Waitangi Tribunal looks at Māori health outcomes
26 October 2018
On Monday 15 October, Waitangi Tribunal hearings for a new Māori health inquiry got underway. This inquiry draws together all current health-related claims. More than 200 claims have been lodged, with most claimants saying the national health system is still failing Māori.
The Wai 2575 Health Services and Outcomes and other hearings are being held at Tūrangawaewae marae in Ngāruawahia and, as stage one of the inquiry is focused on primary care, several College members are participating. Distinguished Fellow Dr Peter Jansen made submissions on the Wai 1315 claim, while his brother Dr Rāwiri Jansen made submissions on the WAI 2575 claim during the first week of hearings, with Distinguished Fellow Associate Professor Sue Crengle presenting during the second week.
Rāwiri’s submission outlines how the New Zealand health system “continues to produce and maintain inequities in health outcomes for Māori”. It questions the measurement and reporting of programmes designed to improve Māori health outcomes, noting in particular the failure of DBHs to meet targets set by Māori Health Plans - and that DHBs are not required to report by ethnicity. He also highlights differing access to primary health resources for Māori and non-Māori populations.
"Māori experience greater levels of illness and disability than other New Zealanders"
His submission asserts: “Overall, in the current system it is clear (including from the Ministry’s own publications) that Māori have less access to primary health care compared to the whole population, especially when the burden of disease is taken into account.
Poor access to primary health care for Māori is considered a key factor in higher rates of illness and hospitalisations amongst Māori, in generating poorer health outcomes for Māori, and in the inequalities in health in Aotearoa/New Zealand (Pōmare et al., 1995; Ministry of Health/Manatū Hauora, 2006).”
Distinguished Fellow Dr Sue Crengle’s written submission notes the vision of the New Zealand Primary Health Care Strategy 2001 has not been fully realised. She says there is a lack of information about Māori health outcomes and health sector performance data. She points out that even the number Māori provider general practices and Māori-led PHOs is not publicly available – as is the number of Māori enrolled in these entities.
She also highlights adverse outcomes for Māori patients at a national level, quoting significantly higher ambulatory sensitive hospitalisations, amenable mortality rates, screening rates, and immunisation coverage than that of non-Māori.
Pictured left - Attendees at the 24 October tribunal hearing
Dr Peter Jansen has published a number of reports about the problems Māori face in relation to primary care, and on ways to improve primary care consualtions or plan and implement better approaches to health for Māori. His written submission summarises his key findings which include: unequal distribution of health resources, differing exposure to risk or protective factors, and provider bias. He also reports inequitable levels of care and treatment, insufficient funding, and Ministry of Health policies which have not been supported by equitable distribution of general practices or primary care providers.
He concludes “Māori experience greater levels of illness and disability than other New Zealanders resulting in having a greater proportion of our shorter lives in a state of reduced health and wellbeing. Access to primary care to receive help for these problems has been less than other New Zealanders, and when in care Maori are likely to receive a lesser standard of care. And, primary care policies have not sufficiently prioritised Maori health and the role of Māori providers to address these issues.”
In his oral submission, Peter began by noting the just-published report by the Perinatal and Maternal Mortality Review Committee (PMMRC) which highlighted ethnic differences in the likelihood of pre-term babies receiving resuscitation.
"No, we're not in much of a better position."
These differences in clinical intervention based on ethnicity not need, are due to decisions by specialist clinicians. He noted that this highlighted the evidence for bias against Māori is persistent and pervasive – occurring in most areas of medicine from primary care through to highly specialised treatments.
He also identified limited areas of no bias such as emergency care where treatment was directed to the illness or injury, not the characteristics of the person. He concluded his submission by asking the tribunal to recommend a commitment by the government to achieving equity in access and outcomes before the bicentennial of the Treaty of Waitangi signing.
Distinguished Fellow Professor David Tīpene Leach’s claim ‘Achieving Equitable Outcomes’ builds on his work relating to pregnancy, bed-sharing and sudden infant death syndrome. He uses the example of a wahakura sleeping pod as a way of developing culturally appropriate and successful health solutions for Māori.
In a Radio NZ interview, Distinguished Fellow Professor Tīpene Leach (pictured right) commented that "We've had a generation and a half of people who have put their professional lives into this area .. and no, we're not in much of a better position.”
These hearings are stage one of the inquiry and are expected to continue until March 2019. A Tribunal-commissioned report is expected to be completed by April 2019, with the Crown’s report due by July 2019. Following this, the Tribunal will make arrangements for stage two of the inquiry which will focus on issues relating to mental health, disabilities, and substance abuse.
Listen to the interview