Was colonisation good for Māori?
This challenging question reared its head in recent weeks following comments by National Party MP Paul Goldsmith that colonisation was, "on balance", a good thing where "the good outweighed the bad."
While the outcry that followed may have come as a surprise for some, it shouldn't have. For Māori, colonisation is a deeply sensitive and traumatic experience - in a way many Pākehā can never fully understand.
For Māori, colonisation represents a process that saw our people stripped of their whenua, the intergenerational loss of language and culture, and the relegation to second-class citizens in our own land.
And it also saw the creation of a system that has continually failed too many Māori for the past 180 years.
This failure can be seen across a range of socioeconomic indicators, where Māori have worse outcomes than non-Māori across almost every measure.
And it is a system that we are still living with today.
Some of the most striking disparities are found in our health system.
Māori die at four times the rate of non-Māori from cardiovascular disease. We are more likely to suffer from type 2 diabetes, asthma and arthritis.
Wāhine Māori are the least likely to access cervical and breast screening, and Māori are more likely to be diagnosed and die from cancer.
Our tamariki have a mortality rate one-and-a-half times the rate found in non-Māori children.
And Māori are much more likely to be diagnosed with a mental health disorder and to die by suicide.
As a result, Māori have a life expectancy more than seven years lower than non-Māori.
Whatever way you cut it, a system where the indigenous population dies nearly a decade earlier than our non-indigenous population is a system that is failing.
So, while colonisation has had a profound impact on Aotearoa, for many Māori it was a traumatic experience that has left a lasting impact that we are still living with today.
And while we can't change the past, we need to acknowledge it so we can inform our future.
This means recognising that we need to do things differently. How? By constructing a system with Te Tiriti and equity at its heart.
An equitable system recognises different people have different levels of advantage, and that resources and opportunities need to be allocated differently to reach fair and equal outcomes.
It is about acknowledging that a "one size fits all" approach to health services does not work.
That is why the Government's recent health reforms are welcome news - especially the establishment of a Māori Health Authority with responsibility for funding and commissioning kaupapa Māori health services and monitoring health system outcomes.
And it is this type of meaningful and sustainable change that our health system is crying out for.
While more detail is needed on how the Māori Health Authority will work in practice, its establishment is an important step in the right direction.
Critical to its success is the creation of services that support more Māori to access healthcare when they need to and how they want to.
Despite having poorest health outcomes, Māori are the least likely group in Aotearoa to be registered with a GP.
We also know that many Māori aren't able to go to the doctor because they can't afford to, or they can't take the time off work to go. And when they do go, they say they have had a poor experience.
Clearly, we need to turn this around, but it doesn't need to be complicated.
A good start would be to make it easier for Māori to access Māori-led and culturally appropriate health services – whether that is making greater use of marae-based, digital health services or mobile clinics to better reach remote communities.
It includes incorporating tikanga and Te Reo Māori more into our primary healthcare system, and making sure that when it is used, it is used appropriately.
Research tells us the use of Te Reo can significantly enhance the experience of Māori patients. It demonstrates respect and can improve whānaungatanga and relationships between healthcare providers and their patients.
And over the longer-term, it means recruiting more Māori and Te Reo speakers into our health system.
Māori make up nearly 17 per cent of Aotearoa's population, but only three per cent of our medical practitioners and only seven per cent of our nurses.
As our Māori population continues to grow, it is important that our health workforce reflects who we are as a country.
While these might seem like small steps, they can work together to be a catalyst for change so that in our quest for health equity, we can continue to narrow the health gaps.
• Dr Mataroria Lyndon is co-founder and clinical director for primary healthcare provider Tend. He completed his Master of public health at Harvard University and his PhD at the University of Auckland.
Tend offers its app in te reo Māori – the first primary healthcare provider to do so.