It seems like “co-governance” is a concept we will continue to hear much about in political debate. Jim Bolger and Doug Graham (NZ Herald, December 14) are a couple of the latest contributors.
As is often the case, we find the new health services system and Te Aka Whai Ora in the firing line. Blue blood still running through an old knight’s veins as election year beckons. The continued existence of Te Aka Whai Ora post-election is again threatened.
As chair of Te Whatu Ora, I’ve spent the last year working with Te Aka Whai Ora and we are building relationships together to make a big positive difference to health services in this country for everyone. The people in our health services do great work – well above what the resources available really justify – but we are called on to substantively lift the efficiency, effectiveness, excellence and equity of those services for everyone.
Te Aka Whai Ora is created not to make a separate health services system. That already exists.
It exists in the long-standing and well-documented inequity in health outcomes for Māori. (I will come back to the many other inequities). It exists in the access to health services. It exists in clinical and management staffing. It’s not a matter of only having to look, it’s worse than that. You have to deliberately look away not to see it.
Fortunately for all of us, the Māori reaction to this is far from negative. For many years (I recently read Michael King’s biography of Te Puea and her work on health services for her people as an example) Māori have been creative from minimal resources in kaupapa Māori health services. In recent times, this has boomed.
Let’s be clear, such services are delivering some of the most well-utilised and effective primary care we have and are outstanding in pandemic response. They are providing a model of health services which is delivering improved outcomes for Māori, serving many others as well. This model is gaining global recognition. But some here seem to think only a monocultural health services system can work.
They are demonstrably wrong.
We have a huge opportunity to support this initiative from Māori. Another effort to “assimilate” would be a grievous error.
The long-standing health services inequities for Māori are not inevitable or necessary or an accident. They derive from the social and economic conditions of Māori life and the inflexibility of a monocultural health services system.
Te Aka Whai Ora and the mana motuhake it can support for kaupapa Maori health services is central to the shift.
It is instructive to think about the other inequities which characterise our health services system in this context. Take the various and deep specific inequities facing health outcomes for the peoples of Te Moana nui a Kiwa. The same things apply: lots of inequities, growing community-specific responses developing and showing real success.
The answer must be to support those responses and allow culturally appropriate responses to drive health services.
Who on earth is hurt by this? Our Ola Manuia plan, driven by a Pasifika team within Te Whatu Ora, is designed to do just that.
Or to take the many and growing “Asian” communities in our big cities especially. The health issues of access and outcomes are different but it is blindingly obvious that simply applying the same monocultural lens is not adequate and new responses driven by those communities are needed.
Repeat for rural populations, for those with disabilities of various kinds. The issues are not all the same and neither are the answers. The answers are best driven by the communities concerned.
Unlocking this in primary health services is core to the work of Te Whatu Ora. To do this we also need to create a sound national technology base, capable of serving diverse interests and services. And we have to integrate this with excellent and accessible and responsive hospital services.
Te Aka Whai Ora carries a huge burden. It has to meet immediate demands and build the indigenous services necessary for a fair future. We are their partners in this and stand with them. We don’t have to lead or tell them their role. It’s more important to listen and respond.
They certainly take that approach with us. They don’t need a “veto” nor do they have one.
Respect and support go a whole lot further.
Rob Campbell is the chair of Te Whatu Ora.