Harawira Hone: Public Health Bill — First Reading 
Harawira Hone: Public Health Bill — First Reading 
[Volume:644;Page:13851] 
HONE HARAWIRA (Maori Party—Te Tai Tokerau) 
: 
 Tena koe Mr Speaker. I say tena koe to Mr Henare. I would like to congratulate the previous speaker on the most intelligent dissertation on this topic today. 
Three months ago the Business Council for Sustainable Development did a survey that showed nearly 80 percent of New Zealanders believe that the public health service has worsened over the past 5 years. That same poll predicted that on the current rate of spending on health at $11.6 billion a year by the year 2050 the Government could expect to be allocating more than $21 billion a year to help. In the context of that high public interest and exorbitant expenditure two other reports were issued that brought the matter to a head. The first was a comprehensive analysis monitoring the health of New Zealand children and young people which concluded that children with chronic conditions long-term disabilities mental health issues or conditions traditionally managed in the primary care and out-patients setting such as diabetes epilepsy and chronic renal failure were not being adequately captured by routine hospital or mortality data. That report also said that traditional data failed to capture issues of cultural identity or the role this played in health and well-being. Following on from these conclusions Te Roopu Rangahau Hauora a Eru Pomare tabled another report from their series  
Hauora: Maori Standards of Health IV—A study of the years 2000-2005 
. As Dr Papaarangi Reid and Bridget Robson explained very clearly in the very first sentence of their report: “Maori have the right to monitor the Crown and to evaluate Crown action and inaction.” This is a right that derives from the indigenous rights of tangata whenua enshrined in Te Tiriti o Waitangi and embodied in the United Nations Declaration on the Rights of Indigenous Peoples. 
So the stage is firmly set from all perspectives for this bill to start the process of legislative review for the effective management of public health. The explanatory note states that the bill is designed “to improve promote and protect public health” in order to help attain “optimal and equitable health outcomes for Maori and all other population groups.” A worthy purpose indeed—on that statement alone the Maori Party could support this first reading of the Public Health Bill. 
So let us just see whether this bill achieves that goal. But firstly I want to put the statement made by Dr Reid and Bridget Robson into context. As tangata whenua our primary right to self-determination is understood in our capacity to be recognised as indigenous peoples. But it also extends to a sense of duty of manaakitanga to ensure the well-being of all people living in our territories. This means logically that Maori must monitor health including any persistent disparities between Maori and non-Maori. Secondly the urgency for Maori to monitor Crown performance is required by the consistent disparities in health outcomes the ongoing exposure to determinants of ill-health the overwhelming lack of responsiveness of the health service and the ongoing under-representation of Maori in the health workforce. So the Maori Party shares with Maori health professionals the priority that must be given to a focus on Maori as a population group and our collective responsibility for te oranga o to tatou whanau. 
We must care about these longstanding inequities. We must not accept normalising and tolerating such unfair and unjust deficiencies of a health system meant to operate in everyone’s interests. We must care about Maori approaches and models being supported across purchasing environments. We know that the Maori health sector has had problems with the population-based funding models promulgated by district health boards and primary health organisations because these models have insufficient resources to truly support stand-alone Maori or Pasifika primary health organisations. We know too that other determinants impact on whanau ora. Poverty income low-paid employment all forms of violence educational underachievement dealings with the criminal justice system income support impoverished housing conditions and isolation and alienation from other whanau members all impact on whanau well-being. 
We have a major challenge in front of us. In particular all research pathways lead to three major challenges that contribute to ethnic inequalities in health: differential access to specialist general practitioner and specialist-nursing services and inadequate screening leading to slower pathways through health care; differences in the quality of care received; and differential access to determinants of health such as the exposure to other risks like unsafe workplaces substandard and crowded housing and environmentally unsafe living conditions. But on top of that we have specific instances in Aotearoa linking institutional racism and interpersonal racial discrimination as a key factor accounting for much of the inequality between Maori and others. Evidence is relentlessly paraded through this House that shows that Maori receive lower levels of health services and poorer quality of service. Other evidence including Ministry of Health analysis of the New Zealand Health Survey confirms that discrimination may be an important cause for ethnic inequalities in health. 
Yet as unbelievable as it sounds the Ministry of Health has still not filled the vacancy that has existed for much of this year in the appointment of the Deputy Director-General Maori Health. Given the quality of the applicants the Maori Party finds it astounding that no appointment has yet been made. Alongside that the public health unit itself has been diluted and its focus dissipated across the ministry. It now stands under the rule of the strategy directorate rather than maintaining specialist public health leadership in one area. The statutory requirement to carry out public health advisory functions as set out in section 3E of the Health Act of 1956 is thus compromised by organisational impediments. It remains to be seen how this bill will achieve equitable health outcomes for Maori or indeed manage the risks of emergent threats to public health without having the organisational structures in place to address these inequalities. 
The desired change is not impossible. We have not reached the point of no return. All it would take to make a big difference would be to focus on the issues of significance to Maori to focus on Maori development and to guarantee a specific focus to address and eliminate inequitable health outcomes for Maori. A big part of making a difference would be to instigate the mandatory collection of ethnicity data and mandatory analysis by ethnicity at all points throughout the public health sector including planning and management. We note of course the correlation with the  
Monitoring the Health of New Zealand Children and Young People 
 report which was also concerned about the paucity of data. I said before that we have not reached the point of no return but we do not also want to be so hands-off that we drift off down a one-way street that ends up in a policy cul-de-sac closing off all possibilities for progress. 
It gives us huge concern that despite the upfront stated objective of equitable health outcomes for Maori there is nothing that specifically gives weight to that commitment. There has been no consultation with Maori. There is no commitment in the Public Health Bill to Te Tiriti o Waitangi. There is no explicit focus on inequities or Maori health development. It appears to be another case of “Do what I say not what I do.” In fact other than the purpose statement at the front of the bill Maori seem to be completely absent from the entire bill. We are prepared to let this bill go to the select committee as we are keen to enable Maori health collectives and professionals to have their say at the table. But we signal our strong concern which is the unnecessary avoidable unfair and unjust ethnic inequalities that continue to plague the sector. Public heath must benefit from specific focus on Maori if we ever hope to make the difference that is really needed. Kia ora Mr Deputy Speaker. Tena tatou katoa.