AOTEAROA NEW ZEALAND HEALTH REFORMS: HE AROTAKE - A PERSONAL REFLECTION

ABSTRACT

Background: Iwi Maori (Maori people) are the Indigenous people of Aotearoa. Some estimates predict that Maori have been occupying the lands of Aotearoa for more than 1000 years. After claiming sovereignty in 1835 with He Whakaputanga (Declaration of Independence) following annexing international interests, Maori signed the Treaty of Waitangi (Te Tiriti o Waitangi) 5 years later to ensure independence, protection, ongoing prosperity and justice. Maori were prosperous, trading, had a strong economy and thriving in all areas of life. Maori knowledge systems and language were mainstream and many Pakeha who settled embraced all aspects of Maori culture including te reo Maori. Our history tells us that Te Tiriti was not honoured and this had catastrophic effects on Maori existence. By the late 1890s the Maori population had nearly been wiped out by infectious illnesses, loss of lands and the encroaching effects of assimilation, colonial shift in power and the disempowerment of Maori. Access to health care is a human right and was protected under treaty rights but successive governments have failed to address inequities. Moving forward to 2021, the Ministry of Health recently announced a new health structure and the establishment of a Maori Health Authority (MHA) to independently advise, commission health services for iwi Maori. Many see this change as transformative and a true act of Tino Rangatiratanga (self-determination). The act of re-Indigenising our health systems landscape may find the solutions to restoring equity. Objectives: To provide a personal reflection of the proposed new health care system reforms with a particular focus of the historical socio-cultural context of Aotearoa and illustrate why these reforms are important and transformative. I want to demystify the ideas and rationale for de-colonisation. I also want to consider the implications for Maori health and the enormous expectations others may have towards Maori solutions and the anticipated critics of the new system. Methods: I will briefly review the historical context of Maori in Aotearoa, the causes of poor mental health (MH) outcomes, why equity is important and why things need to change. I will discuss the most recent independent health reviews, which provides the basis of the new health reforms. Understanding Indigenous concepts like Tino Rangatiratanga and Mana Motuhake will be articulated. Understanding the concept of health and wellness from a Maori perspective will be discussed. Findings: Maori MH incidence and prevalence rates for most health conditions continue to be disproportionately higher than the dominant culture. Like Indigenous Australians, youth suicide rates for Maori remain the highest in the modern world, and other health crises such as COVID-19 can perpetuate these outcomes. Healthcare systems (in Australia and New Zealand), health structures and those in the positions of influence continue to underperform. The new proposed health reforms put Maori health leaders in the frontline in decision-backing processes and delivery 'Ma Maori, mo Maori - By Maori, for Maori'. Conclusion: The enduring effects of colonisation continue to create inequitable health outcomes for Maori in Aotearoa. The new health reforms proposed may generate needed ideological, philosophical and culturally mandated shifts which align with the intent of Te Tiriti o Waitangi and the achievement of Tino Rangatiratanga and Mana Motuhake. There is now a process to re-empower Maori to find their own solutions to poor health outcomes, to rediscover lost knowledge and indigenise our healthcare system. The effects of the new system should be given time to make a difference.