Riana Manuel is the Chief Executive of Te Aka Whai Ora (Māori Health Authority) in Aotearoa (New Zealand). She delivered the keynote address at Healing Our Spirit Worldwide on Thursday, Sept. 14.
She started her speech with an historic overview of the mistreatment of the Māori people by the New Zealand government – a mistreatment that began almost immediately after the signing of the Treaty of Waitangi in 1840.
In 1975, under pressure from the Māori community, the Waitangi Tribunal was initiated to examine alleged breaches of the treaty. The original scope of the tribunal was to investigate grievances from 1975, but in 1985 it was extended to investigate grievances since the signing of the treaty itself.
In a health care context, the treaty and the New Zealand health care system discounted Indigenous needs, forcing upon the Māori community a system that did not support their wholistic health and wellbeing.
Historic racism and having a system that was not designed by or for the Māori has led to significant health deficits, such as a seven-year life span gap between Māori and non-Māori.
To close the gap in health outcomes, the Pae Ora (Healthy Futures) Act was legislated in 2022. In the same year, the Māori Health Authority (MHA) was created, with the goal of allowing the community to take control over their own health care to meet their specific needs.
In her presentation, Manuel listed five key priorities for the MHA:
- Supporting the Māori people and their wider aspirations.
- Indigenizing the health system by integrating and promoting Māori solutions.
- Accountability for health outcomes for the Māori people by monitoring the system's delivery and outcomes.
- Having a collective impact by delivering social, cultural and economic outcomes.
- Enabling equitable health resourcing for the Māori people.
“The MHA has a $750-million budget to undo 200 years of colonization," said Manuel with a wry smile, in an acknowledgement of the underfunding the MHA receives considering the vast work ahead of them.
A key component of that work, she said, is building relationships. That is because the MHA takes its direction from local Iwi Māori Partnership Boards, similar to how the First Nations Health Authority is based on the principle of being “Community-Driven, Nation-Based."
The MHA principle follows a similar framework, to work with communities to meet their needs with services that are Māori led, designed, and deployed. Manuel said this is a collective Māori approach, as opposed to colonial top-down mandates where feedback and consultation is treated as an afterthought.
Despite the intergenerational trauma that continues to impact the Māori, their continued strength and resiliency forced the New Zealand government towards reconciliation and to recognize their needs and wants.
She ended her presentation by saying, “This is the last generation that will struggle this way."
