“Shame on your undies!” – health experts on racist governments
From the current “evil layer” of emboldened racism here and around the world, to a vision of aroha and equity at the centre of healthcare, health system experts Lady Tureiti Moxon (Ngāti Pāhauwera, Ngāti Kahungunu, Kāi Tahu) and Dr Elana Curtis (Ngāti Rongomai, Ngāti Pikiao, Te Arawa) covered sooo many topics that you really need to listen to this one – maybe more than once! – rather than just reading this brief report (and the related concepts explainer). Happily, they communicated their deep knowledge beautifully, ably assisted by chair Stacey Morrison whose own insights and stories added to the richness of the kōrero.
What the heck are they up to?
The context for the evening was a National-led government which has disestablished Te Aka Whai Ora (the Māori health authority); has now appointed a Health Minister (Simeon Brown) who was president of an anti-abortion club at university; has removed the key funding source for social sciences and cultural research (Marsden); and significantly, has prohibited health services from using the evidence-based and efficient method of identifying need by ethnicity to increase equity.
Yet, as Stacey reminded us, the life expectancy gap between Māori and non-Māori is currently seven years.
Lady Tureiti Moxon – Chair of the National Urban Māori Authority whose long years of Waitangi Tribunal advocacy were instrumental in achieving the establishment of all-too-short-lived Te Aka Whai Ora, and who owns and runs a large health provider in Kirikiriroa – reminded us there is a cyclical rhythm to government attitudes to Māori. Dr Elana Curtis – whose University of Auckland research into healthcare cultures is world-leading, and who now assists health teams with cultural safety via Taikura and Oro Nuku – didn’t disagree… but she does feel “what’s happening right now is another layer, a really evil layer… that I haven’t quite experienced [until now]”. Lady Moxon identified that layer as (emboldened) racism. Elana described it as “weird” and “ugly”: You’re seeing it around the world […] every day I’m like, ‘what the heck are they up to? Shame on your undies, why are you doing that?’ You know, like, you can’t just say ‘we don’t care about equity’. That means you don’t care about humanity.”
Te Aka Whai Ora: the disestablished potential life changer
But as well as equity of outcomes, the government has a responsibility to uphold te Tiriti o Waitangi – to ensure Māori have rights-based healthcare. Yet this government destroyed Te Aka Whai Ora – both kōrero guests had been involved in its establishment. Lady Moxon explained what she loves about the “outcomes driven” holistic approaches shared by both Te Aka Whai Ora and Whānau Ora: it’s not just about counting widgets – or immunisations. It’s about asking “ ‘how is that baby? How is that māmā? How are they progressing? Are they in a warm whare? … Have they been seeing their doctor regularly? … Do they have enough kai in the cupboard?’ You know, all of those things have a huge impact on our health.” Te Aka Whai Ora was important because “we could create plans that actually met the needs of the communities we were working in.” With the new authority, “we finally thought we’d made it”. (Stacey later quoted Sir Mason Durie: “we don’t ask what’s the matter with that whānau, we ask what matters to that whānau.”)
Elana too talked about the “promise and hope” of Te Aka Whai Ora – its opening “was a bit of an emotional day. You knew, ‘wow, this could actually be a huge change!’.” But by gutting the initiative and “dumping” its staff back into Te Whatu Ora (mainstream Health NZ) “you’ve lost something, the wairua behind those staff….morale is dropping off…. The wairua of people that actually saw some hope and then you take it away should never be underestimated. … It’s quite hard for me to watch this gutting out, gutting out, gutting out rather than purposely building up and enhancing our Māori staff. … That’s going to take years of recovery.”
Stacey suggested the current approach is “aroha kore” – devoid of aroha, and Lady Moxon agreed – for all people: “our hospitals have lost the plot.. there’s no caring anymore. So a lot of people are feeling like they can’t trust their loved ones to be there on their own. And they’ve got to be there so they can take care of their ordinary needs on a daily basis…. Our healthcare system… should be a place of caring, of loving, of feeling like you are the most important person who is there in that place at that time.”
Everything they do favours Pākehā domination
An audience member asked a question about the idea that “we have to get it right for Māori before we get it right for others”. It’s about equity and rights – and also about privilege (see Elana and Lady Moxon’s explanations here). “I would say that to get it right for Māori is to have a deep understanding about … the language of oppression and marginalisation,” said Elana. “And so if we understand that language, we will therefore, should, get it right for Māori and therefore get it right for all people who are marginalised and oppressed. And that’s actually not about anything Māori per se, that’s about those that are doing the oppressing and those that are doing the marginalisation. So if they can get it right, they have to change themselves in that practice, therefore that will have an impact on all of us, not just Maori.”
Lady Moxon also talked about the success of the Whānau Ora commissioning agencies, including during COVID – and about the fact the current commissioning agencies have been told they’ve been unsuccessful in their bid to continue, despite ten years of success and established networks. “It’s about power and control,” she said. “And it’s basically saying to us, ‘get back in your little box and stay there’. And we’ve been here too long… we’re not going to get back into no box and stay there. [But] that’s the destructiveness of this government. … And they still haven’t finished yet because they’re taking away every reference to Te Tiriti o Waitangi everywhere. So I am very very disheartened and disappointed in this government, in the Minister and in the government of today that they think that we are just pawns in a game.” Later she continued: the government’s ethos in healthcare has been “basically get rid of anything Māori” – which aligns to their overall approach. “Everything they’re doing favours Pākehā domination.”
No wonder Elana feels “a deep sense of the ground moving and it’s been moved and it’s unsafe.” She describes the reneging of the free bowel cancer screening (which was going to drop to age 52 for Māori and Pasifika, but is now going to start at age 58 for everybody), as “abhorrent , probably one of the most shocking things, given the evidence that we have [about current ethnic inequity of bowel cancer outcomes].” The change in policy will kill Māori and improve things for Pākehā – so it will make health outcomes more inequitable – “we have deliberately chosen to do that … against what should be our ethic, moral, responsibility. And so that was institutional racism right there in our face,” says Elana. “Because you’re putting efficiency above equity. [You’re saying:] A good Māori is a dead Māori. A cheap Maori is a dead Māori. So it’s everything that I can’t stand.”
The end game is aroha
So resistance is important: Both Stacey and Lady Moxon expressed the encouragement they felt when they saw non-Māori overtly supporting Māori aspirations – by displaying “Together for Te Tiriti” stickers for example. And – “don’t let anybody colonise your headspace,” says Elana. “That’s my biggest message: stay sovereign. Stay tino rangatiratanga in your head. Understand what’s happening, rise above it…. ‘I know what they’re doing – I can see what it’s up to – but it’s not gonna break me’…. There’s always hope. … Yeah, there is cray crayness right now, but I’m going to stay fighting. I know what the end game is, and it’s aroha. … We’ve got the future, we can hope and dream, because that’s what our ancestors did, and that’s what we’re gonna do in their memory.”
Need to help some ignorant rellies, or that guy at the gym? Read explanations of Elana and Lady Moxon’s big concepts – cultural safety, equity – here.