The work that Te Whatu Ora does to improve Māori health reflects the expectation that Māori health improvement and equity are everyone’s business. Te Aka Whai Ora ensures that our system has a strong focus on Te Ao Māori and that the responsibility for improving Māori outcomes is shared across the whole health system.
In Te Pae Tata Interim New Zealand Health Plan 2022, we have selected a few priority actions that Te Whatu Ora can take direct ownership of, and which Te Aka Whai Ora will hold us to account for delivering. Te Pae Tata also contains a great many other actions which will have a direct impact on Māori health and equity.
Priority areas for Māori health
The health needs assessment for Māori, including the main causes of avoidable death and illness for Māori, influenced the selection of four of the six Te Pae Tata health priorities for action. These areas offer the greatest potential for positive intervention and results.
Mate pukupuku | People with cancer
Cancer is a leading cause of illness and death for Māori, making up 25 percent of preventable deaths for Māori women and 10 percent for Māori men. There are persistent inequities in cancer incidence, mortality and survival rates for Māori with those diagnosed being more likely to be diagnosed at a later stage, more likely to die and die sooner, than non-Māori with cancer.
Māuiuitanga taumaha | People living with chronic conditions
Chronic conditions, including diabetes, cardiovascular disease, chronic respiratory disease and stroke, make up the largest causes of death and impairment for Māori, with people often experiencing multiple conditions. Māori are more likely to be exposed to the leading and preventable risk factors of tobacco, obesogenic environments, unhealthy diets and alcohol. Risk factors are, in turn, strongly influenced by determinants such as poverty, social exclusion and racism.
Kahu taurima | Maternity and early years
The 2,000 days between preconception and a child’s fifth birthday are critical to secure their future health and wellbeing. A healthy pregnancy, safe birth, good nutrition, low stress and nurturing whānau relationships will have a profound impact on giving a child a great start to life. While infant and maternal mortality are higher for Māori than non-Māori, many of the leading causes of deaths in Māori children, including prematurity, sudden unexpected death in infancy (SUDI), respiratory disease, or accident, injury and assault are preventable. Services have not been appropriate, effective nor sufficiently accessible to many Māori whānau and parents. Nearly half of Māori women do not have a Lead Maternity Carer in their first trimester of pregnancy and more than half of Māori children have not received their vaccinations by 18 months of age.
Oranga hinengaro | People living with mental distress, illness and addictions
The top ten contributors to overall health loss for Māori include mental health conditions like anxiety and depression, traumatic brain injury, alcohol use disorders and schizophrenia. Suicide is the second leading cause of death for Māori men and a major contributor to the life expectancy gap for both Māori men and women. Māori experience poorer mental healthcare – being less likely to receive pharmaceutical treatment and more likely to be placed in seclusion and under compulsory treatment orders. Poor mental health results from many of the same drivers of health inequities – racism, colonisation, intergenerational trauma, poverty and cultural disconnection. A significantly higher proportion of Māori than non-Māori experience stress and difficulty in daily life, and experience social isolation and exclusion.
All the above areas need a strong population health approach. The creation of the priority for Pae Ora | Greater Health and Wellbeing is derived from the need to create environments in our communities that support healthy lifestyles for whānau.
Enablers for change
Each of the conditions above relies on a core set of activities to enable change.
Māori leadership and mana motuhake
The autonomy of Māori within the health sector to lead as Māori will be strengthened to support a system that is characterised by a genuine Te Tiriti partnership. Iwi Māori Partnership Boards are an important part of this shift towards an equity and Tiriti-dynamic system. The future will be characterised by Māori in leadership positions making decisions in their own right and in partnership with other key stakeholders. The system will engage in a mana-enhancing way with the Māori health workforce, and Māori technical experts will be included at all levels of health system design and delivery.
Evidence-based policies for prevention and wellbeing
Strong population health and prevention is critical to achieve equity and overall health improvement. This includes action on the social, cultural and commercial determinants of health that have the strongest influence on Māori health inequities. The future will be characterised by a system that prioritises prevention and early intervention. It aims to reduce risk and build on the positive factors that contribute to Hauora, for example, whānau wellbeing, removing discrimination against Tāngata whaikaha | Disabled people, and promoting the uptake of healthy food options.
Integrated, whānau-centred services
Services will be whānau-centred and cohesive. This requires a greater focus on understanding the health needs of communities; addressing these needs in a more connected way; expanding outreach and home-based care; and addressing the social, cultural and commercial determinants of health.
Health services must provide a safe, culturally aligned, diverse and inclusive space. Services must offer comprehensive wellbeing screening and support, where ‘any door is the right door’, backed up with community engagement, well developed primary, secondary and tertiary pathways, system-level solutions and Māori leadership.
Primary care designed to work for Māori
Primary care services for the future will be accessible, affordable, available and appropriate for Māori. Increased access to primary care ensures high quality care is available where it is most needed and where there are considerable benefits to be gained, avoiding the need for hospital treatment. This will make positive changes in all leading health areas for Māori, including cancer, chronic conditions, mental health, maternity care and support for pēpi in their earliest years. Radically redesigning the primary care system will be done with Māori autonomy, leadership and oversight. Iwi Māori Partnership Boards and locality planning will be critical here.
A culturally safe workforce, with many more Māori workers and leaders
Māori working in the health and disability sector make the biggest contribution to improved health outcomes and equity for Māori. We will grow the number of Māori coming into health careers while also making our organisations safe and mana-enhancing places, not just to work in, but places to develop careers and exert influence. The workplace will value, support and protect Māori from discrimination and racism, and will do this through a universal expectation of cultural safety. Cultural safety training will help make a tangata tiriti workforce of healthcare professionals who are conscientised around racism and bias. Everyone will bring this awareness into their service to guarantee quality of care.
Below, we outline the priority actions across Te Pae Tata that ensure equity for all Māori and make Māori health outcomes everyone’s accountability. These actions shift the system towards Māori outcomes by growing Māori leadership through mechanisms such as Iwi Māori Partnership Boards, increasing Māori in leadership positions and in the general workforce, strengthening Māori providers and improving access to Te Ao Māori services.
Māori health improvement actions
- Partner with Iwi Māori Partnership Boards to develop interventions that are tailored for Māori, build community capability and ultimately work for Māori.
- Work with the Public Health Agency to develop and implement evidence based public health and legislative interventions that reduce harm from alcohol and other drugs.
- Review the national approach to Māori suicide prevention and construct suicide prevention approaches consistent with mātauranga Māori to reduce the rate of suicide and suicidal behaviour.
- Take a pro-equity approach to age thresholds for access to cancer screening and removing barriers to primary care to improve early detection.
- Redesign primary care to remove barriers to access for Māori and to provide a more comprehensive option for whānau.
- Design and expand Te Ao Māori mental health service solutions including primary mental health and wellbeing services, known as Access and Choice.
Māori health gain enabling actions
- Iwi Māori Partnership Boards are in place and engaged locally, regionally and nationally.
- More Māori are in leadership and decision-making roles in Te Whatu Ora and Te Aka Whai Ora.
- Establish a Te Ao Māori intelligence and insights function, that includes use of mātauranga Māori.
- Implement evidence-based policy interventions to address health priorities for Māori, including tobacco control, alcohol, obesity and diet.
- Fairly fund Māori providers, valuing their role in primary care and maximising the value of comprehensive models of service delivery. Where there is good performance, we will develop longer-term and more flexible contracts to improve outcomes.
- Commission comprehensive primary and community care services for Māori populations that improve access.
- Support health sector interventions to increase the number and type of Māori health workers within the current workforce.
- Ensure accountability for results for Māori.