
Katherine Gottlieb, chief executive of Alaska's Southcentral Foundation, gave evidence about her experience developing the system, how it allowed self-determination for indigenous communities, and ensured they had the funding they needed.
The second claimant group, WAI 2687, had similar concerns with the current health system and also wanted a new Māori-led agency established.
"We need our own agency, to assist and drive health outcomes for Māori," said Simon Royal, chief executive of the National Hauora Coalition, the largest Māori primary health organisation in the country.
"The current system has failed, and will continue to fail. While structures in the mainstream system need to improve, the time has come for the creation of our own independent agency, which acts as both a policy and funding body. Key principles will be of Māori control, mana motuhake."
Royal said equity of outcomes and Māori involvement needed to be entrenched, based on constitutional reform through Te Tiriti o Waitangi.
The group also wanted a focus on health equity, rather than reducing inequality.
"Reducing inequality infers there is an acceptable level of inequality. That needs be removed, and replaced with language of equity.
"The current system is archaic in its design. Funding is not simple, and needs to be adjusted for things like the burden of disease. There are all sorts of factors that need to go into it for equity to be achieved, and the reality is equity is not cheap.
"There has been huge underinvestment in Māori health, and that needs to be brought to account."
In his evidence Ministry of Health director general Ashley Bloomfield said the state of health for Māori was "unacceptable".
"Māori experience, on average, poorer health and higher levels of premature mortality across a wide range of measures. This state of health for Māori is unacceptable and it is the core business of the New Zealand health and disability system to respond effectively."
Rather than establish a new, separate system, Bloomfield said outcomes for Māori could be improved within the current system.
"By carving off accountabilities in the system for specific population groups, the wider healthcare system may be discharged of its responsibility to be responsive to Māori and to improve equity for Māori."
He said he supported strengthening Māori providers, which was a feature of He Korowai Oranga – the Māori Health Strategy – where the pathways to action specifically included effective health services for Māori.
The hearings of stage one continue this week and next week. In late 2019, the tribunal would start stage two, looking at Māori mental health, disability, alcohol and substance abuse. The focus of the final stage was still to be announced.