PHOTO: By Daniel Sone (photographer) - This image was released by the National Cancer Institute, an agency part of the National Institutes of Health, with the ID 9713; Public Domain,

Māori Health Authority to be disestablished – Expert Reaction

Parliament will today attempt to consider all three stages of a bill to scrap Te Aka Whai Ora – the Māori Health Authority.

Te Aka Whai Ora was established in July 2022 in an effort to improve the health and wellbeing of whānau Māori and address inequity in the health system.

The SMC asked experts to comment.

Associate Professor Clive Aspin (Ngāti Maru, Ngāti Whanaunga, Ngāti Tamaterā), Associate Professor in Health, Associate Dean (Māori), Victoria University of Wellington, comments:

“Te Aka Whai Ora represents one of the most innovative and promising initiatives to confront and overcome the challenges faced by Māori and improve Māori health outcomes.

“On every health indicator Māori have higher health needs and suffer worse health and social outcomes than other New Zealanders. Among other things, Māori die 7.5 years earlier than everyone else, they are twice as likely to die from cancer, and they encounter significant barriers to appropriate care and support.

“Te Aka Whai Ora was set up to address these shameful health disparities and was demonstrating great promise and optimism for the future of Māori health. A major feature of Te Aka Whai Ora was its commitment to establishing community focused initiatives such as iwi Māori partnership boards that allowed iwi to be the agents of change and find solutions to the health problems in their localities.

“Te Aka Whai Ora demonstrated significant success in building workforce capacity and strengthening community responses to Māori health, and had garnered significant support from whānau, hapū and iwi.

“Te Aka Whai Ora stands as a beacon of hope for Māori communities and provides an example of the importance of innovation and Māori-centred strategies in overcoming the historical and systemic challenges faced by Māori after almost 200 years of colonisation.

“By disestablishing Te Aka Whai Ora, this government will oversee the further entrenchment of Māori health disparities that will endure well into the future and disadvantage generations of Māori.”

Conflict of interest statement: “No conflict of interest. I was seconded to Te Aka Whai Ora for six months in 2023 to lead the development of their Health Research Strategy.”

Dr Rawiri Keenan (Te Atiawa/Taranaki), GP and Associate Professor Primary Care, Te Huataki Waiora, University of Waikato, comments:

“The planned scrapping of Te Aka Whai Ora has been well signalled by the government but is still deeply disappointing. While not as unpopular as the repeal of tobacco control legislation, the move has still been largely condemned within the health system. While some simply just want the reform and restructure to stop, many are deeply concerned about what it means for Māori health equity and the flow on effects for the health system overall.

“The desire for an independent Māori Health Authority comes from decades of reports and statistics with little action. Despite some labelling the establishment of Te Aka Whai Ora as racist or favouring Māori over others, within Māoridom and many parts of the health system it has been celebrated as an opportunity to do things differently. It has been seen as a way to make more significant progress towards equity.

“Nothing formal has been put forward as an alternative but through the election, a strengthened Māori unit with the Ministry of Health and more cultural competence training were suggested. Both of these have been or are already in place, so basically nothing will be done to tackle the persistent poorer health outcomes experienced by Māori. There is a line of conversation that Te Aka Whai Ora has not achieved anything, yet it’s barely had twelve months and if fixing the decades of health inequity was so easy, it would have been done by now.

“Sadly this is largely an ideologically driven move not backed by evidence. If you look at the health literature you target resources where there is most need and economically it makes sense to intervene there as inequity leads to greater costs on the health system. When you combine the disestablishment of Te Aka Whai Ora, with directives for English first naming of Te Whatu Ora and other government departments and plans to review programmes like MAPAS and indeed rewrite the meaning of Te Tiriti o Waitangi, it is clear that this government has an agenda that is anti Māori, anti equity and quite simply racist.”

Conflict of interest statement: “I am a Locum GP; Member of Te Aho o Te Kahu Clinical Assembly and Member of Health Quality and Safety Commission Patient Experience of Care Governance Group and national Mortality Review Committee”.

Associate Professor Marama Muru-Lanning (Waikato, Ngāti Maniapoto, Ngāti Whātua), Director of James Henare Research Centre and Principal Investigator with Te Pūnaha Matatini, and Dr Hilary Lapsley, Senior Research Fellow, James Henare Research Centre, comment:

“‘E kore tēnei whakaoranga e huri ki tua o aku mokopuna’: We must provide our children and their children with a better platform than the one we inherited’.

“Three years ago kaumātua and kuia from Waikato-Tainui greeted the announcement of the establishment of Te Aka Whai Ora, the Māori Health Authority as a signal that the vision of Princess Te Puea Herangi, their beloved leader in times past, would now come to fruition. After decades of pushing for Māori control of their own health initiatives, a new day was on the horizon.

“There is no way of knowing how much the health of older Māori will be set back by the disestablishment of Te Aka Whai Ora. Our research has shown that overwhelmingly, kaumātua are disappointed in health services. ‘The system is not designed for us,’ they say. ‘The way it works does not suit Māori.’ At the heart of their accounts is mistrust arising from violations of tikanga. Manaakitanga, the mutual process of hospitality, respect and kindness, is part of tikanga and is essential to trust. For the kaumātua we work with, it is difficult to achieve trust because of the
way Western-modelled health services are organised and delivered.

“It is a long road to closing the massive gap between kaumātua and older non-Māori health and life expectancy. But kaumātua are resilient and have their eyes on the future. Hoping that things will be better for their mokopuna gives them heart. The present government’s actions crush that hope.”

Conflict of interest statement: “We are undertaking research on kaumātua health and wellbeing funded by the Health Research Council.”