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A Hauora Journey:
Fundamental Reform of Primary Health Care for iwi Māori and
Aotearoa
Ma whero ma pango ka oti ai te mahi
With red and black the work wil be complete
Introduction
Every year the Minister of Māori Affairs
1 is required to report to Parliament on the Crown’s
implementation of the Waitangi Tribunal’s recommendations.
2 This report marks the first in a new
approach to the section 8I Report series, taking a deeper dive into kaupapa that is of critical importance
to Māori and aligns with the commencement of reports released under the Waitangi Tribunal’s kaupapa ACT
inquiry programme. This approach wil provide a richer story of each kaupapa and an annual reporting
process provides a new way to identify intersectionality and common themes across years of reporting.
This year’s focus is on the Waitangi Tribunal’s Wai 2575
3 report
Hauora: Report on Stage One of the
THE
Health Services and Outcomes Kaupapa Inquiry (“
Hauora” or “Wai 2575”), which related to two claims
concerning the legislative and policy framework for the primary health care system in Aotearoa.
4
Hauora was chosen as a focus because hauora (health and wel being) has a direct impact on life, and
quality of life, for Māori. It also connects with and impacts on outcomes in other critical areas such as
education, employment, social care, and housing.
Wai 2575 and Primary Health Care in Aotearoa
Mai i te kōpae ki te urupā, tātou ako tonu ai
From the cradle to the grave, we are forever learning
UNDER
What is ‘Primary Health Care’ and what was in scope for the Waitangi Tribunal in Stage 1?
The Waitangi Tribunal focused on the “legislative, strategic and policy framework that administers New
Zealand’s primary health care system including, in particular, the New Zealand Public Health and
INFORMATION
Disability Act 2000, the New Zealand Health Strategy, the Primary Health Care Strategy and He Korowai
Oranga (the Māori Health Strategy).”
5 Under the New Zealand Health and Public Disability Act 2000,
the public health system was “primarily funded and overseen by the Ministry of Health and district
health boards, which are primarily responsible for the system and its performance.”
6
The Waitangi Tribunal defined Primary Health Care as encompassing: “services provided in the
community by general practitioners, nurses, pharmacists, counsel ors, dentists, and others.”
7 As the
Tribunal noted, “the core purpose of primary health care is the treatment and prevention of health
RELEASED
1 Minister of Māori Affairs is used in the legislation and the function is performed by the Minister of
Māori Development.
2 Section 81, Treaty of Waitangi Act 1975.
OFFICIAL
3
Hauora: Report on Stage One of the Health Services and Outcomes Kaupapa Inquiry (Waitangi
Tribunal, 28 June 2019). “
Hauora” or “WAI2575”
4 Ibid, pg. 1.
5 Section 8I Report 2021-2022, (Te Puni Kōkiri, 2022), pg. 22. [Look at an alternative source – not sure
we want to quote ourselves here].
6 The Hauroa Report, pg. 17.
7 Ibid, pg. 1
1
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issues before they become serious enough to need care at a higher level.”
8 At this time, the primary
health care system was delivered by District Health Boards. A Chronology of the Primary Health System
in New Zealand was provided by the Ministry of Health and is availabl
e here9 on the Tribunal’s website.
The Parties and Causes of the Wai 2575 Claims
. Stage 1 of the Wai 2575 inquiry involved the consolidation of a number of claims. In its scoping of the
inquiry, the Tribunal granted interested party status to over seventy claims, and named claimant status
to the fol owing two claims: Wai 1315 (Coalition of Tauranga-based Māori Primary Health
organisations)
10 and Wai 2687 (National Hauora Coalition).
11 The Crown was represented during the
inquiry by the Ministry of Health, District Health Boards (which were responsible for administering the
Public Health and Disability Act 2000), and Te Puni Kōkiri (which has a statutory responsibility to monitor
its Crown counterparts in the delivery of health services for Māori).
12 The Crown took a cooperative
and proactive role in its provision of key acknowledgements, statistics and evidence that assisted the
Tribunal in its findings.
13 During the hearing process evidence submitted by claimants was largely
undisputed by Crown counsel.
14 It was acknowledged by both claimants and the Crown that Māori
health inequities were influenced by the cumulative effects of colonisation over the past 180 years
15. It ACT
was also acknowledged that Māori health inequities are influenced by a range of social determinants,
such as income, poverty, employment, education and housing.
16
How does the Treaty of Waitangi relate to hauora?
THE
As part of its inquiry, the Tribunal considered how hauora was embodied in Te Tiriti, and found the
fol owing areas were relevant:
Partnership
Partnership requires the Crown to consult and partner with Māori in the design,
delivery and monitoring of health care and health outcomes.
17 In partnership, the
Crown recognises that Māori have the right to organise themselves and it is the
responsibility of the Crown to work with Māori through whatever means they are
organised and represented.
18
Active
When directly applied to health issues, active protection requires the Crown ’to
UNDER
Protection
make available to Māori, as citizens, health care services that reasonably and
adequately attempt to close inequitable gaps in health outcomes with non-
Māori‘.
19 It involves ensuring that al health services are cultural y appropriate –
8 Ibid.
9 https://www.health.govt.nz/our-work/populations/maori-health/wai-2575-health-services-and-
INFORMATION
outcomes-kaupapa-inquiry.
10 The first statement of claim was filed in November 2005 by Taitimu Maipi, Tureiti Lady Moxon,
Elaine Tapsel and Hakopa Paul on behalf of a coalition of Tauranga-based Māori Primary Health
organisations.
10 The claim concerned health issues on a national scale and a request for an urgent
inquiry because of an imminent threat to the survival of their organisations. Ibid, pg. 1.
11 A later claim was filed in October 2017 by Henare Mason and Simon Tiwai Royal on behalf of the
National Hauora Coalition. The National Hauora Coalition is a national primary health organisation,
operating in five district health board catchment areas across the North Island (Counties Manakau,
Waitematā, Waikato, Whanganui, and Auckland). The focus of the Wai 2687 claim was on the flaws
they identified in the primary health care system. Ibid, pg. 9.
RELEASED
12 Ibid, pg. 10.
13 Judge Stephen Clarke to Hon. Dr David Clarke, Hon. Nanaia Mahuta and Hon. David Parker, Letter of
Transmittal, 28 June 2019,
Hauora, p. xix.
OFFICIAL
14 Ibid; Judge Stephen Clarke to Minister Clark, Minister Mahuta and Minister Parker, 28 June 2019,
Hauora, pg. xix.
15 Lydia – reference.
16 Hauora, pg. 20.
17 Hauora, p. 28.
18 Ibid.
19 Hauora, p. 31.
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that tikanga and mātauranga Māori are recognised and respected, and that
discrimination, bias and systemic racism are addressed through clear and
purposeful action.
20
Equity
Article 3 of Te Tiriti confirms that Māori have all the rights and privileges of British
citizens.
“The Tribunal has found that this article not only guarantees Māori
freedom from discrimination but also obliges the Crown to positively promote
equity.’
21 Both Māori and non-Māori should expect equitable treatment and
equitable health and wel being outcomes.
Options
Māori have the right “to continue their way of life according to their indigenous
traditions and worldview while participating in British society and culture, as they
wish.”
22 The Crown has an obligation to ensure that there is a fair and equitable
primary health care system for Māori, and that Māori can continue to access and
benefit from both Māori and mainstream primary health care services.
The Guarantee of Tino Rangatiratanga
ACT
A core feature of each of the Treaty principles set out by the Tribunal is the guarantee of tino
rangatiratanga. An effective partnership begins with Crown acknowledgement of tino rangatiratanga
and the right of Māori to manage their own affairs in a way that aligns with their customs and values.
23
The guarantee of tino rangatiratanga requires the Crown to not just partner with Māori but to actively
THE
protect their right to tino rangatiratanga and keep the partnership balanced.
24 In the health sector, this
includes ensuring that Māori can expect cultural y appropriate support, whether they choose kaupapa
Māori or mainstream providers.
Māori Health Inequalities
The Waitangi Tribunal noted that “despite a few years of hope and some areas of improvement since
2000”
25, significant financial investment
26, and attempted reforms and adjustments, “the statistics
27
paint a grim picture of the state of Māori health”
28. The Waitangi Tribunal found that health inequalities
persisted under the New Zealand Health and Disability Act 2000.
29 For example:
UNDER
•
Life expectancy: Overal , the gap in life expectancy at birth between Māori and non-Māori is 7.3
years for males and 6.8 years for females;
•
Amenable mortality rates (i.e. premature deaths (deaths under age 75) that could potential y be
avoided, given effective and timely healthcare): were almost two and a half times higher for Māori
than non-Māori;
INFORMATION
•
Cancer: Higher risk of dying from cancer than non-Māori (1.7 times more likely)
30. For breast and
cervical screening programmes, coverage rates were lower for Māori than non-Māori
31;
•
Asthma: Māori aged 5-34 years were more than twice as likely as non-Māori in the same age group
to have been hospitalised for asthma in 2012-2014;
20 Ibid; Te Pae Tata: Interim New Zealand Health Plan 2022, (Te Whai Ora, Te Aku Whai Ora, 2022), p.
18.
21 Ibid, p. 33.
RELEASED
22 Ibid. p 35.
23
Hauora, pg.28.
24
Hauora, p. 30.
OFFICIAL
25 Ibid, pg. 23.
26 $220 bil ion since 2000. Ibid, pg. 25.
27 provided by the Director-General of Health, Dr Ashley Bloomfield.
28 Ibid.
29 Ibid.
30 In 2010-2012.
31 To 31 March 2015.
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•
Sudden unexplained death of infants (SUDI): The rate amongst Māori infants is nearly five times
as high as among non-Māori infants; and
•
GP visits: Māori adults were less likely to have reported seeing a GP in the last 12 months and were
more likely to report cost as a barrier to seeking health care from a GP.
32 A lack of transport was
also more likely to be reported as a barrier to accessing a GP or after-hours healthcare.
Why Stage 1 Wai 2575 Matters
Primary health care matters. It is a key time to intervene in health issues, to assess and treat early signs
of health problems and to prevent them from becoming worse. The statistics and other evidence
provided by the parties led the Waitangi Tribunal to conclude that the primary health care framework
fails to consistently state a commitment to achieving equity of health outcomes for Māori.
33 This was
reflected, for example:
• In the Treaty clause in the New Zealand Health and Disability Act 2000 through to lower-level
documentation (often omitting Treaty references or insufficiently embedding)
34;
• Māori primary health organisations were underfunded from the outset often as a direct result of
the devolution of power and the al ocation of funding to district health boards
35; and
ACT
• The Crown did not col ect sufficient qualitative and quantitative data to know how the primary
health care sector was performing in relation to Māori health.
THE
The Crown was found to have known about the failure of the DHB system to serve high-needs
populations for wel over a decade and failed to adequately amend or replace the current
arrangements.
36 Te Puni Kōkiri was also implicated in this finding for its failure to carry out its statutory
duty to monitor the health sector by failing to conduct agency reviews.
37
Section Two – Major reform of the health system
Nāku te rourou nau te rourou ka ora ai te iwi
With your basket and my basket, the people will live
UNDER
The Government has made significant in-roads into implementing the recommendations in Wai 2575
(Recommendations in Appendix A). In its initial response, the Government agreed that there was:
“a need to address the existing inequities by reducing fragmentation, strengthening central
leadership, and focusing on population health… that while the COVID-19 pandemic had
exposed existing systemic fractures, it had also highlighted the resilience of the health sector
INFORMATION
and its ability to adopt new practices and embrace fundamental change.”
38
On 1 April 2021, the Government announced its decision to commence reforms and build “a truly
national New Zealand Health Service”
39 which would involve significant reform to the health and
disability system, including:
• Replacing al DHBs and PHOs with Health New Zealand (Te Whatu Ora), a single entity with four
regional arms;
• Establishing an autonomous Māori Health Authority (Te Aka Whai Ora);
RELEASED
32 In 2013/2014.
33 Judge Stephen Clarke to Minister Clark, Minister Mahuta and Minister Parker, 28 June 2019,
OFFICIAL
Hauora, p. xv; Section 8I Report 2021-2022, p. 22.
34 Ibid.
35 Ibid, pp. xv, xvi.
36 Ibid, p. xv.
37 Ibid, p. xvi.
38 Cited in Wai2575 – pg 173 – but see if here’s the original that we can cite here instead.
39 Ibid – pg 173, see if original somewhere.
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• Changing the Ministry of Health’s focus to stewardship, policy, strategy and monitoring. Its
commissioning role would be devolved to Te Whatu Ora and Te Aka Whai Ora; and
• Tailoring services to meet the needs of particular communities and geographic regions through a
“locality approach”. These would comprise networks of primary health and community services
such as general practitioners, primary health nurses, maternity carers, and optometrists
40; and
• The implementation of iwi-Māori Partnership Boards with a statutory mandate.
The principal vehicle for these changes was the passage of the Pae Ora (Healthy Futures) Act 2022 (“the
Pae Ora Act”), which entered into force on 1 July 2022.
While not a formal acknowledgement, in passing the Pae Ora Act, the responsible Ministers made a
number of statements about the purpose of the reforms and why such a major structural and
system change was needed. For example:
First Reading, Minister Little:
“It is a system that has done OK, in some respects and it has allowed hospitals to develop what
ACT
they perceive as their needs for their community. But, actual y, over time a problem has emerged:
differences between DHBs, differences in performances … we have the benefit of the interim
report from the Waitangi Tribunal reflecting on the health system and the extent to which it has
served, or not served, the interests of Māori and the extent, most importantly, to which it has not
THE
been consistent with the Crown’s obligations under Te Tiriti o Waitangi…. The Māori Health
Authority… makes sure that the needs of Māori are met in a way that they simply have not been
for many, many years.”
First Reading, Minister Henare
“What we also saw in Wai 2575, the evidence became clear, that in order for us to make the
changes in health, it had to be a fundamental shift and a systemic change, and that’s what this is
offering us today.”
Quote41 from Minister Henare
UNDER
“Many Māori don’t like going to the doctor. And it’s not because we don’t care about our health, or
the health of our whanau. It’s because our experiences of the health system, the experiences of
our parents and grandparents have been negative. That’s why we must change. That is why we
must transform our Māori health system. Māori must be enabled to provide effective leadership
INFORMATION
and partnership throughout the health system. And we wil require all organisations to share
responsibility for improving outcomes for Māori.”
The Pae Ora Act implements and addresses several recommendations from the stage 1 Wai 2575
report:
•
Section 6 adopts a comprehensive Te Tiriti clause, including practical steps for embedding a te ao
Māori lens within its structures and how Te Tiriti is given effect to by different actors within the
health system. For example, s6(f) provides for iwi-Māori partnership boards to enable Māori to
RELEASED
have a meaningful role in the planning and design of local services.
OFFICIAL
40 FIND PRESS RELEASE. BEEHIVE.
41 “Minister Henare Contribution to a Speech on Building a New Zealand Health System that works for
al New Zealanders.” (Beehive, Wel ington, 21 April 2021)
https://www.beehive.govt.nz/speech/minister-henare-contribution-speech-building-new-zealand-
health-service-works-al -new
5
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•
Section 7 sets out new principles. The Waitangi Tribunal noted
42 that in 2020 the Ministry of
Health included principles (Tino rangatiratanga, Equity, Active protection, Options, and
Partnership) in their reissued Māori health action plan
43, which applies to the whole health sector.
Section 7 of the Pae Ora Act sets out new principles for the health sector, which alongside the
Treaty of Waitangi section (section 6) and the structural and system changes in the Pae Ora Act,
embodies the recommended principles above. For example, s7(1)(a) states that the health sector
should be equitable, which includes ensuring Māori and other population groups have access to
services in proportion to their health needs, receive equitable levels of service, and achieve
equitable health outcomes.
•
Partnership: The Pae Ora Act strengthens the partnership approach that Māori and the Crown have
within the public health system. This can be seen, for example, in sections 6 (Te Tiriti), 7 (Principles),
the establishment of the Te Aka Whai Ora as an independent statutory entity, the establishment
of iwi/Māori partnership boards, and how Māori health plans, strategies and commissioning wil
take place under the Pae Ora Act.
ACT
“The Māori Health Authority wil be constituted to represent the Māori voice from all iwi and
hapori. Embedding partnership must also happen at a local level. Māori wil have a clear voice in
decision-making through the evolved iwi-Māori partnership boards that wil approve priorities and
THE
service plans for localities.”
44
Ka pū te ruha, ka hao te rangatahi
The old net is cast aside, while the new net goes a-catching
New Bodies
The Government has gone further than exploration of the new bodies and completely restructured the
health care system with the passage of the Pae Ora Act. This has included the creation / reform of four
core national health organisations. UNDER
Manatū Hauora / Ministry of Health
Manatū Hauora is the government department with primary responsibility for health policy, strategy,
and regulation. “In [their] role as kaitiaki (chief steward) of New Zealand’s health system, Manatū
Hauora is the chief adviser to the Government on policy, sets direction, and regulates and monitors
the health system to ensure it performs well and delivers better health outcomes for everyone.”
INFORMATION 45
Te Whatu Ora / Health New Zealand
Te Whatu Ora is a new public health government agency that has taken over the planning and
commissioning of services and functions from the 20 former District Health Boards. Unlike DHBs, Te
Whatu Ora operates nationally, with four regional offices.
Te Aka Whai Ora / Māori Health Authority
Te Aka Whai Ora is a new independent statutory entity with primary responsibility for managing
RELEASED
Māori health policies, services, and outcomes. Unlike DHBs, Te Aka Whai Ora operates nationally.
OFFICIAL
42
Hauora, pg. 180.
43
Whakamaua: Māori Health Action Plan, 2020-2025 (Ministry of Health, Wel ington, 2020), pg.15.
44 https://www.beehive.govt.nz/speech/building-new-zealand-health-service-works-al -new-
zealanders.
45 https://www.health.govt.nz/about-ministry/what-we-do and
https://dpmc.govt.nz/sites/default/files/2021-04/heal th-reform-white-paper-summary-apr21.pdf.
6
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Te Pou Hauora Tūmatanui / Public Health Agency
Te Pou Hauora Tūmatanui leads al public health and population health policy, strategy, regulatory,
intel igence, surveil ance, and monitoring functions, and has a key role in providing advice to
Ministers on al public health matters. Te Pou Tūmatanui sits within Manatū Hauora.
These organisational changes and the additional features outlined below also respond to the Waitangi
Tribunal’s recommendations about strengthening the monitoring and accountability mechanisms in the
public health system. For example:
Te Aka Whai Ora
Under section 19, the functions of the Te Aka Whai Ora specifical y include monitoring the delivery of
hauora Māori services by Te Whatu Ora and providing public reports on the results of that monitoring
46;
and monitoring, in cooperation with the Ministry and Te Puni Kōkiri, the performance of the publicly
funded health sector in relation to hauora Māori. This sits alongside a suite of other functions that wil
enhance Māori health outcomes, such as improving service delivery and outcomes for Māori at al levels ACT
of the health sector
47, and evaluating the delivery and performance of services provided or funded by
the Te Aka Whai Ora.
48
Iwi-Māori Partnership Boards
THE
Under section 30, the functions of the iwi-Māori partnership boards include monitoring the
performance of the health sector in a relevant locality.
Reporting on the Charter
Under section 50, Te Aka Whai Ora and Health New Zealand must prepare a report on how the New
Zealand Health Charter has been given effect to in the health sector and present it to Parliament / make
it publicly available.
Te Puni Kōkiri
Te Puni Kōkiri retains its monitoring function under section 5 of the Ministry of Māori Development Act
1991. Te Puni Kōkiri has reformed the way it performs its monitoring function and is now “walking
UNDER
alongside” the new health agencies as they develop strategies, plans and other forms of
implementation.
Health Strategies and Plans
INFORMATION
The Waitangi Tribunal made specific recommendations about the Māori health strategy, the New
Zealand Health Strategy, the Primary Health Care Strategy, and the strategies’ relevant action plans.
He Korowai Oranga was initial y launched in 2002 providing a 10-year outlook with an overall aim of
whānau ora (healthy families).
49 Pae Ora sits within this Strategy as the Government’s vision for Māori
health. “Pae ora is a holistic concept and includes three elements:
• mauri ora – healthy individuals
• whānau ora – healthy families
• wai ora – healthy environments.”
50
RELEASED
46 S19(l).
OFFICIAL
47 S19(c).
48 S19(r).
49 Whakamaua: Māori Health Action, p. 16. The strategy continues to
set the direction for Māori
health underpinning the current action plan to improve Māori health outcomes between 2020 and
202549 and provides guidance at a strategic level on how the health and disability system can support
Māori health aspirations and health equity.
50 Reference needed – ref website link below.
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Al three elements of Pae Ora are interconnected and mutual y reinforcing, and further strengthen the
strategic direction for Māori health for the future.”
51
Sections 41 to 46 of the Pae Ora Act outline several strategies that the Minister must prepare and
determine, including:
• New Zealand Health Strategy
• Hauora Māori Strategy, which must be jointly prepared with Te Aka Whai Ora
• Pacific Health Strategy
• Health of Disabled People Strategy
• Women’s Health Strategy
• Rural Health Strategy.
52
Sections 47 to 49 of the Pae Ora Act
outline the process of developing a health strategy and monitoring
its success for the respective populations. Section 49 specifies that health entities must have regard to
al health strategies in the exercise of their powers and performing their duties. These changes more
clearly articulate the expectations for how each high-need population, including Māori, is treated in the ACT
health sector and a central point of oversight of the progress and outcomes for each population group.
Plans
THE
In 2020, fol owing the release of Wai 2575 stage 1, the
Whakamaua Māori Health Action Plan 2020-
2025 was released by Manatū Hauora. Sections 50 to 53 of the Pae Ora Act outline the development,
content and performance reporting of a New Zealand Health Plan. The purpose is to provide a 3-year
costed plan for the delivery of publicly funded services by Te Whatu Ora and the Te Aka Whai Ora and
the Plan must be jointly developed by both agencies.
53
Te Whatu Ora and Te Aka Whai Ora jointly created the first plan,
Te Pae Tata Interim New Zealand
Health Plan in 2022.
Te Pae Tata is described as ‘an interim plan only’, designed to establish the national
service coverage fol owing the retirement of the district health board system.
54 The plan sets out six
priority actions for the formative period:
UNDER
• Place whānau at the heart of the system to improve equity and outcomes;
• Embed Te Tiriti o Waitangi across the health sector;
• Develop an inclusive health workforce;
• Keep people well in their communities;
• Develop greater use of digital services to provide more care in homes and communities; and
• Establish Te Whatu Ora and Te Aka Whai Ora to support a financially sustainable system.
55
INFORMATION
The New Zealand Health Plan is one of the keys to addressing the previous lack of partnership and tino
rangatiratanga in the design and delivery of primary health care. When the Ministry of Health released
the first action plan for Māori health in 2020, the guarantee of rangatiratanga was separated out and
listed alongside the above principles outlined by the tribunal.
56 Sections 54 and 55 set out the provision
of determining localities and the development of respective locality plans. Iwi-Māori partnership boards
51 https://www.health.govt.nz/our-work/populations/maori-health/he-korowai-oranga/pae-ora-
healthy-futures.
RELEASED
52 Pae Ora (Healthy Futures) Act 2022;
https://www.legislation.govt.nz/act/public/2022/0030/latest/whole.html#LMS575525; accessed 26
June 2023.
OFFICIAL
53 Pae Ora (Healthy Futures) Act 2022;
https://www.legislation.govt.nz/act/public/2022/0030/latest/whole.html#LMS575525; accessed 26
June 2023.
54 Te Pae Tata Interim New Zealand Health Plan 2022, (Te Aku Whai Ora – Māori Health Authority, Te
Whatu Ora – Health New Zealand, 2022), p. 5.
55 Ibid.
56 Whakamaua: Māori Health Action Plan 2020-2025, (Manatū Hauora, 2020), p. 15.
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now have a mandated role in the Pae Ora Act.
57 The locality plans must be developed in consultation
with communities, local authorities, and the Māori Health Authority, along with the relevant iwi-Māori
partnership board.
58 The provision of locality plans and insights from communities and iwi-Māori
Partnership Boards al ows the new national health system to access and use valuable local knowledge.
The Pae Ora Act created a national health service that is local y planned, local y funded, and local y
delivered.
Mā te huruhuru ka rete te manu
Feathers al ow the bird to fly
The Crown remains in conversation with claimants from the stage 1 Wai 2575 report about funding
issues. Last year the Government committed to providing a record funding boost for Māori primary and
community healthcare providers as part of the $71.6 mil ion in commissioning investments by Te Aka
Whai Ora. It is the largest commissioning investment to date enabling funding for Māori health
providers and includes:
ACT
• $29.3m for Te Pae Tata – interim New Zealand Health Plan priority areas;
• $13m for Māori primary and community providers;
• $17.6m for te ao Māori solutions, mātauranga Māori and population health; and
• $11.7m to support innovation, workforce development, and whānau voice.
THE
Whaowhia te kete mātauranga
Fil your basket of knowledge
The Waitangi Tribunal made several recommendations about the col ection and use of data and
information relevant to Māori health outcomes.
59 Some of these are now superseded by the passage
of the Pae Ora Act and others are part of active departmental and cross-agency work programmes.
As the new health agencies are established, there are regular Cross-Agency System Monitoring for
Hauora hui, led by the Ministry of Health. At the second hui, the group moved from an overview of
UNDER
monitoring across the sector to looking deeper into how monitoring is taking place.
The Ministry of Health
The Ministry of Health receives data from different parts of the health sector through the utilisation of
health services or mandatory reporting national collections, and also from national population health
INFORMATION
surveys
.60 The annual New Zealand Health Survey (NZHS), for example, has been conducted since
1992/93. The survey asks respondents to recal their experiences from the past 12 months across a
range of topics and indicators. An interactive data explorer presents latest results by ethnic group,
gender, age, disability status and neighbourhood deprivation, as wel as changes over time.
61 The NZHS
data explorer provides a break-down by total Māori population, gender and Māori vs. non-Māori
comparison and trends over time.
The Ministry of Health also provides public access to an electronic dashboard that provides data and
information about Whakamaua 2020-2025 – the Māori Health Action Plan 2020-2025 - that guides the
Ministry of Health, the whole health and disability system, and government to give effect to He Korowai
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Oranga – the Māori Health Strategy. Quantitative monitoring via measures identified for the online
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57 Section 29-31 Pae Ora Act.
58 Pae Ora (Healthy Futures) Act 2022;
https://www.legislation.govt.nz/act/public/2022/0030/latest/whole.html#LMS575525; accessed 26
June 2023.
59 Complete list on
Hauora, pg. 168.
60 https://www.health.govt.nz/nz-health-statistics/about-data-col ection
61 https://minhealthnz.shinyapps.io/nz-health-survey-2021-22-annual-data-explorer
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dashboard report are designed to provide a broad view of the current state of system performance
against the Action Plan’s four objectives, rather than to reflect progress on any individual action in
Whakamaua.
Te Aka Whai Ora
Te Aka Whai Ora has a key role in the new health system for monitoring and driving improved outcomes
for Māori. Their functions also include undertaking and supporting health research.
62 They are already
developing a Māori health research agenda with Māori health experts, and they are currently building
a monitoring and evaluation team. This mahi wil be supported by insights from local communities, iwi-
Māori partnership boards and others working in the health sector.
Te Puni Kōkiri
Te Puni Kōkiri is supporting this cross-agency group as it develops monitoring systems and frameworks.
Opportunities are discussed in Section Three.
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Te Puni Kōkiri has enhanced its data and analytics capability in recent years, creating tools to harness
data and insights on Māori wel being, and has utilised lessons learned from monitoring, research, and
evaluation to support initiatives in improving public sector effectiveness for Māori. Te Puni Kōkiri has
developed a data and analytics platform, MahiTahi, which is a cloud-based service designed to enable
THE
kaimahi to make evidence-based decisions. MahiTahi wil support Te Puni Kōkiri to analyse what is and
what is not working for Māori across different sectors to best advise government and other public
sector agencies.
63
Specifical y related to health, Te Puni Kōkiri has been col ecting COVID-19 vaccination data since August
2021 for reporting purposes. Likewise, an example of the effectiveness of Te Puni Kōkiri walking
alongside mainstream agencies (“monitoring by doing”)
64 while they design and deliver local y-led,
indigenously-designed interventions, has been through the creation and implementation of the Māori
Communities COVID-19 Fund (MCCF). The MCCF was established to respond to the significant gap
between Māori and non-Māori COVID-19 health outcomes.
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Section Three – The Future
E huri tā aroaro ki te rā, tukuna tō ataarangi ki muri i a koe
Turn and face the sun and let your shadow fal behind you
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Introduction
The Waitangi Tribunal’s stage 1 Wai 2575 report has provided new opportunities for improving both
the Treaty partnership and Māori health outcomes. This section outlines some of the key future
opportunities for the health sector, including Te Puni Kōkiri, which take into account the Waitangi
Tribunal’s recommendations.
The current implementation of the Waitangi Tribunal’s recommendations is taking place in a particular
context for Māori and Aotearoa. Population estimates in June 2021 estimated the Māori population
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was 17.1% of the total population. There was estimated to be 436,000 Māori males and 439,300 Māori
females, with median ages of 27.3 and 25.3 years (Stats NZ, 2021a).
65 Alongside this youthful profile,
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62 Section 19(1)(q).
63 TPK Annual Report, pp. 45.
64 Annual report, pp. 4
65 Long-term insights briefing: Evidence Brief. LINK NEEDED.
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the largest growth in the Māori population wil be in the 65+ year age group.
66 This wil have
implications for the future health needs of Māori.
Te Puni Kōkiri’s Long-term Insights Briefing projects health
outcomes for whānau in 2040 based on
historical data trends
.67 Although average Māori life expectancy is expected to improve from 75 years
to 80 years, it remains six years less than the average for non-Māori. In addition, the proportion of
Māori who are physical y active wil decrease by three percent and drinking alcohol to hazardous levels
amongst Māori is expected to increase by eleven percent.
68
Future Opportunities
The Waitangi Tribunal’s stage 1 Wai 2575 report recommendations and the new health system provide
a number of opportunities to change the way we operate and col ectively improve health outcomes for
Māori. For example:
• Embedding whanau-cantered approaches to policy, service design and delivery;
• A new approach to monitoring by Te Puni Kōkiri;
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• Ensuring that there is accessible Māori health data;
• Resolving any outstanding Waitangi Tribunal recommendations from
Hauora stage 1; and
• The benefit of a wairua-centred approach to hauora.
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Embedding whanau-cantered approaches to policy, service design, and delivery
In November 2022, the Social Wel being Board agreed and endorsed the fol owing ten key
characteristics for a whānau-centred approach, which can be applied to policy, service design and
delivery services.
1 Culturally
2 Supports whānau 3 Based on whānau 4 Restores and
grounded in te ao
to determine their
strengths, values
strengthens
Māori, with
own future.
and aspirations.
whānau.
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whānau at the
centre.
5 Provides holistic
6 Addresses
7 Measures
8 Enables long term,
responses to
individual needs
effectiveness
intergenerational
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whānau needs
within their
based on
planning and
and aspirations.
whānau context.
outcomes and
sustainable
invests in whānau
solutions.
wellbeing.
9 Minimises system 10 Uses collaboration
barriers, enabling
and integration
flexible and
across
innovative
government.69
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responses.
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66 Ibid, pg. 17.
67 These projections assume that there wil be no significant changes or reductions in the services and
supports delivered by the public system over the next twenty years.
68 These projections are based on New Zealand Health Survey data.
69 SWB Paper – not official y released
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It is important that the public service implementation of whānau-centred policy and approaches, and
the investment in Whānau Ora across government and into our communities, is robust and authentic.
70
As outlined above, the creation and implementation of the Māori Communities COVID-19 Fund (MCCF)
was in response to the significant gap between Māori and non-Māori COVID-19 health outcomes.
Commissioning providers with in-depth knowledge of the unique needs within their communities to
provide the wraparound support needed was the best approach to lift Māori vaccination rates.
71 In the
future, starting with a whānau-centred approach and embedding it into policy, programme design and
implementation wil help to ensure more equal health outcomes from the beginning. As noted above,
s6(f) of the Pae Ora Act provides for iwi-Māori partnership boards to enable Māori to have a meaningful
role in the planning and design of local services. Alongside Te Aka Whai Ora, the place of iwi-Māori
partnership boards within the new system wil provide a valuable resource as a source of information
about local needs and key relationships for helping to make the design and implementation of health
programmes a success.
A new approach to monitoring by Te Puni Kōkiri
Te Puni Kōkiri has a legislated responsibility to monitor the performance of the public sector for Māori. ACT
The system operates in a permanent state of underperformance to Māori and Te Puni Kōkiri has
recently refreshed its monitoring approach, also taking into account the recommendations from the
Waitangi Tribunal in Wai 2575. Te Puni Kōkiri has moved away from relying solely on the traditional
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monitoring model of assessing the effectiveness of Government services after the fact or just providing
policy advice in response to departmental briefings.
“A punitive monitoring system has not worked and did not change outcomes for Māori, and
therefore it is unlikely that such an approach would bring about positive outcomes in the
future”.
72
Instead, the Secretary for Māori Development stated that the Ministry’s future focus wil be on using
monitoring as an active tool in service delivery – walking alongside mainstream agencies, ensuring that
agencies know what does and does not work for Māori as the agencies design and deliver initiatives,
and consider how they might measure their success.
73 Te Puni Kōkiri is model ing practice of whānau-
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centred approaches both to delivery and to measuring performance, and has worked alongside Māori
and iwi thought-leaders, practitioners and rangatahi, and the Treasury, to support a Māori-designed
waiora measurement framework with measures and indicators. This is a more dynamic approach to
monitoring, ensuring improved traceability from Te Puni Kōkiri advice through to public sector
investment and delivery of improved outcomes.
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Te Puni Kōkiri is uniquely placed to examine the whole health system, including al the health bodies,
and to monitor how health outcomes for Māori are impacting other areas of wel being and
development. Te Puni Kōkiri will continue to work with Te Whatu Ora, Te Aka Whai Ora and the Ministry
to monitor the performance of the health system in relation to Māori wel being outcomes – including
Māori health outcomes.
Ensuring that there is access to Māori Health Data
Active protection means actively addressing the gaps between Māori and other populations, looking at
the specific needs of the Māori population and directing time and resources to ensure more equitable
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70 Strategic Intentions p. 24-25
. https://www.health.govt.nz/publication/commissioning-pae-ora-
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healthy-futures-2022 talks to commissioning approaches and whānau ora model within the health
system. Published early 2023. Approach reflects the Health and Disability System Review (2019)
recommendations, the Wai 2575 Health Services and Outcomes Kaupapa Inquiry recommendations
(Waitangi Tribunal 2019), pp. 3 of report.
71 TPK Annual Report, pp. 4.
72 Dave Samuel’s Brief of Evidence to the Royal Commission Inquiry into Abuse in State Care
73 Dave Samuel’s Brief of Evidence to the Royal Commission Inquiry into Abuse in State Care
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outcomes.
74 As noted above, Te Aka Whai Ora is in the process of establishing its new monitoring team.
It also has responsibilities for:
• “improving service delivery and outcomes for Māori at all levels of the health sector; and
• collaborating with other agencies, organisations, and individuals to improve health and wel being
outcomes for Māori and to address the wider determinants of health for Māori; and
• providing accessible and understandable information to Māori on the performance of the publicly
funded health sector.”
75
Te Puni Kokiri wil work alongside Te Aka Whai Ora (and the cross-agency group) as it develops and
implements this work programme. In addition, there are opportunities for the whole health sector to
support the accessibility of Māori health data for Māori, hapu, and iwi. For example, the Ministry of
Health’s New Zealand Health survey database has useful data about Māori health.
Te Puni Kōkiri is also investing $19.91 mil ion over four years to increase Māori community resilience ACT
through data capability and access with a focus on climate and waiora data. This initiative wil :
• equip hapori Māori with the skil s and ability to access climate and waiora data in support of their
aspirations for adapting to climate change;
THE
• invest in technology systems that expand the use of existing Government data solutions for Māori
that can be safely shared with iwi, hapu and whānau;
• enable Māori to safely share data of their choosing back to Government or with other communities;
and
• enable Government agencies to access data of importance to hapori Māori while championing
Māori data sovereignty and iwi and whānau-centred approaches to data management.
While various Government agencies have supported initiatives to provide data and insights to Māori,
they are working independently with hapori Māori and meeting their needs by subject area. This
initiative,
Hapori Māori: Increasing Community Resilience through Data Capability and Access,invests
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in a joined-up holistic Government approach, including the design and testing of how to enable both
the sharing and col ection of waiora datasets to/from Māori communities into a centralised solution.
The intention is for bespoke data products to be curated for Māori communities that leverage data
from the centralised solution and from communities themselves. This wil help to inform evidence-
based, community led decisions, and support hapori Māori consider their future needs in relation to
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climate change, waiora and hauora.
The benefit of a wairua-centred approach to hauora
Key insights, such as the difference between waiora and wellbeing or how wairua inspired processes
can be used in development, were presented to hui members at the Cross-Agency System Monitoring
for Hauora Hui led by the Ministry of Health. Hui members showed interest and plan to further explore
how the insights from Ngā Tohu Waiora, a Māori-led and designed framework developed to measure
waiora with support from Te Puni Kōkiri and Te Tai Ōhanga, could inform how the sector thinks about
measuring hauora. In addition, hui members want to explore connections between:
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• He Korowai Oranga (Māori Health Strategy);
• Whakamaua (Māori Health Action Plan);
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• He Ara Waiora (Treasury’s framework for considering waiora); and
• Ngā Tohu Waiora.
74 Ibid, p. 32.
75 Section 19(1)(c) to (e).
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This is additional to exploring how Whānau Ora and Whānau-Centred approaches could guide any
approaches to measuring hauora.
Resolving any outstanding Waitangi Tribunal recommendations from Hauora stage 1
As outlined above, conversations are ongoing between
Hauora stage 1 claimant groups and the Crown,
and there wil be a continued need to monitor how the new health system is delivering for Māori. Te
Puni Kōkiri’s Te Tautuhi-ō-Rongo (Māori Policy Framework) provides a positive reading of te Tiriti with
four core components:
• A relationship management agreement;
• The ideal marriage;
• A move away from a focus on breach and deficit; and
• The potential for what should, could and must be.
Te Tiriti is a living document, and hauora, like other key aspects of life and wellbeing is directly related
to how this constitutional document is respected and the Treaty partnership is honoured. The changes ACT
to the health system to embed Treaty principles, elevate a focus on partnership and equity, and enable
more meaningful local insights and mana motuhake approaches to health policy, design, and delivery
provide an opportunity to innovate and transform the health system and set a course for a more
THE
equitable and responsive future. We look forward to supporting the health system and our
communities as they respond to changes, and to receiving the Waitangi Tribunal’s next
Hauora report.
“We need to remember that Te Tiriti was, and continues to be, a
means to bring us together and benefit our society.”76
Appendix A: Recommendation Areas UNDER
Interim/Final Recommendation Areas
Recommendations – Full List
[EXAMPLE:
[EXAMPLE:
Te Tiriti clause
New Treaty of Waitangi clause [compared to the Treaty
INFORMATION
clause in the New Zealand Public Health and Disability
Act 2000].
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76 Minister Henare, speech to Waitangi Tribunal Members.
14
