Harawira: Public Health Bill
Public Health Bill
Wednesday 12 December 2007; 10pm
Hone Harawira; Member of Parliament for Te Tai Tokerau
Three months ago, the Business Council for Sustainable Development survey showed that nearly 80% of New Zealanders believed the public health service had worsened over the past five years.
That same poll predicted that on the current rate of spending on health at $11.6 billion a year, by the year 2050 Government could expect to be allocating more than 21 billion dollars a year to health.
In the context then of high public interest and exorbitant expenditure, two other reports were issued which brought the matter to a head.
The first was a comprehensive analysis monitoring the health of New Zealand children and young people which concluded that children with chronic conditions, long term disabilities, mental health issues or conditions traditionally managed in the primary care and outpatient setting, such as diabetes, epilepsy, chronic renal failure; were not being adequately captured by routine hospital or mortality data.
The report also said that traditional data failed to capture issues of cultural identity or the role this played in health and well-being.
And following on from these conclusions, Te Ropu Rangahau Hauora a Eru Pomare tabled another report from their series, Hauora: Maori Standards of Health IV; a study of the years 2000-2005.
As Dr Papaarangi Reid and Bridget Robson explained so clearly in the very first sentence of their report “Maori have the right to monitor the Crown and to evaluate Crown action and inaction”, a right which derives from the indigenous rights of tangata whenua enshrined in Te Tiriti o Waitangi, and embodied in the United Nations Declaration on the Rights of Indigenous People.
And so the stage is firmly set, from all perspectives, for this Bill to start the process of legislative review for the effective management of public health.
Clause 3 of this Bill is designed “to improve, promote and protect public health in order to help attain optimal and equitable health outcomes for Maori and all other population groups.” – a worthy purpose – indeed on that statement alone the Maori Party could support this first reading of the Public Health Bill.
So let’s see just whether or not this Bill achieves that goal, but first let me just put Dr Reid and Bridget Robson’s statement into context.
As tangata whenua our primary right to self-determination is understood in our capacity to be recognised as indigenous peoples, but it also extends to a sense of duty, of manaakitanga, to ensure the wellbeing of all people living in our territories. This means, logically, that Maori must monitor health, including any persistent disparities between Maori and non-Maori.
Secondly, the urgency for Maori to monitor Crown performance is required by the consistent disparities in health outcomes; the ongoing exposure to determinants of ill-health; the overwhelming lack of responsiveness of the health service, and the ongoing under-representation of Maori in the health workforce.
And so the Maori Party, shares with Maori health professionals the priority that must be given to a focus on Maori as a population group; and our collective responsibility for whanau ora.
We must care about these long-standing inequities, we must not accept normalising and tolerating such unfair and unjust deficiencies of a health system meant to operate in everyone’s interests.
We must care about Maori approaches and models being supported across the purchasing environment.
We know that the Maori health sector has had problems with the population based funding models promulgated by District Health Boards and Primary Health Organisations, because these models have insufficient resources to truly support stand alone Maori or Pasifika primary health organisations.
We know too, that other determinants impact on whanau ora. Poverty, income, low paid employment, all forms of violence, educational under-achievement, dealings with the criminal justice system, income support, impoverished housing conditions, isolation and alienation from other whanau members all impact on whanau well-being.
We have a major challenge in front of us, and in particular all research pathways lead to three major challenges which contribute to ethnic inequalities in health:
* Differential access to
specialist health services, GP and specialist nursing
services and inadequate screening leading to slower pathways
through health care;
* Differences in quality of care received;
* Differential access to determinants of health – such as the exposure to other risks like unsafe workplaces, substandard and crowded housing, environmentally unsafe living conditions.
But on top of that, we have specific instances in Aotearoa linking institutional racism and interpersonal racial discrimination as a key factor accounting for much of the inequality between Maori and others.
Evidence is relentlessly paraded through this House which shows that Maori receive lower levels of health services and poorer quality of service.
Other evidence, including Ministry of Health analysis of the New Zealand Health Survey confirms that discrimination may be an important cause for ethnic inequalities in health.
And yet, as unbelievable as it sounds, the Ministry of Health has still not filled the vacancy that has existed for much of this year in the appointment of a Deputy Director General Maori Health, and given the quality of the applicants, the Maori Party finds it astounding that no appointment has yet been made.
And alongside that, the Public Health Unit itself has been diluted and its focus dissipated across the Ministry.
It now stands under the rule of the Strategy Directorate, rather than maintaining specialist public health leadership in one area. The statutory requirement to carry out public health advisory functions, as set out in section 3E of the Health Act 1956, is thus compromised by organisational impediments.
It remains to be seen how this Bill will achieve equitable health outcomes for Maori, or indeed manage the risks of emergent threats to public health, without having the organisational structures in place to address these inequalities.
The desired change is not impossible. We haven’t reached the point of no return.
All it would take to make a big difference, would be to focus on the issues of significance to Maori, to focus on Maori development, and to guarantee a specific focus to address and eliminate inequitable health outcomes for Maori.
A big part of making a difference, would be to instigate the mandatory collection of ethnicity data and mandatory analysis by ethnicity at all points throughout the public health sector, including planning and management.
And we note, of course, the correlation with the Monitoring the health of New Zealand children report which was also concerned about the paucity of data.
Mr Speaker, I said before that we haven’t reached the point of no return – but we don’t also want to be so hands off that we drift off down a one way street which ends up in a policy cul-de-sac, closing off all possibilities for progress.
It gives us huge concern that despite the upfront stated objective of equitable health outcomes for Maori, there is nothing which specifically gives weight to that commitment.
There has been no consultation with Maori, there is no commitment in the Public Health Bill to Te Tiriti o Waitangi, and there is no explicit focus on inequities or Maori health development.
It appears to be another case of do what I say, not what I do. In fact, other than the purpose statement at the front of the Bill, Maori seem to be completely absent from the entire Bill.
We are prepared to let this Bill go to Select Committee as we are keen to enable Maori health collectives and professionals to have their say at the table.
But we signal our strong concern which the unnecessary, avoidable, unfair and unjust ethnic inequalities which continue to plague public health must benefit from specific focus on Maori, if we ever hope to make the difference that we need.