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Forty years ago, in 1980, Professor Eru Pomare published the first volume in the series Hauora - Māori Standards of Health.1 That volume documented patterns of mortality, comparing Māori with non-Māori between the years of 1955 and 1975. Although we now know that data at that time undercounted the number of Māori deaths, this work drew attention to inequities for Māori for most of the common and amenable diseases in Aotearoa. Since that time, efforts have been made to improve the quality of ethnicity data and the literature detailing health inequities has expanded, including another three volumes in the Hauora series.
Health inequities are defined as "the presence of systematic disparities in health between groups."2 Within Aotearoa and internationally, significant work has sought to understand how inequities arise, how they are maintained and how they can be eliminated. Internationally, the work of Professor Sir Michael Marmot has provided leadership,3 and in 2011 the New Zealand Medical Association hosted Professor Marmot on his visit to Aotearoa. It is generally understood that inequities in health are bad, not only for those who suffer from inequity, but also for the public health of a nation. Social and political willingness to invest in the elimination of inequities fluctuates over time. We are currently in a time of some political willingness to address equity.
On 21 April this year, the Minister of Health, Honourable Andrew Little, released details of the proposed programme of reform for the New Zealand health and disability sector.4 This proposal follows the publication of reports from a review of the sector, led by Ms Heather Simpson,5 and from Stage 1 of the WAI 2575 Hauora claim to the Waitangi Tribunal.6 Both reports highlighted comprehensive, consistent and compelling health inequities for Māori as motivations for reform, and noted that the health and disability system continues to underperform for Māori.
While New Zealanders are generally proud of the work that our health system is able to achieve, many of us would also agree that the system faces very significant challenges from repair, replacement or development of critical infrastructure; integration of new technologies; ensuring access to services and timely primary care across our unique geography; health workforce development and appropriate distribution; elimination of duplication of planning and administration functions;...