Kerri Nuku, Kaiwhakahaere
NZNO Tōpūtanga Tapuhi Kaitiaki o Aotearoa

At recent NZNO conventions and events I’ve spoken about Te Tiriti o Waitangi (Te Tiriti) and the way in which Māori health has been politicised. I’m often asked to explain why and how Te Tiriti is relevant to our work as nurses, midwives and healthcare workers, and particularly to our Pākehā, tauiwi, and non-Māori members.

I can’t answer this question in one blog so I will explain so over time. For now, let us look at why Te Tiriti remains relevant to us as members.

Te Tiriti remains a foundational and living document that Māori Chiefs (Rangatiratanga) and representatives of the British Crown (Kāwanatanga) agreed to abide by in 1840, and which we work to honour today. Margaret Mutu, co-author of Matike Mai, views Te Tiriti as “a treaty of peace and friendship, one that promised what the rangatira had asked for: acknowledgement and respect for their absolute power and authority throughout their territories while relieving them of responsibility for lawless British immigrants” who remained ungoverned throughout the lands.

Te Tiriti gave the Crown the right to settle their British citizens in Aotearoa and to set up a government for them, while assuring Māori that they could maintain their way of life – “the unqualified exercise of their chieftainship over their lands, villages and all these treasures”. It is important to remember that treasures – taonga – is more than pounamu and gold: the health of the whānau, hapū and iwi is a taonga; the survival of te reo Māori is a taonga; enduring access to fresh water and ancestral lands are taonga.

For the Māori and Rangatira partners of Te Tiriti, their Tino Rangatiratanga is yet to be realised. The assertion of The Treaty of Waitangi, an English and interpreted replica of Te Tiriti, has enabled the Crown to enforce governance over the taonga of Māori, including themselves and their health. This process was well-practiced by European colonisers and was enacted with guns, disease, death and legislation, such as the 1907 Tohunga Suppression Act. Through force, the Crown established an entirely new way of life for Māori who were no longer allowed to heal and care for their people in the manner they had for centuries.

Māori had no choice but to rely upon the Euro-centric approach to health and medicine that we continue to uphold and enforce. The hostility and distrust many Māori have towards the Crown’s healthcare system is a result of centuries of legislative and policy-enforced oppression and racism. For us Māori health professionals and Members, our role is to advocate for the very existence of our people, through a healthcare system that is inequitable by design. Colonisation has a lot to answer for when it comes to low Māori life expectancy.

The context by which British immigrants found themselves in Aotearoa is thanks to Te Tiriti. Te Tiriti has been recognised as one of the first written immigration agreements in history – it protects the rights and interests of British, and future, immigrants by entrusting them to Kāwanatanga. Apart from the “God, Guns, and Glory” goal of colonisation, the Crown had ulterior motives to sign Te Tiriti. First, the French had landed in Aotearoa and were also hoping for access to the whenua and taonga.

Secondly, the behavior of the British who were already here – whalers, sealers and miners, was at risk of punishment by Māori. Most importantly, Britain was overcrowded and the poor and working class were growing a political and class consciousness. The Crown needed Te Tiriti to minimise the risk of revolt in Britain.

Māori assumed that Kāwanatanga would protect their people just as Rangatira would theirs, yet this continues to not be the case. The removal of Aotearoa New Zealand’s plan to be smokefree by 2025 is already harming non-Māori. The cut to bowel cancer screening is already harming non-Māori. The review of the HPCA Act will harm non-Māori. The rollback of the public health system is not in the interest of our non-Māori members, but in the interests of the Coalition Government’s donors and lobbyists. No one is safe while Te Tiriti is dishonoured.

Not one Government in the history of this country has been able to kill Te Tiriti. The Crown’s legal representatives in Aotearoa have shown publicly that Te Tiriti still applies, although both parties would agree there’s a lot of mahi to be done to honour it.

In future blogs I will address the ‘how’ part of the question – how Te Tiriti is relevant to us as NZNO members: Pākeha, tauiwi, non-Māori and Tangata Whenua. Once we accept the ‘why’, then we can look to the ‘how’. By understanding Matike Mai and the NZNO Draft Constitution we can embed Te Tiriti into our future.

Anne Daniels, President
NZNO Tōpūtanga Tapuhi Kaitiaki o Aotearoa

Curiosity (from Latin cūriōsitās, from cūriōsus “careful, diligent, curious”, akin to cura “care”) is a quality related to inquisitive thinking, such as exploration, investigation, and learning, But there is also a saying that ‘curiosity killed the cat’. This suggests that asking too many questions might get you into ‘hot water’. Curiosity has not always been encouraged. In fact, censorship has always been evident in our political and societal history. Censorship is used to control and restrict the choices of individuals and groups and is a hallmark of far-right politics.

Challenging such ideologies start with challenging conversations. Censorship is the antithesis of being open to having challenging or difficult conversations within our society and in our workplaces. But challenging conversations are necessary to become aware and informed of potentially conflicting opinions. When the option to have challenging conversations is taken from us, many of us, rightly, push back.

Very recently Sir Colin Tukuitonga (Professor of Public Health, Auckland University and President of the New Zealand College of Public Health Medicine) described the current Coalition governments decision to demand that Medical Officers of Health must get their employers permission to speak out about health issues, as censorship. Professor Micheal Baker (Otago University Public Health Specialist) stated that this policy would ultimately reduce the ability of our system to respond to public health issues and safety. Further it has been noted that complying with such a policy would breach collective employment agreements and if extended to other health professionals, their ability to practice to the standard required by the Health Practitioners Competency Assurance Act and consequent regulations and competency standards.

This is just part of the attack on the regulations that support patient safety. It started with the austerity policy of ‘freezing’ nurse, doctor, and support staff recruitment. It continues with the proposed deregulation of regulated health staff, which once again does not put patient safety first. In a recently published review paper by the Minister of Health entitled “Putting Patients First: Modernising health workforce regulation, patient safety is mentioned once over 13 pages, whereas cost, bloated bureaucracy, red tape and various types of ‘assistants’ were mentioned frequently. Current regulations not only put patients first, but they put patient safety as the priority. Yet this government is trying to change this priority amid a workforce and patient safety crisis.

Recently Te Whatu Ora published a Clinical quality and safety review that analysed the results of care provided over the last ten years. It found that overall access to care at both primary and hospital level has deteriorated, particularly since 2020. Death rates in patients who left an emergency department without being seen increased. The number of complaints involving Te Whatu Ora, received by the Health and Disability Commissioner, has doubled from 330 to 653.

But reading between the lines and looking at what is not there is even more important. The actual rate of adverse events is unknown. With the exception of severe harm events, this information is not collected. Nor is there any mention of the relationship between workforce decimation and patient harm. However, quality and safety indicators that require nurse resource and time to prevent patient harm have deteriorated significantly, particularly since 2020 when Covid arrived on our shores and workforce pressures exacerbated. These include healthcare-associated Staphylocccus aureus bacteraemia, pressure area injuries, and DVT/PE injuries.

The relationship between high nursing workloads, lack of experienced, knowledgeable and skilled staff and deteriorating patient outcomes is well researched. Te Whatu Ora chose not to include workforce resourcing as part of its review. The question is why not? Censorship is not just about restricting free speech, it is also about restricting information, changing the messaging, and ‘putting the muppets back in their box.’

These sentiments are growing in Aotearoa and leading to a fractured cohesions where younger disaffected New Zealand men, under the age of 48, believe that having a strong leader in charge of the country, without the checks and balances of a democratic government is preferrable, another hallmark of far-right politics. We need to ask why and where this is heading. We need to have more challenging conversations not less and use facts not fiction in our kõrero. As a nation, we need, more than ever, to all be politically aware so we can stand up together and fight to keep our rights to freedom, democracy and a safe quality public health system. Only then will we be able to turn the tide of the deteriorating health and wellbeing of our nation.

Maranga Mai!