Ranei Wineera-Parai: Māori equity in healthcare and beyond

Māori health needs holistic care that includes wairua, whānau, tinana and hinengaro considerations. Photo / John Cowpland, alphapix, File

Opinion

OPINION

My husband and I recently visited a wonderful part of our paradise within Aotearoa. We encountered beautiful scenery, friendly people and lots of exciting opportunities for adventure.

One evening while walking to an event, we happened to overhear some young people talking about which part of the brain is used to learn music and maths, and that they were good at both. We were surprised and impressed by this level of intellectual conversation.

We also took a coach tour where our guide told lots of historic tales, and shared details of the wonderful adventures you can go on in the region. Another highlight was dining in a restaurant high above the city, with a sensational view of all its lights and activity. We had a great time.

Now let me tell you about the conversations of our young people where I live – a suburb of one of our larger cities. I notice the young people here talking of their concern for schoolmates who can't afford their sports uniform; and how lunches provided in schools mean that they can now have karakia together to bless the kai, and feel good knowing that everyone has something to eat.

On the tour bus, we had to listen to someone with very little knowledge telling our traditional Māori stories, who called a taniwha a dragon and focused on the "settler history" with a decorative splash of Māori myth. While we were having dinner high in the sky, cloud came over the city so we could no longer see the bright lights. We knew the city was there — we just couldn't see it from our viewpoint.

Changing the picture

Manurewa Marae vaccination centre. Photo / Michael Craig, File

So now, let's talk about what this has to do with equity. How do we expose our young people to more supportive, compatible experiences? How do we ensure balance in our shared history, so that the foundation culture of Aotearoa is accepted and represented by the people of this land?

How do we move the clouds of access to healthcare and information, and allow all people to have a healthy view of their future – when so many know it is there, but are unable to access it?

Equity is not about giving everyone the exact same knowledge and experiences. It is about ensuring a more balanced community culture and social systems, which allow each person to reach their goals and well-being potential.

For Māori, particularly in health, this means offering holistic care that includes wairua (spirituality), whānau (family), tinana (physical) and hinengaro (mental) elements. It means seeing and having care providers who look like us, it means that resources set aside to care for Māori are used for that purpose, it means Māori at the decision-making tables. It means that if we want the same health outcomes for Māori as for Pākehā, we need to put in the same effort to cater for what supports Māori to thrive in our own terms.

This is what has been promised in the new health reforms.

Just as the Westminster parliamentary system, with all its quaint theatre, was transplanted into these islands from half a world away, so are many default models of care and administration in our health sector. Who are they designed to cater for?

According to information currently on the Ministry of Health website, in 2013, life expectancy at birth was 73 years for Māori males and 77.1 years for Māori females. It was 80.3 years for non-Māori males and 83.9 years for non-Māori females.

In terms of our youth, Māori aged 5–34 years were almost twice as likely as non-Māori in the same age group to have been admitted to hospital for asthma. Māori also had a higher disability rate than non-Māori, regardless of age, and Māori overall were significantly more likely than non-Māori to be hospitalised for intentional self-harm in 2012–14.

We need healthcare providers who are both clinically and culturally capable; willing and agile enough to be truly responsive in practice to the health needs of Māori; to be patient-and whānau-centric, be bilingual and use models like Te Whare Tapa Whā to care for the whole person while responding to illness.

Who can help? Everyone.

Josephine Gagan. Photo / Supplied

Does it matter if the provider is a public or private entity, or an NGO? All are constituted by law.

Does it matter if we talk about cost-benefit, lean thinking or cost efficiencies to reduce waste? No, it does not. What matters is that the health system is caring, prudent, reliable, and consistent for patients.

Let's consider the approach used by the biggest health-networked company across Aotearoa: my employer, the New Zealand Health Group. This is a company committed to building a better New Zealand through health and wellness. We employ local workers, largely under contract to Government agencies and DHBs, to support people with their home and community services, disability support, rehabilitation, mental health, behavioural support, health staffing, and training.

"Our goal is to make our wide range of innovative services accessible to all New Zealanders, tailored to support individual needs and self-care," says group chief executive Josephine Gagan.

"Currently, we're supporting over 30,000 New Zealanders across the country.

"Our passionate team of over 12,000 caregivers, nurses, and other health professionals, all work together to provide nearly 200 different services in almost every corner of Aotearoa."

While the group is a business, and needs to make some profit to stay in existence, the margin is tight. Again, the vast majority of our work is funded by DHBs and other government agencies. In fact, back in 2019, independent professional services consultants EY reported that financial constraints had led to more than 20 Home and Community Support Services (HCSS) providers exiting the market in the preceding five years.

Our whāinga – our purpose

Ranei Wineera-Parai. Photo / Supplied

As employees, our satisfaction comes from knowing that the healthcare our clients receive in their homes helps them to live independently, well and surrounded by whānau and friends.

Our regular quality assurance audits show that care is provided to exceed the standards and expectations of our health authorities, while being financially accountable. And, as the group is able to analyse costs across various types of care, we can identify promptly when additional resources are needed, and work with our government and DHB partners put this into place quickly.

In addition, the New Zealand Health Group is working to improve responsiveness to Māori across the wider community, by launching the new Hiwa-i-te-rangi Maori Health Leadership scholarship, aimed at developing future Māori health leaders and decision-makers. This is worth a total of $20,000 annually, and has been launched during Matariki to inspire our people to reach for the stars and help build our pathway to Māori health equity.

It feels good to be part of this company and to be able to support this shared essential goal in my own daily work.

Let's make sure we all see the same stars

People beside a placement of stones as a mātai whetū, or place to view the stars, wait for the sunrise at the Hakikino Conservation Reserve in Waimarama. Photo / Kerry Marshall, Getty Images

The next time my husband and I visit a wonderful holiday location, we look forward to seeing, hearing and feeling more of the spirit of Māori as part of Aotearoa's lived experience.

Let us all work together to remove the cloud of increased health risk from above our Māori whānau, and ensure all our people have a healthier view of their future through true equity of care.

• Ranei Wineera-Parai is group executive cultural advisor with New Zealand Health Group.