Doctor in the house
He’s the first Māori minister of health in nearly 99 years, but it took Dr Shane Reti fewer than 99 days to scrap Te Aka Whai Ora Māori Health Authority, which Māori health advocates spent years fighting for. Jeremy Rose talks to Reti about his first few months in the job and his priorities for the future.
By Jeremy Rose
In February 2021, National Party health spokesperson Shane Reti wrote to Labour Minister of Health Andrew Little asking that tens of millions of dollars be spent equipping Māori health providers to roll out a Covid vaccination programme.
“I am of a view that the current coronavirus pandemic and the need to roll out a comprehensive vaccination program is a one-in-100-year opportunity for Māori and iwi health providers to demonstrate some of what they are best at doing. This is especially so for embracing hard-to-reach communities such as remote rural,” he wrote.
Sitting in his Beehive office, Shane Reti says he would argue exactly the same thing today.
“I said, ‘We need to back Māori health providers. They are doing what the mainstream cannot, or will not do.’ And it’s the same today.”
In a previous life, Reti was the sole Māori doctor in Northland and the head of a marae-based health service.
Reti has an up-to-date GP practising certificate and has continued to help out on the medical frontlines since becoming the National Party MP for Whangārei in 2014.
His last stint as a locum was between last year’s election and the government being sworn in.
In 2018, he took time out from his MP duties to vaccinate children at Hikurangi School against meningitis. The Northland DHB’s meningococcal vaccine campaign had been limited to children between nine months and four years and 13 to 19. Hikurangi parents raised the $20,000 needed to have their children vaccinated following the death of seven-year-old Alexis Albert from meningitis. A former Northland DHB member, Reti was publicly critical of its response to the meningitis outbreak.
So, on one level there’s nothing surprising about Reti’s letter. But the issue of Māori self determination in health remains a political hot potato, just as it was in the early 2000s, when the Helen Clark government dropped its “Closing the Gaps” policy following a public backlash.
Reti’s letter was in effect a blank cheque to the Labour government to turbo-charge the vaccine rollout by handing the reins to Māori.
Public health experts and the Māori medical community had been warning that Māori were likely to be hardest hit when Covid finally arrived in Aotearoa, and that New Zealand risked a repeat of the Spanish flu epidemic of 1918, when Māori by some estimates died at eight times the rate of Pākehā.
The cheque wasn’t cashed, with the government opting for a whole-of-population strategy with DHBs — not Māori and iwi health providers — in the driver’s seat when it came to the Māori vaccination campaign. Over the following year, Māori Covid vaccination rates lagged behind the general population, with many Māori and non-Māori public-health experts blaming the government’s failure to back the sort of campaign called for by Shane Reti.
So, does he think it was a missed opportunity that ultimately would have saved lives?
“Look, that’s hard to project back,” Reti says in a tone that’s more concerned GP than media trained politician. “I just wanted to know that Māori health providers were going to be given the opportunity for a national pandemic to do what they do best and better than anyone else.”
Was his suggestion rejected because of the potential for a political backlash? “No, not at that time. Not in the middle of a pandemic. I truly believe most stakeholders just wanted the best outcomes.
“We need to back Māori health providers. They are doing what the mainstream cannot, or will not do.”
“I have contemplated whether it was the politics of envy. Whether it was rejected because it came from the Opposition benches,” he muses.
The letter to Little wasn’t the first time Reti had expressed enthusiastic support for the government throwing its weight behind Māori-led health initiatives. Going into the 2020 election, he praised a bipartisan Māori Select Committee report on Māori health inequities, and said he hoped to be able to introduce some of its recommendations should he become health minister.
That wasn’t to be, with Labour romping into government in a landslide election on the back of its handling of the pandemic. Four years on, he can’t recall which of the 19 recommendations he had in mind.
The first recommendation was the setting up of a new entity to be tasked with “eliminating health inequities for Māori, and be given the authority and resources to do so”.
Another was the beefing up of anti-smoking strategy to achieve the government’s Smokefree 2025 goals.
Within months of winning office, the National led government abolished Te Aka Whai Ora Māori Health Authority, the entity that the bipartisan select committee, and others, had advocated for, and watered down the country’s world-leading smokefree legislation.
Both moves were heavily criticised by the medical community. The abolishing of Te Aka Whai Ora — under parliamentary urgency — was done in the face of opposition from the Royal Australasian College of Physicians, a letter signed by 700 GPs, a petition with more than 10,000 signatures and an urgent hearing of the Waitangi Tribunal.
Similarly, the repeal of the country’s smokefree legislation has been slammed by the public-health community both here and overseas. A Public Health Communication Centre Aotearoa briefing authored by 12 leading academics said the government was ignoring peer-reviewed studies in favour of a policy that would only benefit tobacco companies. The briefing pointed out that every year 5000 people die as a result of smoking related illnesses — with Māori disproportionality represented among the dead. “Repealing the legislation will cause more deaths, more preventable cancers and other serious diseases, more healthcare costs, and more suffering among families bereft of loved ones.”
It’s tempting to see Reti, a former territorial, as a reluctant general in a cultural war not of his making. Like an Antipodean field marshal at Gallipoli, he has little choice but to battle on, declaring it a war to end all wars while knowing that in truth it’s an endless battle causing pointless carnage with no clear objectives.
But Reti is adamant he’s not caught up in a cultural war, and that his policies will reduce casualties.
“I focus on the outcomes. And if we can deliver the outcomes for Māori they will be well pleased.”
He says some academics have a tendency to focus on structures and “various other things” rather than what matters: “At the end of the day, if we can protect Māori from an impending measles outbreak, and if we can improve their quality of life, and if we can improve the quality and the time that they live on this mortal Earth.”
One of Reti’s first acts as health minister was the announcement of a $50 million, two-year measlesvaccination programme to be delivered by Māori health providers. “When there are outbreaks of serious disease like whooping cough or measles, which happens usually every three to four years, it’s highneeds communities and pēpi Māori who are often more adversely affected,” he said at the time.
Reti defends the scrapping of Te Aka Whai Ora, pointing out that all three coalition parties had campaigned on getting rid of it. Sounding more like the politician he is than your friendly GP, Reti says that select committee report has been “superseded now by more modern strategic thinking”. And he claims a report on Te Aka Whai performance, from May of last year, vindicates the decision to close it down.
But Rob Campbell, a former chairman of Te Whata Ora (Health New Zealand), wrote, in the New Zealand Herald, that a “prolonged lack of resource, capability
and capacity” was responsible for any deficiencies. In other words, the problem wasn’t with the concept but its implementation and a lack of time and financial support from government. And, he said, nothing in the report suggested it shouldn’t continue to be funded.
Introducing the Pae Ora (Disestablishment of Māori Health Authority) Amendment Bill on its first reading, on 27 February Reti said: “Often in politics, there is near universal agreement on the destination, what needs to get better; it is often how we get there that varies. This bill signals the beginning of a different journey. We acknowledge inequities. We acknowledge long waiting lists. At a macro level, this bill commences a journey that is different in three key ways from the previous government’s approach. One: we believe in decentralisation and not a centralised, “Wellington knows best” approach to decision making and resourcing. Two: targets will be brought back and be at the forefront of our health policy. Unlike the previous government, which said targets would not be at the forefront of their health policies, it will be at the forefront of our health policies. Three: health workforce shortages are the biggest hurdle facing our health system, despite what the previous government stated and put on record.”
For Green MP Hūhana Lyndon it wasn’t the beginning of a journey but an attempt to end a decades old Māori health hikoi.
It’s tempting to see Reti… as a reluctant general in a cultural war not of his making.
“Today is day one of the recolonisation of hauora Māori in Aotearoa New Zealand. Why? Because this government is scrapping Te Aka Whai Ora, the Māori Health Authority. As Janice Kuka, the lead claimant in the Waitangi Tribunal urgent inquiry into the disestablishment of Te Aka Whai Ora shared, this is the closest model of tino rangatiratanga in hauora Māori in history.”
She pointed out that the Waitangi Tribunal’s 2019 Health Service and Outcome Kaupapa Inquiry had played a major role in the establishment of the authority. The coalition government, by introducing the bill under urgency, was denying Te Aka Whai Ora the chance to have a say on its scrapping.
The Tribunal had been due to hear an urgent appeal just two days later.
Reti is also unapologetic about the changes to the smokefree legislation citing New Zealand’s large decrease in smoking rates and says that both he and Prime Minister Christopher Luxon are on record as being “absolutely committed to driving down smoking rates”.
Most experts are, to say the least, sceptical.
The full story appears in the May 2024 issue of North & South.