May 31, 2014

Being Accountable for Māori Health

We all know that Māori are overrepresented in negative health statistics for a range of complex reasons (Robson and Harris 2007 I suspect there are many instances where this failure of the health system successfully protecting and promoting Māori health is a contemporary breach of Te Tiriti o Waitangi. The New Zealand Public Health and Disability Act 2000 puts a statutory imperative on District Health Boards (but ultimately the whole health sector) to deliver accessible, clinically safe and effective health services to all New Zealanders and work towards reducing heath disparities between Māori and non-Māori.

accountability

A recently released report from the Office of the Auditor-General has pointed out the District Health Boards (DHB) inadequate reporting of their efforts to reduce health disparities.

Te Manu Korihi News reported that:
Assistant auditor-general Gareth Ellis said DHBs were vague about the initiatives they had implemented for Maori, with the one exception being Counties Manukau DHB, which served a high Maori population. Mr Ellis said he expected to see better information on setting targets and reporting trends provided by the next audit. That would make it easier for the auditor-general to assess how DHBs were performing, and how well various programmes and initiatives were working, he said. The report gives examples of good practice but does not specifically name those DHBs which need to improve in relation to Maori health disparities.

This vagueness in reporting is a greater level of accountability than I found in my own research within the public health sector. I asked a Senior Crown Official how they monitored ‘mainstream’ public health providers’ service delivery to Māori. They responded by indicating “they didn’t [monitor them], as they did not have the capacity”. So, in a context where Māori providers were reported feeling intense levels of scrutiny across all their service delivery, mainstream providers were not held accountable for their service delivery to Māori at all. This is not acceptable.

It is time these double standards are stamped out within the health sector. Those charged with delivering health services need to be accountable for their performance. While health bureaucracies (re)learn how to deliver services to Māori communities – Māori whānau, hapū and iwi continue to disproportionately bear the burden of health inequities.

  • Perhaps it’s time to walk across the road and (re)engage with the Māori health leadership about what works and does work, OR reread the recommendations of the health hui from the 1980s (i.e. Hui Whakoranga) that remain relevant, insightful and unimplemented.
  • Perhaps it’s time to strategically invest in Māori public health initiatives to strengthen Māori resilience.
  • Perhaps it’s time for the health sector to take serious the words of Pickett and Wilkinson about health inequities and ensure Māori have equitable access to the positive determinants of health (ie. Education, housing, employment etc).

Bravo to the Office of the Auditor-General for noticing the slipperiness of DHB reporting. May we all be vigilant in ensuring Crown agencies fulfil their duty of care in relation to Māori health.

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