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Expert Mechanism on the Rights of Indigenous Peoples: Study on the right to health and indigenous peoples [2016] NZHRCSub 7 (11 March 2016)
Last Updated: 4 June 2016
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Expert Mechanism on the Rights of Indigenous Peoples:
Study
on the right to health and indigenous peoples
11 March 2016
Introduction
- The
New Zealand Human Rights Commission (“Commission”) welcomes the
Expert Mechanism’s study on the right to health
and indigenous peoples
with a focus on children and youth, and appreciates the opportunity to
contribute.
- This
submission outlines implementation of the right to health of indigenous peoples
in Aotearoa New Zealand, with reference to:
- Health
equity
- Indigenous
health practices
- Issues for
Māori children and young people.
Indigenous Peoples’ Right to Health
- The
right to health is a fundamental and universal human
right.[1] How the right to health is
delivered is considered in relation to the availability, accessibility,
acceptability and quality of health
services.[2] The right to health
encompasses not just the absence of disease or infirmity but “complete
physical, mental and social well
being.”[3] It includes access to
both timely and appropriate health care as well as the underlying social and
economic determinants of health,
such as conditions of work and adequate food
and shelter.[4]
- The
UN Committee on the Rights of the Child has emphasised that for children, the
right is inclusive and includes the “right
to grow and develop to their
full potential and live in conditions that enable them to attain the highest
standard of health through
the implementation of programmes that address the
underlying determinants of
health”.[5] It has also
highlighted particular issues for indigenous children, including: the need for
special measures to address inequalities;
the importance of disaggregated data
collection; the interdependence of the right to health with other rights; the
need for special
attention to the needs of indigenous children with
disabilities; the critical importance of cooperation and participation of
indigenous
peoples in the design and implementation of policies and
programmes.[6]
- Indigenous
concepts of health encompass individual and collective wellbeing, and are
interconnected to the realisation of a range
of rights, including:
self-determination, development, culture, language, land and the natural
environment.
- The
right to health for indigenous peoples is affirmed in articles 21, 23, 24 and 29
of the UN Declaration on the Rights of Indigenous
Peoples (UNDRIP). Article 22
emphasises the need for specific focus on children and young people, as well as
women, older people
and disabled people in the implementation of the
Declaration.
- In
Aotearoa New Zealand, the right to health is reflected and affirmed in the
Treaty of Waitangi (the Treaty). The Treaty was signed
in 1840 between
representatives of the British Crown and Māori rangatira (leaders). The
human rights obligations it contains
may be summarised as:
- Partnership
– which entails good faith cooperation and shared decision making
- Protection of
rangatiratanga (self-determination) and taonga (treasured possessions, tangible
and intangible, including such things
as: culture, language, land and
health) [7]
- Participation in
society on an equal basis to others, and freedom from
discrimination.
- Alongside
the human rights instruments which protect the universal right to health, the
Treaty and UNDRIP affirm the rights of New
Zealand’s indigenous people
to:
- Health
equity
- Participation in
the development of health services and programmes
- Traditional
health practices, medicines and resources.
Implementation in New Zealand
Data and research
- There
is considerable, good quality, publicly available data on Māori health
(although, not always to the same extent in relation
to Māori children and
young people or for disabled people). Data on Māori health outcomes
includes:
- Regular
comparative data on Māori and non-Māori health outcomes, across the
country’s 20 District Health
Boards[8]
- Disaggregated
data from the national Health
Survey[9]
- Annual Health
and Independence
reports[10]
- Tatau
Kahukura: Māori Health Chart Book 2015 provides a snapshot of
Māori health and covers: socioeconomic determinants of health, risk and
protective factors and health
status
indicators[11]
- Social Indicator
data[12]
- Quarterly
reports on the performance of general practices within Whānau Ora
collectives.[13]
- In
addition, specific data that reflects Māori perspectives on the right to
health is available through Statistics NZ surveys:
- Te
Kupenga (survey of Māori social and cultural
well-being)[14]
- Te Ao
Marama (on Māori well-being and development, from a Māori
perspective)[15]
- Ngā Tohu
o te Ora: The determinants of life satisfaction for Māori
2013[16]
- A
range of further data collection and monitoring initiatives is also underway,
including:
- Work by the
Treasury on a Higher Living Standards framework, aimed at raising living
standards and increasing
equity[17]
- Statistics
NZ’s Integrated Data Infrastructure work, which brings together data from
a range of agencies[18]
- Analysis of
Ministry of Social Development Integrated Child Dataset to identify and
understand children and young people at risk of poor
outcomes[19] – a significant
number of children and young people in this group are Māori
- The National
Action Plan for human rights, which records government actions and commitments
made under New Zealand’s 2014 Universal
Periodic
Review.[20]
- New
Zealand’s commitment to realising the UN Sustainable Development Goals,
including through the development of indicators
could further contribute to the
monitoring and tracking of Māori health outcomes.
Health Equity
- The
data shows that Māori continue to experience entrenched inequalities in the
enjoyment of the right to health. A snapshot
of some key statistics is attached
as appendix 1. Overall, Māori have higher rates for most health
risks and conditions, and also are more likely than non-Māori to have
unmet
health needs.[21] In relation to
the broader determinants of health, Māori also experience disadvantage
across all socio-economic indicators.
These include higher rates of poverty and
deprivation, family violence, and poorer outcomes in education, employment and
justice.[22] Disparities,
particularly for Māori women and children, are also evident in family
violence data. Family violence directly
contributes to and accompanies a wide
range of health (physical, sexual and mental) and social issues (employment and
education)
and discrimination.[23]
Māori women who are victims of family violence are more likely to
experience racist attitudes and indifference when seeking
help from agencies and
services.
- Around
one in four Māori identify as disabled, and disabled Māori are
particularly vulnerable to poor
outcomes.[24] Almost a third (32%)
of disabled Māori reported their state of health as fair or poor (compared
with 6% of non-disabled
Māori).[25]
- There
is a growing body of research that links discrimination to inequitable health
outcomes.[26]
[27] Experience of racial discrimination
is associated with poor health outcomes and has impact on a wide range of risk
factors. Of note,
studies have found that racism, as a particular and ongoing
stressor, may have a greater impact than more general factors.
[28]
- Recent
data shows that Māori adults were almost twice as likely as non-Māori
adults to have experienced any type of racial
discrimination in the areas of
health care, work or housing.[29]
Māori adults were almost three times as likely as non-Māori adults to
have experienced any unfair treatment on the basis
of ethnicity.
Law and policy responses
- New
Zealand has a publicly funded health system underpinned by a clear legislative
framework, and numerous strategies and policies.
These include the New Zealand
Public Health and Disability Act 2000, which governs public health services and
which has among its
key objectives: to reduce health disparities by improving
the health outcomes of Maori and other population groups. The Act also
makes
explicit reference to the Treaty of Waitangi, and provides for mechanisms to
enable Māori to contribute to decision-making
on, and to participate in the
delivery of, health and disability
services.[30]
- Responsibilities
of District Health Boards under the Act include reducing disparities, improving
Māori health and ensuring that
Māori are involved in both
decision-making and service delivery.
- The
New Zealand Health Strategy (currently being reviewed) deals with the
health system as a whole. The consultation draft of the updated Health Strategy
includes
the following guiding
principles:[31]
- The best health
and wellbeing possible for all New Zealanders throughout their lives
- An improvement
in health status of those currently disadvantaged
- Acknowledging
the special relationship between Māori and the Crown under the Treaty of
Waitangi
- Timely and
equitable access for all New Zealanders to a comprehensive range of health and
disability services, regardless of ability
to pay
- A
high-performing system in which people have confidence
- Active
partnership with people and communities at all levels
- Thinking beyond
narrow definitions of health and collaborating with others to achieve wellbeing.
- The
primary policy document for Māori health is He Korowai Oranga / The
Māori Health Strategy
(2014).[32] The Strategy sets the
overarching framework to guide the Government and the health and disability
sector to achieve the best health
outcomes for Māori. The Pae Ora
framework that underpins the Strategy reflects Māori concepts of health and
wellbeing,
and includes three elements: mauri ora – healthy individuals;
whānau ora – healthy families; and wai ora –
healthy
environments. The framework and strategy is intended to “encourage
everyone in the health and disability sector to
work collaboratively, to think
beyond narrow definitions of health, and to provide high-quality and effective
services”.[33]
- Significantly,
the Strategy refers explicitly to:
- Māori
aspirations and contributions
- Rangatiratanga
(Māori self-determination)
- Equity
- Whānau
(family), hapū (extended family), iwi (tribal) and community
development
- Māori
participation.
- Case
studies of promising and successful Māori health initiatives are profiled
on the Ministry of Health
website.[34]
Whānau Ora
- Whānau
Ora is a cross-government programme that aims to improve the provision of
government services to Māori, by making
them whānau focussed and
whānau-led. The approach is significant in that it is underpinned by
Māori values and concepts,
and seeks to empower families as a whole, rather
than focusing separately on individual members and their problems. The
programme
operates through a system involving:
- Commissioning
agencies which are non-government organisations contracted to fund and
support initiatives
- Provider
collectives which provide health, education, social and other services to
whānau and families in need within their communities
- Navigators
who work with whānau and families to identify their needs and aspirations,
support their participation in education, primary
health and employment, and
link and co-ordinate access to specialist services.
Māori health services
- There
are approximately 72 Māori health providers contracted to district health
boards throughout the country to provide kaupapa
Māori services (ie, based
on indigenous knowledge and
values).[35] In addition, many iwi
(Māori tribes) and other Māori organisations implement their own
health strategies and programmes,
and operate kaupapa Māori health
services.[36] A number of these are
funded through Whānau Ora.
Māori health workforce
- Key
to the success of initiatives for Māori health, is a workforce that is
diverse and reflective of its communities, and which
has the cultural capability
to meet communities’ needs. Increasing and adequately valuing and
supporting the Māori health
workforce, is vital.
- Māori
are under-represented in all regulated health occupations. Māori make up
5% of the total health workforce; around
3% of doctors, 6.5% of nurses and 9% of
midwives. [37]
- The
national organisation representing Māori nurses has, over recent years,
repeatedly raised concerns about the difference in
pay rates available to nurses
working for Māori health services and those employed by
DHBs.[38] While the discrepancy
relates to the different contractual arrangements operating in the different
sectors, it has been an issue
of concern to the NZNO for over a decade, with
little progress apparent.
Rongoā Māori – Traditional health
practices
- Article
24 of the UNDRIP affirms the right of indigenous peoples to traditional
medicines, health practices, and the conservation
of their medicinal plants and
natural resources.
- The
Waitangi Tribunal[39] has examined
issues relating to traditional knowledge, health practices and medicines in its
long-running inquiry into the place
of mātauranga Māori (traditional
knowledge and culture) in New Zealand law, policy and practice. In its 2011
report, Ko Aotearoa Tēnei, the Tribunal discussed the nature of
traditional Māori health practices, and noted that “[t]he practice of
rongoā
and the knowledge and concepts that underpin it are vital aspects of
Māori culture
itself”.[40] The Tribunal
confirmed that rongoā Māori is a taonga under the Treaty, requiring
active protection by the Crown, and further
noted that “even if
rongoā was not the subject of Treaty rights, supporting it would be
justified for its potential contribution
to Māori
health”.[41]
- The
Tribunal noted the significant impact of environmental and social changes upon
rongoā, as well as attempts by colonial governments
to suppress it through
legislation. The Tohunga Suppression Act 1907 (which remained in force
until 1962) which banned the activities of tohunga (expert healers) was, the
Tribunal found, a clear breach
of the Treaty. The practice of rongoā has
also been severely affected by environmental and social changes which have cut
Māori
off from the sources of rongoā.
- The
Tribunal noted that in spite of these factors, rongoā Māori continues
to be practised. However the support from government,
while an improvement on
the past, still “lacked urgency and remains inadequate and in breach of
the Crown’s Treaty obligations”.
Specifically, the Tribunal noted
the “tiny” proportion of government funding allocated to Māori
healing, the growing
demand for rongoā and need for the expansion of
rongoā services.
- The
Tribunal concluded that:
Māori are facing a health crisis. Rongoā has significant potential
to help address that crisis, because of its spiritual
and biomedical qualities,
and because of its potential to bring sick people into contact with the health
system.
The Crown has suppressed rongoā in the past and currently fails to
support it with the energy or urgency required by both the
Treaty and the
Māori health crisis.
- The
Tribunal’s recommendations included that the Crown:
- Recognise that
rongoā has significant potential to improve Māori health
- Expand
rongoā services (for example by requiring primary healthcare organisations
servicing a significant Māori population
to offer rongoā clinics)
- Adequately
supporting the national rongoā association, Te Paepae Matua mō te
Rongoā to play a quality-control role
- Gathering data
on demand for rongoā services.
- The
government has not yet formally responded to the Tribunal’s report with a
timetable for implementation.
- A
2013 survey of Māori engagement in cultural practices found that 11 percent
of Māori adults took part in traditional Māori
healing or
massage.[42] Another 2013 survey of
rongoā (traditional healing) practitioners highlighted a pressing need for
expansion of the rongoā
Māori workforce and training/service funding,
to sustain rongoā practice.[43]
Health issues for Māori children and young
people
- Māori
children and young people are over-represented in negative health outcomes. For
example, around one in five Māori
children has asthma – a rate 1.4
times that of non-Māori
children.[44] Māori children
are almost twice as likely to be either obese or morbidly obese compared with
non-Māori children.[45]
Māori young people have a suicide rate that is 2.8 times higher than that
of non-Māori youth.[46]
Māori children have a higher rate of unmet health needs: Māori
children were 1.4 times more likely not to have accessed
primary health when
they needed it than non-Māori
children.[47] Māori children
are also more likely to be exposed to the risk factors linked to poor health,
social, educational and developmental
outcomes.[48]
Wider determinants of health
- Key
issues affecting the health of Māori children and young people, include
poverty, material deprivation and poor quality housing.
Poverty rates for
Māori children are consistently higher than for European
children.[49] Over the three years
2012–2014, on average, around 33% of Māori children lived in poor
households, compared to an average
of 16% of European children. The higher rates
of poverty and material deprivation seen in Māori children potentially
reflect
the relatively high proportion of Māori children living in sole
parent beneficiary households. On average, during 2012 to 2014,
just under half
(46%) of children living in poverty were Māori or Pacific.
- Disabled
Māori children are particularly vulnerable; experiencing higher rates of
socio-economic disadvantage. Within the Māori
population, disabled people
were more likely than others to live in the most deprived areas and less likely
to live in the least
deprived
areas.[50] Disabled Māori also
tend to have lower levels of educational attainment, and disabled children face
specific barriers in relation
to
education.[51] Other groups that
are particularly vulnerable to poorer outcomes include: children in state care,
children of prisoners and children
in gang families.
- Māori
children are also more likely to live in poor housing conditions. While
Māori make up 14% of the New Zealand population,
they comprise 35% of those
living in severe housing deprivation. Twenty-three percent of Māori
children live in over-crowded
households.[52] Housing issues are
further exacerbated for disabled Māori children: 45 % living in houses
considered cold, 39 % in houses regarded
as damp, and 16% in houses that were
considered not large
enough.[53]
- In
December 2012 the Expert Advisory Group on Solutions to Child Poverty
(“EAG”) – a group of independent experts
commissioned by the
Children’s Commissioner – issued a report containing 78
recommendations that covered a range of areas,
including social security
benefits and tax credits, housing policy, legislative mechanisms, education and
child care, health, employment
and community
strategies.[54] The report
highlighted the need to give specific attention to overcoming inequalities for
Māori and Pacific children, and the
need to consider the issues against the
backdrop of colonisation and its lasting
impacts.[55]
- The
government has introduced new policy measures that reflect the EAG
recommendations. These have included support for food-in-schools
programmes and
increasing the age threshold for free primary healthcare for children from 6
years to 13 years. However, to date the
government is yet to take any steps
towards developing a systemic approach to reducing household income poverty and
its impact on
child health and well-being. The EAG recommended that the
Government develop a systemic, whole-of-government strategy underpinned
by
legislation as “a first step” in addressing child
poverty.[56] Parliament’s
Health Committee has also recommended that the government develop an action plan
for reducing child poverty,
with annual targets and a transparent monitoring
system.[57] In its response to the
Health Committee, the government did not address this recommendation directly
but instead pointed to various
other existing
actions.[58]
Inquiry into determinants of health for Māori
children
- From
2011-2013 a Parliamentary Select Committee Inquiry was conducted into the
‘determinants of health for Tamariki Māori
(Māori
children)’. The Committee’s report was released in 2014, and
included over 40 recommendations relating to:
research and policy; health
services; education; employment and
incomes.[59]
- Key
principles identified included:
- The wellbeing of
Māori children is inextricable from the wellbeing of their
whānau.
- Acknowledging
the importance of collective identity for a Māori child is a first step in
realising the potential of a whānau-centred
approach to their
wellbeing.
- Enduring change
and success for whānau (and therefore Māori children) is possible
where whānau themselves are engaged
in making the decisions that will
affect them.
- The
intergenerational nature of many of the problems facing Māori children be
acknowledged and addressed.
- The application
of the Whānau Ora approach is fundamental.
- The
government response to the Inquiry was issued in 2014, and referred to various
government programmes and initiatives such as He Korowai Oranga / The
Māori Health Strategy and Whānau
Ora.[60]
Climate change
- The
UN Committee on the Rights of the Child has highlighted the relevance of the
environment, and specifically climate change, to
children’s
health.[61] The Committee has
stated:
Environmental interventions should, inter alia, address climate change, as
this is one of the biggest threats to children’s
health and exacerbates
health disparities. States should, therefore, put children’s health
concerns at the centre of their
climate change adaptation and mitigation
strategies.
- This
call has been echoed by health professionals in New Zealand; 16 health
professional groups issued a joint statement, calling
for stronger action across
government.[62] The ‘Joint
Call for Action’ noted (among other points) that:
- Those at highest
health risk from climate change in New Zealand include Māori, Pacific
peoples, children, elderly and low income
people.
- Measures to
address climate change have the potential to widen or reduce existing health
inequities, depending on design and implementation.
- The
actions called for by the coalition of health professionals included:
- Improved health
sector planning to prepare for health impacts of climate change
- Measures that
prioritise and protect groups likely to be worst affected – Māori,
Pacific peoples, children, elderly and
low income people.
- Health
(including equity) Impact Assessment (HIA) to be routinely undertaken to inform
key climate-relevant policies.
Conclusion
- Māori
experience entrenched health inequalities, and Māori children and young
people and disabled Māori are particularly
vulnerable in this respect. In
response, a range of initiatives are attempting to address these. There is
increasing understanding
and awareness of structural barriers; widening
acceptance of the fact that one size doesn’t fit all; and a range of
policies
and programmes that incorporate and provide for Māori values and
world views. He Korowai Oranga / The Māori Health Strategy is key
among these, and is significant in the extent to which it reflects and is
underpinned by Māori values and concepts.
It also makes explicit
references to the Treaty of Waitangi and to human rights concepts including
self-determination and participation.
- There
is some government support also for traditional Māori health practices,
although a recent Waitangi Tribunal report found
that the nature and level of
support needs considerable strengthening.
- Māori
children and young people are particularly vulnerable to poor health outcomes.
Poverty, substandard housing conditions
and the impacts of climate change are
key issues affecting the health of Māori children. Climate change poses a
further threat
to indigenous children’s health, although there is also
potential for strong responses to climate change which could provide
opportunities to address (rather than exacerbate) existing health disparities.
- Māori
concepts of health and well-being are holistic, encompassing physical,
spiritual, emotional, environmental, individual
and collective wellbeing.
Enjoyment of the right to health is inextricably linked to the realisation of a
range of rights. Advancing
indigenous people’s right to health requires a
systemic response to implementation of the UNDRIP, and an approach which
encompasses
the full range of human rights. The participation of indigenous
peoples, and support for the indigenous health workforce are key
to achieving
progress. Addressing the health of indigenous children and young people must be
a particular priority, and should not
be in isolation of their family and
community.
- The
Commission appreciates the opportunity to make this submission and would welcome
the opportunity to engage further with EMRIP
as it continues its study on the
right to health.
Appendix: Data
The
life expectancy gap between Māori and non-Māori has been steadily
narrowing, but remains significant: in 2013, life
expectancy at birth was 73.0
years for Māori males and 77.1 years for Māori females; it was
80.3 years for non-Māori
males and 83.9 years for non-Māori
females.[63]
Māori have
higher rates than non-Māori for many health conditions and chronic
diseases, including cancer, diabetes, cardiovascular
disease and asthma.
Māori also experience higher disability
rates.[64] The 2013 Disability
Survey identified one in four Māori as
disabled.[65]
A recent
international cancer study found
that:[66]
- Lung cancer
rates were four times higher among Māori women and 2.5 times higher among
Māori men
- Stomach and
liver cancer rates were more than double among Māori
- Smoking was the
biggest determinant of lung cancer
- Smoking rates
among Māori women were the highest in the study
- Overall
Māori die eight years earlier than non- Māori
- Childhood
poverty increased the likelihood of cancer in adult
Māori.
Māori adults and children were also more likely
than their non-Māori counterparts to have unmet health needs.
[67] Identified barriers where the
difference was significant included in relation to cost, childcare availability
and transport.
- Lack of child
care was about twice as likely to be a barrier that prevented Māori parents
taking their children to a GP as it
was for non-Māori parents
- Māori
children were more than 3 times as likely as non-Māori children to have
experienced an unmet need for a GP due to
lack of transportation
- Māori
children were more than 5 times as likely as non-Māori children to have
experienced an unmet need for after-hours
services due to a lack of
transportation The disparity was greater for Māori girls compared with
non-Māori girls.
- Māori
adults were more than 1.5 times as likely as non-Māori adults to have
experienced an unmet need for a GP due to cost
- Lack of
transport was more than twice as likely to be a barrier to accessing GP services
for Māori adults as it was for non-Māori
adults
- Cost was almost
twice as likely to be a barrier to accessing after-hours services for Māori
adults as it was for non-Māori
adults
- Lack of
transport was nearly 3 times as likely to be a barrier to accessing after-hours
services for Māori adults as it was for
non-Māori adults. The
disparity was greater for Māori males compared with non-Māori males.
[1] The right to health is
expressly referred to in a number of core human rights instruments which have
been ratified by New Zealand:
- Convention on
the Elimination of all Forms of Racial Discrimination (CERD): Article
5(e)(iv),(1965)
- International
Covenant on Economic, Social and Cultural Rights (ICESCR): Article 12
(1966)
- Convention on
the Elimination of All Forms of Discrimination against Women (CEDAW): Articles
11(1)(f), 12 and 14 (2)(b) (1979)
- Convention on
the Rights of the Child (UNCROC): Article 24 (1989)
- Convention on
the Rights of Persons with Disabilities (CRPD): Article 25(2006)
In
addition, New Zealand has also committed to the Sustainable Development Goals,
which include Goal 3: Ensure healthy lives and promote
wellbeing at all ages,
along with a range of related targets.
[2] UN Committee on Economic,
Social and Cultural Rights, (2000), General Comment No. 14: The right to the
highest attainable standard of health, E/C.12/200/4.
[3] Preamble to the Constitution
of the World Health Organisation. Accessible online at http://www.who.int/about/definition/en/print.html
[4] UN Commission on Human Rights
(2003), Economic, social and cultural rights: The right of everyone to the
enjoyment of the highest attainable standards of physical and mental
health:
Report of the Special Rapporteur, Paul Hunt, (E/CN.4/2003/58,13
February). Accessible online at http://ap.ohchr.org/documents/dpage_e.aspx?m=100
979.pdf
[5] UN Committee on the Rights of
the Child, (2013), General Comment No. 15 on the rights of the child to the
highest attainable standard of health, CRC/C/GC/15. Accessible at: http://tbinternet.ohchr.org/_layouts/treatybodyexternal/Download.aspx?symbolno=CRC%2fC%2fGC%2f15&Lang=en
[6] UN Committee on the Rights of
the Child, (2009), General Comment No.11: Indigenous children and their right
to health under the Convention, CRC/C/GC/11. Accessible at: http://tbinternet.ohchr.org/_layouts/treatybodyexternal/Download.aspx?symbolno=CRC%2fC%2fGC%2f11&Lang=en.
[7]
Waitangi Tribunal 1992 Te Roroa Report. Brooker and Friend p 210.
[8] See: http://www.health.govt.nz/publication/dhb-maori-health-profiles
[9] See: http://www.health.govt.nz/publication/annual-update-key-results-2014-15-new-zealand-health-survey
[10] See: http://www.health.govt.nz/about-ministry/corporate-publications/health-and-independence-reports
[11] See: http://www.health.govt.nz/publication/tatau-kahukura-maori-health-chart-book-2015-3rd-edition
[12] See: http://www.stats.govt.nz/maori#health
[13] See: http://www.health.govt.nz/publication/report-performance-general-practices-whanau-ora-collectives-june-2015.
See below at p 6 for further information on Whānau Ora.
[14] See: http://www.stats.govt.nz/tekupenga
[15] See: http://www.stats.govt.nz/browse_for_stats/snapshots-of-nz/te-ao-marama-2014.aspx
[16] See: http://www.stats.govt.nz/browse_for_stats/people_and_communities/maori/te-kupenga/determinants-life-satisfaction-maori.aspx
[17] See: http://www.treasury.govt.nz/abouttreasury/higherlivingstandards
[18] http://www.stats.govt.nz/browse_for_stats/snapshots-of-nz/integrated-data-infrastructure.aspx
[19] http://www.treasury.govt.nz/publications/research-policy/ap/2015
and http://www.treasury.govt.nz/publications/research-policy/ap/2016
[20] http://npa.hrc.co.nz/#/
[21]Ministry of Health, (2015),
Annual Update of Key Results 2014/15: New Zealand Health Survey, at p
viii. Accessible at: http://www.health.govt.nz/publication/annual-update-key-results-2014-15-new-zealand-health-survey
[22] Eg, Ministry of Health
(2015), Health and Independence Report 2015, (Wellington: MoH), at
p6. http://www.health.govt.nz/system/files/documents/publications/health-and-independence-report-2015-oct15.pdf.
[23]
Family Violence Death Review Committee, (2016), Fifth Report: January 2014 to
December 2015. Accessible at: http://www.hqsc.govt.nz/our-programmes/mrc/fvdrc/publications-and-resources/publication/2434/
[24] Statistics NZ, (2013),
He Hauā Māori: Findings from the 2013 Disability Survey.
Accessible at: http://www.stats.govt.nz/browse_for_stats/health/disabilities/He-haua-maori-findings-from-2013-disability-survey.aspx
.
[25] Ibid.
[26] Moewaka Barnes, A., et al,
(2013), ‘Māori experiences and responses to racism in Aotearoa New
Zealand’, MAI Journal Vol.2, 2, pp 64-77. Accessible online at: http://www.journal.mai.ac.nz/sites/default/files/MAI%20Journal%20Vol.2_2%20pages%2063-77%20Moewaka%20Barnes%20et%20al..pdf.
At p 73
[27] Ministry of Health,
(2015). Tatau Kahukura: Māori Health Chart Book 2015 (3rd edition).
Wellington: Ministry of Health. At pp 14-15.
http://www.health.govt.nz/publication/tatau-kahukura-maori-health-chart-book-2015-3rd-edition
[28]
Moewaka Barnes, A., et al, (2013), ‘Māori experiences and responses
to racism in Aotearoa New Zealand’, MAI Journal Vol.2, 2, pp 64-77.
Accessible online at: http://www.journal.mai.ac.nz/sites/default/files/MAI%20Journal%20Vol.2_2%20pages%2063-77%20Moewaka%20Barnes%20et%20al..pdf.
At p 73
[29] Ministry of Health,
(2015). Tatau Kahukura: Māori Health Chart Book 2015 (3rd edition).
Wellington: Ministry of Health. At pp 14-15.
http://www.health.govt.nz/publication/tatau-kahukura-maori-health-chart-book-2015-3rd-edition
[30]
New Zealand Health and Disability Act 2000. Accessible at: http://legislation.govt.nz/act/public/2000/0091/latest/DLM80051.html
[31] Ministry of Health,
(October, 2015), Update of the New Zealand Health Strategy: All New
Zealanders live well, stay well, get well: Consultation draft, at p 9.
Accessible at:
http://www.health.govt.nz/system/files/documents/publications/update-new-zealand-health-strategy-consultation-draft-oct15_0.pdf.
[32]
S. 22(1), New Zealand Health and Disability Act
2000.
[33] http://www.health.govt.nz/our-work/populations/maori-health/he-korowai-oranga
[34] See: http://www.health.govt.nz/our-work/populations/maori-health/maori-health-case-studies
[35] See: http://www.health.govt.nz/our-work/populations/maori-health/maori-health-providers
[36] For example: http://www.waipareira.com/index; http://www.ngatiwhatua.iwi.nz/manaakitanga/te-ha-oranga;
http://www.raukura.org.nz/index.asp?pageID=2145877094.
[37] Ministry of Health, (2016),
Health of the Health Workforce 2015. Accessible at: http://www.health.govt.nz/publication/health-health-workforce-report-2015.
Medical Council of NZ, (2015), The New Zealand Medical Workforce 2013-14,
at p 24. Accessible at: https://www.mcnz.org.nz/assets/News-and-Publications/Workforce-Surveys/2013-2014.pdf.
Ahuriri-Driscoll A et al., (2015), ‘Mā mahi, ka ora: by work, we
prosper – traditional healers and workforce development’,
NZ Medical
Journal, 2015;128(1420):34-44. Accessible at: http://www.nzma.org.nz/__data/assets/pdf_file/0007/43954/Ahuriri-Driscoll-13661420.pdf.
[38]
‘Māori Nurses Missing Out’, Waatea News, 15 August 2013.
Accessible at: http://www.waateanews.com/Waatea+News.html?story_id=NTE1MA.
See also: http://www.parliament.nz/en-nz/pb/presented/petitions/48DBHOH_PET2921_1/petition-of-ngaitia-nagel-and-11370-others-requesting.
[39] The Waitangi Tribunal is a
permanent Commission of Inquiry mandated to consider claims relating to
Government actions or omissions
which may breach the principles of the Treaty.
[40] Waitangi Tribunal, (2011),
Ko Aotearoa Tēnei: Factsheet 8 – Rongoā (Traditional
Māori Healing). Accessible at: http://www.justice.govt.nz/tribunals/waitangi-tribunal/documents/generic-inquiries/flora-and-fauna/wai-262-rongoa-traditional-maori-healing.
[41]
Ibid.
[42] Statistics NZ, (2014),
Te Kupenga 2013, at p 6. Accessible at: http://www.stats.govt.nz/browse_for_stats/people_and_communities/maori/TeKupenga_HOTP13.aspx
[43] Ahuriri-Driscoll A et al.,
(2015), ‘Mā mahi, ka ora: by work, we prosper – traditional
healers and workforce development’,
NZ Medical Journal,
2015;128(1420):34-44. Accessible at: http://www.nzma.org.nz/__data/assets/pdf_file/0007/43954/Ahuriri-Driscoll-13661420.pdf.
[44] Ministry of Health,
(2015), Annual Update of Key Results 2014/15: New Zealand Health Survey,
at p 51. Accessible at: http://www.health.govt.nz/publication/annual-update-key-results-2014-15-new-zealand-health-survey
[45]
Ibid., at p 17.
[46]
Ibid., at p 19.
[47]
Ibid., at p viii.
[48] Ministry
of Health, (2015), Health and Independence Report 2015, at pp 32-33.
Accessible at: http://www.health.govt.nz/system/files/documents/publications/health-and-independence-report-2015-oct15.pdf.
[49]
Simpson J, Duncanson M, Oben G, Wicken A, Pierson M., (2015), Child Poverty
Monitor 2015 Technical Report, Dunedin: NZ Child and Youth
Epidemiology Service, University of Otago; 2015. Accessible at: http://www.nzchildren.co.nz/#.
[50] Statistics NZ, (2013),
He Hauā Māori: Findings from the 2013 Disability Survey.
Accessible at: http://www.stats.govt.nz/browse_for_stats/health/disabilities/He-haua-maori-findings-from-2013-disability-survey.aspx.
[51]
Ibid.
[52] Simpson J, Duncanson
M, Oben G, Wicken A, Pierson M., (2015), Child Poverty Monitor 2015
Technical Report, Dunedin: NZ Child and Youth Epidemiology Service,
University of Otago; 2015. Accessible at: http://www.nzchildren.co.nz/#.
[53]
Statistics NZ, (2013), He Hauā Māori: Findings from the 2013
Disability Survey. Accessible at: http://www.stats.govt.nz/browse_for_stats/health/disabilities/He-haua-maori-findings-from-2013-disability-survey.aspx.
[54]
Children’s Commissioner’s Expert Advisory Group on Solutions to
Child Poverty, (2012), Solutions to Child Poverty in New Zealand: Evidence
for Action. Accessible at: http://www.occ.org.nz/assets/Uploads/EAG/Final-report/Final-report-Solutions-to-child-poverty-evidence-for-action.pdf
[55] Ibid., at
p13.
[56] Ibid., at p
vii.
[57] Health Committee,
(2014), Report of Health Committee on Inquiry into improving child health
outcomes and reducing child abuse with a focus on preconception
until three
years of age, Recommendation 5. Accessible at: http://www.parliament.nz/en-nz/pb/sc/business-summary/00DBSCH_INQ_11221_1/inquiry-into-improving-child-health-outcomes-and-preventing.
[58] Government response to
Report of Health Committee on Inquiry into improving child health outcomes and
reducing child abuse with a
focus on preconception until three years of age,
(2014), at page 9. Accessible at: http://www.parliament.nz/en-nz/pb/presented/papers/50DBHOH_PAP25992_1/government-response-to-report-of-the-health-committee-on.
[59] Māori Affairs
Committee, (2014), Inquiry into the Determinants of Health for Tamariki
Māori. Accessible at: http://www.parliament.nz/resource/en-nz/50DBSCH_SCR6050_1/bbe4e16f5d440017fd3302f051aca3edff179b7f.
[60] Government Response to
Māori Affairs Select Committee Inquiry into the Determinants of Wellbeing
for Tamariki Māori, (2014). Accessible at: http://www.parliament.nz/resource/en-nz/50DBHOH_PAP26103_1/2e33f98fcf911cafeb661335e2c181cea9164a11
[61] UN Committee on the Rights
of the Child, (2013), General Comment No. 15 on the rights of the child to
the highest attainable standard of health, CRC/C/GC/15. Accessible at: http://tbinternet.ohchr.org/_layouts/treatybodyexternal/Download.aspx?symbolno=CRC%2fC%2fGC%2f15&Lang=en
[62]See: http://www.orataiao.org.nz/joint_nz_health_professional_s_call_for_action_on_climate_change_and_health
[63] NZ Social Indicators
– health: http://www.stats.govt.nz/browse_for_stats/snapshots-of-nz/nz-social-indicators/Home/Health.aspx
[64]
Ministry of Health, (2015). Tatau Kahukura: Māori Health Chart Book 2015
(3rd edition). Wellington: Ministry of Health.
http://www.health.govt.nz/publication/tatau-kahukura-maori-health-chart-book-2015-3rd-edition
[65]
Statistics New Zealand (2015). He hauā Māori: Findings from the
2013 Disability Survey. Available at: http://www.stats.govt.nz/browse_for_stats/health/disabilities/He-haua-maori-findings-from-2013-disability-survey.aspx
at pp11-12
[66] http://www.scoop.co.nz/stories/GE1510/S00079/reducing-cancer-inequalities-in-maori-a-priority.htm
21 October 2015
[67] Ministry of
Health, (2015). Tatau Kahukura: Māori Health Chart Book 2015 (3rd
edition). Wellington: Ministry of Health. http://www.health.govt.nz/our-work/populations/maori-health/tatau-kahukura-maori-health-statistics/nga-ratonga-hauora-kua-mahia-health-service-use/primary-health-care
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