The 'Authoritative' View: Māori Health Authority with executive decision-making sovereignty

Last night, the NZ Doctor and He Ako Hiringa hosted a webinar to start a discussion about this topic- Commissioning possible: A Māori health agency.. There were many great questions posed, but they were not all able to be addressed. Perhaps this can be a place to continue those discussions. I will post a start to some of the questions I recall, that can be replied to.

Please select a question of interest to you, by highlighting the question. Then click on the quotes icon that should appear (image). This will open a reply-post for you that directly references the text you are replying to.

  • Given the known impacts of social determinants of health (e.g., housing, access to education/employment, justice system, etc.), which contribute to rates of smoking and access to healthy diets among many other factors, how will an MHA with executive decision-making authority address these differently than the status quo?
    Discussion found here- The 'Authoritative' View: Social Determinants of Health & MHA with excutive decision-making sovereignty

  • What are the different understandings around the terms associated with executive decision-making? (e.g., sovereignty, commissioning, procurement, contracts, etc.)

  • For services governed by MHA, will there be inclusion/exclusion eligibility criteria? How does self-identified ethnicity and acestry factor into the services governed by MHA?

    [My personal thoughts would be that any service that uses public funding must be required to collect ethnicity data, and that the governance of this data, as it pertains to people who identify as Māori, will be carried out by the MHA.]

  • As Te Tiriti is the founding document of the modern state of Aotearoa NZ, it is a document that only exists because two parties partnered to sign it: Māori and the Crown. The obligation to achieve all the same rights, including health, between the two parties, can only be met if this signing partnership is maintained. Therefore, having a MHA as equal party to the Crown’s MOH is Te Tiriti compliant. Given our current mono-governance structure (e.g., MOH) has not addressed the health needs of other groups who contend with inequities (e.g., Pasifika), how will an MHA contribute to equity for these non-Māori groups?

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3 posts were merged into an existing topic: The ‘Authoritative’ View: MHA & Social Determinants of Health

Thanks for posting this Emily. I enjoyed the popcorn panel as an opportunity to think about these issues more. I haven’t been able to formulate a reply to any of the questions yet but didn’t want to read and run. I will have more to say soon…

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Tena koe Emily
Words are just words and interpretation like history will be pertinent to the day and the particular conversation. The risk with health is falling into the trap of using “business speak” to describe a much broader context of funding and managing wellbeing. Commissioning to me is a wider description and enables interpretation by action and supported by action research. Commissioning can be influenced by “what matters to Whanau “ through the action research . Procurement and contracting are by my definition more a “master servant relationship “ with decision already made on outcome before the product gets to market.

I would value our readers interpretation of commissioning from an historical culturally safe perspective .

Check out the delivery of the petition in support of an independent and empowered Māori Health Authority that can commission and govern health services by and for Māori:

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That was one windy Wellington day! Kudos to you @emily.gill for your ongoing passion and commitment to innovative and culturally effective ways to improve Maori health in Aotearoa.

My Pakeha brain is wary of increasing the complexity of health governance in New Zealand, which this would do. On the other hand, we don’t seem to have been making much progress in Maori health with the status quo and perhaps this would be the empowering change that is needed.

Kia ora @Nathan :wink: Yes, it is exciting times and thank you for acknowledging :wink: My perspective is that the current complexity is because of foundational problems so the complexity derives from putting on lots of band-aids. If we change the foundation of governance, because this is the proposed solution put forward by experts in health system approaches, this may be the only way to reduce complexities.

I like this quote:

We want people to understand the actual Te Tiriti articles — that sovereignty was not ceded to the British Crown but that the relationships imagined in 1840 can provoke an ongoing journey to re-imagine the way we can share power in Aotearoa.

Like a healthy, fair partnership of marriage/co-parenting, that might seem to be more complex than single-parenting, regardless of the inevitable differences in opinion my husband and I have at times, on child-rearing approaches, there is no question in my mind, single-parenting would be a whole lot worse :wink: