Tackling health inequities head on
By the turn of the millennium it was clear that PHARMAC’s work was contributing to the wellbeing of New Zealanders, but some still weren’t getting the full benefits of subsidised medicines.
The health needs of Māori were made a focus of PHARMAC’s work in 2001 as it set about developing its first Māori Responsiveness Strategy. This would see PHARMAC reflect in its work Te Korowai Oranga, the New Zealand Māori Health Strategy, which was released in April 2001.
PHARMAC’s senior staff travelled the country to meet face to face with Māori as part of a series of hui that explored barriers to access and use of medicines among Māori and looked for practical ways to overcome them.
This was the first time PHARMAC had undertaken major face-to-face consultation with Māori.
“The hui and the messages we received from them underline a very important point. If public sector health organisations such as PHARMAC are to succeed in improving people’s health, it is vital that they hear the views of the end user – the patient – as part of their decision-making processes. If they don’t do this, they risk making decisions that don’t reach the people they are aimed at… ,” McNee wrote in the 2002 Annual Review.
The resulting strategy laid out PHARMAC’s obligation under the Treaty of Waitangi to be as responsive as possible to Māori, and to improve Māori health. It outlined six areas where the agency would focus its efforts.
These ranged from identifying Māori health priorities and boosting resources for training and development activities, through to collecting better ethnicity data on medicines use and improving Māori representation in PHARMAC’s key decision areas and governance.
Marama Parore, who had extensive experience in the public health sector and in training Māori community health workers, helped PHARMAC develop the strategy and considered it a powerful statement of intent to tackle inequalities in access to medicines.
“For people like me it gave us incredible, intense hope.” - Marama Parore
Marama Parore would join PHARMAC in 2003 and spend the following decade at the agency leading PHARMAC’s Māori Responsiveness Strategy.
She recalls her initial hesitancy at joining PHARMAC as a staff member.
“Aren’t they the geekiest of the geeks in the health sector?” she remembers thinking to herself.
“But Wayne McNee gave me great leeway to get on with it and pathfind for PHARMAC their pathway to being more responsive to Māori.”
Parore’s work with PHARMAC would coincide with a proliferation of community-based Māori health providers. A great deal of effort went into working alongside them to improve access to medicines to treat conditions such as diabetes, respiratory disease, cardiovascular disease, mental health, rheumatic fever, obesity and cancer – all areas where Māori were and continue to be over-represented in health statistics.
At the same time, PHARMAC was looking internally to ensure it was living and breathing its Māori Responsiveness Strategy, with the creation of the Māori health team, and Māori appointments to the advisory committees and the Board. This was also integrated throughout all planning and accountability documents, from the agency’s Funding Agreement and Statement of Intent to its Annual Plan.
“You’ve got these very brainy young analysts doing the prioritisation process and they are already thinking, ‘what will this mean for Māori?’” says Parore.
A second Māori Responsiveness Strategy would follow, and a third taking effect in 2013 took a long term view out to 2023.
That strategy, Te Whaioranga 2013–2023, references not only Treaty of Waitangi obligations, but also the United Nations Declaration on the Rights of Indigenous Peoples.
“It says that agencies are enabled to take measures to create equity. PHARMAC were pretty brave to do that,” says Parore.
The long-running One Heart Many Lives programme epitomises the work PHARMAC has embarked on in communities to tackle health inequity.
The kaupapa of One Heart Many Lives at its inception in 2003 was to increase the survival rate of Māori and Pacific men when it came to heart disease.
“We took the data for statins and found that brown men aren’t getting them. They are going to hospital and dying. That’s not a good picture – what can we do?” says Parore.
The programme expanded into the community in 2008, with free heart checks for tāne Māori and Pacific men at community and sporting events as well as training sessions for primary care nurses.
‘Get your heart checked bro’ became the unofficial catchphrase of One Heart Many Lives, which carries on as an initiative of Whānau Ora collectives, health providers and communities.
Another PHARMAC programme, He Rongoā Pai, He Oranga Whānau, involves wānanga held around the country to improve understanding of the use of medicines in Māori communities.
Nearly 20 years of work on Māori and Pacific peoples’ health has made a difference, says Parore, who continues to work on community and public health sector initiatives.
“PHARMAC let me do stuff that really made a difference.”
Last updated: 13 September 2018