In Aotearoa New Zealand, people have differences in health that are not only avoidable but unfair and unjust (John Whaanga, Deputy Director-General for Māori Health (New Zealand Ministry of Health), New Zealand Emergency Departments Equity Conference (October 2019))
“Equity recognises different people with different levels of advantage require different approaches and resources to get equitable health outcomes”, said Mr Whaanga.
“Equity for Māori lives within a Treaty of Waitangi framework ... However, our obligations to Maōri under the Treaty go beyond equity and on to realising Māori health aspirations,” said the Deputy Director-General.
“To understand Māori health aspirations and expectations, you have to go back to the Treaty of Waitangi,“ he said.
So what is Te Tiriti o Waitangi?
- Te Tiriti o Waitangi is New Zealand’s founding document and was signed in 1840 by representatives of the British Crown and rangatira (chiefs) on 6 February 1840 at Waitangi.
- Aotearoa New Zealand recognises two language versions of Te Tiriti o Waitangi, Te Tiriti o Waitangi (in te reo Māori, the Māori language) and The Treaty of Waitangi (in English). The two versions do not translate to mean the same. Representatives of the British Crown signed both versions. More than 570 rangatira (or chiefs) gave their agreement, most of whom signed the Māori language version (only 35 signed the English version).
- Te Tiriti o Waitangi has a preamble that sets the context and the agenda – that people will come together in peace, to work together with each other, and respect each other's position. The te reo Māori version, Te Tiriti o Waitangi (and an additional oral declaration), provided that:
- Māori were guaranteed ‘te tino rangatiratanga’ – chieftainship over their lands, villages and treasured things. It also gave the Crown a right to deal with Māori in buying land
- Māori were given the Crown’s protection and the rights of British subjects.(1)
- Different understandings of Te Tiriti o Waitangi, including differences in meaning between the te reo Māori language version and the English version have long been the subject of debate. This, along with breaches of Te Tiriti o Waitangi by the Crown, has led to conflict and mistrust for generations.
- From the 1970s especially, many Māori have called for the terms of Te Tiriti o Waitangi to be honoured. There have been studies of Te Tiriti and a growing awareness of its meaning in modern New Zealand. It is common now to refer to the intention, spirit or principles of Te Tiriti o Waitangi/The Treaty of Waitangi.
The principles of Te Tiriti o Waitangi/The Treaty of Waitangi are commonly referred to as Partnership, Participation and Protection. The principles are expressly included in much of New Zealand’s legislation in force today, including cultural safety requirements for health practitioners.
The report from the second stage of the Health Services and Outcomes Kaupapa Inquiry (Wai 2575) calls on the Government to embed the principles of Te Tiriti o Waitangi to address widening inequitable health outcomes.
Within this context, ACEM acknowledges the importance and significance of Te Tiriti o Waitangi between the Crown and Māori. ACEM’s board and leadership team will continue to explore how ACEM gives appropriate effect to Te Tiriti o Waitangi and its principles for and on behalf of ACEM’s Fellows and trainees.
How is Te Tiriti o Waitangi applied in a healthcare context?
In the context of healthcare these principles of Te Tiriti o Waitangi are applied by the New Zealand Ministry of Health as follows:
- Partnership—involves working together with iwi, hapū, whānau and Māori communities, to develop strategies for Māori health gain and appropriate health and disability services;
- Participation—requires Māori to be involved at all levels of the health and disability sector, including in decision-making, planning, development and delivery of health and disability services; and
- Protection—involves the Government working to ensure Māori have at least the same level of health as non-Māori, and safeguarding Māori cultural concepts, values and practices.
Within this framework, New Zealand’s Ministry of Health has focused its health goals and actions for Māori based on the Treaty as follows.
Source: Deputy Director General for Māori Health, Ministry of Health, Oct 2019. Keynote address at New Zealand Emergency Departments Conference on Equity.
Explanation of terms
- Declaration / Whakapuakitangia Ritenga Māori refers to He Whakaputanga o te Rangatiratanga o Nu Tirene: the Declaration of Independence of the United Tribes of New Zealand, signed by 34 rangatira in 1835;
- Iwi is an extended kinship group, tribe, nation, people, nationality, race. It also often refers to a large group of people descended from a common ancestor and associated with a distinct territory.
- Mātauranga Māori is Māori knowledge - the body of knowledge originating from Māori ancestors, including the Māori world view and perspectives, Māori creativity and cultural practices.
Te Rautaki Manaaki Mana
In 2019 the College launched Te Rautaki Manaaki Mana: Excellence in Emergency Care for Māori (Manaaki Mana). The vision of this strategy is that emergency departments will provide excellent, culturally safe care to Māori, in an environment where Māori patients, whānau and staff feel valued, and where leaders actively seek to eliminate inequities.
Manaaki Mana includes goals and actions that work towards embedding the principles of Te Tiriti o Waitangi. One of these goals is for Governance entities at ACEM to represent our commitment to Manaaki Mana, and this includes a specific action to explore updating the ACEM Constitution to reflect a commitment to the principles of Te Tiriti o Waitangi and the United Nations Declaration on the Rights of Indigenous Peoples.