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5.4 Treaty Obligations

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According to Carmen (2009, p. 94) the Declaration has already been used to good effect by the Yagui indigenous people in Mexico in their fight against the use of pesticides.88 Reports from Australia are less promising with the Aboriginal and Torres Strait Islander Social Justice Commissioner (2009, p. 137) raising significant concerns about the slowness of the Australian government in implementing the Declaration. Likewise the New Zealand Prime Minister, Right Hon. John Key has publicly stated (see Watkins, 2010, April 20) New Zealand’s endorsement of the Declaration is both conditional and symbolic. The potential impact of the declaration remains unclear at this time.

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An enquiry to the Waitangi Tribunal confirmed that as of April 2011, there are eighty-nine deeds of claim related to health (Crown official, personal conversation, April 15, 2011).89 Whānau, hapū and iwi and Māori communities lodged these claims from 1984 through to the most recently in 2008. Some of these claims substantially relate to health sector activity, others having more indirect links.90 These are claims are either predominately historical or more contemporary in their focus. The following sub-section outlines the major themes of these health related Waitangi Tribunal claims.

Historic Claims

Many of the identified claims were comprehensive in nature, and related to the historical alienation of whenua from whānau and hapū, and the disruptions of customary practices of land tenure. Several claimants explicitly noted the acts of war initiated by the Crown in pursuit of land and the resulting loss of life.

The decimation of the Māori population through the introduction of alcohol, tobacco and new diseases was identified as a direct negative health impact of Crown practices. Mihinui (2000) in her claim cited the contribution of the Crown to the spread of tobacco amongst Māori communities. Maniapoto, Maniapoto and Haereroa (2008) cited the breach of Te Rohe Potae compact by the Crown, which for some time had kept alcohol out of the King Country. Within their claim (2008, p. 6) they suggest Crown practices both impaired and damaged “...the spirit, wairua, mana and ihi (essential force) of the hapū and its members”.

Within the health-related claims, many represented the Crown as being an active agent in the undermining of Māori rangatiratanga and traditional practices. Within the Whanganui Mana Wahine (Waitokia, 2008, p. 2) deed of claim they describe how the Crown forced “...cultural, political and social, and economic systems [over Māori women] which effectively alienated their authority over their properties and resources and diminished their way of life”.

Claimants also outlined the Crown’s failure to uphold and recognise traditional holistic health and healing practices. A low-point of this approach was seen as the criminalisation of traditional healers through the Tohunga Suppression Act 1907.

Tangiahua (2008) in her deed of claim on behalf of Ngāti Hauiti argued traditional Māori practices of health and healing were subsumed by mono-cultural western traditions. Wolfgramm et al. (2008, p. 5) explain:

The new settlers denigrated Māori knowledge and understanding of the world and the natural, spiritual and social environment to the dimension of myth, legend and superstition, dehumanizing Māori and promoting a belief

89 See appendix J for a log of the health related claims logged with the Waitangi Tribunal.

90 In reviewing, the correspondence related to the claims a number of claimants have died without their cases being resolved.

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they (Pākehā) are superior and therefore have greater rights to resources and services.

A range of claimants expressed concerns about the inadequacies of the Crown’s health service delivery to Māori. Echoing the concerns raised by Tangiahua, many were troubled about the failure of the generic health system to address the wairua, tinana, whānau and hinengaro (emotional) health needs of Māori. Others felt the Crown had failed to provide health services consistent with Māori culture and tikanga. The marginalised of Te Reo within the public health system and beyond was also considered problematic.

In his deed of claim, General Practitioner, O’Sullivan (2008) noted the lower hospitalisation and treatment rates of Māori (compared with non-Māori) in accessing health services. Wolfgramm et al. (2008) reiterated this in relation to each point of the continuum of care from accessing screening, screening to diagnosis, diagnosis to treatment and treatment completion to rehabilitation and care. Others specifically named the lack of access to preventative education and programs experienced by whānau and hapū.

Te Rarawa (Piripi, 2008) in their deed of claim identified poverty and high unemployment as barriers to Māori accessing services available to the general population not addressed by the Crown. Others noted the prevalence of personally mediated racism within the [generic] health system that was likely to impact on clinical decision-making. The influenza epidemic, and subsequent tuberculosis and typhoid outbreaks reinforced for some the failure of the Crown to provide adequate health services.

Contemporary Claims

Many of the contemporary health related claims cited the compromised socio-economic position of hapū resulting from Crown practices of colonisation, assimilation and neo-liberalism. Several claimants alleged that the Crown created an environment of deprivation, which increased the exposure of Māori to the determinants of ill health. O’Sullivan (2008) maintains that access to education, employment, income, housing, income support and health literacy are often compromised for Māori. Others uphold that particularly rural Māori live in the absence of the most basic of resources such as clean running water and appropriate sanitary arrangements. Exposure to addictive substances such as nicotine and alcohol were also highlighted. Hodges and MacDonald (2008, August) claim that the economic reforms and the subsequent welfare policies of the 1980s and 1990s exacerbated this deprivation.

Inequities in health outcomes between Māori and non-Māori are well recognised within health literature (see Pōmare, 1980; Pōmare & De Boer, 1988; Pōmare et al., 1995; Robson & Harris, 2007) and were included in many contemporary deeds of claims. Some claimants included morbidity and mortality rates, while

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others cited infectious diseases, cardiovascular and coronary heart disease, dental health, mental illness, injury, cancer and diabetes rates.

Many claimants did not see health policy as reflecting Māori worldviews or Māori health needs. Cotter, Emery and Hemopo (1998) assert health policy has simply failed to address worsening Māori health status. Where pertinent policy does exist, both McLean (2003) and Hemopo (1994) within their claims allege Crown practice is not consistent with its own policy directions. They cite deviations from both He Korowai Oranga (A. King & Turia, 2002) and Whai Te Ora Mo Te Iwi (Department of Health, 1993) respectively.

Claimants also included both broad references to flawed Crown consultation and governance arrangements and outlined concerns that are more specific. Several deeds of claims were lodged in relation to the closure of the Gisborne Hospital (see Cotter et al., 1998) and by urban Māori groups (see W. S. Kingi, Tawhai, &

Kingi, 2008) who maintain they were excluded from decision-making. Concerns were also expressed about lack of Māori representation in health governance and senior management across a succession of Crown agencies administrating the health sector.

Some claimants allege a systemic pattern of the Crown under-funding Māori health services. Paki (2008, p. 2) in his deed of claim argues “the Crown has continued to cut and under fund health services to Māori and in areas which Māori are highly represented, the evidence of which includes lack of diabetes screening, management, and screening for and treatment of heart disease”. Both Mihinui (2000) and Hohepa-Birks (1994) allege the Crown has ignored kaupapa Māori evidence while making funding decisions. Other deeds of claims raise concerns about the failure of the Crown to monitor mainstream service delivery to Māori.

Some claimants made explicit but more often implicit allegations of institutional racism against the Crown (see Mullen-Mack, 2002; Paki, 2008; Waitokia, 2008).

Wolfgramm et al. (2008, p. 9) explain:

Systemic and institutional prejudice is evident through most components of the health system in Aotearoa and is evidenced daily throughout the country.

Within chapters eight and nine those claims that directly relate to health policy and funding practices will be outlined and woven through counter narratives and related evidence.