Ngā Karere

A third of the Iwi Māori Partnership Boards including five from the Te Manawa Taki region have united in Whakatāne to present their Community Health Plans to government officials, fulfilling their legislated function on behalf of Iwi, hapū, and whānau.

As part of the reset of Te Whatu Ora Health New Zealand, Newly appointed Deputy CE and Regional Director, Catherine Cronin received the Community Health Plans and Hauora Māori Priority Reports highlighting Whānau Voices.

This information was gathered from whānau, hapū and hapori to shape individual IMPB priorities and consolidated into regional priorities to tackle the ‘grim picture’1 of the state of Māori-health.

“The purpose of our collective is to mahi tahi – to work together- to achieve the health and wellness aspirations of our whānau,” said Kataraina Hodge, Co-Chair of Te Tiratū IMPB.

Collectively, the 6 boards serve a combined Māori population of 285,560.

“Our role is not only integral, but fundamental to the success of Te Whatu Ora Health New Zealand and the system’s responsiveness to Māori health needs,” said Louisa Wall, Chair of Tūwharetoa IMPB.

The IMPB are responsible for assessing, monitoring, planning and represent local Māori perspectives on the design and delivery of services and public health interventions within localities.

Their shared priorities focus on public and population health, primary and community care, hospital and specialist services and priorities, workforce, data and funding appropriation for a redesigned delivery model.

“We are all experiencing the same levels of high health need for our whānau so the strategic emphasis into the prevention and health promotion space is essential to make meaningful progress,” Hodge said.

Each IMPB collected the voices of whānau through workshops and surveys, blending these insights with data from Te Whatu Ora and Primary Health Organisations to develop comprehensive, evidenced-based reports for each rohe.

This effort upholds the IMPB’s statutory responsibility in their relevant localities.

The Boards have aligned around regional strategies and delivered all key documents within Minister Reti’s expected timelines—most significantly, meeting the 30 September deadline to be ready for co-commissioning opportunities from 1 January 2025.

Today is another important milestone in achieving our moemoeā (vision) for our whānau. We are actively participating in shaping regional health priorities that we expect will influence funding based on need ahead of the 2025 Budget,” said Aroha Morgan, Co-Chair of Te Taura Ora o Waiariki IMPB.

One critical task ahead is addressing the status of legacy contracts for Māori Providers – to maintain continuity and capacity in the system – which have been extended until 30 June next year.

“We strongly advocate for evergreen contracts for our providers, given the urgent state of our health needs. At every opportunity, we’ve made it clear to politicians and officials: contracts for Māori health providers must be extended and prioritised,” said Rutu Maxwell-Swinton, Co-Chair of Te Moana a Toi IMPB.

The hui was hosted at Te Whare Wānanga o Awanuiārangi, a Ngāti Awa-founded tertiary provider known for its essential role in training and developing the Hauora Māori workforce. The Boards expressed deep appreciation to the Wānanga for providing the venue for this important briefing.

“Since our establishment, we’ve been following our statutory responsibilities to ensure that we have robust governance structures and operational capability,” one Board member explained.

“We’ve had to set up charitable trusts and ensure that trustees represent iwi and mātāwaka organisations from each rohe, which is no small task.”

The IMPBs have collaborated with Te Whatu Ora and Manatū Hauora navigating changes in legislation, leadership, and planning approaches during the transition to a new coalition government.

“We’ve seen a shift from Locality Plans to Community Health Plans. It wasn’t until July this year that we had clarity on the new Minister’s expectations—before that, we were operating under Labour’s directives,” said Hone Te Rire, incoming Co-Chair of Te Moana a Toi IMPB.

The independent analysis aligns with key government priorities, reflecting a shared commitment to achieving mutual goals.

“It’s a great day for us but it’s got to be taken seriously, I was here 35 years ago and not a lot has changed in Māori health,” said Te Pahunga Davis Chair of Te Punangaora IMPB.

“I live in hope that we can make a difference that we can measure. With that I support our pukapuka being placed into the kete but we’ll be watching you, or we aren’t doing our job.”

The rōpū has heard “loud and clear” the consistent message from whānau about Hauora Māori that mirrors what’s been happening over the last 40 years societally that has led to more highly, complex comorbidities.

“Nothing’s really changed. Now we’re living in a climate of household stress, whether that be income, unhealthy homes, violence, lack of job security – all those determinants of health have doubled down on our people over this last decade especially,” said Davis.

Beyond forming the Iwi Māori Partnership Boards and underpinning flax-roots efforts, there is a shared belief that true solutions lie in our vibrant young Māori demographic, now 978,246 strong according to the 2023 Census.

Our emerging next generation bring an inspiring energy and a sense of hopefulness for the future. For us ultimately that’s going to play a pivotal part in the shift for addressing health inequities.”

ENDS

Media Liaison: Sarah Sparks Email: Sarah.sparks@sparksconsulting.co.nz Mobile: 021318813

Background:

The collective of Iwi Māori Partnership Boards that in the Te Manawa Taki region are:

1. Te Taura Ora o Waiariki IMPB (Te Arawa)

2. Te Tiratū IMPB (Tainui Waka, Ngāti Hāua Iwi ki Taumarunui & Mātāwaka)

3. Te Moana a Toi IMPB (Bay of Plenty)

4. Tūwharetoa IMPB

5. Te Pūnanga Ora IMPB (Taranaki)

6. Toitu Tairawhiti IMPB (Tairawhiti)

Te Tiratū will utilise this Community Health Plan to focus on a collaborative approach with Te Whatu Ora | Health NZ both nationally and regionally to improve current mainstream and Hauora Māori services to plan for a renewed focus on our priority areas identified by Te Tiratū whānau. The reason that we have organised themes from the data and whānau voice this way is that this aligns generally with how the health system is organised for instance:

• Public and population health services and programmes are overseen, funded, partially delivered and commissioned by the NZ Public Health Service (NZPHS) so it is important we engage closely with NZPHS leaders to advocate for the interests of whānau in our rohe. Their mandate includes cancer screening, health promotion, prevention and wellness, and social determinants of health
• Primary and community care is managed and commissioned (and partly delivered) by the Regional Commissioner for Te Whatu Ora | Health NZ, so it is vital that we have a strong working relationship with this leader, to ensure they and their team understand the issues facing our whānau and reflect this in their budgeting, service planning and procurement practices.
• We also need to have a strong relationship with leadership for hospital and specialist services in the district, to influence the quality of care for Māori, as well as equity of access, utilization and outcome. For instance, a key area for discussion with both the hospital leadership and PHOs will be to undertake a ‘deep dive’ into emergency department presentations and to determine how much of this is impacted by lack of access to primary care.
• Enablers such as workforce development and quality data / information have dedicated leaders and teams at both national and regional levels, and it will be important that we use the information that we have gathered and documented, to influence their planning and resourcing.

• Public and Population Health
• Primary and Community Care
• Hospital and Specialist Services.

We are pleased to present Volume Two of the Iwi-Māori Partnership Board Health Profiles. Together with Volume One, completed in late 2023, these two reports represent the most up-to-date snapshot of Māori health for the health sector.

We acknowledge the legacy of work associated with Māori-led health data reporting to date, from the seminal Hauora series to Tatau Kahukura and the 2015 District Health Board Māori Health Profiles, this volume continues the commitment to excellence that Māori communities and whānau both need and deserve.

Volume One includes key demographic information, mauri ora (overall health status), whānau ora (healthy families) and wai ora (healthy environments) indicators specific to each Iwi-Māori Partnership Board.

Volume Two presents additional indicators focused on Te Aka Whai Ora-identified health priority areas including kahu taurima (early years), māuiuitanga taumaha (long-term conditions), mate pukupuku (cancer), oranga hinengaro (mental health and addictions) and ko ētahi atu tohu pūnaha (other system indicators) specific to each Iwi-Māori Partnership Board.

The data presented within these profiles are a dimension of ‘whānau voice’. They represent Māori stories and Māori lived experience and should be valued as a taonga for the health system to use and respond to as part of the broader commitment to Te Tiriti o Waitangi and equity.

The data presented in these profiles also require contextualisation – they are a starting point for Iwi-Māori Partnership Boards to interpret, together with other sources of information, and decide how best to respond to the needs (and rights) of the whānau within their rohe.

As the health sector transforms itself, Iwi-Māori Partnership Boards will play a pivotal role in understanding how the health sector is performing to meet the needs and aspirations of whānau in their area. This profile completes a commitment from Te Aka Whai Ora and Health New Zealand – Te Whatu Ora to provide Iwi-Māori Partnership Boards with data analysed from a Kaupapa Māori epidemiology positioning.

As Te Aka Whai Ora as an entity is disestablished, the commitment from Health New Zealand – Te Whatu Ora to continue this important work remains.

• In 2023, Te Tiratū IMPB was home to an estimate of 114,900 Māori, comprising approximately 25% of
  the IMPB’s total population.
• The Māori population of Te Tiratū is youthful, with 48% of the Māori population under the age of 25
  years (compared to only 27% of the non-Māori population in the area) in 2023.
• Over the next two decades, the Māori population is expected to grow to an estimated 156,770 (29% of
  the total IMPB population) and to be older – 10% of the Māori population with be 65 and over, compared
  to 7% in 2023. The non-Māori population of Te Tiratū will decrease its share of the total population,
  from an estimated 75% to 61% by 2043.
• Most Māori in Waikato DHB (62%) live in urban areas, with 38% living in rural areas, compared to 66%
  and 34% of non-Māori, respectively.

Life expectancy

• Life expectancy at birth for Māori born in Te Tiratū between 2018-22 is 76.8 years for females and 72.8 years for males.
• Life expectancy is 7.9 years shorter for Māori females and 8.3 years shorter for Māori males, compared to non-Māori.
• In Te Manawa Taki in 2018-20, the region in which Te Tiratū are situated, life expectancy for Māori was 75.0 years, 8.1 years lower than the non-Māori/non-Pacific population (83.1 years).
• Among Māori in Te Manawa Taki, 2.7 years of the 8.1-year gap can be attributed to conditions that are considered both amenable (through access to high quality health care) and preventable (through public health interventions), followed by 1.4 years from conditions considered preventable only and 0.9 years from conditions considered amenable only. An additional 2.0 years can be attributed to conditions that are considered non avoidable.
• The leading avoidable causes of death that contribute to the life expectancy gap among Māori in Te
  Manawa Taki are lung cancer, coronary disease and diabetes.

Self-assessed health

• In 2018, 78.3% of Māori aged 15 years and over reported their own health status as good, very good or excellent, similar to the percentage to Māori nationally (82.3%). A total of 21.7% of Māori in Te Tiratū reported their health status as fair or poor.

Mortality – deaths

• From 2014 to 2018, the leading causes of death for Māori in Waikato DHB were ischaemic heart disease, lung cancer, diabetes, chronic obstructive pulmonary disease (COPD) and cerebrovascular disease. These are the same five leading causes of death for Māori nationally. This pattern differs to the leading causes of death for non-Māori in Waikato DHB, which were ischaemic heart disease, dementia, cerebrovascular disease and lung cancer in 2014-2018.
• In 2014 to 2018, leading causes of death for Māori females were lung cancer, ischaemic heart disease, COPD, diabetes and cerebrovascular disease; and for Māori males, were ischaemic heart disease, lung cancer, diabetes, COPD and cerebrovascular disease.
• The all-cause mortality rate for Māori in Waikato DHB (336 deaths each year per 100,000 people) was 2.1 time higher than that of non-Māori in 2014 to 2018. This equates to an average of 213 Māori females and 248 Māori males dying each year in Waikato DHB.
• Potentially avoidable death (those deaths considered preventable through high quality health care or public health interventions, or both) was 2.45 times higher for Māori aged 0 to 74 years compared to non-Māori in Waikato DHB in 2014 to 2018.
• In 2014 to 2018, the leading causes of potentially avoidable death for Māori in Waikato DHB were ischaemic heart disease, lung cancer, diabetes, COPD and cerebrovascular disease. These are similar to Māori nationally. For Māori females in the region, leading causes were lung cancer, COPD, ischaemic heart disease, breast cancer and diabetes and for males, leading causes were ischaemic heart disease, lung cancer, diabetes, suicide, and motor vehicle accidents.
• Potentially avoidable death from diabetes was 6.5 times higher for Māori aged 0 to 74 years compared to non-Māori in 2014-18 in Waikato DHB.
• Potentially avoidable death from lung cancer was 4.0 times higher for Māori aged 0 to 74 years compared to non-Māori in 2014-18 in Waikato DHB.
• Potentially avoidable death from COPD was 3.9 times higher for Māori aged 0 to 74 years compared to non-Māori in 2014-18 in Waikato DHB.
• Potentially avoidable death from ischaemic heart disease was 3.0 times higher for Māori aged 0 to 74 years compared to non-Māori in 2014-18 in Waikato DHB.
• On average, there were 38 potentially avoidable Māori deaths under age 75 years each year from lung cancer, and 38 from ischaemic heart disease in Waikato DHB.

• In 2018, most Māori (67.3%) in Te Tiratū reported their whānau was doing well compared to 73.6%
  nationally. About a third (32.6%) reported that their whānau was not doing well.
• 76.9% of Māori in Te Tiratū reported it was easy/very easy to get support in times of need compared
  to 78.1% of Māori nationally.
• Being involved in culture was important (very or quite) 47.8% of Māori in Te Tiratū in 2018 and
  spirituality was very important (very or quite) to 50.4%.
• A quarter of Māori (25%) aged 15 years or over in Te Tiratū reported using te reo Māori regularly in the
  home in 2018.
• Almost all Māori (97%) in Te Tiratū had been to a marae at some time. 84.1% had been to an ancestral
  marae at some time, 46.2% had been in the last 12 months, and 64% reported that they would like to
  go more often.
• In 2018, 14.2% of Māori in Te Tiratū had taken part in traditional healing or massage in the last 12
  months.

Education

In 2018, 62.9% of Māori in Waikato DHB aged 20 years and over had at least a Level 2 Certificate. The proportion of non-Māori with this level of qualification was 77.1%.

Work

• In 2018, 46.6% of Māori adults aged 15 years and over were employed full time and 15.1% were employed part-time.
• In 2018, 9.7% of Māori in Waikato DHB were unemployed, twice the rate of non-Māori, and Māori were 1.2 times more likely than non-Māori to not be in the labour force.
• Most Māori adults were involved in unpaid work (89.1%).
• In 2018, Māori in Waikato DHB were significantly more likely than non-Māori to participate in unpaid work looking after a disabled or ill household (2.0 times) or non-household (1.5 times) member.

Income and Standard of Living

• Using the NZDep 2018 index of neighbourhood deprivation, 48% of Māori in Waikato DHB lived in the two most deprived deciles in 2018, compared to 21% for non Māori. A total of 5% of Māori in Waikato DHB lived in the two least deprived deciles in 2018, compared to 15% of non-Māori in Waikato DHB.
• In 2018, 11.4% of Māori adults reported often postponing or putting off a doctor’s visit, 7.2% often went without fresh fruit and vegetables, and 11.7% often put up with feeling cold, because of cost.
• Māori in Waikato DHB are significantly more likely than non-Māori to receive an income of $20,000 or less. This equated to 37.7% of Māori aged 20 years and over (21,384 people) living on an income of $20,000 or less compared to 27.8% of non-Māori in 2018.
• In 2018, Māori in Waikato DHB were 3 times more likely to be without access to a motor vehicle and 2.2 times more likely to have no access to telecommunications, compared to non-Māori.

Housing

• Māori in Waikato DHB are less likely that non-Māori to own their own home. In 2018, 68.9% of Māori aged 20 years and over lived in a home they did not own/partly own or hold in a family trust compared to 51.1% of non-Māori.
• Living in an overcrowded home (requiring at least one more bedroom) was 2.7 times more common for Māori (23.6%) than non-Māori (8.8%) in 2018.
• In 2018, 45.0% of Māori reported living in a home that was sometimes or always damp, and 37.2% reported living in a house with mould. Māori in Waikato DHB were 1.8 times more likely than non-Māori to live in a damp and mouldy home.
• Māori in Waikato DHB were 1.5 times as likely as non-Māori to live in homes without any source of heating in 2018.
• Primary Care Enrolment
• In October 2023, an estimated 82.5% of Māori in Waikato DHB were enrolled with primary care compared to 97.6% of non-Māori. This suggests 17.5% of Māori in Waikato DHB were not enrolled with primary health care compared to 2.4% for non-Māori.