The Crown has been told to set up a stand-alone Maori health agency and consider compensation for failing to improve Maori health over the past 20 years.
The Waitangi Tribunal said in a report released today that the Crown had breached the Treaty of Waitangi by failing to set up and run the primary health system in a way that reduced the gap between Maori and non-Maori health outcomes.
Changes made in 2000 were meant to close this gap, but Maori life expectancy was still seven years below non-Maori and Maori fared worse in nearly every area of healthcare from cancer rates to child hospitalisations and access to health services.
"Despite a few years of hope at the beginning of the 21st century, and some areas of improvement since 2000, the statistics before us still paint a grim picture of the state of Māori health," the tribunal said.
The tribunal - which investigates any Government actions or laws which could break Treaty promises - made two key recommendations. It said the Crown should consider the establishment of a Māori primary health authority which would control and monitor Māori health-related spending and policy, and also consider compensation for underfunding of Māori health providers over the past 20 years.
One of the claimants estimated that Māori Primary Health Organisations (PHOs) had been underfunded by $348 million - though the Crown disputed this estimate.
One of the claimants, Lady Tureiti Moxon, had said in her submissions Māori wanted a new health system based on self-determination.
"The primary health system has to change, in a way that Māori can determine our own future: for Māori, by Māori," she said.
Moxon, managing director of Māori health provider Te Kōhao Health in Hamilton, told the Herald today she was "very pleased" with the report and that it had addressed their main concerns.
"I think it was a bold and courageous move by the tribunal to look at a stand-alone funding authority. That will be the beginning of tino rangatiratanga and mana motuhake, as promised under the Treaty."
Moxon, who lodged her claim back in 2005, said the Crown needed to apologise for its failings in Māori health.
Māori died on average seven years earlier than non-Māori, were 1.7 times as likely to die from their cancer compared to non-Māori, had heart disease rates more than twice as high as non-Māori, and rheumatic fever rates five times higher than non-Māori.
"I think the Crown should apologise. So many of our people are dying needlessly, dying young, from diseases that are preventable. We need a system that ensures our people get the treatment when they need it."
Prime Minister Jacinda Ardern said the Government would take time to respond to the recommendations, and did not offer an immediate apology.
"But it is fair to say, and there has already been acknowledgement, there have been failings, just need to look at the statistics, failings for Māori, including respiratory illnesses and cancer. There are things we need to fix, but a substantive response will take some time."
Associate Minister of Health (Māori Health) Peeni Henare said work would begin now and they would respond to the recommendations fully in due course.
"My primary priority in health is to work toward equity of health outcomes particularly for Māori given the special relationship that exists between the Crown and tangata whenua.
"As such, I acknowledge the importance of this report and the work that went into it by the tribunal, claimants and other contributors."
The New Zealand Māori Council also welcomed the tribunal's findings.
"This is not just a once in a generation finding – this is a once in a 200-year opportunity for Māori and the Crown to very much focus on the central element of partnership – in this case, to ensure equity when it comes to Maori health," executive director Matthew Tukaki said.
The tribunal's report was the first in an ongoing inquiry into Māori health. It focused on the establishment of PHOs in 2000, which were partly designed to address unequal health outcomes for Māori.
The PHOs allowed community-led healthcare, with funding provided for clinics based on members rather than appointments. Māori groups established their own PHOs as a means to take control of their healthcare.
However, claimants 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.
"All parties … including the Crown acknowledged the situation has not substantially improved since 2000," the tribunal said.
The tribunal gave the Crown until January 20 to respond to its recommendations.
THE MĀORI HEALTH GAP
• Māori life expectancy 7.3 years (males) and 6.8 years (female) lower than non-Māori
• Māori 1.7 times as likely to die from their cancer compared to non-Māori
• Māori deaths from heart disease more than twice as high as non-Māori
• Māori rheumatic fever rates five times higher than non-Māori
• Young Māori twice as likely to be hospitalised for asthma
• 88.9 per cent of Māori immunised compared to 91.9 per cent for non-Māori
• Sudden unexplained death rate five times higher for Māori infants than non-Māori
• Māori more likely to have not seen a GP in last 12 months, not collected a prescription, accessed services later, and faced cost barriers to healthcare, than non-Māori
(Source - Hauora: Report on Stage One of the Health Services and Outcomes Kaupapa Inquiry 2019)