Dr Danny de Lore: "Health is the ability to control your life. Health is tino rangatiratanga."

Paediatrician Dr Danny de Lore, chair of the Indigenous Child Health Working Group for the Royal Australasian College of Physicians, spoke powerfully at our Post-Budget Breakfast in Tāmaki Makaurau on 21 May 2021. This is his speech.

Tēnā koutou katoa.
He mihi ki te wahi ngaro, ki nga atua, ki ngā mana kei tua o te pae o maumahara, tēnā koutou.
Te hunga mate ki te hunga mate, haere, haere, haere.
Ka mihi ki te iwi kāinga, ki a Ngāti Whātua tēnā koutou. Ki a tatou e tau nei, ka nui tāku mihi.
Tēnā koutou tēnā koutou tēnā koutou katoa.

It’s a privilege to be invited to speak at the Child Poverty Action Group post-Budget breakfast, and I congratulate the CPAG on the great work they have been doing.

The College of Physicians, the professional body that all paediatricians in this country belong to, has a position statement that sets out its priorities for the health of indigenous children in Australia and Aotearoa.

The position statement is intended for doctors, but many of the priorities in the statement could also be priorities for us as a country.

The College of Physicians, or more correctly the Royal Australasian College of Physicians, is a conversative organisation with strong British colonial roots. And yet it has embraced the indigenous health priorities I’m about to outline. It gives me great heart that the College of Physicians can do this because it surely must mean that most people in Aotearoa can do it too.

I’m going to go through the most important of those priorities. Then I’m going to consider what they might mean if we as a country also embraced them.  

The first key priority: Māori children have a right to experience the same standard of health as other children. Right now, they do not experience the same standard of health. This isn’t because they have done something wrong. Māori children experience poorer health, and they are set on a trajectory of future poorer health, well before they are old enough to make any health decisions.

The College of Physicians recognises that Māori people are frequently unable to fully realise their human rights.

The College recognises and endorses the unique rights of Māori in Aotearoa under Te Tiriti.

The second key priority: Paediatricians should be able to openly discuss and teach about how unconscious bias, institutional racism, colonisation and privilege impact on the health of children. Racism is coming under the spotlight more and more around the world and in Aotearoa. You hardly heard that word in the media or anywhere, now it is used often. I think that is great. By recognising it we can examine it, we can develop strategies to counter it.  

We should keep talking about the continual active process that is colonisation and the role that privilege, so often invisible to those who enjoy it, plays in our society.

The third key priority:

Māori health works best when designed and delivered by Māori people.

Recently at a College of Physicians conference I was reminded of the work of Sir Michael Marmot. He is a leading authority on the social determinants of health. He found that the lower your social and employment status, the less control you have over your life, the more stress you experience and the poorer your health. This led others to define health not as the absence of disease, but rather the ability to adapt and to self-manage, in the face of the social, physical and emotional challenges. In other words, health is the ability to control your life.

We talk a lot about health equity for Māori, but equity is not the ultimate health aspiration of Māori. The ultimate health aspiration of Māori is tino rangatiratanga, as set out in Te Tiriti.

The ability to determine your own future. The ability to be in control of your life.

Health is the ability to control your life.

Health is tino rangatiratanga.

The creation of a Māori Health Authority is step towards tino rangatiratanga. I’m really positive about the possibilities. I can tell you as someone who is working right at the point where healthcare meets people our health system is fundamentally not equipped to achieve health equity for Māori. It will always favour those who are most similar to the people who designed it, who control, who deliver it.  A Māori Health Authority is a step towards redressing this fundamental flaw in the way we currently deliver healthcare.

Key message number 4: The College of Physicians is committed to the development of a Māori health workforce that mirrors the population. The College aspires to this not just because it will help us achieve equitable services for Māori people, not just because diversity in the health workforce benefits everyone, but because Māori have a right to participate in the delivery of healthcare at every level.

So, these are key priorities for Māori health that paediatricians in this country have stated.

  1. Māori children have a right to experience the same standard of health as other children.
  2. Paediatricians need to understand how institutional racism, colonisation and privilege impact on the health of children.
  3. Health is the ability to control your life; health is tino rangatiratanga.
  4. Māori have a right to participate in healthcare at every level.

If these indigenous health priorities of the College of Physicians were also the priorities of the people and the government of this country, then this is what I think this is what we would do:

We would shed the myth that there is a level playing field of equal opportunity and equal access to our institutions; the myth of meritocracy, that says everyone gets what they deserve. The field isn’t level, and its children at who find themselves at the wrong end of the field, especially Māori children, who continue pay a heavy price. It is the myth that makes us focus on the people who need more when we are analysing the budget, but not focus on those who have much more than they need. It’s the myth that tells us that those who have power and resources deserve those things because they were smart and worked hard, and those without power and resources deserve not to have them because they weren’t smart enough and didn’t work hard enough.

We would make sure that a Māori Health Authority, built on Te Tiriti and tino rangatiratanga, has funding, resources and workforce development that represents true sharing of power in healthcare. I’ve seen some dollar amounts in the budget that looked promising to me at first glance, but the Māori Health Authority will require a long-term commitment from this and future governments.

We would do everything we can to elevate the status of te reo and te ao Māori in our society. I haven’t talked much about what I see day-to-day as a Paediatrician, but one thing I do see is that

Māori children and young people who are connected to their language and culture are protected against the negative health effects of colonisation.

They know they belong to something important, and I think that makes it less likely that crime, drug and alcohol dependence, low participation in education and employment will be part of their lives. By demonstrating that we all value te ao Māori, by showing them that they don’t have to leave it at the door when, for example, they come to hospital to see a health care professional, we are strengthening that protective effect.

We would invest in all our children. We wouldn’t see a more just distribution of the wealth of our country as a burden, we would see it as an investment that we all benefit from.

We would take more collective responsibility for our children’s futures, so that instead of large numbers of children being left behind, they would all have the chance to flourish and reach their potential and become people who fully participate in society, because that benefits all of us.

Tēnā koutou tēnā koutou tēnā tātou katoa.


Recommended Reading:

The Royal Australasian College of Physicians Position Statement on Indigenous Child Health