Wednesday, March 30, 2022

NZCPR Newsletter: Tribal Control of Health

The Pae Ora (Healthy Futures) Bill will radically restructure our entire health system. Our 20 democratically elected and community focussed District Health Boards will be abolished. They will be replaced by two centralised agencies, Health New Zealand and a Maori Health Authority, that will “co-govern” New Zealand’s health services, with its workforce of 80,000, an annual operating budget of $20 billion, and an asset base of $24 billion. The Maori Health Authority will have the right of veto over the entire health system, and as a result, health services in New Zealand will be prioritised according to race instead of clinical need.

Labour’s plan for the restructure of health, comes straight out of their He Puapua playbook, a blueprint designed to replace New Zealand democracy with the tribal rule by 2040. It was not revealed to voters before the 2020 election but rolled out after Labour secured a Parliamentary majority to govern alone.

Not only has this separatist system been created without proper community engagement – other than extensive consultation with Maori interest groups – the Government has even enabled the Bill to sidestep the usual legislative scrutiny of the Health Select Committee by establishing a new Committee, the Pae Ora Legislation Committee, to deal with it.

The Minister of Health Andrew Little justified this new committee on the basis that “the make-up of the committee would permit the Crown to meet its Treaty of Waitangi obligations in a way that had not been provided for in any other piece of legislation”.

That means Jacinda Ardern’s He Puapua “co-governance” agenda is now being forced onto Parliament itself!

The new Committee is made up of 50 percent Maori MPs and 50 percent ‘other’, but since there are 11 MPs on the Committee, the extra MP with the ‘casting’ vote is Maori – a clear indication that under Labour, “co-governance” means “tribal rule”.

Ian Powell, the former executive director of the Association of Salaried Medical Specialists, is outraged by the health reforms: “Ten months ago, health minister Andrew Little announced the government intended to abolish district health boards effective from July 1 this year. This was never signalled and came as a complete surprise to the health sector. DHB abolition was never part of Labour’s election campaign in 2020. It was not part of the narrative around the review of the health and disability system, led by Heather Simpson, nor of the leadup to Little’s announcement. There was a complete lack of prior consultation.”

He refutes allegations that DHBs are creating a “postcode lottery” in the health – the Government’s justification for their abolition – and is scathing about the Pae Ora Bill, describing it as “vacuous on primary and community care and virtually silent on hospitals. Before leaving the health system we have, we deserve to know much more about the one we are going to. Replacing existing structures with new ones that have not been worked through is poor leadership.  Making it worse than irresponsible is doing this in the midst of a raging pandemic… Surely NZ deserves better than this. It is time for sanity, reinforced by an evidence-based approach, to be restored to the political leadership of our health system.”

Not only have inadequate details about the proposed system been provided to the public, the justification for the restructure has been ‘manufactured’ to conceal the He Puapua agenda.

The unfortunate reality is that we are again being subjected to the same sort of misleading public relations spin as Three Waters and Covid, where communications experts are attempting to shift public opinion against our present system through clever “be kind to each other” type catchphrases.

According to the Herald, the Health Transition Unit – the special agency the Prime Minister set up within her Department of Prime Minister and Cabinet to push through the health reforms – will spend almost $20 million on public relations consultants this year, attempting to convince us that New Zealand will benefit from a race-based health system.

This week’s NZCPR Guest Commentator is Dr Lawrie Knight, an Auckland GP who has been practicing medicine since 1974. Dr Knight became so concerned by the ongoing claims that our health system is “systemically racist” and disadvantaging Maori, that he fact-checked the evidence that’s been provided, only to find it is false:

“Maori health leaders have criticised the New Zealand Health System as systemically racist, and that this is the prime contributor to poor Maori health and reduced longevity. The five most common claims that have been made by them in this regard are as stated below. These have all been fact checked and found to be incorrect. This paper presents the evidence to support this view, based on Statistics New Zealand data and the census data:

1. That Maori die seven years earlier than other New Zealanders
2. That Maori have poorer health services than non- Maori
3. That decolonising the health system will improve Maori health and longevity
4. That the primary contributing factor for Maori ill health is “systemic racism,” “white privilege,” and “unconscious bias” in the New Zealand Health system
5. That non-Maori are not affected by inequitable health provision and services

“All the above statements are not correct.”

Dr Knight systematically refutes each of the claims, including that ‘systemic racism’, ‘white privilege’, and ‘unconscious bias’ are primary contributing factors causing poor health, and he outlines the accepted determinants of poor health as identified by the World Health Organisation:

“The Social Determinants of Health (SDH) have an important influence on health inequities – the unfair and avoidable differences in health status seen within and between countries. In countries at all levels of income, health and illness follow a social gradient: the lower the socioeconomic position, the worse the health. The following list provides examples of the social determinants of health, which can influence health equity in positive and negative ways:

– Income and social protection
– Education
– Unemployment and job insecurity
– Working life conditions
– Food insecurity
– Housing, basic amenities and the environment
– Early childhood development
– Social inclusion and non-discrimination
– Structural conflict
– Access to affordable health services of decent quality.

“Research shows that the social determinants can be more important than health care or lifestyle choices in influencing health. Numerous studies suggest that SDH account for between 30-55% of health outcomes. In addition, estimates show that the contribution of sectors outside health to population health outcomes exceeds the contribution from the health sector. Addressing SDH appropriately is fundamental for improving health and reducing longstanding inequities in health.”

Dr Knight then specifies a range of common factors that cause poor health including obesity, hypertension, addictions, smoking, coronary artery disease, depression, anxiety disorders, gout, cancers, diabetes, respiratory problems, and genetic disorders.

He explains that the proposed system intends building on the widespread network of Maori health providers that were set up by Helen Clark’s Labour Government 20 years ago to “close the gaps”, pointing out that since they have made little difference to health outcomes in the intervening years, it is misleading to claim they will make a difference now:

“Since 2000, most Maori health services for Maori have been provided by seventy-seven Maori Health providers. They have been funded by the state but completely managed by iwi throughout New Zealand during this time. They were created twenty years ago to provide a ‘by Maori, for Maori’ health service as a solution for the Maori health problems – the identical reason as for this current bill. However, this network of hauora have not had the breakthrough in improving Maori health statistics that had been hoped would occur with a ‘by Maori, for Maori’ service provider.”

Dr Knight believes the reforms will not create the improvements claimed. His paper can be read HERE, and the submission he made to the Select Committee is HERE.

Social issues commentator Lindsay Mitchell has also examined the claims from academics, politicians, and public servants that colonisation has created growing health disparity for Maori, and her analysis found that for most Maori, “living standards have improved enormously, as has equality of opportunity. The progress of Maori social and economic indicators that has occurred under the process of colonisation stands in stark contrast to the constant barrage of contrary claims.”

In her Breaking Views article, Effi Lincoln investigated one of a plethora of claims of increasing Maori ‘inequity’ in health treatments – namely the evidence relating to gout. While she found that no material prejudice in treatments exists, it became apparent a ‘massaging’ of data had created the illusion of bias.

With the Government’s claims that our community focussed DHBs are failing so badly they need to be centralised not standing up to scrutiny, and the allegations of declining health care for Maori unable to be substantiated from the data, what else should we be concerned about?

If we look back to when the Maori Health Authority was first mooted, Iwi leaders insisted the funding model should be based on Whanau Ora, a social services agency with full commissioning powers that stand outside of government.  

But the Auditor General’s 2015 review of Whanau Ora highlighted major problems – not only was almost a third of all taxpayer funding being wasted on administration, the objectives were so vague it was virtually impossible to ascertain whether the money was being well spent.

Furthermore, because Whanau Ora commissioning agencies are private contractors, they are not covered by the Official Information Act, nor are they accountable to taxpayers.

Pae Ora is heading down the same track, and this is one of the concerns raised by the Auditor General in his submission on the Bill:

“In essence, public accountability is about public organisations demonstrating to Parliament and the public their competence, reliability, and honesty in their use of public money and other public resources… I am concerned that accountability arrangements for the reformed health system may be unclear, confusing, and fragmented…

“It is unclear whether the Maori Health Authority will be a public entity for the purposes of the Public Audit Act 2001. To avoid doubt, we suggest that the Bill include a statement that the Maori Health Authority will be a public entity for the purposes of the Public Audit Act 2001, and therefore within the Controller and Auditor-General’s mandate.” 

As the Bill stands at present, Section 11 states, “Health New Zealand is a Crown agent within the Crown Entities Act 2004”, while Section 17 states “The Maori Health Authority is an independent statutory entity”.  That implies its spending will not be subject to any official scrutiny – billions of taxpayer dollars handed to the control of iwi leaders, without full accountability, and without a public mandate, is scandalous.

Let’s be very clear what this is. The proposed Maori Health Authority will create a separate health system for Maori, paid by non-Maori taxpayers to entities controlled by iwi leaders and accountable to no-one. It’s being justified on the basis of health statistics that are bogus, and to satisfy a Treaty of Waitangi ‘partnership’ that does not exist in law.

Let’s also be very clear about what the effects will be. The iwi elite will control our health system through a veto right. That means the leaders of multi-billion-dollar private business development corporations will control New Zealand’s health system, and public funds will be allocated on the basis of race.

Will it achieve any better outcomes? No. Closing the Gaps has been in place for 20 years – yet iwi leaders claim the gaps have widened, and they trot out their mantra claiming institutional racism and colonisation is the cause.

Behind the veil of fake evidence and misrepresentations, tribal rule – masquerading as “co-governance” – is the ultimate purpose of the reforms.

Jacinda Ardern is about to give iwi leaders control of our health system and the huge funding resources that comes with it. Is this what you want for New Zealand?

Please note: To register for our free weekly newsletter please click HERE.


*Is it acceptable that the proposed new Maori Health Authority will not be fully accountable to taxpayers?

Dr Muriel Newman established the New Zealand Centre for Political Research as a public policy think tank in 2005 after nine years as a Member of Parliament. The NZCPR website is HERE. We also run this Breaking Views Blog and our NZCPR Facebook Group 

1 comment:

Anonymous said...

I have one question that I have asked numerous people, but cannot get an answer to. At present there is one common challenge for Maori - that is to correct the perceived wrongs of colonisation within New Zealand.
This makes non Maori the focus for all that is wrong in this Country at present so all Maori Tribes are united in their current battle.
My question is What Tribe is the most powerful in New Zealand - who has the final say when co-governance is achieved and Maori are governing the Country. Surely it will only be a matter of time before the tribes become embattled in a power struggle - then the whole country is in deep trouble - this could result in returning to tribal wars. It is so sad that the human race is not good at learning from our history.