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Recognising Te Tiriti o Waitangi and its principles, rights, and obligations

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MyRACMA

POSITION

RACMA acknowledges that Māori are the Tangata Whenua of Aotearoa New Zealand. RACMA recognises Te Tiriti o Waitangi and its principles, rights, and obligations. RACMA recognises the unique and enduring partnership between the two treaty partners: Māori and the Crown.

As a peak health leadership body, RACMA commits to implementing the obligations articulated in the principles of Te Tiriti o Waitangi (as articulated by the Courts and the Waitangi Tribunal), to contribute to leadership and vision that lifts the capability of skilled medical leadership to achieve equity for Māori.

RACMA will implement the principles of Te Tiriti o Waitangi outlined in the Waitangi Tribunal in its report: Stage One of the Health Services and Outcomes Kaupapa Inquiry WAI 2575:

  • Tino rangatiratanga
  • Equity
  • Active protection
  • Options
  • Partnership

BACKGROUND

RACMA recognises its role of health system medical leadership in the implementation of the Te Tiriti o Waitangi principles. Our members contribution and influence can be demonstrated in roles that contribute to the practical components of clinical governance in the Aotearoa New Zealand health sector.

RACMA is a medical leadership body with expertise across the Australasian Health Sector. This unique view to positively influence policy and advocacy either in practice, at a national level or where appropriate at a global level is a stewardship RACMA undertakes deliberately.

RACMA CONSIDERATIONS

A commitment to Te Tiriti o Waitangi

RACMA respects the special relationship between Māori and the Crown under Te Tiriti o Waitangi (Te Tiriti). RACMA recognises the rich history, diverse culture and achievements of Māori and is committed to strive for improved healthcare outcomes and equal access to quality healthcare for Māori.

RACMA is a medical specialist college of Aotearoa New Zealand and actively recognises the principles of Te Tiriti o Waitangi relevant to the Health Sector.

The Te Tiriti o Waitangi principles RACMA will embed are the recommendations made by the Waitangi Tribunal in Stage One of its Health Services and Outcomes Kaupapa Inquiry WAI 2575 (1) RACMA has also considered the detail provided in the New Zealand Cabinet Office Circular CO(19) 5 Te Tiriti o Waitangi/Treaty of Waitangi Guidance 22 October 2019 (2).

In Whakamaua: Māori Health Action Plan 2020-2025 (3) the New Zealand Ministry of Health articulates the Te Tiriti o Waitangi principles as:

  • Tino rangatiratanga: The guarantee of tino rangatiratanga, which provides for Māori self-determination and mana motuhake in the design, delivery, and monitoring of health and disability services.
  • Equity: The principle of equity, which requires the Crown to commit to achieving equitable health outcomes for Māori.
  • Active protection: The principle of active protection, which requires the Crown to act, to the fullest extent practicable, to achieve equitable health outcomes for Māori. This includes ensuring that it, its agents, and its Treaty partner are well informed on the extent, and nature, of both Māori health outcomes and efforts to achieve Māori health equity.
  • Options: The principle of options, which requires the Crown to provide for and properly resource kaupapa Māori health and disability services. Furthermore, the Crown is obliged to ensure that all health and disability services are provided in a culturally appropriate way that recognises and supports the expression of hauora Māori models of care.
  • Partnership: The principle of partnership, which requires the Crown and Māori to work in partnership in the governance, design, delivery, and monitoring of health and disability services. Māori must be co-designers, with the Crown, of the primary health system for Māori.

Health Equity

RACMA holds the view that health equity for Māori cannot be addressed or indeed implemented unless initiatives and strategies are developed in partnership with and led by Māori.

RACMA supports the advice from the Waitangi Tribunal (1) that health equity for Māori is a requirement of the Aotearoa New Zealand health sector and that commitments to equitable outcomes for Māori need to be stated unequivocally. 

There is significant research and data to demonstrate that inequities in social determinants of health, institutional and interpersonal racism, and intergenerational effects of colonialism serve as significant barriers to accessible healthcare for Māori.

Cultural Safety

The Medical Council of New Zealand (MCNZ) is the registered health regulator for Aotearoa New Zealand, RACMA recognises and supports the Cultural Safety Standard promulgated by MCNZ in October 2019 (4).  MCNZ have defined cultural safety as (4):

The need for doctors to examine themselves and the potential impact of their own culture on clinical interactions and healthcare service delivery.

The commitment by individual doctors to acknowledge and address any of their own biases, attitudes, assumptions, stereotypes, prejudices, structures, and characteristics that may affect the quality of care provided. The awareness that cultural safety encompasses a critical consciousness where healthcare professionals and healthcare organisations engage in ongoing self-reflection and self-awareness and

hold themselves accountable for providing culturally safe care, as defined by the patient and their communities.

RACMA is a vocational medical training college. RACMA is accredited by MCNZ to provide vocational medical training, continuing medical education, and recertification programmes for Medical Practitioners who register with MCNZ in the vocational scope of Medical Administration.

RACMA recognises its instrumental role to support a culturally safe medical workforce as defined by the Medical Council of New Zealand’s Accreditation standards for New Zealand training providers of vocational medical training, continuing medical education, and recertification programmes (5).

Pae Ora

On the 1st of July 2022 Aotearoa New Zealand’s health system changed the structure for the delivery of health services. This was a regulatory change to a new health act: Pae Ora (Healthy Futures) Act 2022 (6)

The new Act has two significant sections that specifically recognise the Tiriti partnership between Māori and the Crown:

  • Section 6: Te Tiriti o Waitangi (the Treaty of Waitangi) which is to provide for the Crown’s intention to give effect to the principles of te Tiriti o Waitangi, and
  • Part 2 Subpart 3—Māori Health Authority: The establishment of the Māori Health Authority Te Aka Whai Ora

RACMA supporting Position Statements for Te Tiriti o Waitangi Principles

In 2017 RACMA promulgated a Clinical Governance Framework that included foci on patient centred approaches to health service delivery. The “sharing of power” within a clinical framework included consumer advocacy and consumer voice in the provision of health service delivery.

In 2021 RACMA promulgated a position statement on Diversity, Inclusion and Equity this statement acknowledges the expectation that at RACMA: “Everyone works to ensure that perspectives and experiences of others, are invited, welcomed, acknowledged, and respected within inclusive environments.” It has three calls to action the final call being:

“Advancing equitable access in healthcare – ensuring that College members are well prepared to meet the needs of individuals in an increasingly diverse society, by raising awareness and addressing unconscious bias and taking action to address the social determinants of health.”

In 2022 RACMA promulgated a position statement on Remote, Rural and Regional Medical Leadership by Medical Administrators this statement recognised that in Aotearoa New Zealand Māori populations are a feature of rural areas. In Practice Standard 4 the statement acknowledges that the medical workforce strategy should consider that it: Develop culturally safe and appropriate models of care that are enabled by innovative workforce solutions in challenging remote, rural and remote environments to enable equity of access to health care. Practice Standard 4 also articulated to: Actively support workforce strategies that foster Indigenous employment aligned with principles endorsed by appropriate indigenous organisations.

In 2023 RACMA promulgated the RACMA Policy and Advocacy plan 2022 – 2024. One of its priorities is to: Provide effect to the principles of Te Triti o Waitangi (The Treaty of Waitangi) through medical leadership and management. In that plan there was a committed activity to: Develop a position statement to demonstrate how RACMA and its members acknowledge Māori as Tangata Whenua of Aotearoa New Zealand.

POSITION

RACMA acknowledges that Māori are the Tangata Whenua of Aotearoa New Zealand. RACMA recognises Te Tiriti o Waitangi and its principles, rights, and obligations. RACMA recognises the unique and enduring partnership between the two treaty partners: Māori and the Crown.

As a peak health leadership body, RACMA commits to implementing the obligations articulated in the principles of Te Tiriti o Waitangi (as articulated by the Courts and the Waitangi Tribunal), to contribute to leadership and vision that lifts the capability of skilled medical leadership to achieve equity for Māori.

RACMA will implement the principles of Te Tiriti o Waitangi outlined in the Waitangi Tribunal in its report: Stage One of the Health Services and Outcomes Kaupapa Inquiry WAI 2575:

  • Tino rangatiratanga
  • Equity
  • Active protection
  • Options
  • Partnership

References

1.The Waitangi Tribunal. Hauora – Report on Stage One of the Outcomes and Services Kaupapa Inquiry. Lower Hutt: The Waitangi Tribunal; 2019 [cited 2023 07 20. Available from: https://www.waitangitribunal.govt.nz/inquiries/kaupapa-inquiries/health-services-and-outcomes-inquiry/.
2.Cabinet, Michael Webster Secretary of. Department of Prime Minister and Cabinet New Zealand: Te Tiriti o Waitangi / Treaty of waitangi Guidance. [Online].; 2019 [cited 2023 07 23. Available from: https://www.dpmc.govt.nz/sites/default/files/2019-10/CO%2019%20%285%29%20Treaty%20of%20Waitangi%20Guidance%20for%20Agencies.pdf.
3.Ministry of Health. Ministry of Health. [Online]. Wellington: Ministry of Health; 2020 [cited 2023 08 29. Available from: https://www.health.govt.nz/our-work/populations/maori-health/whakamaua-maori-health-action-plan-2020-2025.
4.Medical Council of New Zealand. Statement on Cultural Safety. Wellington; 2019 [cited 2023 07 22. Available from: https://www.mcnz.org.nz/assets/standards/b71d139dca/Statement-on-cultural-safety.pdf.
5.Medical Council of New Zealand. Medical Council of New Zealand: Australasian vocational medical training and recertification providers. [Online].; 2022 [cited 2023 07 12. Available from: https://www.mcnz.org.nz/registration/medical-education/vocational-specialist-training-and-recertification-providers-and-accreditation-standards/australasian-vocational-medical-training-and-recertification-providers/.
6.Parliament Counsel Office New Zealand Legislation. Parliament Counsel Office New Zealand Legislation: Pae Ora (Healthy Futures) Act 2022. [Online].; 2022 [cited 2023 02 14. Available from: https://www.legislation.govt.nz/act/public/2022/0030/latest/whole.html.