Governance and Management: A Report on Maori Healthcare in New Zealand

This report provides an in-depth analysis of the healthcare challenges confronting the Maori population in New Zealand. It begins with an executive summary highlighting the historical context and the significant health disparities, particularly in chronic diseases such as obesity and diabetes, that affect the Maori compared to non-Maori citizens. The report explores the role of the New Zealand government in addressing these inequalities, examining various strategic frameworks and policies aimed at improving Maori health outcomes. It also reviews the Treaty of Waitangi and its implications for healthcare, discussing how the treaty can be a basis for addressing the health inequalities. The report includes proposed recommendations for improving government strategies. The report emphasizes the importance of Maori involvement in policy formulation and healthcare practices, highlighting the need for culturally acceptable approaches. The report uses statistical data to support its claims, and concludes by emphasizing the need for comprehensive strategies to tackle the root causes of the problems and minimize the negative effects of these inequalities.

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Running Head: Governance and Management
Governance and Management
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EXECUTIVE SUMMARY
The historical events within New Zealand created one of the most sophisticated problems that
have taken a lot of efforts and policy formulation to address. While the Maori are the indigenous
inhabitants of New Zealand, they are totally sidelined in important healthcare provisions as they
lead almost in every negative evaluation in relation to their health conditions. Therefore, this
report seeks to analyse and discuss the health care problems facing Maori, the government’s
efforts to create harmony; a review of the Treaty of Waitangi in relation to Maori health care as
well as recommendations that may boost the government’s strategies in addressing the Maori’s
sidelined health care outcomes.

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Table of Contents
EXECUTIVE SUMMARY.............................................................................................................2
Introduction......................................................................................................................................4
Chronic Diseases Health Issue.........................................................................................................5
The role of the Government in addressing Health Inequalities for Maori.......................................7
Te Tiriti o Waitangi (The Treaty of Waitangi)................................................................................9
The Proposed Recommendations..................................................................................................10
The Impact of Policies in Addressing Inequalities........................................................................11
The Rationale of the Recommendations........................................................................................12
References......................................................................................................................................13

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Introduction
The Maori people are the indigenous inhabitants of the modern-day Australia. They have a vast
settlement history starting around 250 and 300 CE. They settled introducing a wide range of
cultural and economic practices including the warrior culture and the horticulture farming. The
Maori people are believed to have originated together with settlers from Polynesia. But in the
beginning of the 17th century, there was turn of events that might have probably changed the
lives of the Maori people for good. There was arrival of the Europeans into New Zealand, and
with their influence and power, they gradually started converting the Maori into their culture.
The integration between the Maori and the Europeans in the New Zealand led to adoption of new
European lifestyles and cultural practices and with time, the original Maori culture started
waning. The initial interactions between the Maori and the Europeans led to the signing of the
Treaty of Waitangi in the 1840 which meant that, the two communities were to coexist together
as part of the British Colony. However, these interactions led to land sales-related conflicts and
there were constant tensions between the Maori and the Europeans. In addition, there emerged an
epidemic of introduced diseases, and Maori found their selves in a very tricky situation which
culminated in the dramatic decline of their population.
Although there has been a steady fight to address the grievances of the Maori people, it is still
apparent that they face challenging issues especially in health care provision. Documented
studies and statistics indicate that the Maori people have not experiencedsystematic
representation in the health sector and the labor force. There is a higher disparity between the

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Maori and the non-Maori. The Maori leads in higher cases of mortality rate, and high frequency
of chronic diseases, than the non-Maori(Triggs & Coulson).
The Obesity Chronic Disease Health Issue
Chronic diseases within New Zealand accounts for almost 40% of the health burden for the
nationals. The health problems are largely attributed to diseases such as cardio-vascular disease,
cancer, diabetes among others. But the most eye-catching observation is that The Maori people
within the country are the most affected. There is a significant prevalence of obesity within the
Maori people, which is a major health concern. The continued existence of disparities in terms of
healthcare provision between the Maori and non-Maori people has constantly left most of the
indigenous New Zealanders under unfavorable health position. It is clear from credible studies
and statistics that most of the Maori people are more affected with chronic diseases such as
obesity as compared to other non-Maori citizens (Oetze, et al., 2017).
According to the (Ministry of Health, 2012), Maori have the highest cases of chronic conditions
such as obesity and diabetes. They also experience high levels of heart disease, stroke, and
arthritis among others. Obesity is even on a worse scale that almost one in every five Maori,
including children (20%) and the adults (20%) do take medication for this chronic condition.
This is unlike the other non-Maori groups of citizens. It is a clear indication that the Maori are
sidelined in the health provision given the highest prevalence of chronic diseases among them
than the other groups of citizens (Ministry of Health, 2012).
With all these problems surrounding them and less impact and solutions, Maori people
furthermore have the poorest access to healthcare services. At least two in every five Maori,

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which translates into (39%), could not meet the primary health needs annually, which also
included 28% of the children in this ethnic group. Lack of access to health care services for most
of them does not bode well with the fact that they are the most adversely affected (CGB Health
Research, 2011). The limited access to health services is a major setback in New Zealand.
Seemingly, the most hindering factor from the access of the basic health care needs by the Maori
includes a variety of setbacks. The cost of medical services prevents most of them from
accessing the basic healthcare needs even if they wanted to. This includes 28% of adults and
another 8% of Maori children. The cost of accessing a GP and the medical appointments means
that a significant number of Maori goes without basic medical care (Croxson, Smith, &
Cumming, 2009). The most astonishing statistic according to the (Ministry of Health, 2012), is
that in the year prior to 2011/2012 health review, a massive 47% of the Maori women had faced
unmet necessity for basic healthcare.
The New Zealand’s government efforts in trying to eradicate the inequalities through various
ways including the primary Health Care Strategy (PHCS) has not addressed much of the Maoris’
plights. They are still languishing in dark embers of modern-day medical advancements. Some of
the main contributing factors to the ethnic healthcare inequalities may result from provision of
quality health care to the specific non-Maori while the Maori are provided with poor quality
healthcare. Another valid reason is the difference in access to the determinants of quality health
care. Non-Maoris are most likely to have easier access to the quality healthcare.
The Maori people have a higher rate of obesity with more than 44% of them with obese
conditions, which translates to about 197, 000 people. And the national statics indicates that
there has not been significant change that indicates any form of improvement or eradication of

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the disease. There have not been any progressive changes in terms of other chronic conditions of
the Maori people either. Strokes, heart diseases, high blood pressure alongside obesity are
diagnosed in an estimated 300,000 Maori people. Even with the government’s efforts; equality
disparities are still evident in health care provision (Gibson, Lisy, Davy, Aromataris, Kite, &
Lockwood, 2015).
The role of the Government in addressing Health Inequalities for Maori
The persistent inequalities in healthcare between the Maori and the non-Maori citizens within
New Zealand have presented the government with a huge challenge of trying to eradicate the
disparities. But even in the struggle to dignify the existence of the Maori by the government,
these efforts have not yet bore visible fruits that cannot be termed as an effective solution to the
problems of the Maori individuals. It is however good to acknowledge the fact that the
government has tried to harmonize the provision of healthcare to bridge a gap between the
discriminated Maori and the privileged non-Maori (Ministry of Health).
The New Zealand government proposed a strategic framework that aimed at tackling the
problem in four different levels. The first is the structural level which focuses on the root causes
of the problems. It is important to understand the beginning of everything that led to the current
situation as it is. The historical development of the New Zealand as a country led to convergence
of the numerous ethnic groups. While the Maori were the indigenous group of the country, rapid
changes from the visiting Europeans led to subsequent changes in all aspects of the Maori life.
This included social aspects of the life, economic aspects as well as the political state.
Another level in the government’s framework to tackle the issue was intermediary pathways.
Under this level the government would undertake all the psychological analysis and elements,
including behavioral changes that can impact on health outcomes. Social and behavioral patterns

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can affect how people operate within an environment. It is imperative to understand cognitive
elements of the Maori ethnic group in trying to understand the best possible ways of addressing
their problems. The complexity of the health care inequalities within New Zealand means that
the solution is not just based on the conclusive opinion but rather a deeply analyzed approach
that touches every aspect of the society (Russel, Smiler, & Stace, 2013).
The New Zealand government further has undertaken special concentration on the health and
disability services and devising frameworks that lead to extensive address of people with
disabilities. Then the final level is the impact of the process, and working sure to minimize on
the negative effects the inequalities have on the socio-economic situation (Blakely, Tobias,
Atkinson, Yeh, & Huang, 2007). The government acknowledges the fact that they are dealing
with current situation caused by historical impacts of colonialism. It is understandable countries
with a past history of colonialism have characteristically poor indigenous people who cannot
afford basic health care services (MH Durie).
In the bid by the government to bring the equality in the health sector, the involvement of the
Maori people themselves is invaluable. They have a role to play in addressing their problems and
this involves taking part in the policy formulation and being part of every health policy within
New Zealand. A number of policy formulations and creations saw Maori being considered in the
subsequent amendments that would see them being actively involved in the inequality
eradication process(Raymont & Cumming, 2009). Policy guides were put in place and they
involve greater involvement of Maori in all divisions of the health sector. There were further
given the priority in the resource allocations which took their health needs and perspectives into
account and finally developing culturally acceptable practices that will promote healthcare.

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Iwi governance provides a basic ground for the advancement of government health policies to
the Maori people. The Iwi in the pre-colonial era, were the biggest political formation within the
Maori society. In this formation they were divide into Hapu (clans) and their social function were
primarily to support each other and defend themselves against foreign invasion. These political
formations within the indigenous Maori can provide good grounds for advancing the policies
created to address the healthcare inequality problem.
Te Tiriti o Waitangi (The Treaty of Waitangi)
The Treaty of Waitangi signing in 1840 summed up a lot of about the New Zealand’s policies. It
was the socially binding treaty and even in the current modern era, the treaty has been used to
address important governance problems and issues (Oh, n.d.). The increased migration of people
into New Zealand and increased competition for resources was the primary reason why the
agreement was signed. The treaty was signed to safeguard the interests of the Maori and to
protect their social and economic well being. However, it is important to note that the treaty was
an agreement of settlement of non Maori into New Zealand therefore they are all treaty partners.
The Treaty of Waitangi therefore provides the best basis for reference in the address of the
inequalities that have seen the Maori people being on the sidelines for better part of the post-
European era.The Treaty of Waitangi addresses the citizenship of the Maori together with the
non-Maori and Maori’s guaranteed continued enjoyment of their Maori rights without objection
on hindrance. The New Zealand country is ethnically diverse. The signing of the treaty was a
better step in accommodating all the kinds of people within the country. There are other non-
Maori ethnic groups living in the country, who have their independent cultural practices and
traditional customs (Population Health, 2012).

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The three major non-Maori ethnic groups include the Pakeha, Pacific people and the Asian
people. The diversity means that they are also part of the New Zealand society, and while they
may have the upper hand in equality ladder; they must be considered in the policies that aim at
empowering the Maori. This scenario brings in the relevance of the Treaty of Waitangi in
addressing the equality disparity. Therefore, in reference to the principles laid down in the treaty,
there are a number of recommendations that can be derived to effectively boost the government’s
bid in addressing the issues in equality disparity.
The Proposed Recommendations
Based on the principle number one which is Partnership, it is imperative for the government to
engage in comprehensive partnership programs that would aim at addressing the disparity in the
health care provision. These partnerships encourage collaborative process that yields desired
results. The government therefore, should partner its health policies together with those
formulated by Maori to create an atmosphere of cooperation and understanding. For instance, the
Maori health policy provides a bridge for partnership between the government and the local
Maori communities. Furthermore, the ministry of health in can partner with other stakeholders in
addressing all the pertinent issues affecting inequalities.
The second recommendation is based on the second principle which is Participation. In the
process of addressing the inequalities in the healthcare service provision, the government and all
the stakeholders involved should emphasize on participation of all the affected parties. This is
more important for the Maori people, given their record of inadequate participation in health
matters. The policies formulated should aim at enabling easier access to medical services and
enforce a policy which allows clinic visits for the affected people. The formulation and
implementation of the policies should follow close insistence on participation.

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And finally, the last recommendation is based on the third principle of Protection. There should
be a defined way of protection of all the health policies formulated as well as safeguarding the
values, beliefs and Maori status. The protection of these policies and addressing various health
provision issues including the state of chronic diseases among the Maori will ensure longevity of
all the government and other policy stakeholders’ efforts in addressing equality disparity in the
health sector provision that has for long affected the Maori people for several decades even after
the colonial era.
The Impact of Policies in Addressing Inequalities
The historical inequality in health among Maori has seen formulation of a significant number of
policies and strategies that have tried to address and solve all these problems. The extent of their
success is not conclusive because currently the Maori people of New Zealand are still faced with
poor outcome of basic healthcare provision. It is clear that, even policies alone cannot have the
sole impact but rather, action is more appropriate to drive the agenda home. With the Maori
ethnic group still having the highest cases of health-related complications, including high
prevalence chronic diseases, the policies need to go a step further.
However, policies have played a significant role in addressing the equality disparity in healthcare
in some ways. They have provided a good foundation on which any actions taken can result in
the desired outcome. For instance, the Maori Health policy which is based on the Treaty of
Waitangi, addresses inequities within the healthcare while outlining the fact that, the rights of the
indigenous people are rightly enshrined and protected under the treaty. This policy advocates for
the continued monitoring of these inequities in while appreciating the contemporary aspects of
the Maori health. However actions are necessary to cement the power of the policies created to
address the inequality problems (Medical Council of New Zealand, 2008).

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In addition, the government’s efforts through proposal of principles that would address the
inequalities with a comprehensive strategy at four levels is a good step forward towards
addressing the issue. The strategy which involves a structural level, intermediary pathways,
disability services, and the impact level are a key foundation for the solutions required to address
the Maori health problem. These policies and formulations however; have relevance only if the
actions can follow the writings effectively.
The Rationale of the Recommendations
From the recommendations suggested in this document, a lot can be utilized to promote
improvements for health outcomes of the Maori people. This ranges from designing a proper
practical foundation within which the aspects of partnership, participation and Protection can
fully be undertaken for the bettering Maori health outcomes.
In addition, these recommendations can provide solutions in addressing Maori’s continued
prevalence of chronic diseases, meaning that, the government strategies and other policies
formulated should address specific areas of concern, such as higher cases of obese population
particularly in one group of the citizens (Regional Public Health, 2017).
The recommendations further insist on the actions rather than theory such that, policies and
strategies formulated are useless without action input and this involves participation processes,
that is, allowing the Maori people more chances to access affordable healthcare and specifically
involving them actively not just on paper but in practice.
Conclusively, the historical occurrences that resulted in the discrimination of the Maori may be a
source of all the inequality problems. But the government through effective management and
systematic communication channels can address all these inequalities effectively (Hussain &