PATHWAYS TOWARDS HEALTH EQUITY FOR TAMARIKI MĀORI
Māori are disproportionately locked in to economic hardship: approximately one-fifth (19%) of Māori children live in households experiencing material hardship (compared with 8% of Pākehā children), and one-third (33%) of Māori children live in families with incomes below the AHC60 poverty line (compared with one quarter of Pākehā children).
The truth relating to inequity in New Zealand is that it has been systematically created from the time of mass European settlement of Aotearoa, initially enforced by soldiers and militia, and now maintained with the financial resources and force of the state. Discourse on inequities often focuses on the characteristics and behaviours of those suffering inequities. However, the key driver of health inequities for whānau Māori – and the key actor whose behaviour needs to change – is the state.
Māori poverty is a significant legacy of colonisation, exacerbated and maintained by ongoing colonisation.
RECOMMENDATIONS
Across all of the pathways recommended below are these principles as tuāpapa (foundations):
1. Address the Crown’s obligations under Te Tiriti for health and equity.
2. Empower whānau, hapū, and iwi Māori to exercise leadership in setting directions and making decisions about their health.
3. Integrate Te Ao Māori solutions within care models for whānau.
Hāpori/Communities, whānau, and individuals:
Implement comprehensive initiatives that tackle social determinants of health, including supporting whānau to access safe and secure housing, reducing child poverty, and expanding access to quality early childhood education.
Increase investments in health-promoting interventions that create healthier environments, prioritising nutrition, physical activity, and preventive measures including equitable childhood vaccination rates, and oral health promotion.
Foster permanent partnerships and fund them on a long-term basis, between healthcare services and community organisations to improve outreach and access to care for Māori populations.
To address mental health inequities, develop and fund targeted interventions, such as mental health services grounded in Te Ao Māori, early intervention programs, and community-based support networks, which are specifically designed to meet the unique needs of tamariki Māori and their whānau. This is crucial.
Youth2000 identified six wellbeing requirements for rangatahi Māori: pride in whakapapa; aroha for whānau and tupuna; connection to whenua; time with loved ones; holistic care for body, mind, heart and spirit; and growth through shared experiences and trying new things. The 2022 Taitamariki Declaration calls for “spaces in which cultural and spiritual wellbeing is prioritised for youth”.
Healthcare providers and services:
Develop and promote health outreach approaches within Te Ao Māori settings, such as Kōhanga Reo, Māori early childhood care and education, kura kaupapa and marae, to enhance healthcare access and health promotion activities for tamariki Māori and their whānau. These initiatives should be supported by adequate and sustained government funding. These approaches can build on existing relationships with whānau within these settings, to increase engagement and trust in healthcare services and health promotion activities.
Mandate nationally consistent cultural safety training for healthcare professionals, and increase the proportion of Māori in the healthcare workforce to better mirror the communities they serve.
Enhance funding for Hauora Māori providers to ensure tamariki Māori have equitable access to kaupapa Māori healthcare services, including equitable access to midwifery services and antenatal care.
Invest in wrap-around support for whānau with support that is tailored to their individual needs and aspirations.
Health system and cross-sectoral actions:
Develop a Child Health Strategy within the system reforms that includes a focus on addressing the social determinants of health contributing to health inequities.
Embed actions for Māori child health equity within the future NZ Health Strategy, Child Health Strategy, Te Pae Tata NZ Health Plan, and the Hauora Māori Strategy.
Strengthen system monitoring and accountability for Māori child health equity by health authorities including Te Aka Whai Ora and Manatū Hauora (Ministry of Health).
Increase health funding for tamariki Māori to a level that promotes equitable child health outcomes.
Increase funding for research into health inequities specifically focusing on tamariki Māori.
Ensure that the Health and Disability System meets the needs of tangata whaikaha (disabled Māori), including disabled tamariki Māori and their whānau.
IMPACTS AND INDICATORS
If implemented, these actions would be steps towards moving Aotearoa to be a nation where all children and families flourish free from poverty.
They would assist us to make significant strides towards achieving health equity for tamariki Māori across all health measures:
Sustaining hauora: Addressing the social determinants of health, such as poverty and inadequate housing, is a key enabler to improving equitable health outcomes of tamariki Māori, and preventing many health challenges before they become more serious.
·Guaranteeing access to trusted, appropriate care: Increasing funding for Hauora Māori providers can contribute to greater access to Te Ao Māori solutions and services, including access to midwifery, antenatal care, and mental health services.
Eliminating health inequities for tamariki Māori will assist the Crown in addressing:
Te Tiriti o Waitangi obligations, including health equity.
Targets for UN Sustainable Development Goal 3: “Ensure healthy lives and promote well-being for all at all ages”.
Obligations under the UN Declaration on the Rights of Indigenous Peoples, including (but not limited to), Article 24, ii: “Indigenous individuals have an equal right to the enjoyment of the highest attainable standard of physical and mental health. States shall take the necessary steps with a view to achieving progressively the full realization of this right.”
Obligations under the UN Convention on the Rights of the Child, Article 24: “recognize the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. States Parties shall strive to ensure that no child is deprived of his or her right of access to such health care services.
And they will help us all realise the national vision “that New Zealand be the best place in the world for children and young people”.
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