SUBMISSION ON THE PAE ORA (HEALTHY FUTURES) BILL

This Bill must be one of the worst pieces of legislation ever to come before the New Zealand Parliament in that it unashamedly and explicitly introduces racism into the New Zealand health sector.

For decades, New Zealanders opposed apartheid in South Africa. For decades New Zealanders opposed the fiction of “separate but equal” in the American education sector.

And yet here we are, in 2021, openly and apparently without embarrassment proposing to move New Zealand from a health system which treats all citizens on the basis of their need to one which provides care depending on a part of a citizen’s ancestry.

Far from being a move to align the health system with the Treaty of Waitangi, it does precisely the reverse. Article III of the Treaty did not pretend that the Crown could guarantee that all citizens would have perfect health, or perfect education, or would live to the same age as all other citizens. That would have been an absurdity. Article III guaranteed that the Crown would treat all citizens equally, by implication according to their need.

But suddenly the Treaty is being distorted beyond recognition by the suggestion that what the Crown has to deliver is equality of outcomes, which was surely not the intention or the expectation of either the Crown or the chiefs when the Treaty was signed.

Section 7(1)(a) iii of the Bill explicitly suggests that the Government should be aiming at equitable outcomes through the health system with the suggestion that because the health status of Maori New Zealanders is below the average of the whole population this must be due to “systemic racism”.

But that there are a multitude of factors having no relationship to the health system which explain relatively poor Maori health is conveniently forgotten. Some of those factors relate to the design of the social welfare system, which has enabled a disproportionate number of Maori to be on a benefit – something which is often associated with poor quality housing and poor nutrition. We know that Maori New Zealanders are much more likely to be over-weight than the general population, and much more likely to be heavy smokers.

And if systemic racism is behind the relatively poor life expectancy of Maori New Zealanders, how do we explain that Maori living in the Cook Islands have a markedly shorter life expectancy than Maori New Zealanders who have the benefit of access to the New Zealand health system?

Or how to explain that the life expectancy of Pacific Islanders in New Zealand is markedly better than the life expectancy of Pacific Islanders in the islands, without the benefit of access to the New Zealand health system?

And which of the two race-based health systems would New Zealanders have access to? There appears to be an implicit assumption that New Zealanders are of only two kinds – Maori and the rest. But what, for this purpose, constitutes a Maori? I have a friend who has one great-great-great-grandparent (of 32) who was Maori. Would he qualify for treatment in the Maori health system? Would he be free to choose between the two health systems envisaged by this Bill?

The Government has provided absolutely no evidence that the existing health system is racist and is proposing an enormously expensive restructuring of the entire health system at a time when the system is already threatened by the pandemic. It is arguably the most irresponsible act by a New Zealand government in the last half century.

Let me quote from a comment on the Bill by the Hon. Dr Michael Bassett, a man who was himself Minister of Health in an earlier Labour Government and who served for many years on the Waitangi Tribunal. He began an article on this Bill thus:

“If you want proof that Jacinda Ardern’s is the most racist government in New Zealand’s history, just take a look at the proposed legislation for the new health structure. The Pae Ora (Healthy Futures) Bill introduced last week that was sent to a select committee concerns itself almost exclusively with Maori health. Maori are mentioned in most clauses of the legislation. The health of 17% of the population seems to be the only concern of this government. Pacific Islanders get a look-in briefly, the Minister being required to produce a specific strategy for their health. But all the rest of us who make up 70% of the people are never mentioned, and are dismissed at one point as “the other populations”. By the time Maori health providers have been accommodated in the new health structure which is amazingly top-heavy and bureaucratic, there won’t be any room for Pakeha or Asian input on anything. The Bill is a further indicator that Jacinda Ardern regards Pakeha as interlopers of whom her government is contemptuous. Like so much else, it too has Nanaia Mahuta’s malign influence stamped all over it. She has become Rasputin to the Tsarina, intent on running a faltering ministry.”

Referring specifically to Section 7(1)(a) iii demanding that the health system provide “equitable outcomes”, Dr Bassett wrote:

“Achieving “equitable outcomes” in health or indeed in any area of life, is an impossibility. Always has been, and always will be. First, we aren’t all born with equal intelligence; we don’t all have parents who care about us; and up to 40% of Maori children are truant on any normal school day. But if all children got their ante-natal jabs, were cared for, got to school, made an effort, and passed their exams, they still wouldn’t have equitable outcomes in life, either amongst themselves, or with other racial groups. DNA and sheer luck play big parts in peoples’ lives. So, if the government persists with Section 7 (1) (a) (iii) of the Bill and gives achieving equitable health outcomes priority then the whole expenditure of $24 billion on Health is in jeopardy. Not even the resourcing of “Kaupapa Maori”, or “culturally safe services” reflecting an undefined “Matauranga Maori” in the delivery of services will produce equitable outcomes for them, let alone for all Kiwis.”

I strongly urge the Committee to tell the Government it must abandon this Bill. Centralise the hospital system if necessary – though that risks making the public sector health system even more bureaucratic than it currently is – but it is crucial for New Zealand’s future that all citizens are treated by the health system on the basis of their health needs, not on the basis of who their parents or great-grandparents were.

Don Brash

4 December 2021