Suchergebnisse

Racism has become a normalised part of New Zealand society despite our governments' endorsement of human rights treaties and our founding document Te Tiriti o Waitangi. The outcomes of racism appear as significant and enduring disparities in social outcomes between Māori and non-Māori. New Zealand has a range of strategies attempting to deal with inequities between population groups but currently lacks a coherent national plan and/or strategy to transform racism. Within this paper the authors offer four pathways as a contribution to a national plan i) addressing historical racism ii) improving racial climate iii) mobilising civil society through collective impact iv) strengthening controls through systems change approaches within public institutions

Prior to colonisation, Māori had a well-developed holistic health system based on maintaining balance between people, place and spirit. The colonial imposition of British economic, religious, educational, legal, health and governance, through warfare, immigration, legislation and social coercion had a devastating effect on Māori health outcomes. With the release of the WAI 2575 Waitangi Tribunal report exposing the failings of our health system in relation to Māori health, the need to decolonise our health system becomes more pressing. A key difficulty in this work is the poverty of transformative language, concepts and frameworks in our workforce. This paper is the product of an anti-racism think tank that occurred in April 2019. While working through a system change analysis on our colonial health system, Māori and Tauiwi activists and scholars created an allegory—from gorse to ngahere. The allegory depicts the ongoing impact of the colonial health system as represented by gorse, and the possibilities of a decolonised health system represented by ngahere—a self-sustaining and flourishing native forest. Racism has a geographic specificity. The allegory we developed is a mechanism for conceptualising decolonisation for the context of Aotearoa. It serves to reinforce the di erent roles and responsibilities of the descendants of the colonisers and the colonised in the pursuit of decolonisation.

In 2010 and 2015 nationwide surveys monitored government management of public health providers. These surveys found evidence of inconsistent management which disadvantaged Māori providers, consistent with institutional racism. In Dec 2019 to March 2020 a follow-up nationwide telephone survey was completed. Public health units, primary health organisations, Māori health providers and non-governmental organisations with public health contracts responded (72%). This paper focuses on the findings about (i) contracts, and (ii) relationships. Descriptive statistical analysis was applied to quantitative responses and explanatory and combinatory analyses informed by thematic analysis were applied to qualitative data. The 2019–2020 quantitative data identified no statistically signficant variations. There was no evidence Māori provider experiences improved, but generic providers reported less favourable conditions. Qualitative data revealed providers remain dependent on individual managers and there was inconsistency across providers that could be addressed by transparent quality assurance. Māori providers were frustrated by contracting environments. They wanted to be recognised as Te Tiriti o Waitangi partners, with flexibility, certainty of investment (longer contracts), support (infrastructure investment) to be able to meet the high needs of their communities. This nationwide survey was completed prior to the current health reforms but implications are considered for the Māori Health Authority.

When te Tiriti o Waitangi is upheld there should be no racism against Māori and in particular institutional racism should disappear, meaning there should be no health disparities and the aspiration of health equity could be achieved. At a moment when the Waitangi Tribunal is investigating health-related breaches of te Tiriti o Waitangi, we argue that institutional racism, a key determinant of health inequalities, has become normalised within the health sector. Anti-racism literature recommends planned, systems-based approaches to eradicate the problem. Historically the Crown response can be characterised by denial and inaction. The Crown has the power and resources to take action through mechanisms such as they are currently applying to child poverty and gender pay inequity. We need our new government to uphold our Tiriti responsibilities and require a plan to end racism in the New Zealand health system.

Māori and Pasifika populations in New Zealand experience poorer health outcomes than other New Zealanders. These inequalities are a deeply entrenched injustice. This qualitative study explores the experiences of six Māori and Pasifika advisors on health policy-making advisory committees. All are health leaders, with extensive experience in the health system. They were recruited, provided semi-structured interviews, the data coded, and a thematic analysis undertaken. Our findings show that inequalities in the health system are reproduced in advisory committees. Participants noted their knowledge and interests were devalued and they experienced racism and tokenistic engagement. Some indicated it took considerable effort to establish credibility, be heard, have impact, and navigate advisory meetings, but even then their inputs were marginalised. Health policy advisory committees need deeper engagement and more genuine recognition of Māori and Pasifika knowledge. Māori and Pasifika leaders have constructive solutions for eliminating health inequities that could benefit all New Zealanders. Our qualitative study explored Māori and Pacific experiences of bring part of health policy making advisory committees. We purposively recruited six Māori and Pacific health leaders with extensive experience and conducted semi-structured interviews. Our findings were generated through a thematic analysis. Several participants indicated it took effort to establish credibility, be heard, have impact and navigate such meetings. Other used the political opportunity to advance outcomes beneficial to Māori and Pacific populations. Many noted that Māori and Pacific knowledge and intelligence was not valued and reported witnessed racism and tokenistic engagement with their contributions and preferred protocols. Health policy would be enriched by the deeper engagement and recognition of Māori and Pacific knowledge. Māori and Pacific leaders have constructive solutions for eliminating health inequities that could benefit all New Zealanders.