I started out reading the legislation thinking that there needed to be some kind of re-jig on Maori health, given the reluctance of more than 20% of them to get vaccinated against Covid, while the rest of us who have had our two jabs sit around waiting for them to come to their senses. Then I got to Section 7 of the Bill setting out the “principles” that should guide the new health legislation. “Equitable” access to services, yes; “equitable levels of service”, yes. But achieving “equitable health outcomes” for all, especially Maori, is demonstrably impossible. With more than 50 % of the new cases of Covid being Maori whose vaccination rate has fallen far behind everyone else’s, and with Maori leaders pleading with their fellow Maori to step up and get jabbed having little apparent effect, the health system would need to concentrate all its energy on the 17% before there is anything left for “the other populations”.
Achieving “equitable outcomes” in health or indeed in any area of life, is an impossibility. Always has been, and always will be. First, we aren’t all born with equal intelligence; we don’t all have parents who care about us; and up to 40% of Maori children are truant on any normal school day. But if all children got their ante-natal jabs, were cared for, got to school, made an effort, and passed their exams, they still wouldn’t have equitable outcomes in life, either amongst themselves, or with other racial groups. DNA and sheer luck play big parts in peoples’ lives. So, if the government persists with Section 7 (1) (a) (iii) of the Bill and gives achieving equitable health outcomes priority then the whole expenditure of $24 billion on Health is in jeopardy. Not even the resourcing of “Kaupapa Maori”, or “culturally safe services” reflecting an undefined “Matauranga Maori” in the delivery of services will produce equitable outcomes for them, let alone for all Kiwis.
But this is only part of the story with this racist legislation. The proposed Board of Health is clearly to be subservient to the stand-alone Maori Health Authority which the Minister is bound to take advice from. The new Co-Chair of that Authority is formidably well qualified and has plenty of relevant experience, but the levels of influence built in below her are a real worry. While the Minister can hire or fire members of the two parallel authorities in this racially charged system, there are lots of other ways Maori can challenge his/her decisions. The Maori organisations the minister must (not “may”) consult are legion. A host of Hauora Maori Advisory Committees and Iwi Maori Partnership Boards will govern ministerial functions. These requirements beggar belief. Anyone connected today with the delivery of health services knows how problematic it is getting suitably qualified Maori for boards or advisory committees, and how it is even harder to get those who are chosen, to attend on any given day. I see no sign in the Bill of any ministerial power to dock attendance fees for members who don’t turn up.
And what about the rest of us? With Covid preoccupying so much ministerial and DHB time these days, what is planned for the delivery of the huge array of health services needed by the rest of us? Amidst all the ways in which Maori can challenge ministerial decisions or protest about failures, where are the rights for non-Maori – the “other populations” – to do the same?
Better to scrap the Pae Ora (Healthy Futures) Bill and start again with inclusive legislation. Better again to shrug off our modern-day Rasputin whose malign influence has become the hallmark of Jacinda Ardern’s ministry.
Historian Michael Bassett, a Minister in the Fourth Labour Government, blogs HERE.