On Budget Day as thousands outside Parliament and around the nation protested the government’s policies and how they apply to Māori, Finance Minister Nicola Willis delivered her first budget.
Asked whether the budget this year, which cut about $250 million from targeted Māori funding, reflected the latest statistics on Māori representing one in five New Zealanders, she remained steadfast, saying the budget delivered for Māori.
“When a New Zealander turns up at the emergency room, or when a child starts school, they don’t turn up thinking about their ethnic identity,” Willis said.
“They turn up thinking about their need, and in our budget, we’re ensuring that resources are going where the need is, including in our hospitals and our schools and our police force.”
The statement, Stuff has discovered, captured a profound difference of opinion between the government and the Māori people outside - who say their livelihoods, careers, literal experiences in the health system, have been deeply affected by their ethnicity.
Speaking to Stuff, Willis said the comment was taken out of context, and the point, which she completely stands by, is that an uplift in funding for the health system benefits all New Zealanders. She said the government was determined to deliver better results for Māori. Meanwhile, Health Minister Shane Reti would not comment on what his colleague said, but was proud of the budget and its “commitment to Māori health outcomes”.
“So how much Māori do you have in you?”
Dr Huhana Hickey (Ngāti Tahinga, Ngāti ira) a lawyer and disability advocate, said Willis’ comment was an inaccurate representation of what Māori experience in the health system.
Speaking of her own experiences, Hickey said it took more than 11 years to be diagnosed with primary progressive multiple sclerosis (MS), as neurologists refused to consider it a possibility despite symptoms showing otherwise.
“They kept saying Māori don’t get MS, and so I was refused treatment. It wasn’t until 2010 when I had a mild car accident that I went to a private specialist who did an MRI and diagnosed me,” she said.
“But I wasn’t treated when I could walk and that led to my MS becoming worse and as a result, I can’t walk any more because of their racial profiling.”
Even after the diagnosis, Hickey said she continued to be met with prejudice and denial about her medical condition, to the point she no longer felt the hospital was a safe place for her.
“My last neurology appointment, for instance, the head neurologist turned around and looked at me and said, ‘so how much Māori do you have in you?’”
This was just one example of how assumptions were being made based on ethnicity, she said, and not purely on symptoms.
“It’s easy to say, you’ll be treated as a New Zealander, but that isn’t true at all... I can tell you now, as a Māori woman, I’m not safe in there.”
Hickey, who also sits on the Waitangi Tribunal, said a lot of the complaints were to do with racial profiling in the health system.
“It’s not uncommon to have a Māori whānau fighting for the basics for their whānau member and the hope they can get good treatment,” she said.
“I felt too whakamā to go to the doctor”
According to the latest NZ Health Survey data, one in three Māori reported unmet primary care needs over the past year, “signalling deep cracks in the system,” Dr Angelique Reweti, Massey University senior lecturer, said.
Reweti (Ngāpuhi), is the co-lead of online platform Wāhi Kōrero - an anonymous space for people to share their experiences of the health system.
The project invites people to share their stories in response to the prompt, “I felt too whakamā/shy to go to the doctor”.
“We know our healthcare is interlinked with ethnicity, racism and other social determinants,” Reweti said. “We know we still have big gaps in life expectancy, just purely based on ethnicity or the area you might live in. These are not things we’re making up.
“If we don’t start targeting some of these areas, I can only see those gaps are going to increase and get bigger. This isn’t just costs and poor logistics. The stories expose systemic biases that prevent equitable access.”
In one post, a user who identified herself as a “Māori woman with a rare disability and endometriosis” said every time she went to the doctors, she felt her voice was not heard, and her pain not taken seriously.
“I stopped asking for stronger medication to manage my endometriosis because they act like I am drug seeking.”
A user who is blind in one eye and has low vision in the other, said they were often asked whether they were an alcoholic or had another drug addiction.
“They think I’m just there to feed a drug addiction. My dreads and bare feet don’t help, but how I look shouldn’t make people treat me differently, but they do. If I feel like they’re gonna box me in, I just walk out and don’t even get my check up.”
What do the statistics say?
Findings from a national retrospective observational study examining Indigenous emergency care outcomes, found Māori people were “significantly” more likely to die within 10 days of their first ED visit - 1.6 times as likely - than non-Māori.
A article published by The Royal New Zealand College of General Practitioners in 2021 found Māori had less appointment time, fewer investigations, fewer diagnoses, less treatment, few referrals to secondary care, and fewer interventions.
A report released in 2022 commissioned by the soon-to-be disestablished Te Aka Whai Ora/Māori Health Authority, found the health system performs worse for Māori in “virtually every domain measured”.
“Māori experience higher exposure to social, environmental and commercial determinants of poor health, most of which can be modified by Government action either through health sector or cross sectoral actions,” the report said.
“Torrent of evidence over the role ethnicity plays in health outcomes”
Dr Rawiri Keenan, a general practice doctor and academic from the University of Waikato, said there was a “torrent of evidence” over the role ethnicity played in health outcomes and the health services people received.
Keenan referred to a 2019 Ministry of Health study, which found the rate of new cancer diagnoses for Māori was 405.7 per 100,000 people, compared to 332.4 per every 100,000 people for non-Māori.
Other Ministry of Health data shows avoidable hospitalisations per 100,000 people nationwide were dominated by Pacific peoples, at 13,998 over 12 months to December 2023.
Māori were second, at 7854, and non-Māori or Pasifika at 6105.
Avoidable hospitalisations are admissions into hospital that could have been avoided by early healthcare interventions and early disease management.
“So over many areas we can see the issues and gaps for Māori and we can link some or all of that in the way in which patient and Māori whānau experience health care,” he said.
In an email to Stuff, Reti would not say whether he agreed with Willis’ comment, instead saying he was “extremely proud of Budget 24 and its commitment to Māori health outcomes”.
He said there was a funding stream focused on developing, implementing and delivering hauora Māori services, commissioning kaupapa Māori services and funding for the development of hauora Māori providers and the government’s partnerships with iwi.
Speaking to Stuff, Willis said: “I accept that it remains the case that Māori in our health system have got poorer outcomes and we are determined to deliver better results for Māori.”
She said the Budget had provided an uplift in funding for the health system, which benefited all New Zealanders.
“One in five New Zealanders are Māori and many of them attend mainstream schools, and it is absolutely true that, when people are injured or are sick, they don’t attend separate hospitals,” Willis said.
“We have an emergency room that needs to deliver for everyone, including for Māori, of course, it needs to do that appropriately. That is our expectation of our hospital services that they appropriately respond to the cultural needs of New Zealanders when they need those services.”
Willis said she appreciated people do not have the same experiences in the health system, and that it was a challenge the health system had to rise to.
“We are very focused as a government on, for example, reducing waiting times in emergency rooms, on improving the delivery of elective surgery and that will benefit Māori New Zealanders and all New Zealanders,” she said.
Additional reporting: Karanama Ruru.
- Stuff
