Papaarangi Reid: 'Aotearoa is built on health inequities'

In October, Professor Papaarangi Reid (Te Rarawa) gave the Sir Ian Hassall Memorial Lecture, hosted by the Child Poverty Action Group, at the Fale Pasifika. Her topic was ‘Visioning our maunga teitei – dreaming of a time when it’s safe to be born a Māori child’. This piece is adapted from that lecture.

The late Sir Ian Hassall’s vision was for a society not just safe for children, but where tamariki can thrive, free from abuse, where they are valued, have a voice and their rights respected and expressed. Where we lobby and advocate for better outcomes.

At the heart of my work as a public health academic are two ideas, and both align with Sir Ian’s. One stems from something Donna Awatere once said: that she dreamed of “a time when it was safe to be born a Māori child”. The second is a well-known whakataukī: “Whāia e koe te iti kahurangi; Ki te tuohu koe, me maunga teitei.”

It has been variously translated, and the best-known fragment of it is, “If you bow your head, let it be to a lofty mountain”.

For me it means have a bold vision and only let something really big and insurmountable stop you.

Associate Professor Bridget Robson, a public health researcher at Otago, reminds me that inequity is like a coin; it has two sides. The flipside of inequity is privilege, because wherever someone is getting less, someone else is getting more.

We must analyse privilege as much as we do inequity because it’s a secret that’s hiding in plain sight. No one likes to talk about privilege.

When we ask why Māori have fewer resources, we should be asking what happened in our society that non-Māori have more?

For me, it’s obvious. Racism and colonisation are at the base of this causal pathway. By racism, I mean processes through which systems, policies and action in our society create unequal opportunities and outcomes for different groups. It’s not about finding out who the racists are. It’s about asking how racism is operating. That’s the question we must face and answer, no matter how difficult.

Attempts to portray health inequities borne by Māori as being the result of an inferior people being overcome by a superior people, are a fantasy. Read our history. Māori lives were disrupted by Treaty trickery, and by war, genocide, racist policies that removed Māori resources, broke up communities and outlawed cultural practices. Our history has been hidden from us for such a long time, so it’s heartening to have the refreshed compulsory New Zealand history curriculum in schools in 2023.

The state of Māori health, especially children’s health, is an outcome of these deliberate policies to break down Māori people, lands, culture and relationships. Not just relationships with each other, but with our history and our whenua. Poverty has not just been economic. It has been spiritual and environmental. And it’s caused by colonisation.

The recent TV documentary No Māori Allowed described it poignantly: what happened to Māori in Pukekohe and in many other parts of the country, created “soul wounds”. When children witness something so damning to their whānau, it wounds their souls and they carry it with them through generations.

What we need now is healing and to put a lot of energy into that. It can’t happen without truth-telling, and will begin with us having the bravery to face what happened.

The documentary ended hopefully, that Pukekohe might become the first anti-racist town in Aotearoa. I thought ‘yes, that’s the new goal: be anti-racist’.

But how does this relate to our prescription for the future of child health? Matike Mai Aotearoa (the report of the Independent Working Group on Constitutional Transformation) provided a blueprint to start a discussion about how we can build a relationship that benefits all equally. It says there are three spaces: the kāwanatanga space, where government has power.

There’s the rangatiratanga space, where Māori are sovereign. The final space is the relational space, where we negotiate how to jointly do business together.

During the height of the pandemic, we saw rangatiratanga emerge to a degree. Iwi roadblocks helped protect communities. And Māori health providers took it upon themselves to educate, support and vaccinate their way. It was so successful that many Pākehā also used these health services.

It was such an interesting time to explore how this model of Matike Mai can work.

We haven’t quite worked out how we do business in the relational space yet and it may be difficult where values are poles apart.

But we can’t afford not to. Over the past few years, I’ve been working with researchers on a project called ‘The Cost of Doing Nothing’. We’ve gathered New Zealand data on the cost of health inequities to both Māori and New Zealand society.

We’d already tried moral and health arguments, citing disparity in the likes of rheumatic fever rates, childhood immunisations etc. Those arguments to get governments to commit to eliminating inequities haven’t worked. It’s beyond disappointing to those who have worked so hard on this.

Aotearoa is built on health inequities. Our research confirms the cost of keeping Māori sick is many millions of dollars. Saving Māori lives will save the country money. This should be an unbeatable argument for the Treasury. We are waiting.

Sadly, if we look in the media, we see more about the rich list than about child poverty action. And there are so many advertisements appealing to our unbridled consumerism; they want us to have bigger SUVs, flash phones and to consume.

I recently read a South American leader say, ‘It’s an honour to pay taxes’. It means you’re investing in the collective social system as opposed to individual greed. Yet we celebrate people who manage to reduce how much they pay in tax. There’s an obvious clash of ideologies between individualism and collectivism.

Economist John Galbraith has said: “The modern conservative is engaged in one of man’s oldest exercises in moral philosophy; that is, the search for a superior moral justification for selfishness.”

How do we move our culture away from greed and individualism to embrace what matters? What should our bold vision be? We need to be values and rights-based. Don’t be lulled into a sense of contentment, because you’re doing quite well on your own little treadmill. Be knowledgeable, because ignorance is our weakness. Honour our history.

But we must first start work on racism and coloniality. Become anti-racist. I truly believe that if we do that, the rest will follow.