- [Alice] Healthcare.
One of New Zealand's favourite types of care,
after "I don't care","Why do you care?" and "Should I care?"
For most of us, our free healthcare system is something
we get to lord over others, but while we've been
busy showing off, it's been busy under-delivering
for Māori, resulting in a life expectancy
that's seven years less than Pākehā.
So how come when there's a global pandemic
we can get our shit together instantly,
but faced with systemic inequality, we consistently fail?
Are they gonna actually fix it, and am I going
to the doctor too much?
We're here in my childhood home.
It is an embarrassment of riches,
and I am here to go through some of my medical history.
I've been to my GP, and I've got them to print off
all my bills, so we're just gonna go through it.
God, I've had so many haemorrhoids!
♪ Ooh, Ahh ♪
♪ She's got bad news ♪
So, we've been looking into healthcare in New Zealand,
public healthcare, and what we've found is that Māori
get the shit end of it, pretty badly.
- Oh, yeah.
- Correct.
(laughs)
- [Alice] Don't be diplomatic, at all, please.
As a Pākehā person, obviously, I get beautiful,
stunning service.
- OK, rub it in.
(laughs)
- It's about Māori getting less care,
and poorer-quality care.
- Fuck.
- It's that simple.
Some research has been done about if you turn up
at A&E with the symptoms of a heart attack,
and you're Māori and non Māori,
you'll get offered different treatment.
The Pākehā person will be offered the more expensive
and more aggressive treatment, and Māori don't
always get asked if they've got health insurance,
and just get offered less options.
- I mean, obviously that's probably something
that you're familiar with.
- Yeah, that's like the story of my life.
(laughs)
- How is the public health system servicing Māori?
- Well, the short answer is that it's not
because it's not set up to serve Māori.
It's not providing accessible services for whānau
in poverty, and poverty obviously links back
to colonisation.
And then it's not prioritising cultural practises
that will benefit Māori.
- Oh no, this is so humiliating.
2013, episodes of diarrhoea.
(laughs)
Abdominal bloating and flatulence.
(laughs)
One of the discrepancies between Māori and Pākehā
that we can measure is that Māori life expectancy
is kind of roughly in the range of seven years lower
than Pākehā.
- Depending on where you live in New Zealand.
- Right.
- 'Cause when I was doing my PhD, I was living
in Whangārei, and in the far north at that time,
it was a 15 year life expectancy gap.
- Holy.
- Every week, there would be a tangi, or a preventable
death from somebody that didn't need to die
if the health sector had been more responsive
to the needs of Māori.
It's a devastating and outrageous inequity
that we need to sort out quick smart.
- In terms of wait times, in hospitals,
we're likely to wait longer and be seen for shorter.
- What the?
- Yeah, and implicitly, as Māori, we know that these biases
are upon us, so we're always kinda like counter-biasing.
So, trying to match it.
- How do you match it?
- By saying, "You gotta see me first."
(laughs)
And then, if they say no, then you're like,
"Oh, well it's 'cause you're racist."
(laughs)
- As it stands, do you think that the health system
has an issue with institutional racism?
- Completely, it does, absolutely.
If you think about Māori at the time of Cook,
what started there was a very different process
to what had been going on for hundreds of years prior.
You've got the disease that the British brought with them,
you've got the 1907 Tohunga Suppression Act,
which means that the ability of Māori to actually
address their own health issues using their own
cultural lens is suppressed.
The traditional ways of keeping yourself well were outlawed.
- They were legislatively outlawed?
- Legislatively outlawed.
- [Alice] Wow.
Do you think it's a hard sell to other people
of your demographic, the idea that life expectancy now
can, in any way, be linked back to Cook
and first encounters?
- That is probably a hard sell, but it doesn't make
it less true.
- Yeah.
- If you're any way sentinent about the way
we've established ourselves, then you have to actually
get to grips with the fact that it hasn't
always been pretty.
- Oh, do you know what's a funny story,
is when I was 15, I got ovarian cysts,
and I had to have them removed surgically,
and I woke up from the surgery, and they'd put
a catheter in me, and they were telling me about it,
and I didn't fully understand what a catheter was
at the time, and I thought I'd lost my virginity.
(laughs)
- There is just no choice.
For most Māori, it's; you either go in the public
health system, or you have private health insurance.
Those are the only two ways health is delivered
in New Zealand.
So in April 2018, Ngāti Whātua Ōrākei partnered
with NIB to deliver a comprehensive universal
health insurance programme for all of Ngāti Whātua Ōrākei
members living in New Zealand.
So it covers everything, from a GP to any kind of surgery
you need, and everything in between that.
Specialist care, follow up care, post-op.
- Was it a hard sell to the Hapu?
The idea that you were gonna privately
health insure everyone?
- Some thought it was actually too good to be true.
- Yeah!
- So, they showed it to the Hui like; "Is this a scam?"
(laughs)
But no, it's not, it's been quite positive, I reckon.
- There's a peace of mind that comes with knowing
that you have private health insurance,
so whatever health need you have, it can be taken care of.
- Theoretically, though, that should be happening
in the public system, right?
- Mm, they're clear on it, but where's the action ...
- [Alice] Yeah.
- In Auckland District Health Board, we have 10 and a half
thousand people that work for us, right?
- Yeah.
- We have a nursing population of over 5,000 people,
and 90 of those are Māori.
- Fuck.
- You've got to have a very high awareness
in the non-Māori working population inside
the health system, who are cognisant of the kind
of attributes Māori would see to be important
in their own space, and that higher degree of awareness
is nowhere near where it needs to be.
- I've identified particular parts in the policy cycle
where the racism seeps in.
- Right, okay.
- So, one of the things that happens is that,
when you look at policy documents, it's very rare
for Māori academics to be cited.
(scoffs)
If they don't cite Māori academics, they're not engaging
with what works for Māori.
- It's so embarrassing at all the levels at what
it operates at.
- There's some great opportunities to strengthen practise.
(laughs)
- Because public health's so broad, effectively,
indigenous sovereignty is public health.
- What does that mean; indigenous sovereignty
is public health?
- So, often we compartmentalise everything.
So, if you got diabetes, you just have diabetes.
But the reality is that you're more likely to have diabetes
if you are in poverty, if you live in communities
with poor urban build, and there's so many compounding
factors, so if we resource Māori communities,
Māori whānau, hapu and iwi to self-determine
what well-being looks like for them, that's a good solution.
We're never gonna rid ourselves of colonisation.
It's always going to be written into our history.
- I'm so sorry about that.
(laughs)
- I feel like that's my first real apology
on that, actually.
(laughs)
- Oh, fucking hell.
- My understanding is still that, less than 3%
of the vote health is spent in Māori health.
- Less than 3%?
- Correct.
- Is spent in Māori health?
- Correct.
- What the-
- I know that takes a moment.
Māori have the majority of the burden of disease,
so for that reason, they should have more than 3%.
- Yeah.
- The fact that they're treaty partners means they should
have more than 3%, so it is-
- That's shocking.
- Scandalous, but that's part of why we have the inequities
in Māori health, is the amount of investment in it.
- What is the cost, if you don't mind saying?
- So for-
- Of insuring people.
- If all of our members go into the scheme,
it's gonna cost $3 million annually.
- Okay, so it's a sizable chunk of money.
- Yeah, and what we're paying per person is a quarter
of what the DHBs get subsidised for our members' care.
- Sorry, can you explain that again?
- DHB gets this.
- [Alice] Yeah.
- We're paying this.
- And we're getting better outcomes out of this through-
- What?
- Through our own money going toward it.
- So the DHB have this much money per person
for shit outcomes, and you guys have this much
money per person-
- Well, that's what we're paying per person.
- [Alice] Per person to get-
- And getting awesome service.
- So there's just something fundamentally wrong then,
in the public health system, if that's the case.
- Yeah.
- You're in control of the DHB, and you think
all of this stuff.
What are the obstacles in the way of just being like,
"Fuck it, let's actually invest in them
as a treaty partner?"
- Well-
- If we know all of this shit, what is it
that gets in the way?
- That people don't share that view, universally, yeah.
- Oh, okay.
(laughs)
That's a fairly big obstacle.
- Yeah.
- This might be a stupid question, but shouldn't
the boards themselves just be half Māori?
- Well, the first thing you strike is the population
argument; that Māori are 15 or 16% of the population,
and therefore, the resources can't possibly go
to greater than 15 and 16%.
The counter to that is that the resources that we've
been putting in at the moment have secured Māori
the position of being way behind Pākehā in terms
of their life expectancy.
Therefore, the argument for a change is pretty slam dunk
because if you keep doing what you're doing,
you're gonna keep getting what you're getting.
- From my perspective, we should have a Māori led
health system.
So if Māori control the money ...
- That's more percentage.
- Yes, isn't it?
- Fuck yeah, you're right, yeah.
- If it means that we've got equitable quality
and quantity of life between Māori and non-Māori,
if we shift some things around and reallocate
some resources, and have some Māori leadership
over health budget, that sounds an excellent idea to me.
- My stomach in the middle of the night
was just like, so sore, and I woke up my friend,
I was like, "You need to take me to the doctor."
Oh, also, it was New Year's Eve.
(laughs)
Anyway, went into surgery, had my appendix out,
turned out what had actually happened was that
a bunch of cysts had burst, and my appendix
was slightly inflamed, but not properly,
but they whipped it out anyway, and then that night,
New Year's Eve, I was in hospital, and all the nurses
came round, and they were like, "Hey, we're going
to such and such's room to watch the fireworks
because there's a good view from there."
So then we all went into this patient's room
who was in a coma.
(laughs)
And watched the fireworks display.
- We're about 16 months into the plan now,
and we've paid about 4,000 claims so far.
While I would like to say, "Yes, we've saved the planet."
I mean, you can walk around and see someone,
"Oh, he's had a new hip, he's got new eyes."
- New eyes?
- Yeah.
- All right.
(laughs)
- We need to do something now.
We're taking a stance now, let's see how this goes.
If it works for whānau, then we have something to take
back to the public health system and say,
"Hey, we've done this, how do we get the best
for our whānau?"
- Yes, we got a settlement, and yes, the general population
thinks that we should get over it, but we're trying
to combat 180 something years of colonisation.
So, the way to address that is to resource iwi
and organisations who are servicing Māori well
to promote wellbeing from the outset.
Don't wait 'till they're sick to say;
"Hey, we're gonna invest in the wellbeing of this child."
- It's ambulance at the bottom of the cliff.
- Yeah, and that ambulance drove away, it's gone.
(laughs)
There's nothing left for us.
- That's a good joke.
That's so sad.
- It is sad.
Sad afternoon.
♪ Ooh, Ahh ♪
♪ She's got bad news ♪
- Anal skin tag.
(laughs)