The need for inclusive and deliberative decision-making in the COVID-19 pandemic

by Rochelle Menzies
Open group meeting of People in an office

New Zealand is in a crisis, which is affecting the entire population, but will hit Māori particularly hard.

What are the current systems for engaging advice from Māori experts and leaders regarding pandemics and crises? Whatever processes may exist appear to have not worked with this crisis, because lack of consultation with Māori around the government’s Covid-19 response has raised serious concerns amongst many Māori public health experts.

According to the Treaty of Waitangi, the New Zealand government has a duty to consult with Māori on all matters affecting them, inclusive of crisis situations, such as the pandemic we currently face. Rather than subjugating Māori to silent or junior partner roles, it is necessary to ensure full partnership with Māori to promote equitable futures for tangata whenua. In fulfilling this duty the government is obliged to consistently apply their responsibilities of consultation in ways that align with Māori decision-making processes. Traditional hui consultative processes are known to be somewhat complex and time-intensive, which may or may not have been a factor in excluding Māori from Covid-19 preparation, however, this would be a Eurocentric assumption at best.

It can be argued that there was sufficient time between the international notification of a novel coronavirus outbreak and it breaching our borders, for the government to consult with Māori extensively in a variety of capacities. Wuhan health officials reported their Covid-19 epidemic on 31 December 2019, and the first case of Covid-19 in New Zealand was confirmed on 26 February 2020, leaving eight weeks to appropriately engage with Māori expertise in planning for the potential arrival of Covid-19 in our country. As such, this begs the question: what consultation was actually happening during this period? In accordance with international standards, Māori have the right to determine their own priorities and needs regarding their sustainable development, health and wellbeing and these rights need to be operationalised now as a matter of urgency, and should continue beyond the immediate threat of this epidemic.

As the Covid-19 pandemic edged closer to our shores, it became increasing clear that New Zealand’s Ministry of Health are not approaching this crisis from a Māori or whānau-based perspective. Despite an extensive body of Māori health professionals and public health experts, they were neither consulted nor asked to assist with pandemic planning in any way. Yet ethically it is reasonable to expect the Ministry to practice inclusiveness and cultural-responsiveness at a time such as this. The subsequent failure to ensure that a Māori perspective on the current crisis informed all its decision-making and preparation now presents serious potential consequences for the health and wellbeing of the Māori population.

Consequently, a group of Māori health experts, including Dr Rawiri Jansen, quickly mobilised to establish a National Māori Pandemic Group, Te Rōpu Whakakaupapa Uruta, and website to co-ordinate a national Māori-specific response within days. Backed by a national forum of iwi leaders, the new pandemic group will utilise the website to provide culturally-relevant knowledge for pandemic planning and expert advice for iwi and Māori organisations. The speed at which this Rōpu mobilised to produce timely, meaningful, and crucial crisis information evidences the urgency of this matter and serious implications of ignoring Māori expertise at this time of uncertainty. Undeniably, Māori leaders and experts can combine to bring transdisciplinary expertise together, along with their collective local knowledge and wisdom tested over time, including mātauranga Māori and tikanga, for more comprehensive and better informed decision-making.

Fresh concerns are emerging, however, as we settle into the current lockdown phase of the government’s response. Experts informing the Select Epidemic Response Committee of Parliament have highlighted growing dangers around community transmission of Covid-19 as a direct result of the government’s incomplete border controls and quarantining regulations as well as under-testing for Covid-19 including community surveillance. These serious issues carry heavy implications for the Māori population, along with the Ministry of Health’s admission that preparedness for a novel Covid-19 epidemic is informed by the extant plan for influenza pandemics. History tells us that compared to non-Māori, Māori people fare poorly in epidemics of infectious diseases, mainly due to policies underpinning such plans, and their high rates of co-morbidity.

As several Māori health experts have pointed out in recent weeks, Māori, Pacific and other vulnerable communities will be hardest hit if this global pandemic is allowed to get a foothold in New Zealand. Poverty is the key determinant of poorer epidemic outcomes, and Covid-19 is predicted to rip through the high deprivation deciles of vulnerable communities if its spread is allowed to continue unabated. To put this in perspective, 40% of Māori live in decile 9 and 10 areas of highest deprivation, and approximately two-thirds of the Māori population live in the four deciles (7-10) of highest socioeconomic deprivation. This alone justifies inclusion of Māori in deliberative pandemic decision-making to protect tangata whenua from any avoidable exposure to Covid-19, as a matter of equity.

Impoverished whānau residing in these deprived areas generally experience multiple disadvantage, precarious accommodation, substandard housing, or overcrowding, all of which increase their risk of poor outcomes. With a youthful population profile, 42% of the Māori population is aged 20 years or younger, which means the pandemic requires special consideration of single parent whānau as well as grandparents raising their mokopuna. In order to adequately protect our most vulnerable taonga, our elders and tamariki, impacts of the pandemic on multigenerational households and disadvantaged whānau with numerous tamariki must be negated. High numbers of homeless and incarcerated Māori also speak to the need for Māori expertise and partnership in decision-making during this pandemic. Socioeconomic deprivation predisposes Māori to poorer health status and disproportionate rates of chronic conditions, which greatly increases risk of serious complications and poor outcomes for the Māori population if Covid-19 is not urgently stamped out.

For example, 21% of Māori children and 16% of Māori adults have asthma requiring medication. Māori aged 0-24years are 6.62 times more likely to be hospitalised for bronchiectasis than non-Māori and approximately two times more likely to be hospitalised for pneumonia than non-Māori. Half of Māori adults are obese, 7% of Māori have diagnosed diabetes, and 45% of kidney disease cases are Māori. Total-cancer registration rates for Māori females is 37% higher than non-Māori females and the Māori male rate is 18% higher than for non-Māori males. Five percent of Māori adults have diagnosed ischaemic heart disease, and Māori aged over 45 years are 2.5 times more likely to die from COPD than non- Māori aged 45+ years. For cardiovascular disease, rates for Māori males are 1.5 times higher than non-Māori males and Māori female rates are two times higher than non-Māori females.

With similar risks for Pacific peoples, these statistics reflect the importance of stamping out Covid-19 as quickly as possible, to prevent avoidable morbidity and mortality for our most vulnerable communities. As a small isolated island nation, New Zealand stood a good chance of avoiding this pandemic through stringent measures, but government strategies did not take full advantage of the opportunity offered before the virus hit our shores with now nearly one thousand known cases. So, now is surely the time for the government to start getting this right, as New Zealanders compliantly social-distance and self-isolate. Last week, Professor Sir David Skegg urged the government to act urgently and utilise this lockdown period as a key “window of opportunity” to stamp out Covid-19 as fast as possible.

Moreover, there is also a window of opportunity for the government to take equitable action by assembling a transdisciplinary body of key Māori and non- Māori leaders and experts, independent from Parliament and the current ‘plan.’ New Zealanders need to be able to trust that every action is being taken to protect them from the pandemic, and Māori need to know that their best interests are being prioritised and handled in a culturally-responsive manner. Trust will be critical if things get worse and trust is fragile. An independent pandemic expert advisory group will be better placed to inform the remainder of the lockdown phase and effectively strategise how to get New Zealand through the pandemic as quickly and safely as possible. Uncertainty and concern around what happens beyond the current lockdown is building, so ethical and effective handling of the next phase is paramount.

As such, transparent processes will ensure honest brokerage of viable options and best practice for well-informed deliberative processes and truly democratic decision-making that affects the lives and futures of all New Zealanders. These recent weeks have undoubtedly exposed weaknesses between Crown and Māori in regards to the Treaty of Waitangi and Māori rights to partnership. Clearly tensions exist between democratic deliberation in decision-making processes and the need for urgency in crisis situations, which now raises new questions about how the Crown can better meet its Treaty obligations in the face of crises. Despite the government’s lack of culturally-responsive planning, communication, and decision-making around Covid-19, opportunity now exists to engage openly with Māori expertise and iwi leaders in developing new processes for future crisis management.

Rochelle (Te Aitanga-a-Māhaki, Ngāti Kahungunu) has recently joined the Koi Tū team, bringing with her expertise in Kaupapa Māori research. Previously, Rochelle has worked as a Māori health researcher and Kaupapa Māori practitioner on a variety of population health and psychological medicine research projects. She has experience of health sciences, public health, health systems, Māori studies, and health psychology within undergraduate and postgraduate teaching settings. Rochelle’s areas of interest include health equity, indigenous health, child and youth mental health, Māori health and wellbeing, tamariki Māori wellbeing, and whānau wellness. Rochelle has a BHSc (psychology) from Massey University, and a PGDipHSc (health informatics) and MHSc from the University of Auckland. She is currently near completion of a PhD in Health Sciences at the University of Auckland.

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