A damning report about Pasifika health is raising questions about the thinking behind the Government’s health reforms.
The report, Bula Sautu, by the Health Quality and Safety Commission shows that in many cases, Pasifika health statistics are far worse than New Zealand European and in many cases worse than Maori.
But while Maori will be part of the proposed Maori Health Commission, Pasifika will be lumped in with the Pakeha and Asian population in the general health service.
Pacific Peoples’ Minister, Aupito William Sio, is questioning the place Pasifika have within the reforms.
Speaking at the launch of the report on Tuesday, Sio outlined factors such as half of Pacific elders over 65 having diabetes, and that rate had remained the same for five years while Pacific people lived six fewer years of life than non-Māori, non-Pacific people, and the gap was widening.
“Why have we allowed this to be normal and acceptable ?” he asked.
“This is not just a question I am asking my colleagues.
I am asking Dr (Ashley) Bloomfield (Director General of Health) and Mr Stephen McKernan (Director of the Health Transition Unit) and their teams as well.
“I am asking every public servant; everyone who is in this room.
“This is all our business; not Pasifika; not Māori, but it’s all of our business.
“Each of you, I ask why?”
Sio said the health reforms needed to ensure that Pacific health wellbeing was lifting and that addressing equity had become not just words but action.
But while the reform blueprint, Heather Simpson’s “Health and Disability System Review”, devotes an entire chapter to Maori health, Pasifika health is not specifically addressed.
Instead, Pacific health needs tend to be included with Maori health needs. Simpson did not envisage a stand-alone Maori Health Authority, nor did she envisage the abolition of the District Health Boards.
She proposed that the DHBs develop “locality health plans” which would address specific needs like those of Pacific communities.
But the Maori Health Authority and the abolition of the DHBs has left Pasifika in limbo.
It is not yet clear how the specific needs raised in the Bula Sautu report may be addressed.
The Bala Sautu report says that in the face of some of the worst inequities in health, a structural response is needed from the system.
“The system must enable Pacific peoples to identify and design Pacific solutions,” it says.
“We must address the unacceptable racism of our system, that is a driver of inequitable health care processes and outcomes, and is enabled by the structure of the system.”
But any real structural change to the health system is going to clash with the “one size fits all” approach of the main body of the reforms, which will see District Health Boards abolished and hospitals ultimately reporting to a Wellington-based health New Zealand.
The report and Sio want to see Pasifika health delivered by Pasifika providers.
“When the Government announced the reform, I immediately themed it E fofo e le alamea, le Alameda,” he said.
“This describes in my mind what is needed to be done to address Pacific inequalities.
“The solutions are found in the Pacific Communities.”
Sio is not going as far as to advocate a Pasifika equivalent to the Maori Health Authority, but there will be some who will ask whether that wouldn’t be a logical outcome.
Certainly, what he is asking for sounds remarkably like the Maori Authority.
The report says that “there are many strengths and resiliencies in Pacific communities, who often hold the solutions and just need support from the health sector to implement them.
“The close working relationships between Pacific providers and churches during the COVID-19 response is a salient example.
“ It is crucial that we build on the learnings and successes of this engagement.”
Sio said that Pacific expertise and leadership needed to be involved at all levels.
“This is necessary to provide me confidence that we will address inequities meaningfully.
“ I also believe that our Pacific values, cultural worldviews and beliefs should be central to everything we do.
“Any decisions around policy, commissioning, and service design which aims to deliver better outcomes for Pacific peoples need to reflect our cultural values to be truly impactful for our Pacific communities.
“Services which resonate with and reflect our shared principles such as – mutual respect, family and I mean extended family, reciprocity, collectivism and spirituality is what has and will work best for our people.
“We need more services built on the ‘by Pacific for Pacific’ philosophy.”
Sio said that he would continue to advocate for total system transformation for Pacific people.
“I encourage those of you already doing so and those that could do more – I urge you to take up the challenge today,” he said.
“I also ask all Pacific and Maori public servants that irrespective of the roles you hold, it is important that you also play a role in advocating for the most vulnerable, including for Pacific, Maori and those with disabilities.”