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WITHIN THE POLICY CYCLE

8.3 Decision-making

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By way of additional explanation da Silva (2010, October 31, p. 2) asserts organisations can tend to be mono-cultural because they are “...largely run by people with a particular dominant cultural view and they employ people with that same view”. She suggests even when policy documents emphasise the importance of responsiveness to Māori, policy makers and senior managers consistently avoid access to treaty or cultural competency training. Rather front line staff with client contact are often sent to complete such compulsory courses. Shortland (2010, September 17, p. 1) asserts, Crown agencies operate from archaic thinking and a safe historic knowledge base, “...so the education around what they are doing within their institution is well behind the times, it is not being challenged so then it is just an ongoing cycle”.

From his involvement with Crown officials in a range of capacities over decades, Berghan (2010, November 7, p. 6) elucidates these claims of culturally incompetence. He asserts:

...these are good people... they are benignly incompetent... [they] don’t take into account other values; it is kinda like the universality of western values... and that tends to happen through most of the policy processes...

they [Crown officials] don’t see the need to be competent because why should they?... it is the others that need to understand. When in Rome do as Romans do, so when in New Zealand do as Pākehā do; it is that kinda stuff.

Drawing on their background in health governance, several counter storytellers expressed concerns about the appropriateness of a range of DHB board members who have limited or no background in either health or Te Ao Māori. However, they are involved in making high-level decisions affecting Māori. Speaking more broadly Wano (2011, June 24, p. 2) suggests that although some DHBs are better than others are, some are simply “not as competent in engaging with iwi or Māori providers”.

As illustrated in chapter seven and reinforced here, much health policy is based on bio-medical traditions of epidemiology at the exclusion of other traditions and evidence. When combined with inconsistent levels of cultural competency among Crown officials, mono-cultural analysis can become a defining feature of policy formation.

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Once policy evidence is reviewed and courses of action identified, decisions are then made about what specific areas to include within a policy document and how it should be framed. Decision-making processes contends Fafard (2008, p. 11), can range from involving a handful of people (as in technical decision-making), to complex processes involving dozens (as in Cabinet decision-making). He observes that at times, within politicised policy environments, evidence is assembled retrospectively in order to justify a decision that has already been taken – a practice which sociologist, Tilley (1999, p. 49) coined as ‘policy-led evidence’.

From their extensive experience on policy reference and/or advisory groups for the Crown, several of the counter storytellers highlighted that policy decision-making was often problematic for Māori. Counter storyteller, Māori Policy Analyst (2010, November 16, p. 3) suggests decision-making processes within the health sector are like a battlefield. They explain:

I have sat around decision-making bodies that developed policy with just Māori or in the education sector, and it just hasn’t existed, the kind of violence I experience in the health sector, it is all about resources, it is all about money, and they [Crown officials] lose track of the kaupapa, because if they had their eye on the kaupapa then all the money would be going to Māori health (p. 3).

Kuraia (2010, September 22, p. 6) also likened Crown decision-making processes to a battlefield. She shared her experiences of a prioritisation process:

...we had prepared our bids alongside our colleagues in the DHB and we [MAPO staff] get in there and we have to argue for every little point about it. And because all our bids focussed on Māori rangatiratanga, Māori provider development all of those sorts of things they were automatically challenged, it didn’t matter that we could point out the policy at the macro and DHB board level, which all of our bids fits into... all the Māori bids they just seem to get stuck. And the DHB colleagues were getting their bids processed and there was very little questioning of them... I am proud we did things in a way that are tika and pono... we had the appalling situations of people that definitely should know better getting up and storming out of rooms (p.6).

Within this sub-section, I examine three key themes arising from counter narratives in relation to decision-making. These are the active marginalisation of Māori viewpoints, flawed consultation processes and the impact of Crown filters through policy sign-off processes.

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Marginalisation of Māori Viewpoints

Marginalisation of Māori viewpoints was a reoccurring macro theme of counter storytellers across all the policy development stages in this study with both subtle and more overt manifestations. Marginalisation is widely recognised as an observable manifestation of institutional racism (Kearns, Moewaka-Barnes, &

McCreanor, 2009; Nettleton et al., 2007).

MAPO through their fourteen-year co-funding partnership with the Crown enjoyed unique access to the workings of the Crown in relation to its policymaking and funding practices within the Northern region. MAPO staff attended the vast majority of funding and planning related meetings with both Ministry of Health and Northland DHB with both generic and Māori public health providers over that period. This enabled the organisational staff to witness the behaviour of Crown officials across different groupings of providers. A counter storyteller (Senior Māori Executive, 2010, November 7, p. 4) clarifies “...the MAPO were there to represent the viewpoints and the korero directly from the leadership of Māori health providers and their governance levels”.

Working on a daily basis with the Northland DHB for twelve years, Kuraia (2010, September 22, p. 5) notes that over a period of some years, expert Māori health analysis provided to the DHB, was actively rejected and marginalised. She explains:

The input we [MAPO] were providing would be written out, it would be ignored, it would be twisted, it would be reframed, we would reframe it back again into what it was supposed to be and then it would be left out entirely. And when we challenged it, when we questioned it, excuses usually came in the form of “oh we were under time pressure to get this produced because the CEO wanted it published” or some such thing.

Basically they’d say “we ran out of time so just couldn’t put your stuff in”

(p.5).

Kuraia confirms the frequency and the intensity of this behaviour varied depending on the racial climate at the time. However, overtime it escalated to becoming a commonplace, every-day experience.

Kuraia (2010, September 22, p. 6) illustrated her point with the specific example of the development of regional strategy. She explains:

They [DHB] weren’t analysing Māori data properly... Māori in Northland had the worst access of everybody across the region... But what was getting to me was the analysis was so victim blaming, [the DHB were saying] it was because Māori didn’t turn up to their appointments and presented late for diagnosis... I couldn’t quite articulate it myself why I felt it was so wrong. Then [a senior Māori academic]... gave me the words...

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“This is an example of inequitable and racist analysis of the numbers, of using the numbers to try and portray a line that Māori are wrong and bad”... So I expressed all of this in writing to the DHB, because they were using this…analysis to make decisions that were affecting people’s lives...

it was ignored (p.6).

Reid (2007) has consistently presented and published on the tendency of Pākehā to misrepresent Māori experience and apply ‘racist’ cultural deficit analysis to quantitative data to explain Māori ill health. She often cites the work of sociologist, Nazroo (1999, p. 215) who describes this process as the radicalisation of health issues. He explains:

...by identifying the health disadvantage of ethnic minority groups as inherent to their ethnicity, a consequence of their cultural and genetic

‘weakness’ rather than a result of the disadvantages they face because of the ways in which their ethnicity or race is perceived by others (p. 215).

Rather than focussing attention on structural determinants of health, with a racialised analysis the gaze remains fixed on finding fault with the minority group experiencing the disadvantage.

Berghan (2010, November 7, p. 5) shared his experiences of a sector-wide workforce development review that was broken up into review teams covering different occupational groups, nursing, doctors, and public health and so on. He explains:

There is no mention of Māori, not one mention all through that [review].

The assumption is that Māori will be captured in each of those service reviews... So what happens is when they end up doing these reviews the particular needs of Māori in the workforce are disregarded (p. 5).

Berghan had advocated for a dual strategy of developing a particular Māori workforce stream as well as including Māori analysis within each service review team. He suggests an inclusive process would have included an overview of the cultural needs and skills needed to work with Māori. These omissions he asserts

“...is a continual denial of Māori as Māori” I suggest this is an illustration of the marginalisation of Māori policy concerns.

Flawed Consultation

I applaud the ones that come out and ask questions...[but] somehow it tends to get lost as they go to write (Māori Provider CEO, 2010, November 1, p. 5).

Well-planned consultation can build on knowledge and experience, test assumptions and produce workable solutions. As outlined in chapter seven, it is a

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statutory and legislative obligation of both DHBs and the Ministry to undertake consultation processes to engage with communities and particularly with Māori.

Consultation is a key mechanism within many Māori responsiveness frameworks to solicit Māori opinion and engagement. Both Ministry of Health (2002c) and Treasury (2009a) have developed specific consultation guidelines to enable effective consultation. Māori health advocate, Lawson-Te Aho (1995, p. 24) suggests internal consultation with Māori Crown officials is not comparable with external engagement.

Ministry of Health (2002c, p. 7) consultation guidelines acknowledge the difficulties of identifying whom to contact and listen to within Māori communities. Māori providers (see Te Puni Kōkiri, 2000a, p. 25) have similarly expressed concerns about the ability of Crown agents to assess effectively Māori needs at the community level. This concern stems from Crown agencies perceived lack of local relationships and understanding of the dynamics of Māori communities.

Counter storyteller, Shortland (2010, November 17, p. 1) succinctly maintains Crown officials are “[j]ust not listening, the writers who are writing the policy don’t have a paradigm about an articulation of what is on the ground...”.

Furthermore, she suggests Crown-led policy often has incorrect information about demographics and communities and there is a clear lack of accountability and feedback to communities who could provide correct and accurate information. Te Puni Kōkiri (2000b) in their research into Māori experiences of Crown contracting practices, identified Māori providers often play a middle ground between the government and Māori communities. Māori providers are often very aware of the particular needs of communities and have established informal and formal accountabilities back to whānau and hapū.

The following examples relate to the introduction and/or revision of key policy development by the Ministry of Health. Bradbrook (2010, October 4, p. 7) comments on the introduction of the new brief intervention approach to tobacco cessation. He argues, “Suddenly it was the only thing... no consultation, no discussion, this is just the way it is”. He maintains this was problematic for Māori on two fronts, firstly as the new approach was incompatible with the long established aukati kai paipa134 intensive cessation programs run by Māori across the country, secondly he asserts there had been no analysis or study to show the efficacy of brief interventions for Māori. Additionally the brief intervention approach denies the body of evidence that demonstrates the relevance of culture to health (Durie, 1994b; Ramsden & Erihe, 1988).

The Public Health Service Handbook (Ministry of Health, n.d.) as introduced in chapter six has been the basis of most public health contracting in New Zealand

134 Aukati Kaipa is a kaupapa Māori kanohi ki te kanohi smoking cessation program.