Â鶹ֱ²¥

Principles of the Treaty of Waitangi Bill

RANZCOG

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists

Updated
15 January 2025
SHARE

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), as the organisation responsible for training and ongoing professional development of obstetricians and gynaecologists in Australia and Aotearoa New Zealand, is committed to developing the workforce to reflect the populations it serves, and to including cultural safety and health equity in our training curriculum and programmes.

Â鶹ֱ²¥reaffirms our commitment to te Tiriti o Waitangi and partnership with MÄori as tangata whenua in Aotearoa New Zealand. We firmly believe that ethnicity is established by evidence as a strong identifier of need and this is supported by a wide range of evidence showing the link between ethnicity and life expectancy, access to care and health outcomes.

The Principles of the Treaty of Waitangi Bill aims to promote a national conversation. Â鶹ֱ²¥is fully supportive of broad community discussion of important issues and matters that significantly impact the wellbeing of its population. However, the conversation in relation to the Principles of the Treaty of Waitangi Bill risks creating both division and distraction from the important work of ensuring pae ora for all and addressing the current inequities in health. We urge the Government to drop the bill, which it has no intention of passing.

Te Tiriti o Waitangi (te Tiriti) is a founding document in Aotearoa New Zealand that is fundamental to health and social policy. Â鶹ֱ²¥recognises that MÄori are tangata whenua of Aotearoa New Zealand and have Indigenous rights that are reaffirmed by He Whakaputanga (Declaration of Independence), te Tiriti and the United Nations Declaration on the Rights of Indigenous Peoples.

Â鶹ֱ²¥is not an expert on Te Tiriti or the current principles that guide its interpretation on contemporary matters. Never the less we view this Bill as attempting to rewrite the meaning of Te Tiriti o Waitangi in law, undermining the rights of MÄori to equitable, culturally responsive healthcare. It ignores systemic inequities entrenched over generations and impedes the tailored approaches required to achieve equitable outcomes.

Te Tiriti principles as they apply specifically to health were developed by the Waitangi Tribunal. Recommendations were that the delivery of health care in Aotearoa New Zealand be guided by five treaty principles – tino rangatiratanga, equity, active protection, options and partnership. These principles provide guidance and a pathway to enable improvements in MÄori health outcomes.

Â鶹ֱ²¥are experts on women’s healthcare and we have deep concern that the proposed Principles of the Treaty of Waitangi Bill, which formed part of the coalition Government agreement, has been progressed with undue speed and at a time when New Zealand is facing significant pressures and our healthcare system is in crisis. This means the opportunity for meaningful analysis and broad consultation is constrained. We note that the Ministry of Justice’s Regulatory Impact Statement: Providing certainty on the Treaty principles has supported maintaining the status quo “to minimise the risk of damaging MÄori-Crown relations because the proposed Bill could be seen as an attempt to limit the rights and obligations created by the Treaty. This would present a significant risk to the MÄori-Crown relationship and could have flow-on effects into other parts of the relationship.â€1

Â鶹ֱ²¥is deeply concerned that at a time when our social services and health system are failing to meet the needs of whÄnau and wÄhine MÄori, that resources are being invested in a conversation that is unlikely to result in change, but very likely to create stress and fracture relationships and at best do little to address the needs of our most at risk population.

The health community has worked hard over recent years to address systems that have disadvantaged MÄori and other ethnicities2 , and to enact the commitments of te Tiriti o Waitangi. Â鶹ֱ²¥has been disturbed to see doctors and health providers criticised for prioritising the needs of MÄori3. Equity of health for wÄhine and whÄnau MÄori requires significant focus, new approaches, and the effort of the whole health system and all who work in it.

We are deeply disturbed by MÄori being excluded from any engagement with the development of The Principles of the Treaty of Waitangi Bill. This has been described as a clear breach of te Tiriti . The proposed principles in this Bill trample the mana of te Tiriti4 5, discriminate against MÄori, abrogate MÄori rights, and extinguish tino rangatiratanga.

MÄori currently experience a range of poorer health outcomes generally and in respect of their reproductive health. While broad social determinants of health such as education and socioeconomic factors play a role, as they do for other populations within Aotearoa, these poorer outcomes are significantly contributed to by systemic barriers and structural racism6 7, . A needs-based approach, while relevant for all of our populations, is not sufficient for MÄori. Equity for MÄori and commitment to te Tiriti are inextricably intertwined. Te Tiriti provides both the impetus and structure for enacting the kinds of changes that are required to right inequities in health and other outcomes for MÄori. Â鶹ֱ²¥calls for whole-of-government approach, that aligns with already detailed principles, to address systemic barriers and structural racism which are linked to important determinants of health such as income, education, and housing.

Evidence from various studies and reports indicates that MÄori in New Zealand experience significant health disparities compared to the non-MÄori population8:

Life Expectancy: MÄori life expectancy is lower than that of non-MÄori. According to the Ministry of Health, the life expectancy for MÄori men is about seven years shorter than for non-MÄori men, and for MÄori women, it is about five years shorter than for non-MÄori women.

Higher Rates of Chronic Diseases: MÄori have higher rates of chronic health conditions, such as diabetes, cardiovascular disease, and respiratory conditions. For instance, MÄori are almost twice as likely to be hospitalized for diabetes-related complications.

Mental Health Disparities: MÄori report higher rates of mental health issues, including depression and anxiety disorders. They are also less likely to receive appropriate mental health care, contributing to poorer outcomes.

Barriers to Access: MÄori face more significant barriers to accessing healthcare services, including geographical isolation, cultural differences, and socioeconomic factors. This leads to lower rates of preventive care and delayed treatment for health issues.

Maternal Health: MÄori women experience higher rates of complications during pregnancy and childbirth. For example, MÄori women have higher rates of preterm births and low birth weight infants.

Child Health: MÄori children are more likely to experience health issues, including higher rates of hospital admissions for preventable diseases.

Socioeconomic Disparities: MÄori are overrepresented in lower socioeconomic groups, which correlates with poorer health outcomes. Factors such as income, education, and employment status significantly impact health.

These inequities are significant, unjust, and avoidable, and persist across the lifespan and over time and represent breaches of te Tiriti.

Inequities in health are particularly evident across a range of women’s health areas. The Perinatal and Maternal Mortality Review Committee has chronicled poorer outcomes for MÄori across its 15 reports. MÄori, Pacific peoples and Indian populations experience worse outcomes than those of New Zealand European ethnicity. And the Fifteenth Annual Report of the Perinatal and Maternal Mortality Review Committee9 provides the stark fact that “WÄhine MÄori were 2.91 times more likely to die by suicide as a direct result of maternal mortality than women of New Zealand European ethnicity in the 2006–2020 period.†Â鶹ֱ²¥has been a partner in development of the recommendations and has championed them. It has become clear that improvements in outcomes for wÄhine, pepÄ« and whÄnau will not happen unless foundational inequities are addressed.

Various studies, including those conducted by the Health Quality & Safety Commission and The Treasury, highlight the persistent disparities in health outcomes for MÄori10 11. Reports often emphasize the need for targeted interventions to address these inequities. These disparities are influenced by a combination of historical, social, and economic factors, highlighting the need for sustained efforts to improve health equity for MÄori communities.

Evolving opinion within the health community is that foundational to addressing need within our MÄori populations is the need for the health system and the broader structures of government to consider cultural safety for Maori as critical for empowerment and engagement. If our system is not safe, then MÄori will continue to fare less well than the rest of the population in various health and social indicators.

RANZCOG, in line with many other colleges has made it a focus to consider health equity. This is an ongoing requirement of the Medical Council of New Zealand and forms part of accreditation of medical colleges in Australia and New Zealand. We have worked with our community of MÄori specialists, trainees and consumers over many years to develop a strategy focused specifically on the needs of MÄori, both in training and practice, and the needs of our whanua and wÄhine. Te Rautaki MÄori me te Ara Whakamua – our MÄori Strategy and Action Plan is an important document that informs all of the professional work that we undertake as a college. This strategy is critically important because systemic barriers and racism are very much alive in Aotearoa, impacting both the outcomes of our wÄhine MÄori and our ability to recruit, train and retain MÄori specialist doctors.

Â鶹ֱ²¥is committed to continuing the journey towards equity and to improving health outcomes for MÄori. Achieving health equity requires a clear commitment to Te Tiriti o Waitangi principles, which obligate the Crown to actively protect MÄori health and address disparities. This is not only a legal imperative under the Pae Ora Act 2022, but a moral responsibility aligned with international commitments such as the United Nations Declaration on the Rights of Indigenous Peoples.

We contest that that focusing on the Principles of the Treaty of Waitangi Bill, which the government has indicated they do not plan to support, is not only an unreasonable pressure on precious resources, but perhaps even more importantly, creates and perpetuates an environment that is culturally unsafe for our MÄori population and risks further magnifying the inequities that they face.

We call upon the Government to stop the Principles of the Treaty of Waitangi Bill, and to ensure that our health system enacts the commitments of te Tiriti o Waitangi and focuses on equity of health in Aotearoa.

NÄku noa, nÄ

Dr Susan Fleming
Vice President Aotearoa New Zealand
Chair Te KÄhui Oranga Å Nuku


1Ministry of Justice. Regulatory Impact Statement: Providing certainty on the Treaty Principles. 28 August 2024. ()

2Loring B, Reid P, Curtis E, et al. Ethnicity is an evidence-based marker of need (and targeting services is good medical practice). N Z Med J 2024 Sep 27;137(1603):9-13

3Department of the Prime Minister and Cabinet. CO(24) 5 Needs-based Service Provision. 13 September 2024. ()

4Ministry of Justice. Regulatory Impact Statement: Providing certainty on the Treaty Principles. 28 August 2024. ()

5Waitangi Tribunal. NgÄ MÄtÄpono The Principles. 2024. Tribunal releases report on Treaty Principles Bill | Waitangi Tribunal.

6Devakumar D, Selvarajah S, Abubakar I, et al. Racism, xenophobia, discrimination, and the determination of health. Lancet 2022 Dec 10;400(10368):2097-2108

7Talamaivao N, Harris R, Cormack D, et al. Racism and health in Aotearoa New Zealand: a systematic review of quantitative studies. N Z Med J. 2020 Sep 4;133(1521):55-68

8Brewer KM, Grey C, Paynter J, et al. What are the gaps in cardiovascular risk assessment and management in primary care for MÄori and Pacific people in Aotearoa New Zealand? Protocol for a systematic review. BMJ open 2022;12(6):e060145.

9Fifteenth Annual Report of the Perinatal and Maternal Mortality Review Committee.

10A window on the quality of Aotearoa New Zealand’s health care 2019 – a view on MÄori health equity.

11Te Tai Waiora: Wellbeing in Aotearoa New Zealand 2022


For media enquiries

Bec McPhee
Head of Advocacy & Communications
bmcphee@ranzcog.edu.au
+61 413 258 166

CATEGORIES
Advocacy Aotearoa New Zealand

LATEST NEWS

Advocacy 7 February 2025
Briefing for new NZ Minister of Health
Following the appointment of the Honourable Simeon Brown as Minister…
Training 3 February 2025
Training updates
Read the latest updates relevant to your training program.
Advocacy 19 December 2024
Roundtable Report: Driving Collective Reform in Private O&G
Urgent collective reform is needed to protect private O&G services.
Aotearoa New Zealand 16 December 2024
Kua hinga te tÅtara o te wao nui a TÄne – A mighty tÅtara tree has fallen in TÄne’s great forest
Â鶹ֱ²¥mourns the passing of kaumatua Luke Crawford.
Our Members 22 November 2024
Â鶹ֱ²¥Extraordinary General Meeting
Extraordinary General Meeting (EGM) of Fellows of the Â鶹ֱ²¥will…
Advocacy 18 November 2024
Â鶹ֱ²¥reaffirms commitment to Te Tiriti o Waitangi and health equity
Â鶹ֱ²¥is committed to continuing the journey towards equity and…
Advocacy 14 November 2024
Private O&G Services Under Threat in Australia Due to Systemic Gender Bias
Â鶹ֱ²¥leads call for urgent reform in private obstetrics and…
Training 1 November 2024
RANZCOG’s Fetal Surveillance Education Program Achieves Record Numbers
The Â鶹ֱ²¥Fetal Surveillance Education Program has achieved over 36,000…
Advocacy 21 October 2024
Health and Safety Must Take Precedence Over Political Agendas: Defend Abortion Rights in Queensland
Â鶹ֱ²¥and leading health and advocacy organisations have come together…