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Cure more difficult than identifying the cause

Opinion Piece

Frustrations with the failure of the public health system to deliver for Maori have reached boiling point across the nation. Understandably, some iwi leaders are saying “Enough!”

The evidence that was presented mainly by Maori health professionals to the Waitangi Tribunal Health Services and Outcomes Hearing at Ngaruawahia recently left those in attendance in no doubt that the root cause of this failure is institutionalised and individually-practised racism within the New Zealand health system.

Some of you will be reacting to this claim with scepticism based on a developed mistrust of “so-called evidence” describing similar deficiencies in other public institutions, and I must confess that my own first response to these emotive disclosures is to regard them as probably the work of radical revisionists with ulterior motives and, as such, not something to be taken seriously.

Some would say that reaction is evidence of a racist flaw in my own character but, frankly, I don’t “give a monkey’s” what others think.

While I may not agree with the emphasis they place on racism as the main cause of this failure, I identify with their general concerns and have had enough personal experiences with the system, both as a patient and as an administrator, to understand their frustrations.

If the national health system that should be looking after Maori is as broken as is being suggested, then surely we all have a responsibility to ensure it is functioning properly.

I can’t imagine the ethnic European section of society tolerating such a situation for longer than it takes to ring up the Prime Minister and inform her that her Government is in danger of being consigned to history if she doesn’t fix it and fast.

However, trying to adapt a Pakeha-designed health system into one delivering health services to Maori populations requires skills and creativity that only Maori can provide, and it is probably fair to reflect that Maori themselves haven’t always supported some of the brightest ideas coming from their own people that could have made a difference.

Entrenched racism may well influence outcomes, but it isn’t the only reason for the failure to get runs on the board country-wide.

There are many high-profile cases of Maori health professionals and leading iwi politicians (previous associate Minister of Health Dame Tariana Turia and Dr Lance O’Sullivan, naming but two) who have developed systems that can deliver the much-needed healthcare advances for their people, but far too many of these are isolated and have had little impact on the system as it delivers for Maori as a whole.

A question: would we not be more likely to obtain better results by building on the successes of these Maori health trail-blazers, and introducing delivery systems across the country that are known to suit the people for which they were designed?

You see, my understanding and experiences of the public health system, particularly in delivery mode, is that each region has to deal with its own specific problems as best they can. We have to match our local geographic and demographic variables with the resources we have on hand in order to try to provide adequate care for all residents, no matter where they live or who they are on the social scale within their community. Consequently, what works for some, may not work for others.

It also usually means that the delivery of health services to the more isolated patients will be relatively much more expensive and less efficient. In that context, the type and quality of health services delivered will have little to do with the racism discussed at the Ngaruawahia summit.

And so, even if we were able to completely stamp out the racism plaguing the system, the problems related to cultural acceptance and adoption of prevention methods and sickness treatment will remain as a shadow over the whole damned lot.

My own opinion is that we would be much better off fast-tracking and expanding delivery services based on the Whanau Ora philosophy, which is “to take the services to the patient” and deal with them in an environment that is likely to extract the maximum amount of co-operation.

We are right to acknowledge that our health system has failed Maori but I don’t believe it will be resurrected to a more acceptable service for Maori simply by focusing on a problem such as racism which, no matter how debilitating, is for most a perceived impediment. You can talk about it all you want but you can’t remove it unless there is a quantum shift in the attitudes of us all towards one another.

Much better to concentrate on providing a service that fits with the cultural limitations of isolation, poor housing, nutrition and adequate numbers of affordable aged-care facilities.

We already have the ability and resources to do that nationwide, so we should start rolling it out immediately. We can’t afford to be side-tracked by another red herring.