Aafter decades of neglect, inequality and outright racism in New Zealand’s healthcare system, a shift towards indigenous sovereignty and tino rangatiratanga in health care is long overdue. The Maori Health Authority that the government announced this week appears to be a step in the right direction. But the devil will be in the details, as we wait to see if this produces any real change, or just more showcases.

The inability of the health and disability system to serve Maori has been evident for decades. A visit to the Ministry of Health website will result in report after report documenting the seven-year life expectancy gap between Maori and non-Maori, higher rates of cancer and other preventable diseases, poorer care outcomes and a myriad of other inequalities. Being able to describe Maori health inequalities is necessary. But ultimately, it is insufficient.

In the 1980s, the Maori organized themselves to advocate for changes in the health sector – through national events like Recovery meeting in 1984 and with the establishment of Maori health and disability providers across the country. But much of the health and disability system has always been outside of direct Maori influence, and certainly outside of Maori decision-making. Over time, Maori health inequalities have remained absolutely intact. An Indigenous health organization with real authority could start to change that.

These inequalities and poor health outcomes for Maori are caused by a complex array of factors, including appalling access to housing, unequal incomes, and reduced access to social supports. This reality is sometimes used by health professionals and government officials to shirk responsibility for the unfair differences that arise in health care. However, the Waitangi Tribunal in 2019 found that the way the health care system was run violated te Tiriti o Waitangi – the founding treaty between Maori and the Crown that guarantees, among other things, Maori rights, sovereignty and equal treatment . The court ruled that the Crown had let the Maori down time and time again. They had failed to properly fund services, failed to hold the health system accountable, and failed to ensure that Maori had the decision-making power to design and deliver effective healthcare.

The changes described on Wednesday have their roots in this landmark decision. A year later, the government health system review saw much of the same evidence – but recommended only a slight version of the change.

What Health Minister Andrew Little and Deputy Health Minister Peeni Henare have announced falls in between. Whether it’s more of the drastic and unique change we need or a softer dressing will depend on what happens next. A Maori health authority will be established over the next 12 months and will partner with the Ministry of Health and a new National Health Service for New Zealand. It will have the ability to order – or purchase – Maori Kaupapa health services and it will have some political role. But the answers to the critical questions of who has the power and the money, and who is really going to be in charge, are still vague.

The answers to these questions and the really difficult issues around a Maori health authority are best solved by the Maori. One of the big questions is the role of mana whenua, Maori communities, and whānau, or family groups, in the changes. Maori are not a monolith, and there must be a strong voice from different iwi, or tribal groups, across the country. The ministers said this problem would be solved by transforming the current Maori partnership councils into something more powerful. Since these tips have had uneven support – at best – from their district health councils and are sometimes seen as a non-event by the iwi because of this “evolution” seems to be an understatement.

Another thing to watch out for is how quickly the government wants the new system to be up and running. We need to make changes decisively and quickly, but setting deadlines that are too ambitious can also increase the likelihood of taking the easier choices and the path of least resistance. If speed is our number one goal, the tough decisions will be postponed (and postponed) and there will be another investigation in a decade or so covering exactly the same ground.

Still, I watch the news from the Māori Health Authority with cautious optimism. I see a huge task ahead, and one where the possibility of accepting the simpler option rather than the best remains a very real risk. The work has started, but the work is far from over.

  • Gabrielle Baker (Ngāpuhi) is a health policy expert and director at Baker Consulting. She works with organizations on pro-equity, anti-racist initiatives and the development of a health and disability system that honors te Tiriti o Waitangi