Maori Health and Government Policy 1840-1940
Victoria University Press, $39.95,
ISBN 0 86473 366 6
May the People Live: A History of Maori Health Development 1900-1920
Auckland University Press, $39.95,
ISBN 1 86940 214 6
Whaiora: Maori Health Development
Oxford University Press, $39.95,
ISBN 0 19 558403 1
The health services are being restructured again. By the time this review is published, the Health Funding Authority will have been disestablished; staff will have been reintegrated into the Ministry of Health; and members of the public will have been appointed to new District Boards of Health established by legislation introduced by the Labour and Alliance Government.
The health system in New Zealand seems to have a history of constant change in which previous administrative structures have been developed or revisited. For Maori, these changes can create both opportunities and threats, while issues that were current previously continue to surface in the present – which supports the Maori view that the past shapes the present and the future.
Without knowing our history, we often cannot see clearly the mistakes we have made in the past and the power we have to reshape and change our futures. All three books reviewed here give different perspectives of the history of Maori health – whether in order to assist Maori prepare claims to be considered by the Waitangi Tribunal, or to show how health is an important part of Maori cultural values, beliefs, structures and aspirations. All three books are complementary to each other and give insights into whether the proposed new structural health changes will make a difference in reducing the growing gap in health status between Maori and non-Maori.
Derek Dow’s Maori Health and Government 1840-1940 exposes the ad hoc political process that underlies the ongoing development of Maori health policy. This book has been sponsored by the Crown Forestry Rental Trust, and it draws upon historical material from the files and annual reports of the Department of Health and Native Affairs, as well as information tabled in Parliament or incorporated in the Appendix to the Journals of the House of Representatives and reference material from New Zealand health journals.
Dow’s comprehensive review of Maori health policy from l840-1940 focuses on the government agencies and their policies. He also illuminates the conflict that often exists within and across government agencies and identifies the importance of key personalities in influencing whether or not a policy is supported or declined.
The first major theme Dow highlights is the question of who is responsible for Maori health and, secondly, who is responsible for providing funding for Maori health. He observes that the provision of Western medical services to Maori prior to 1846 was haphazard. It was dependent upon the patchy distribution of subsidised native medical doctors, many of whom were poorly trained and often wore two hats since they were also missionaries for different religious persuasions.
In 1850 the Chief Protector of Aborigines, Governor George Grey, attempted to place Maori health care on a sound footing with the provision of Civil List payments for “native purposes”. This plan was defeated by the opposition of settlers and it was not until 1852, through the New Zealand Constitution Act, that specific annual funding was set aside in a Civil List budget for Maori purposes to cover the cost of medical care, pensions and rations for the indigent.
This fund was controlled by Grey, and from the outset it created conflict between the Departments of Health and Native Affairs and provided the opportunities for different government and local bodies to accept or reject their responsibilities for providing health care for Maori.
Financial appropriation of funding by government specifically for Maori health has always been a contentious and political issue. No consistent policy existed then or exists now for allocating resources to fund health care for Maori. The result is that Maori communities and tribal groups generally depend upon the advocacy of their local Maori politicians, elected leaders and public servants to negotiate funding on their behalf. Dow has shown that, historically, access to and payment for primary medical care for Maori has not always been equitably distributed. Similarly, Maori access to local hospitals was influenced by the views of elected local hospital board members. Non-Maori relationships with Maori also influence whether Maori are welcomed into health facilities and whether services are provided which are sensitive to Maori values and needs. Maori have been and still are often used as a “political football”, as a means to maintain or secure additional local and national health funding.
When funding was allocated last century for medical services to selected Maori communities, many Pakeha objected. They considered such support should only be available to those Maori who were poor, without land resources and who could act responsibly in looking after their health. These views are still evident today. But Maori now see equitable access to health, the provision of health services by Maori for Maori and Maori participation in all levels of health decision-making as both a Treaty of Waitangi right and a human right.
Dow also highlights the fact that politicians and health leaders have often ignored or glossed over the state of Maori health when choosing areas of research or presenting our nation’s health profile internationally. For example, in the 1920s, New Zealand boasted its low infant mortality rate internationally, but failed to mention the appalling state of Maori child health where half of all Maori died before the age of four.
We often like to promote the world the way we want it to look. Dow points out that for many health issues Maori have not fitted the ideal, leaving Maori to advocate for matters that are important for Maori. This reality persists today, with Maori having different health priorities, health strategies and perceptions of the world.
Raeburn Lange is an historian who became interested in the events that led to the Tohunga Suppression Act 1907, which subsequently forced many tohunga to practise “underground” until the mid-1960s. It is only in recent years that guidelines have been released with the support of the health sector to acknowledge the work of tohunga as legitimate health practitioners. Maori still have a view on which health problems they consider are “mate Maori” and those which are “mate Pakeha” and require Western treatment.
As part of his research for May the People Live: A History of Maori Development 1900-1920, Lange became aware of the influence of Rua Kenana Hepetipa, a healer and prophet from Tuhoe. Lange then read many of the official reports written by Maui Pomare, Dr Rangi Hiroa (Peter Buck), and Apirana Ngata, becoming extremely interested in their work and what caused them to have the passionate belief that they could save what seemed to be a dying race.
To find out more about them other than from official sources, he then travelled around the North Island interviewing descendants and relatives of these leaders and also those who had knowledge of the work and background of Native Health Officers, Native Sanitary Inspectors, Maori Council members and early Maori nurses.
Lange’s survey, initially prepared as a thesis, incorporates many different sources and offers an understanding of the role many people played in improving the Maori approach to health and ameliorating the devastating effects infectious diseases had on Maori communities and families. Because of the sources of information and the interests of the author, this book is perhaps weighted more towards a Maori view of the world. However, it does provide a succinct account of health in New Zealand and acknowledges the men and women who have laid down the foundations of our public health system.
It is only recently that our public health history, both Maori and Pakeha, has been taught in New Zealand. In general, our focus has been more often directed to public health developments in Europe and America. This omission is to the detriment of the education of health professionals in New Zealand, for it means that we fail to understand our own roots, our relationships with each other and why at times we experience conflict and barriers to using the available health services and information.
Lange’s study gives many interesting insights into the family, education and religious influences which guided Pomare, Ngata, Buck and other Maori leaders to play a key role in encouraging Maori to adopt selected Western health practices. It is through their collective efforts that sanitation improved and hygiene and clean water became available in many villages.
Their success, however, was not just related to their knowledge or the positions they occupied. They had a commitment to talk with people about their health problems in their own environment, and a willingness to support local tribes through tribal councils, to attend areas of epidemics and to work with other Maori health workers. These approaches are still relevant today but are often forgotten or played down in developing public health strategies in New Zealand.
Mason Durie’s book Whaiora: Maori Health Development is now in its third edition, which indicates the degree of interest in this publication as a reference or text used for teaching. Durie states in the preface that it is dedicated to his grandchildren in the hope they will enjoy good health and long lives. The book covers many issues relating to Maori health, and from a Maori perspective in particular. It also explains and illustrates Maori concepts such as tapu and noa through different frameworks.
It is often thought that the development of a public health system in New Zealand did not occur until the Pakeha arrived and with the implementation of the Public Health Act 1900. Durie, however, destroys this myth and explains how Maori have always had in place their own health system using their own knowledge and social support structures. He, like the other writers, acknowledges the strength of Maori leaders who through time have worked for or with the health sector to create change.
One of Durie’s strengths is to present information in a way that is understood both by Maori and Pakeha. Several chapters in this book relate to health developments that have occurred since the early 1980s, and they provide an overview of the health reforms, the development of Maori initiatives and explanations of why Maori health developments need to be seen as part of Maori development as a whole.
Whaiora: Maori Health Development provides useful information to people locally and internationally. I recommend this book for those who wish to understand how Maori health can no longer be ignored by policy- and decision-makers and why Maori are at the “cutting edge” of social and health change in New Zealand.
Lorna Dyall teaches in the Department of Community Health at the Auckland University School of Medicine and Health Science.