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WITHIN THE POLICY CYCLE

8.2 Policy Formulation

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...to get more effective and productive with the limited resources they have. The immediate default position is to take out...Māori and Pacific Island people who have the least qualifications... [as] it is much easier to be able to justify getting rid of those people... I think this is the institutional racism... they defend themselves by saying it’s not about Māori... it’s actually about getting the best value for the dollar (p. 2).

The ability of Māori and non-Māori allies alike to promote and maintain Māori policy concerns on the policy agenda is affected by both majoritarian decision-making and changeable racial climate. These structural and political barriers to Māori policy concerns entering the policy cycle are compounded through the subsequent stages of policy development and implementation, entrenching, I maintain, the marginalisation of Māori.

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What is considered valid knowledge and what is recognised as evidence are contested sites within both academic and policy contexts (Crotty, 1998). Policy centered in Te Ao Māori and mātauranga Māori have a profoundly different ontological base than policy centered in western bio-medical understandings of health. The prevailing ideological hegemony has a powerful impact on both the framing and content of policy. As delineated in chapter seven the dominant discourse of Crown-developed health policy in Aotearoa is epidemiological analysis of morbidity and mortality patterns.

Population level analysis has become the core platform of Crown health planning.

It is used to assess trends at a national level and determine what interventions will maximise health gain for the majority of New Zealanders. Kawharu (2001, p. 3) suggests such analysis is useful for mapping general themes, but in relation to social development policies, an exclusive reliance on this type of information is inadequate. Without ethnic-specific analysis, the dominant majority masks the dynamics of Māori patterns of disease and injury and planned interventions may simply not be effective within an indigenous context.

Counter storyteller Bradbrook (2010, October 4, p. 5) commenting on the Ministry’s (2004a) tobacco control strategy explains it:

...is about tobacco control dogma and what is current global policy of the day, which then comes into a New Zealand context. Someone says quit attempts are really important and so inevitably what happens in New Zealand is we take on that mantra.

He asserts policy is simply rolled out without adequate analysis to ensure what is best practice in Europe or elsewhere (where ever the policy is lifted from) is relevant or effective within indigenous communities. This practice occurs despite the often disproportionate high health needs of Māori.

Kuraia (2010, September 22, p. 4) points to a published case study undertaken by Otago University (L Signal et al., 2008, pp. 22-24) to test the revised HEAT tool using a draft tobacco control plan as an illustration of the misuse of evidence. The HEAT tool trial showed that the DHB-proposed tobacco control approach was flawed and that “...it was likely to increase rather than decrease inequalities”. She explains:

...it was demonstrably shown that the particular (so-called) strategic approach the DHB were wanting to take was wrong... there was a complete ignoring of that reality and an insistence on continuing on the pathway that they had determined... it was like “whatever, we are still going to do it” and that is exactly what they did...flying in the face of all the evidence that was piled up in front of them about that approach not being workable for Māori (p.4).

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Another counter storyteller (Senior Māori Executive, 2010, November 28, p. 1) shared concerns around how they felt DHBs rejected evidence provided by Māori.

... [we] would explain why our thinking would be in a particular direction and provide... absolute irrefutable [Māori] evidence... or talk about the necessity for tikanga for instance to be honoured within that contract or policy or strategic framework. Most if not all would be soundly ignored by the DHB. Because they in their white western thinking were not able to give [it] any credence whatsoever... Māori thinking was not welcome at the table (p.1).

In reviewing the evidence base of Ministry public health plans and strategies over the last ten years, only a handful of Māori health academics and research institutes are cited.128 Durie’s (1994b) book Whaiora overwhelmingly being the most frequently cited text. Much Crown-developed policy exclusively cites documents produced or commissioned by the Ministry of Health and/or cite no Māori health literature what so ever (see Ministry of Health, 2001b, 2002a, 2002f, 2003e, 2006b, 2007c, 2010f). As showcased annually at the Health Research Council sponsored Hui Whakapirirpiri129 Aotearoa has a impressive collection of established and emerging Māori academics with a broad-based interest in health research.

It appears the process used by Crown officials to decide what gets included in literature reviews, consistently marginalises the voices of many Māori health academics from policy development. This process is compounded when those plans and strategies are then peer reviewed (see Ministry of Health, 2003c, 2003h, 2008e) primarily by international reviewers with no transparent external indigenous review process.130

Bradbrook (2010, October 4, p. 6) asserts policy relevant to Māori needs to located within the context of “...iwi and our aspirations as iwi Māori”. Working with iwi, he has developed a Tupeka Kore131 approach to tobacco control that contains a mix of conventional tobacco control measures but it also has a tikanga Māori framework. He maintains, “...none of those policies from Ministry ever include those [tikanga frameworks]. I think it is just too hard, having a kaupapa driven approach, it is an anathema to the system”. Both Te Tai Tokerau Strategic Public Health132 and Māori Health Plans (Te Rōpū Kai Hapai o Hauora o Te Tai

128 These include; Durie, Pere, Ratima, Dyall, Aspin, Reid, Te Rōpū Whāriki, Te Rau Matatini and Te Rōpū Hauora o Eru Pōmare.

129 Hui Whakapiripiri is an annual Māori health research hui.

130 The exception being the utilisation of Durie to peer review the Building on Strengths: A New Approach to Promoting Mental Health in New Zealand/Aotearoa (Ministry of Health, 2002b).

131 Literally meaning without tobacco, as a tobacco control strategy it requires a focus on Māori communities, the assertion of tino rangatiratanga through the reclamation of tikanga and Māori leadership.

132 This plan took twenty five iterations to reach agreement on this approach.

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Tokerau, 2008; Te Tai Tokerau MAPO Trust & Northland DHB, 2008) are illustrations that policy can be developed inclusive of both epidemiology and kaupapa Māori traditions, though neither have yet been substantively implemented.

Cultural Competence

Of course, we all view the world through our own eyes, so the way we view the world is determined by the way we were brought up. I have been in circumstances where I have challenged a particular viewpoint or policy on the basis of its mono-culturalism and people have been genuinely surprised at the comments that I have made (Berghan, 2010, October 18, p. 4).

Tiriti trainer, da Silva (2010, October 31) argues that cultural competency requires non-Māori practitioners to be aware and actively manage their dominant cultural viewpoints. It involves the ability to recognise a range of viewpoints and value systems different from one’s own. Cultural competency is a core element of professional practice for a range of public health disciplines133 (see Health Promotion Forum, 2011; New Zealand College of Public Health Medicine, 2008;

Public Health Association, 2007). It appears not to be a requirement for either Crown policy makers nor managers (see State Services Commission, 2007).

Many of the counter storytellers participating in this research raised concerns about the prevalence of mono-cultural policy analysis, claims that are echoed in Māori health literature (see Lawson-Te Aho, 1995; Maaka & Fleras, 2009). With nearly two decades working as a policy analyst with the sector Kuraia (2010, September 22, p. 3) asserts that policy typically reflects the dominant cultural views of the time. Therefore, in relation to health policy the overarching culture sends the message that “Māori aren’t as good as Pākehā”. These prejudices she maintains are then embedded into policy decisions about defining issues, sourcing evidence and prioritising actions. When Crown officials do not have the necessary level of cultural competency to break through their dominant viewpoint, the result in her experience is often mono-cultural practice.

Senior Māori Health Advisor (2011, July 1, p. 1) clarifies this dynamic:

…it is predominately about set values and one set of values being the norm and that is the benchmark that everything is put against. It is about systems then, that process those values and move them through into everyday working life and process them as the norm, they reinforce those views as the norm.

133 This is further entrenched for some groupings of health professionals who are covered by the Health Practitioners Competency Assurance Act 2003.

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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.