District health boards were only paying lip service to Treaty of Waitangi, article says

An article examined district health board annual plans from 2019/2020 to see whether they were consistent with the principles of Te Tiriti o Waitangi. Photo / 123RF

A recent report in the New Zealand Medical Journal has found that district health boards have been paying lip service to the Treaty of Waitangi.

The article examined district health board annual plans from 2019/2020 to see whether they were consistent with the principles of Te Tiriti o Waitangi.

It found that while DHBs’ annual plans universally contained expressions of commitment to Te Tiriti o Waitangi, their content did not sufficiently realise these commitments, amounting to a response grounded in rhetoric and a lack of action.

Despite the study’s limited scope, co-author Dr Kyle Eggleton said there were lessons which could prevent some of the same problems under Te Whatu Ora.

“With the advent of Te Whatu Ora the same organisational way of thinking, the same people, the same institutional knowledge will still exist and our concern would be whether the plans that have to be developed by Te Whatu Ora will actually articulate the principles of Te Tiriti o Waitangi or whether it will be just rhetoric.”

There was a need for more genuine partnerships to be formed between Te Whatu Ora, Te Aka Whai Ora and Māori health providers - in particular, it was critical to allow Māori organisations to have more control and autonomy over their services, he said.

Trying to retain control

“A common thing that I often saw as a DHB board member was that most of the things that the DHB did were really trying to retain control over its own services and improve its own service rather than thinking about how to foster self-determination,” he said.

Many organisations, especially Crown entities, want to retain control in spite of the principles of Te Tiriti calling for Māori self-determination, Eggleton said.

“So the challenge would be for Te Whatu Ora to think about what service would be best delivered by Māori health providers and to provide the appropriate level of funding. We know that Māori health providers are really underfunded.”

A report from the Ministry of Health in the years prior to the study showed the funding for Māori providers as a percentage of DHB funding remained small and static, at around 1.5 per cent over five years.

Lady Tureiti Moxon, managing director of Te Kōhao Health in Waikato and chairwoman of the National Māori Urban Authority, said the DHBs failed to properly support Māori health providers.

“The way that the DHBs were operating had never really supported the work that Māori providers have been doing except through a contract and often a very limited one.”

No instant solution

Te Aka Whai Ora provided a pathway to realise some Māori aspirations that did not come to fruition under the DHBs, but it would take time to turn around inequities in Māori health, she said.

“The truth of the matter is that they’ve been establishing themselves, both Te Whatu Ora and Te Aka Whai Ora, for just over a year. To turn around a huge beast like that and to start from scratch as in the case of Te Aka Whai Ora, it does take time.”

It was important to give Te Aka Whai Ora the chance to do what it was set up to do, especially heading into an election year, she said.