(Implication of the Treaty of Waitangi in improving Maori health outcomes)

INTRODUCTION

Ministry of Health plays a crucial role in developing various strategies, policies, and legislation that further guide how to achieve the maximum health outcomes for the Maori population keeping in mind regarding the articles of the Treaty of Waitangi and its principles.  As the Treaty of Waitangi is recognized as a founding document of New Zealand which helps to promote health equities among Maori and non-Maori. Therefore, this essay will provide a description regarding the Treaty of Waitangi, as to how it effectively involved in New Zealand Public Health and Disability Act (2000), New Zealand Disability Strategy, Maori Health Strategy, Whanau Ora Programme, and Maori Health Plan. In the end, this essay will consider the role of the Treaty of Waitangi in Health promotion and overall conclusion by concluding health outcomes for Maori; as Maori population is getting any benefits from these strategies and acts or not.

Treaty of Waitangi

Treaty of Waitangi is the “founding document” of New Zealand. Treaty of Waitangi was first signed on 6

^th

February 1840 in the Bay of Islands. It is an agreement between Maori chiefs and the British Crown. Approximately, 40 chiefs, starting with Hone Heke signed the Maori version of the treaty. On the other side, William Hobson, a naval officer represents the British crown and Government ( New Zealand Government, 2005).

Treaty of Waitangi has three articles which are described as follows:

Article 1 Kawanatanga

: According to this article “Maori gave the right of conduct to Britishers and in the back they want protection and authority to manage their own events, but in the English version it says Maori give up sovereignty”. (Waikato Regional Council, 2019).

Article 2 Tino Rangatiratanga

: This article explains that “Maori chiefs guaranteed the chiefs ‘te tino rangatiratanga ’and they agreed to give the Crown a right to deal with them over land transactions. However, in the English version, it confirmed and guaranteed to the chiefs ‘exclusive and undisturbed possession of their lands and estates, forests, fisheries, and other properties”. (New Zealand Government, n.d.)

Article 3 Oritetanga

: This article states that “Queen will be responsible for the protection of Maori population in New Zealand and Maori people will get the same rights as British people and can have the same equality like that of other New Zealanders”. (Wilson, 2016)

In 1998, the Royal Commission on Social party recognized the treaty principles and authorized that Treaty Principles should be used in present activities to improve Maori health status. Treaty of Waitangi has three ‘Ps ’principles

i.e.

Partnership, Participation, and Protection which formulate actions in Maori Health Strategy (He Korowai Oranga) with the main objective to involve the Maori population in the health sector.  As well as DHBs are taking more responsibility to engage Maori participation to achieve maximum health outcomes (Ministry of Health, 2002).

New Zealand Health Legislation and Strategies

New Zealand Public Health and Disability Act (2000)

The New Zealand Public Health and Disability Act (2000) was established to produce forceful changes to the general public health funding and provision of public health services and disability support services. As well as, this act conjointly encompasses a similar objective to reduce health disparities among Maori and perpetually improve their health outcomes (Ministry of Health, 2019). District Health Boards and therefore the Ministry of Health and other agencies are working collaboratively to produce the best health services for Maori through equitable funding distribution and disability support services. DHBs also encourage Maori communities to participate in healthcare improvement policies and tries to develop numerous ways to improve their health outcomes (Ministry of Health, 2000).

Moreover, in 2016/2017, the Ministry of Health spent $2.879 billion for health and disability services and support (Ministry of Health, 2016). Its main focus is to promote independency and participation of disabilities in the community. On the other side; funding for hospitals has inflated to $21 million annually (Tan, Carr, & Reidy, 2012). Apart from this, in 2004- 2005 lower cost of GP visits at primary health care organizations promotes to overcome the cost barrier for Maori. Moreover, it shows that more than 50% of Maori and low- income populations were successfully enrolled in primary health organizations in the view of increasing accessibility of health services and reducing health disparities. In addition to this, life expectancy for New Zealanders has increased for males it is 79.5 years and for females is 83.2 years and it is above the OECD average (New Zealand Government, 2016).

On the other side, from 1 July 2017, the Ministry of social development has considered $11.38 million in funds to support Whanau Ora outcomes for many vulnerable families, particularly Maori and Pacific. As well as it follows Maori Health Strategy to support Whanau Ora (Ministry of Social Development, n.d.).

Regardless of the high quantity of funding, DHBs are still not able to tackle health disparities among Maori. As stated by, Teresa O’ Connor “14 out of the 20 DHBs addresses the pathway to reduce disparities for Maori.  However, descriptions were usually general rather than specific and mostly involved workforce, governance and process initiatives, rather than health services.” Holistic approach care is not delivered properly and Whanau ora support is not efficiently carried out. As well as, lack of cultural awareness and lack of support and critical resources negatively affecting the health and well- being of Maori (O’Connor, 2012).

According to the report, “Maori health funding are poorly targeted and barely monitored. The report shows that Crown has rebuked for breaching the Treaty of Waitangi, both in its failure to close the persistent gap between Maori and non-Maori and its failure to guarantee Tino rangatiratanga, or Maori sovereignty and self- determination.” (Radio New Zealand, 2019)

New Zealand Disability Strategy

The first New Zealand disability strategy was established in 2001 to overcome the barriers that come in the way of disabled people and stop them to reach their goals. However rather than its progress, still several disabled children and adults are facing a lot of barriers to succeed in their potentials. Keeping in view of this, New Zealand Disability Strategy 2016- 2026 was initiated by the Minister of Disability Issues “Hon Nicky Wagner” on 29 November 2016 (Ministry of Social Development, 2017).

The main aim of this 2016-2026 strategy is to make New Zealand as a non-disabling society, and wherever disabled people can have equal opportunities to attain their goals and aspirations. This strategy is going to be guided by the three ‘Ps’ principles of Te Tiriti o Waitangi, which equally promotes the participation of the disabled Maori population by improving their quality of life and promoting Whanau Ora.

The New Zealand Disability Strategy will provide guidelines to the government agencies on disability issues from 2016 to 2026. In addition to this, other action plans are also going to start in order to implement this strategy. For instance, a combination of New Zealand Maori health strategy (He Korowai Oranga) and Maori Disability Action Plan for Disability Support Services (Whaia te Ao Marama) that are aiming to provide pathways to enhance maximum outcomes for disabled Maori (New Zealand Government , 2016).  By considering the Maori Health Strategy, the New Zealand Disability Strategy tries to promote the usage of Maori  language by healthcare providers to reduce the language barrier and to support Whanau Ora.

Despite this disability strategy, the New Zealand Disability survey report shows that, in 2013, 26% of the Maori population (176,000 people) was recognized as a disabled and therefore the rate of disability was slightly above than that of the entire population. Nevertheless, 13% of all disabled Maori adults faced discrimination as compared with 6% of non- disabled Maori (Statistics New Zealand, 2015).

Lastly, in order to effectively implement this strategy, equitable health services should be distributed among disabled and non- disabled populations, awareness campaigns should be organized especially in rural areas.

Maori Health strategy (He Korowai Oranga)

Maori health strategy was first developed in November 2002. Its main target is to provide support to all Maori families (Whanau Ora) in order to maintain their health status and well-being.  He Korowai Oranga is a method that the health system acknowledges and respects the principles of the Treaty of Waitangi (Health Navigator, 2019). Four steps are used to implement this strategy and to achieve its outcomes which are as follows:

1. “Development of whanau, hapu, iwi and Maori population.
2. Maori participation with in the health and disability areas.
3. Effective health and disability services.
4. Working across sectors.” (Ministry of Health, 2003)

Ministry of health is working collaboratively with other health sectors to evolve the Maori Health Action Plan that authorized more co-ordinately and collectively to implement He Korowai Oranga. This action plan is the basic key to get rid of health disparities among the Maori population by providing the best quality and effective services (Ministry of Health, 2019).

He Korowai Oranga provides the pathways for Maori to think about their own desires and issues for health and disability. District Health Boards will provide support to Maori by delivering effective services (He Korowai Oranga Maori Health Strategy, 2001).

Despite Government efforts, still 75% of the Maori population have poor health status; according to Ted Alcorn; in 2006 and therefore the main reason behind this is often low income (Alcorn, 2011).  Also there is a difference in a delivery of primary and secondary care health services among the Maori population which further creates poor health conditions.

There is also a piece of evidence that Maori have less accessibility to healthcare services than Non- Maori groups. According to the survey report, 38% of Maori adults are facing problems in obtaining health care services in their local area, as compared to 16% of non- Maori population. As per Loschmann and Pearce, in order to overcome these disparities: more involvement of Maori providers should be considered in the rural areas, and cultural safety education must be given to all non- Maori health providers to reduce cultural barriers and to enhance Maori health status (Loschmann & Pearce, 2006). Moreover, Pae ora is that the Government’s vision for Maori Health and it is derived from He Korowai Oranga. As well as, it is an integrated approach that delivers pathways for Maori to stay healthy in an environment that promotes a better quality of life. Pae ora has three main elements that are interrelated to each other: 1. “Mauri ora- healthy individuals, 2. Whanau ora- healthy families, and 3. Wai ora- healthy environment” (Ministry of Health, 2014). Maori healthy strategy effectively promotes the treaty principle

i.e.

partnership which directly involves Maori contribution in decision making and delivery of better services for Maori groups. An evidence shows that 46% of Maori participate in healthcare delivery and decision-making process. Maori contributors play an integral role in improving the health status of their community. Government agency which is known as “Te Puni Kokiri” monitors programme delivery for Maori and their development. However, Maori Development Organisation (MDO) was set up to assist the Maori health and disability areas (Oh, 2005).

He Korowai Oranga is that the high-level strategy that assists the Ministry of Health and District Health Boards to improve Maori health status by following: Whanau Ora programme, New Zealand Disability Strategy, and New Zealand Public Health and Disability Act 2000 (Ministry of Health, 2019).

Whanau Ora Programme

The word “Whanau” is the base of Maori society. Whanau provides them a sense of support, strength, and identity. Whanau Ora programme was executed by the Ministry of Health, Te Puni Kokiri and the Ministry of Social Development. Whanau Ora acknowledges that whanau well-being is closely joined to Maori cultural values, along with social and economic as well. The main point of this programme is to improve health outcomes, education level, housing and employment levels of Maori and their Whanau (Ministry of Health, 2018).

In order to improve its efficiency; in 2010/2011; $6.6 million were allocated to develop stronger connections for Whanau and for the development of whanau leadership (Ministry of Maori Development, n.d).

According to the “Whanau Ora Minister, Peeni Henare”, the number of funds is going to be enhanced by up to $80 million for Whanau Ora support over 4 years. According to him, Whanau plays an integral role in the decision- making process regarding Whanau Ora’s support. In addition to this, an extra $19.8 million are going to be used for te Reo Maori with the aim of getting one million people speaking basic te Reo Maori by 2040, because it will produce more stronger relation between Crown and Maori (Radio New Zealand, 2019).

Moreover, the Treaty of Waitangi principles plays an important role in developing Whanau Ora by securing Maori rights and well- being, by providing equitable health services and by safely protecting Maori culture, and tradition. In addition to this, Maori Health Plan, DHBs Annual Plan, Public Health Plan, and Regional Services Plan, are contributing together as a team to support Whanau Ora.

Maori Health Plan

The main task of the Maori Health Plan is to provide fundamental planning, reporting and monitoring documents to DHBs and Primary Health Organizations to obtain equality in health services and to enhance outcomes for Maori health status. The main motive of this plan is to promote the principle of health equity, Whanau Ora support and Maori participation which is also the important objectives of Maori Health Strategy. Auckland and Waitemata DHBs are working together and have one joint Maori health team known as ‘He Kamaka Wairoa’. Moreover, the Maori health plan provides a description to DHBs regarding the Maori population and their needs. After making interventions and actions DHBs make plans to fulfill the health needs of Maori (District Health Board, 2016).

Similarly, Auckland and Waitemata DHBs follows the principles and articles of the Treaty of Waitangi and provides a framework for Maori development, health, and well-being by involving Maori participation in health decision making. The ambition of this plan is to see that, “Maori are enjoying a better quality of life, living happily and longer in their region by 2020.” (Auckland and Waitemata DHBs, 2017).

With the help of the Maori Health Plan, Auckland district health board has achieved the success to improve the health outcomes for the Maori community. It shows that the rate of smoking has decreased by 11% for Maori from 2006 to 2013. 78% Maori are enrolled at PHOs and 95% Maori children were fully immunized. Although, life expectancy at birth in Auckland DHB has increased by 1.1 years over the last ten years. Nevertheless, there are still health disparities are present in between Maori and non-Maori population which can be easily seen from the Auckland district health board plan. As it shows that, life expectancy for Maori is 79.3 years which is 3.9 years shorter than other non-Maori groups. However, the main reason behind their high mortality rates is ischaemic heart disease, lung cancer, suicide and diabetes (Auckland DHB, 2015). Apart from this, use of tobacco and smoking prevalence is higher in Maori (38%) than Pacific (25%) and other New Zealand Europeans (15%) and this habit badly affecting the health of Maori community (Gifford, Tautolo, Erick, Hoek, & Gray, 2019).

Well, it is the responsibility of the Maori Health Plan to make strategic health plans by acknowledging the Maori culture and Maori language in order to deliver a better quality of services and universal healthcare services for everyone and for the Maori population. Health counselling sessions must be organized to support Whanau Ora.

Role of the Treaty of Waitangi in Health Promotion

The relationship of the Treaty of Waitangi to health promotion is well established and it can be easily through New Zealand Public Health and Disability Act (2000) which tries to eliminate the health inequalities between Maori and non- Maori populations (Came & Cornes, 2018). It has been stated that there are inaccessible health services and health inequalities are present between Maori and non-Maori population. Therefore, in order to overcome these disparities, the Treaty of Waitangi plays an important role in promoting the health status of Maori. Since the 1970s, awareness regarding the Treaty of Waitangi has increased continuously and resulting in growing the Maori aspiration for self- determination. Also, the Government has started programme of accessible services of public health and Maori health promotion programs, as well as appointing Maori health workers to contribute more to Maori communities.

Owing to the Treaty of Waitangi, life expectancy for Maori has been increasing consistently at almost the same rate as non-Maori since the late 1990s. Also, the gap in life expectancy between Maori and non- Maori had decreased to 7.1 years. In 2013, life expectancy at birth for Maori male was 73.0 years and for Maori females was 77.1 years; while for non- Maori males were 80.3 years and for non- Maori female was 83.9 years (Ministry of Health, 2018).Furthermore, in 1991 major reformation of health services was begun and the level of funding was elevated to improve the accessible services for Maori by an engaging Maori healthcare provider and by developing cultural safety education programs. Similarly, the number of Maori health providers has increased from 13 to 240 and, even that, Maori health leaders played an important role in promoting health promotion and prevention of disease occurrence with in Maori communities (Loschmann & Pearce, 2006).

Conclusion

The overall conclusion of this essay is to indulge Maori participation in decision- making the process at different levels in order to reduce health disparities between Maori and non- Maori and to promote a universal healthcare system for everyone. Also, funds for whanau ora development has increased up to $80 million. This essay concludes that how Maori Health strategy and health strategies, programs and act is beneficial for Maori health and wellbeing.

However, despite all these strategies and policies, this essay explains that Maori health needs are not fully met, and still Maori are living in deprived areas with no access to health services. Even though, higher incidence of mortality rate, risk of cardiovascular disease and a higher rate of cancer is present among Maori than in non- Maori. As cardiovascular disease death rates were 2.3 times higher for Maori and cancer mortality rates were 77% higher. As well as, Lack of Maori health providers, lack of cultural education, and language barriers are becoming obstacles for the Maori population. Consequently, everything must be considered, while delivering equitable health services for everybody.

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