Indigenous health: New Zealand experience

he health status of indigenous populations in Australia and New Zealand gives justified cause for concern. After European colonisation, their survival was threatened by a range of infectious diseases to which they had little or no immunity. Though no longer the threat posed in the 19th century, the incidence of infectious diseases remains disproportionately high in indigenous populations,1 and a range of non-communicable chronic diseases has also emerged, including cancers (breast, lung, stomach), mental disorders, youth suicide, alcoholand drug-related disorders, obesity, obstructive respiratory disease, ischaemic heart disease, stroke and diabetes.2 In both Australia and New Zealand, the incidence of all these conditions is significantly higher in the indigenous population than the non-indigenous population.3 Solutions for indigenous health will depend on a range of factors, most well outside clinical arenas. Consequently, significant gains in health will be unlikely unless there is a concerted intersectoral, whole-of-government approach reflected in practices, legislation and national policies.4 In New Zealand, that prescription was signalled in the 1840 Treaty of Waitangi, when Maori and the Crown agreed to recognise British sovereignty in exchange for guarantees that indigenous rights to customary resources would be protected and that Maori would have the same “rights and privileges” as other British subjects. Although subsequent governments reneged on many Treaty promises, the Treaty of Waitangi Act 1975 endorsed the relevance of the Treaty to contemporary New Zealand and created a mechanism for dealing with claims against the Crown for breaches of the principles of the Treaty. Most such claims have concerned land, but the 1988 report of the Royal Commission on Social Policy affirmed that the principles of the Treaty, such as partnership, protection and participation, were also relevant to social policies including health and education.5 Later, under the New Zealand Public Health and Disability Act 2000, district health boards were required to “recognise and respect” the principles of the Treaty of Waitangi by ensuring Maori participation in decision making and in the delivery of health services. A more recent and global statement on indigenous rights is contained in the United Nations declaration on the T Mason H Durie CNZM, MB ChB, DPsych, DLitt, Professor of Maori Research and Development, and Assistant Vice-Chancellor (Maori & Pasifika)