Zoe Hawke on New Zealand Herald: Is the new order of health really going to fix Māori inequality?

OPINION:

E Tipu E Rea Whānau Services has a focus on rangatahi with pēpi or who are hapū (pregnant).

We celebrated the announcement of health reforms more than six months ago with high hopes for the Māori Health Authority, Te Aka Whai Ora, and we still remain very supportive of the move.

But due to the nature of our mahi - we work in the health and social services sector and with whānau who must navigate these systems - we don’t believe the changes in the health sector are the full and complete answer to reducing inequalities.

We know, like many others, that the move to Te Aka Whai Ora was never going to be the silver bullet to solve health inequity for Māori, but more and more we are seeing that it is not even going to be a drop in the ocean without cross-sectoral reform.

We see daily the often-colliding policies and systems across sectors that act against the goals of Health. For example, a new priority of Te Aka Whai Ora and Te Whatu Ora is child health and pregnancy care, however, many young parents that E Tipu E Rea work with are often refused housing because they are too young or because they are hapū.

On top of this, they have to wait for the Youth Parent Payment from the Ministry of Social Development, which does not kick in until after their baby is born.

 

These social-care policies and systems create massive barriers for young hapū māmā and parents to get to a midwife, or get to GP appointments for childhood immunisations, or the likes of Plunket for their child’s health.

If you have nowhere to live, no fixed address and no income, it is next to impossible to have stable healthcare.

A home, food and money are whānau first priorities and healthcare usually comes last as the former are requirements for the latter.

Current MSD Youth Parent Payment rules and processes often prevent young hapū māmā from getting financial support early on in their pregnancy.

This does not support young hapū māmā or parents prioritising their health or their babies.

We also know, from our experience with whānau, that many young parents and wāhine hapū who are faced with financial and emotional stress do not ask for help out of fear of looking like they are unfit to parent.

The health and social service sectors need to work together to understand the fear that many young wāhine hapū and young parents hold in relation to Oranga Tamariki, and how this fear can prevent health care visits or stop hapū māmā and young parents from talking openly about any mental distress, they are experiencing.

Research shows that the leading cause of death in pregnant women and new mothers is maternal suicide. If we think the solutions to this issue just lie with health, we are mistaken and we will not solve a thing.

This is the shared responsibility of the Ministry of Education, Health, Social Development, Urban Development and Housing and Oranga Tamariki. These sectors also need to commission additional and expanded kaupapa Māori initiatives for whānau wellbeing, with a particular focus on reducing high rates of perinatal distress and maternal suicide among wāhine Māori.

Te Aka Whai Ora, Te Whatu Ora, Oranga Tamariki, Ministry of Social Development, Ministry of Education and others, need to all recognise and acknowledge that young hapū māmā and young parents have often navigated a range of complexities to get them to their GP appointment, to engage with a midwife, to turn up to class, and these complexities range from transport, waiting until baby is born so they can get the young parents payment, financial restraints, and sometimes other crisis like whānau violence and housing.

There desperately needs to be cross-sector collaboration to assist the health sector with its brave and much-needed reforms.

Overall, the dreams of hapū māmā, mātua taiohi (pāpā included), speak to the importance of whānau support and access to support systems and services that don’t just sit in health, for them to thrive. They would like to be viewed without stigma, where they have the support to positively grow whānau relationships, achieve education and employment goals, be healthy and become responsible, confident and financially independent parents.

A cross-sector response that does not just lay in the responsibility of the health sector needs to occur, our whānau do not operate in silos, they are across sectors, and each sector can either open doors to hauora or close them. Support systems in health and social care need to talk daily and operate closely to be an ecosystem that works to reduce inequalities.

Zoe Hawke is CEO of E Tipu E Rea Whānau Services.