OPINION: Former Health NZ chairman Rob Campbell opened a health conference in Tāmaki Makaurau this morning to discuss health equity. Here’s his speech (which has been edited).
I can only imagine that you are here today because you care about equity in health. It’s an odd thing, is it not, that you would be surely very hard pressed to find a conference or person who would argue for the opposite. No one would openly advocate for “inequity in health” but that is what we have.
In a conversation just this week with a person closely involved in Māori health equity issues she referred to the “two doors” that one could go through when seeking healthcare, one so much simpler and better than the other. That is the separate system that some politicians profess to dislike but in practice it is the system they favour. One door the privileged can pay to use.
There are those facing other ethnicities, abilities, genders and class. To my mind the principles which underlie the Pae Ora legislation point in a sound direction. That said, there are many aspects of the structures which it creates which are clumsy and unhelpful and the initial implementation has compounded some of that.
I want to be positive rather than review the many such issues. I think that these can be worked through over time and that further emphasis on them is not the vital action needed.
As it happens, the existing plan Te Pae Tata has six “priorities” which sometimes get labelled “key shifts”. These are all at a high level of generality and come on top of four “foundations” at an even higher level.
You may note that I was there. And I was repeatedly redrafting and commenting as officials trained in such stuff wore us down. Time ran out, and something was adopted to just satisfy the public service process and so that at least some people could get on with real health work.
I recall that a new minister in 2023 outlined three new priorities which I confess to forgetting and lacking the energy to uncover. But something about waiting lists, staffing and winter springs to mind. Health equity matters. The theme of this conference and the Pae Ora legislation. While we all here today may not need this spelled out, let’s put that on the table.
To be clear, by health equity, I mean access, process and outcomes of healthcare which are fair to all groups in our society. What is good for Māori health is good for all of us. And the patterns which are being established by Māori for Māori health equity are guides to all.
The important thing is to identify how that can be achieved. I suggest that the key things about the current structure we need to understand are these:
* Health equity cannot be achieved by Te Whatu Ora.
* No matter how much you restructured or tortured what is now Te Whatu Ora it could not deliver health equity.
* There are things Te Whatu Ora is able to do and should do in its own operations but it is far from enough.
It should also separate its property investment and development functions from its clinical and care functions.
Manatu Hauora is a problem. For years it has been associated with good words on matters of health equity but, as the Lyle Lovett song goes, it is a matter of “It’s a simple fact of life, that no one cares to mention/she wasn’t good, but she had good intentions”.
The fact that it had, to be kind, limited operational capability in the past has not prevented it from still having influence over operational matters in its monitoring and “steward” functions and its access to ministers. That needs to be limited and tempered as part of the empowerment of those facing inequity.
Te Aka Whai Ora is only a problem because of its limitations.
It is hard to avoid the suspicion that, reduced to monitoring and advice and without any funding role, it might become a frustrated observer.
Those are simply some thoughts about the current structure but I am wary of suggesting that there are structural changes which, on their own, will get us to a situation in which we have Pae Ora on a basis of health equity, which is the only sound basis it can have. It is the same with resources. More funding is essential but not in itself enough.
Having more staff is essential in many roles, but not in itself enough. We currently approach this, even those who care about it deeply, from a viewpoint which is too narrow, too influenced by current structures and funding patterns.
At the New Zealand Climate and Health Council I suggested we needed to turn our thinking about health systems inside out if we were to achieve Pae Ora.
This in turn would draw in Tā Mason Durie’s model through human interaction as part of that natural world. The four taha would define what services were needed
Instead of this, we are trying to graft equity on to structures devised and operated for other purposes, just as we have done for sustainability. It’s no wonder we find it too hard and we end up doing a bit of greenwashing and other brand management instead.
Health equity change is core political change, not a board game in which the same pieces are shifted around the same board.
So we have to stop thinking that it can be delivered like this. Just as we must empower and resource communities or groups facing inequities to drive their health services, they have to drive how those are formed and operated and be part of them. It is not enough just to choose from a takeaway menu determined and operated by others.
This same principle applies to those who work in health services.
Leadership is key in this.
That’s the key thing we need now to push. But let us not kid ourselves. This is only possible by confronting the inequities which are comorbidities – economic, housing, education and other inequities.
The future of travel for the health system is still unwritten. It will be written by those with power and resources. It’s up to us whether that is acceptable
Rob Campbell is a professional director and investor. He is chancellor at AUT, chairman of Ara Ake, chairman of NZ Rural Land, and an adviser for Dave Letele’s BBM charity. He is also the former chairman of Te Whatu Ora (Health NZ).