Māori face poorer health outcomes across almost all metrics, with mortality rates twice as high as non-Māori.
Māori and Pacific women have lower breast and cervical screening rates and higher death rates for these cancers than other women.
Only 20% of Māori and Pasifika adults have health insurance.
Rob Hennin is the chief executive of nib New Zealand, the second-largest private health insurer in the country and has led its growth in New Zealand, with a commitment to enhancing health outcomes through accessible and inclusive services.
OPINION
When closing the Māori Health Authority, it was encouraging to hear Health Minister Shane Reti set out his intention to focus on delivering health services to Māori that are outcomes-focused, driven by need, and with decisions made closer to the home and hapū.
Health disparities between Māori and non-Māori are stark and well-documented.
Māori face poorer health outcomes across almost all metrics, from chronic disease prevalence to life expectancies over seven years shorter than non-Māori. According to Ministry of Health data, cardiovascular disease mortality rate for Māori was twice as high as for non-Māori. Māori aged 25 years and over have significantly higher cancer diagnosis rates, with cancer mortality more than 1.6 times higher for Māori.
Changing these statistics requires focus across multiple areas of health - from preventative health and social focus to health treatment.
Prime Minister Christopher Luxon.
As Prime Minister Christopher Luxon said: “We think there’s a better way in which we can deliver better health outcomes for Māori, which is actually localism, devolution, partnering with iwi and other organisations to do that job well.”
The big question is how? One interesting model is emerging from Canada.
I, along with a group of nib representatives and iwi CEOs, visited Canada’s First Nations Health Authority in March to see if and how a truly needs-based approach can be achieved.
The model, rooted in community empowerment and strategic partnerships, showcases how effective healthcare can be when it is tailored to cultural needs and driven by local input – bottom up rather than top down.
What we saw in Canada is similar to what nib is striving for with our dedicated iwi programmes – partnering with iwi and hapū on preventative care, culturally appropriate services, and strong community partnerships to achieve health equity for Māori.
Developed in collaboration with Ngāti Whātua Ōrākei, Toi Ora is about listening to and working with the people it aims to serve. It’s a model that aligns with the principles of “localism”, providing care that’s both culturally resonant and practically effective.
Only 20% of Māori adults have private health insurance; the lowest represented group alongside Pacific Island adults (20%).
Toi Ora aims to improve this uptake by working directly with iwi to create health services tailored for their community, such as personalised private health insurance, access to culturally safe healthcare providers, health management programmes, support from wellness coaches and kaiārahi, and care coordination.
We’ve crunched the numbers - our social return on investment was calculated at $1:$2.20, meaning that from November 1, 2022 to October 31, 2023, every dollar invested into the programme resulted in a 120% positive impact of social return.
Since its 2018 inception, Toi Ora has seen 6270 total enrolments across Ngāti Whātua Ōrākei and other iwi clients, and over half have (53%) have gone on to engage with a health service.
Take Jamie as an example. After Jamie, a Ngāti Whātua Ōrākei hapū and 6-year Toi Ora member, visited specialists for spine complications, they discovered kidney and blood cancer in his system. Paired with a nib wellness coach to guide him through the treatment process, he said, “From the first phone call, I could tell that whoever I was talking to over the phone really cares. And that matters.”
Removing barriers to better health outcomes for Māori is critical, and stories like Jamie’s remind us of the importance to keep driving this positive change forward.
The Government’s emphasis on localism and decentralised approaches could address the realities and experiences of different communities that traditionally suffer worse outcomes.
When last in government, National introduced innovative approaches to social service delivery based on principles of self-reliance, decentralisation and subsidiarity, with initiatives like Whānau Ora and charter schools.
Former National leader Sir Bill English is a firm believer in social investment.
This sort of thinking is reflected in National’s Social Investment Fund, which will invest in programmes targeting the greatest needs outside of the traditional one-size-fits-all model.
The fund could be deployed - alongside private capital - to deliver positive social change for disadvantaged communities. Toi Ora is, I suggest, a model that could be considered for a social investment approach.
Social investment sees the Government intervening earlier and more effectively for our most disadvantaged citizens.
It identifies, funds and scales up the actions that will have the most positive impact on people in the long run, using data and evaluation to discern what works and, crucially, what doesn’t.
The evidence we have to date suggests that Toi Ora is effectively reducing these obstacles, ensuring families are accessing quality and timely healthcare.
This will result in improved health outcomes and a reduced need for publicly provided resources that address diabetes, immobility, obesity and chronic illnesses on a population basis.
Rob Hennin.
By supporting initiatives like Toi Ora, we can continue our work on a larger scale and help transform our healthcare system into one that is inclusive, culturally respectful, and truly needs-based.
The Government’s support for localism and devolution could see tangible support for community-driven initiatives that genuinely meet the different needs of different groups, moving the health system out of Wellington and into the whare.
