Driving Equitable Health Outcomes

Nā Anna Brankin

After the passing of the Pae Ora (Healthy Futures) Act in 2022, Te Rūnanga o Ngāi Tahu mobilised to establish Te Tauraki, the entity that is spearheading hauora within the Ngāi Tahu takiwā. Te Tauraki is one of 15 Iwi-Māori Partnership Boards (IMPBs) throughout Aotearoa, and its role is to drive current reform of the health system to achieve more equitable outcomes for Māori. Kaituhi Anna Brankin talks to some of the people behind Te Tauraki.

Most Māori will have firsthand experience of the challenges within the current health system. There are the practical barriers: finding an available appointment, taking time away from work and whānau to attend, not to mention the increasing costs.

Then there are the systemic barriers: culturally unsafe experiences with healthcare staff and failure to be provided with best practice treatment options. All of this means that often whānau don’t prioritise seeking medical attention until they’re really unwell, and the result is that Māori have poorer health outcomes and a shorter life expectancy than any other demographic in Aotearoa.

This is a widely-known and longstanding issue. Iwi and Māori health researchers have been advocating for change for decades, and there have been amazing initiatives that go some way to addressing the problem. Ultimately, it’s clear the only solution is a complete overhaul of the way that Aotearoa delivers health services, and Pae Ora (Healthy Futures) Act offers the opportunity to do just that.

The establishment of Iwi-Māori Partnership Boards has enabled iwi throughout the country to take a more active role in determining how Te Whatu Ora – Health New Zealand will operate within their takiwā. And, as Te Tauraki Chair Rakihia Tau (Ngāi Tahu, Ngāi Tūāhuriri) says,
it gives iwi the ability to hold the government to account in its role as treaty partner.

“We have a big opportunity to change the system, to achieve rangatiratanga for our people and, above all, the equity we were always entitled to,” Rakihia says. “Even our name, Te Tauraki, is derived from Te Kerēme and speaks to the importance of our work.”

Rakihia says there are several meanings behind the word “tauraki”: something that is incomplete; a guarantee or a promise; to grieve for. The name Te Tauraki traces today’s health inequities back to their origins – promises made and broken by the Crown over 150 years ago.

In the mid-19th century the Crown committed to establishing schools and hospitals for Ngāi Tahu as part payment for tribal land. Although the land blocks changed hands, the promised schools and hospitals were never built. Today, Te Tauraki is tasked with holding the Crown to account for these broken promises and ensuring Ngāi Tahu aspirations for health and wellbeing are finally realised.

To do this, Rakihia says it’s crucial for Te Tauraki to look inwards and outwards. “On one hand our work relies on our connections within the tribe, so that’s everything from having cups of tea with whānau to making sure we hold our board meetings at venues all around the island,” he says. “On the other hand, it’s about external relationships, dealing with government officials, ministers and primary health care organisations and pulling levers at the systems level.”

From the outset, Te Tauraki has always been about making a difference for Māori living within the Ngāi Tahu takiwā. “We see it as our responsibility, in keeping with our values of manaakitanga and kaitiakitanga, to be working on behalf of all Māori,” Rakihia says. “Ultimately, we are all related one way or another and Te Tauraki will not be successful if we’re leaving any whānau behind.”

The board of Te Tauraki brings together a depth of skill sets and experience, and Rakihia is quick to acknowledge the influence of the late Norm Dewes (Ngāti Kahungunu).
“We were very lucky to have Norm alongside us until his death earlier this year,” Rakihia says. “He was eminently capable and an incredible resource in terms of his experience and his relationships within ngā maata waka.”

Rakihia and his fellow directors hope to honour Norm’s legacy by continuing the work they began together, and improving health outcomes for all Māori in the Ngāi Tahu takiwā. “And we’ve got the team to do it,” he says. “We’ve got Professor Suzanne Pitama, Professor Emma Wyeth and Dr Maira Patu, all experts in Māori health and Māori health research, and we’ve got Ruth Jones, an expert and advocate for tangata whaikaha, who are especially vulnerable within the current system.”

For Professor Pitama (Ngāti Kahungunu), sitting on Te Tauraki is an immense privilege and an opportunity to give back to her husband’s iwi and create a better future for their tamariki.

“I’ve always loved the Ngāi Tahu whakataukī so much: mō tātou, ā, mō kā uri ā muri ake nei – for us and our children after us,” Suzanne says. “It’s about kaitiakitanga and it’s about our mokopuna, and Te Tauraki weaves together those aspirations as well. We want to ensure that in
20 years our children are not telling the same story about inequities.”

Besides building and maintaining relationships, Te Tauraki is focused on gathering data to make sure they understand the current health landscape. “To me, data is just another medium in our storytelling history. Māori have always shared our narratives through waiata, haka, rock carvings, whare whakairo, painting,” says Suzanne. “Data tells us its own story. It tells us how many Māori present to general practice and don’t get the best practice or care. It tells us how many turn up at hospital and don’t receive appropriate treatment. Every time someone goes to the doctor or the hospital, or picks up their medication from the pharmacy, we understand more of our health story.”

Suzanne uses the example of gout to demonstrate the story that data can tell. Gout is a kind of arthritis that causes pain and swelling due to a high level of uric acid in the blood, but it can be easily managed by taking medicine like allopurinol. Data tells us that Māori are more likely to experience gout, but less likely to be prescribed allopurinol when they first present with symptoms.

“Some people think data lacks humanity, but to me it’s a way of scanning the landscape without dragging out personal trauma. It shows us the lengths that Māori are going to to achieve hauora and it gives us the evidence we need to advocate for whānau,” Suzanne says. “Let’s say we manage to change the way Māori with gout are treated. Firstly, we’d improve their quality of life and reduce their risk of cardiovascular disease. And secondly, it means the rest of their whānau is more likely to recognise the symptoms of gout, and know that there is a treatment, and to feel confident in seeking it for themselves. It changes the narrative immediately.”

By examining existing data and uncovering the stories that whānau have already shared about their experiences in the health system, Te Tauraki will be able to advocate for changes that will address the inequities Māori face. “The good thing about Te Tauraki is that we’re not discovering a new approach to best practice healthcare,” Suzanne says. “We just need to look at what is working for Pākehā and say ‘well I’ll have that, thank you.’ It’s not rocket science, it’s just understanding existing best practice and demanding it.”

Day to day, the work of Te Tauraki is led by general manager Sonya Stevens (Ngāi Tahu, Ngāti Kahungunu ki te Wairoa). Rakihia says he’s confident in his team and the work they’re undertaking.

“I’m really proud of the team we’ve put together, led by Sonya. They are staunch advocates of the rights of Ngāi Tahu and they’re unashamed and unapologetic when it comes to holding Te Whatu Ora – Health New Zealand to account, which is exactly what we need.” With her legal background and determined drive for social justice, Sonya sees the work of Te Tauraki as the perfect fit for her.

“For so long the health system has not been a welcoming space for whānau, and I see some whānau developing this internal barrier that prevents them from seeking help, because they’re used to being shut out,” she says. “That is something I absolutely want to see changed, and I want whānau to know that we are working hard to make sure that the health system delivers for them.”

Te Tauraki occupies a unique space within health reform, acting as a bridge between Te Whatu Ora, other Crown agencies and Māori communities. At times it can be a challenging path to walk as the political landscape constantly changes, but Sonya says their purpose remains clear.

“Te Tauraki aims to fortify the rangatiratanga of papatipu rūnaka, as well as enhance the role of hauora Māori service providers who know their communities, who know their whānau,” Sonya says. “Te Tauraki offers an opportunity for whānau to speak into spaces where we haven't necessarily been able to influence before."

Even the disestablishment of Te Aka Whai Ora (Māori Health Authority) has not deterred Te Tauraki from its goal. “We take the opportunities where we find them. Te Aka Whai Ora was its own opportunity, and it is sad it came to an end on 30 June. Now we have the ability to partner directly with Te Whatu Ora and continue to make change across the broader health system,” Sonya says. “We have the mandate of Te Rūnanga o Ngāi Tahu and we have legislative mandate through the Pae Ora Act. We have the ability to pull levers in the system and we’re going to use them to amplify the voice of whānau Māori, and to influence for better.”

As Te Tauraki works towards the fulfilment of broken promises, Rakihia says their eyes are fixed on success. “I reflect back to the Ngāi Tahu claim and the famous words of Tā Tipene O’Regan: ‘I climbed to the top of the mountain, and do you know what I saw? Valleys, and beyond them, yet more mountains to climb,’” Rakihia says. “That is how I see the work of Te Tauraki. Our guiding principle is the relentless pursuit of whānau hauora and our success will be reflected in climbing every mountain in our path to achieve it.”

Members of the Te Tauraki board and operational team. L-r: Holly Weir-Tikao, Jade Lee-Walker, Anne Thomas, Rakihia Tau, Ruth Jones, Taone O'Regan, Sonya Stevens, Professor Emma Wyeth. Missing – Dr Maira Patu and Professor Suzanne Pitama.