Submissions on the Pae Ora (Healthy Futures) Bill


Oral submission by the Chair of Democracy Action Lee Short to the Pae Ora Legislation Committee on the Pae Ora (Healthy Futures) Bill.
Presented 2:20 pm on Friday, 28 January 2022

Oral submission text:

Thank you for the opportunity to provide comment on the Pae Ora (Healthy Futures) Bill. I am presenting this submission on behalf of Democracy Action. 

Firstly, I want to make it clear we wholeheartedly support the purpose of the Act - that is to protect, promote, and improve the health and future health of all New Zealanders.

But, if the intention is to improve the health of ALL New Zealanders, this proposed legislation is absolutely the wrong way to go about it. 

Instead, the bill focuses on improving the health outcomes of just one sector of the community. It concerns itself almost exclusively with Māori health, with Māori mentioned in most clauses. The health of this 17% of the population seems to be the only concern. The rest of NZ get a look-in briefly, and are dismissed at one point as “the other populations”.

We at Democracy Action are so concerned about provisions in the Bill that we engaged Queens Counsel – Mr Gary Judd - to give us an opinion on the implications for the rights and interests of the ‘other’ New Zealanders. We asked whether non-Māori New Zealanders or what the bill calls “other population groups,” are likely to be disadvantaged by provisions in the Bill. This submission draws on Mr Judd’s opinion.

Pae Ora proposes inequality. It will institutionalise inequality before the law by creating what are intended to be permanent structures and mechanisms promoting rights and privileges based on race, such as the establishment of a health system with special governance rights for Māori. 

Our publicly funded health system will be subject to co-governance by both Health NZ and the Māori Health Authority. In response to a question to clarify this arrangement, Minister of Health Andrew Little said: 

“Health New Zealand and the Māori Health Authority will work together in partnership to plan for a system that responds to all the people of New Zealand. They will have to agree on key plans and service arrangements”. 

As there is a requirement for them to agree, effectively this means that the Māori Health Authority will have a right of veto over policy that affects the entire community.

Furthermore, provisions in the bill make it is obvious that Māori influence will be greater than equal. The Māori Health Authority is established to be entirely Māori focused, and although Health NZ has additional focuses, it is also significantly focused on Māori, so the whole system is tilted towards Māori. 

Additionally, Health NZ must engage with iwi-Māori partnership boards. But, what about the rest of the population? Amidst all the ways in which Māori can be involved in the health system, challenge ministerial decisions or protest about failures provided for in the bill, by comparison, it is silent on the similar avenues for the “other populations” to do the same. 

In terms of deployment of health system resources, this tilting must result in relative advantage to the Māori community and relative detriment to the non-Māori community. From a total allocation for health services, if more resources per capita are devoted to Māori, obviously less resources per capita are available for others. 

We recommend that health needs — only health needs — should be the determinant of how the resources are deployed.

 It would be proper for a health service funded by the general taxpayer to direct attention to remedying deficiencies in the system by applying criteria developed by reference to health needs, not the race of the beneficiaries. Approaching the problem in this way means that those Māori along with others, who have special health needs would have those needs recognised within the system. For instance, if there are proportionately more Māori than non-Māori with or likely to become affected by diabetes, it will be a purely factual matter that Māori will proportionately benefit more than non-Māori from resources directed to its prevention and treatment. The proportionate greater benefit will be health-based, not race-based.

We support the bill’s principles of equitable access to services, and equitable levels of service, but achieving equitable health outcomes for all is impossible and doomed to failure. 

I say it is doomed to failure because the main causes of ill health do not lie in the public health system, but elsewhere. Health outcomes are only partially linked to the services provided by the health system. A much larger percentage of health outcomes is linked to a variety of issues. I quote the Health and Disability System Review, Interim Report October 2019, which arrived at the following conclusion:

“Although many people continue to consider health care in the context of clinical and medical care only, it is widely acknowledged that this accounts for only about 20% of a person’s health and wellbeing status. The other 80% arises from the conditions in which a person is born, grows, lives, works, and ages, including physical, cultural, and natural environments, housing, education, the distribution of power and income, and health behaviours. The impacts of these can accumulate over a lifetime.”

None of these contributing factors can be altered by the services that are the responsibility of the health providers. So, unless other factors are concurrently addressed, the stated purpose of achieving equitable health outcomes will be impossible to achieve.

To suggest otherwise flies in the face of reality and is setting the health system up to fail in this objective.

And as to the bigger picture, I believe this legislation is more about promoting a political ideology than it is about better health outcomes. It is a means to create a political partnership, a constitutional change which is at odds with our democratic conventions. If this Bill is allowed to proceed in its present form, I fear for the damage this will do to the social fabric of our country. Separate health entities based on race will drive a wedge between people, fostering a “them vs us” dynamic - the population is forced to see themselves as something apart from one another, to choose one side – Māori or ‘other’. We would be retribalizing our country. Tribalism and democracy are incompatible - they cannot exist together as political systems in the one nation. 

The Bill says it is intended to give effect to the principles of the Treaty of Waitangi, but contains proposals go beyond anything envisaged in the Treaty, and at the same time ignores Article III of the Treaty which sets out the right to equality for all. This right is also protected under the New Zealand Bill of Rights Act and the Human Rights Act, but this Bill appears to disregard this obligation

Not only is this bill ill-judged in content, but also timing. This massive overhaul of our health system is taking place when we are grappling with an unprecedented pandemic. Our resources must be totally focussed on the best health outcomes for all NZers during this time.  Just this week the Association of Salaried Medical Specialists warned of severe staffing shortages in the health sector, saying it has never been so bad. The executive director reported that the lack of adequate staffing means that there is extremely limited or no ICU capacity in some regions. So, instead of spending around $500 million of our precious funds overhauling the health system at this time - and I understand that is just to get the process started – remedying this dire situation is where our priority should lie.

I believe the best way forward is to promote a health system that does its best for ALL THE PEOPLE OF NEW ZEALAND. This proposed legislation does not fit the bill.

If the government wishes to disestablish the District Health Boards and put something else in their place, I recommend going back to the drawing board to produce a structure and mechanisms which place the aim of achieving equally good health comes at the forefront and eliminates Pae Ora’s race-based approach.

Therefore, I strongly urge the committee to recommend to the Government that the bill be withdrawn. It is crucial for New Zealand’s future that all citizens are treated by the health system based on health needs, not race.

I am happy to supply a copy of Mr Judd’s opinion on the bill if you wish to read it. This offers far more detail than I can hope to achieve in a 10-minute oral submission.

Thank you.

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