Commitment to te Tiriti o Waitangi and health equity
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), as the organisation responsible for training and ongoing professional development of obstetricians and gynaecologists in Australia and Aotearoa New Zealand, is committed to developing the workforce to reflect the populations it serves, and to including cultural safety and health equity in our training curriculum and programmes.
TV reaffirms our commitment to te Tiriti o Waitangi and partnership with Māori as tangata whenua in Aotearoa New Zealand. We firmly believe that ethnicity is established by evidence as a strong identifier of need and this is supported by a wide range of evidence showing the link between ethnicity and life expectancy, access to care and health outcomes.
The Principles of the Treaty of Waitangi Bill aims to promote a national conversation. RANZCOG is fully supportive of broad community discussion of important issues and matters that significantly impact the wellbeing of its population. However, the conversation in relation to the Principles of the Treaty of Waitangi Bill risks creating both division and distraction from the important work of ensuring pae ora for all and addressing the current inequities in health. We urge the Government to drop the bill, which it has no intention of passing.
The Principles of the Treaty of Waitangi Bill
Te Tiriti o Waitangi (te Tiriti) is a founding document in Aotearoa New Zealand that is fundamental to health and social policy. RANZCOG recognises that Māori are tangata whenua of Aotearoa New Zealand and have Indigenous rights that are reaffirmed by He Whakaputanga (Declaration of Independence), te Tiriti and the United Nations Declaration on the Rights of Indigenous Peoples.
TV is not an expert on Te Tiriti or the current principles that guide its interpretation on contemporary matters. Nevertheless we view this Bill as attempting to rewrite the meaning of Te Tiriti o Waitangi in law, undermining the rights of Māori to equitable, culturally responsive healthcare. It ignores systemic inequities entrenched over generations and impedes the tailored approaches required to achieve equitable outcomes.
Te Tiriti principles as they apply specifically to health were developed by the Waitangi Tribunal. Recommendations were that the delivery of health care in Aotearoa New Zealand be guided by five treaty principles – tino rangatiratanga, equity, active protection, options and partnership. These principles provide guidance and a pathway to enable improvements in Māori health outcomes.
TV are experts on women’s healthcare and we have deep concern that the proposed Principles of the Treaty of Waitangi Bill, which formed part of the coalition Government agreement, has been progressed with undue speed and at a time when New Zealand is facing significant pressures and our healthcare system is in crisis. This means the opportunity for meaningful analysis and broad consultation is constrained. We note that the Ministry of Justice’s Regulatory Impact Statement: Providing certainty on the Treaty principles has supported maintaining the status quo “to minimise the risk of damaging Māori-Crown relations because the proposed Bill could be seen as an attempt to limit the rights and obligations created by the Treaty. This would present a significant risk to the Māori-Crown relationship and could have flow-on effects into other parts of the relationship.”1
TV is deeply concerned that at a time when our social services and health system are failing to meet the needs of whānau and wāhine Māori, that resources are being invested in a conversation that is unlikely to result in change, but very likely to create stress and fracture relationships and at best do little to address the needs of our most at risk population.
The health community has worked hard over recent years to address systems that have disadvantaged Māori and other ethnicities2 , and to enact the commitments of te Tiriti o Waitangi. RANZCOG has been disturbed to see doctors and health providers criticised for prioritising the needs of Māori3. Equity of health for wāhine and whānau Māori requires significant focus, new approaches, and the effort of the whole health system and all who work in it.
We are deeply disturbed by Māori being excluded from any engagement with the development of The Principles of the Treaty of Waitangi Bill. This has been described as a clear breach of te Tiriti. The proposed principles in this Bill trample the mana of te Tiriti4 5, discriminate against Māori, abrogate Māori rights, and extinguish tino rangatiratanga.
Impact of systemic barriers and structural racism on outcomes for Māori
Māori currently experience a range of poorer health outcomes generally and in respect of their reproductive health. While broad social determinants of health such as education and socioeconomic factors play a role, as they do for other populations within Aotearoa, these poorer outcomes are significantly contributed to by systemic barriers and structural racism6 7, . A needs-based approach, while relevant for all of our populations, is not sufficient for Māori. Equity for Māori and commitment to te Tiriti are inextricably intertwined. Te Tiriti provides both the impetus and structure for enacting the kinds of changes that are required to right inequities in health and other outcomes for Māori. RANZCOG calls for whole-of-government approach, that aligns with already detailed principles, to address systemic barriers and structural racism which are linked to important determinants of health such as income, education, and housing.
Health outcomes for Māori
Evidence from various studies and reports indicates that Māori in New Zealand experience significant health disparities compared to the non-Māori population8:
- Life Expectancy: Māori life expectancy is lower than that of non-Māori. According to the Ministry of Health, the life expectancy for Māori men is about seven years shorter than for non-Māori men, and for Māori women, it is about five years shorter than for non-Māori women.
- Higher Rates of Chronic Diseases: Māori have higher rates of chronic health conditions, such as diabetes, cardiovascular disease, and respiratory conditions. For instance, Māori are almost twice as likely to be hospitalised for diabetes-related complications.
- Mental Health Disparities: Māori report higher rates of mental health issues, including depression and anxiety disorders. They are also less likely to receive appropriate mental health care, contributing to poorer outcomes.
- Barriers to Access: Māori face more significant barriers to accessing healthcare services, including geographical isolation, cultural differences, and socioeconomic factors. This leads to lower rates of preventive care and delayed treatment for health issues.
- Maternal Health: Māori women experience higher rates of complications during pregnancy and childbirth. For example, Māori women have higher rates of preterm births and low birth weight infants.
- Child Health: Māori children are more likely to experience health issues, including higher rates of hospital admissions for preventable diseases.
- Socioeconomic Disparities: Māori are overrepresented in lower socioeconomic groups, which correlates with poorer health outcomes. Factors such as income, education, and employment status significantly impact health.
These inequities are significant, unjust, and avoidable, and persist across the lifespan and over time and represent breaches of te Tiriti.
Women’s health outcomes
Inequities in health are particularly evident across a range of women’s health areas. The Perinatal and Maternal Mortality Review Committee has chronicled poorer outcomes for Māori across its 15 reports. Māori, Pacific peoples and Indian populations experience worse outcomes than those of New Zealand European ethnicity. And the Fifteenth Annual Report of the Perinatal and Maternal Mortality Review Committee9 provides the stark fact that “Wāhine Māori were 2.91 times more likely to die by suicide as a direct result of maternal mortality than women of New Zealand European ethnicity in the 2006–2020 period.” RANZCOG has been a partner in development of the recommendations and has championed them. It has become clear that improvements in outcomes for wāhine, pepī and whānau will not happen unless foundational inequities are addressed.
Focus on addressing structural basis of inequity
Various studies, including those conducted by the Health Quality & Safety Commission and The Treasury, highlight the persistent disparities in health outcomes for Māori10 11. Reports often emphasise the need for targeted interventions to address these inequities. These disparities are influenced by a combination of historical, social, and economic factors, highlighting the need for sustained efforts to improve health equity for Māori communities.
Evolving opinion within the health community is that foundational to addressing need within our Māori populations is the need for the health system and the broader structures of government to consider cultural safety for Maori as critical for empowerment and engagement. If our system is not safe, then Māori will continue to fare less well than the rest of the population in various health and social indicators.
TV, in line with many other colleges has made it a focus to consider health equity. This is an ongoing requirement of the Medical Council of New Zealand and forms part of accreditation of medical colleges in Australia and New Zealand. We have worked with our community of Māori specialists, trainees and consumers over many years to develop a strategy focused specifically on the needs of Māori, both in training and practice, and the needs of our whanua and wāhine. Te Rautaki Māori me te Ara Whakamua – our Māori Strategy and Action Plan is an important document that informs all of the professional work that we undertake as a college. This strategy is critically important because systemic barriers and racism are very much alive in Aotearoa, impacting both the outcomes of our wāhine Māori and our ability to recruit, train and retain Māori specialist doctors.
In conclusion
TV is committed to continuing the journey towards equity and to improving health outcomes for Māori. Achieving health equity requires a clear commitment to Te Tiriti o Waitangi principles, which obligate the Crown to actively protect Māori health and address disparities. This is not only a legal imperative under the Pae Ora Act 2022, but a moral responsibility aligned with international commitments such as the United Nations Declaration on the Rights of Indigenous Peoples.
We contest that focusing on the Principles of the Treaty of Waitangi Bill, which the government has indicated they do not plan to support, is not only an unreasonable pressure on precious resources, but perhaps even more importantly, creates and perpetuates an environment that is culturally unsafe for our Māori population and risks further magnifying the inequities that they face.
We call upon the Government to stop the Principles of the Treaty of Waitangi Bill, and to ensure that our health system enacts the commitments of te Tiriti o Waitangi and focuses on equity of health in Aotearoa.
Nāku noa, nā
Dr Susan Fleming
Vice President Aotearoa New Zealand
Chair Te Kāhui Oranga ō Nuku
References:
1Ministry of Justice. Regulatory Impact Statement: Providing certainty on the Treaty Principles. 28 August 2024. ()
2Loring B, Reid P, Curtis E, et al. Ethnicity is an evidence-based marker of need (and targeting services is good medical practice). N Z Med J 2024 Sep 27;137(1603):9-13
3Department of the Prime Minister and Cabinet. CO(24) 5 Needs-based Service Provision. 13 September 2024. ()
4Ministry of Justice. Regulatory Impact Statement: Providing certainty on the Treaty Principles. 28 August 2024. ()
5Waitangi Tribunal. Ngā Mātāpono The Principles. 2024. Tribunal releases report on Treaty Principles Bill | Waitangi Tribunal.
6Devakumar D, Selvarajah S, Abubakar I, et al. Racism, xenophobia, discrimination, and the determination of health. Lancet 2022 Dec 10;400(10368):2097-2108
7Talamaivao N, Harris R, Cormack D, et al. Racism and health in Aotearoa New Zealand: a systematic review of quantitative studies. N Z Med J. 2020 Sep 4;133(1521):55-68
8Brewer KM, Grey C, Paynter J, et al. What are the gaps in cardiovascular risk assessment and management in primary care for Māori and Pacific people in Aotearoa New Zealand? Protocol for a systematic review. BMJ open 2022;12(6):e060145.
9Fifteenth Annual Report of the Perinatal and Maternal Mortality Review Committee.
10A window on the quality of Aotearoa New Zealand’s health care 2019 – a view on Māori health equity.
11Te Tai Waiora: Wellbeing in Aotearoa New Zealand 2022
For media enquiries
Bec McPhee
Head of Advocacy & Communications
0413 258 166
bmcphee@ranzcog.edu.au
