Dr Heather Came advocates a new tool for evaluating health policy in relation to te Tiriti o Waitangi.
Critical te Tiriti Analysis (CTA) is a five-step process for policymakers, decisionmakers, advisory groups and interested citizens to strengthen and review public policy in relation to the articles and provisions of te Tiriti o Waitangi (the Māori text signed in 1840).
CTA evaluates the strength of Māori participation in policymaking and the extent to which Māori aspirations and expectations are positioned to influence policy.
The project was led by Dr Came, a senior lecturer based at AUT’s Taupua Waiora Centre for Maori Health Research.
“Critical te Tiriti analysis may be useful to strengthen alignment with te Tiriti and the pursuit of equitable outcomes. It looks at policy rhetoric and the policymaking process in detail,” says Dr Came.
A previous study shows that health policy documents under the Clark and Key governments, from 2006 to 2016, rarely addressed te Tiriti or the Treaty.
Dr Came says, it is timely to reconsider te Tiriti and its place in health policy, given the compelling evidence presented at the Waitangi Tribunal Health Services and Outcomes Inquiry (WAI 2575), the government’s commitment to health equity and this year’s general election.
In an academic paper, published in the January issue of the UK journal Ethnicities, she provides a working example of CTA using New Zealand’s Primary Health Care Strategy (PHCS). The retrospective review of this policy reveals that it is poorly aligned with the articles and provisions of te Tiriti.
The PHCS does clearly attempt to address health equity. It recognises that Māori carry a disproportionate burden of disease, but it is orientated to the universal rather than needs-based provision of services. Despite wairuatanga (spirituality) being central to Māori health, it is silent in this respect.
“The enduring life expectancy gap between Māori and non-Māori suggests that the Primary Health Care Strategy has failed to deliver its promise of health equity. Quality and quantity of life should always be key measures of the performance of the health system and health policy,” says Dr Came.
“A revised strategy needs to address racism and other determinants of health and wellbeing, contemporary and historical. It would also need to engage the work of Māori academics.”
Stronger policy around health equity and social justice requires that policymakers are explicit in their policymaking processes.
“Being transparent about what evidence has informed policy is crucial. Explaining the extent of Māori participation in a policy’s authorship and whether a Māori advisory group has been involved in its development would be valuable. Where appropriate, naming the advisory members or describing their expertise would also be helpful,” says Dr Came.
“Structurally and operationally, all providers and funders of health services need to be monitored and held accountable for their performance in relation to Māori health outcomes. The health workforce, at all levels, requires the political and cultural competencies to work effectively with Māori,” says Dr Came.
These broad competencies are important, because more than 50 per cent of Māori deaths are attributable to avoidable causes.
CTA was developed for the health sector, but Dr Came says the process might usefully be applied far wider. She hopes that the framework will be challenged, debated, adapted and adopted as a tool for evaluating all public policy.