The directive to Pharmac to refrain from considering Te Tiriti o Waitangi in its operations could be challenged on several fronts, highlighting the importance of an inclusive and culturally aware healthcare system in New Zealand.

These arguments suggest that focusing on Te Tiriti o Waitangi (Treaty of Waitangi) and cultural responsiveness distracts from the core function of healthcare institutions. However, such a stance overlooks the systemic inequities that exist within the current system and the significant benefits of adopting a culturally responsive approach to healthcare.

Why Te Tiriti o Waitangi Matters in Healthcare

Te Tiriti o Waitangi is not just a historical document; it is a living agreement that underpins the relationship between the Crown and Māori. In healthcare, this means recognising the importance of health (hauora) as a taonga (treasure) protected under Article 3 of the Treaty. The Treaty guarantees equity, including in healthcare, and ensures that Māori have access to the same health outcomes as non-Māori.

Ignoring Te Tiriti in healthcare policy perpetuates the disparities that already exist between Māori and non-Māori populations. Māori experience worse health outcomes, with higher rates of preventable diseases and lower life expectancy. These issues are not merely the result of individual choices but are deeply rooted in historical marginalisation, systemic barriers, and a lack of access to culturally appropriate services. Therefore, incorporating the principles of Te Tiriti into healthcare policies, including those governing Pharmac, is essential for addressing these inequities.

The Role of Pharmac in Promoting Equity

Pharmac, New Zealand’s drug purchasing agency, recognised the importance of cultural responsiveness in its operations through its Māori Responsiveness Strategy, Te Whaioranga (2013 – 2023). This strategy acknowledged the role of Te Tiriti o Waitangi in ensuring equitable healthcare and sought to address the unique needs of Māori communities. For example, Pharmac developed partnerships with local Māori health organisations to deliver targeted interventions that directly address the health disparities faced by Māori. One such initiative, “One Heart Many Lives,” focused on improving heart health among Māori, a demographic disproportionately affected by cardiovascular disease.

Pharmac’s approach aligned with the broader understanding that health equity cannot be achieved without considering the social, economic, and cultural contexts that affect access to healthcare. Ethnicity, far from being a rare factor, plays a crucial role in shaping health outcomes. The failure to recognise this correlation risks perpetuating systemic bias, making it impossible to close the health gaps that exist between different communities.

Misconceptions About Resource Allocation

One argument raised against culturally responsive healthcare is that focusing on ethnicity and the Treaty is a misallocation of resources. This perspective suggests that diverting attention to cultural factors detracts from the primary goal of improving access to medicines and healthcare for all New Zealanders. However, this viewpoint neglects the long-term benefits of addressing health inequities through culturally appropriate care.

By prioritising equity and cultural responsiveness, the healthcare system can reduce the incidence of chronic conditions and preventable diseases that disproportionately affect marginalised groups, including Māori and Pacific populations. In the long run, this approach reduces the burden on the healthcare system, leading to significant cost savings. Culturally responsive healthcare is not a drain on resources; it is an investment in the well-being of all New Zealanders.

The Financial and Ethical Imperative

Pharmac’s goals should extend beyond simply reducing immediate costs. Its vision includes eliminating inequities in access to medicines by 2025, generating significant savings to reinvest in health outcomes, and creating systems that ensure the best investment choices across all areas of healthcare. These objectives are both financially prudent and ethically necessary. A culturally responsive approach aligns with these goals by ensuring that resources are used in a way that benefits those who have historically been underserved by the healthcare system.

The argument that focusing on the Treaty and ethnicity detracts from financial considerations is therefore unfounded. In fact, equitable healthcare not only improves health outcomes but also contributes to the overall efficiency and sustainability of the healthcare system. By addressing health disparities early, we prevent costly hospitalisations and the development of chronic conditions, reducing the strain on public health resources.

The Path Forward: Embedding Cultural Responsiveness

Pharmac’s commitment to cultural responsiveness through Te Whaioranga and its partnerships with Māori health organisations highlighted the importance of embedding cultural competence within healthcare. This is not just a token effort but a crucial step in building trust and fostering better health outcomes for Māori and other marginalised communities. The health system must continue to evolve by incorporating the principles of partnership, protection, and participation, as outlined in Te Tiriti o Waitangi.

The call to remove cultural considerations from healthcare policy overlooks the profound impact of systemic inequities and the role that culturally appropriate care can play in addressing these issues.