how the Treaty really guides NZ’s drug-buying policies

Reports that Associate Minister of Health David Seymour has told Pharmac, the pharmaceutical purchasing agency, to “stop factoring Te Tiriti o Waitangi into its decisions” aren’t strictly accurate.

His five-page letter of expectations to Pharmac only gave the Treaty of Waitangi a few lines. Seymour said Pharmac should no longer follow the previous government’s instruction to “consider how it could contribute to embedding Te Tiriti o Waitangi across the health sector”.

In short, whatever “embedding” means, Pharmac shouldn’t consider it. Instead, he instructed:

Pharmac’s role should focus on delivering improved health outcomes underpinned by robust data and evidence, in accordance with its statutory responsibilities. This should serve all New Zealanders based on actual need, without assigning their background as a proxy of need.

Seymour later said: “We’ve got to be open about the fact that sometimes ethnicity’s a factor, sometimes it just isn’t.”

Genetic influences on illness and responsiveness to medicines are best left to those with the appropriate expertise. But the politics of the issue is another matter. The fact is, ethnicity (let alone “race”) is not mentioned in te Tiriti or in Pharmac’s own detailed Tiriti policy.

Te Tiriti and ethnicity

Notions of race – these days a debunked colonial concept – and ethnicity often accompany these debates. But serious interpretations of te Tititi’s relevance and importance don’t involve discussion of race.

Essentially, te Tiriti is about equality, including the idea that health policy should work as well for Māori as for anyone else.

On the other hand, Seymour’s interest in “robust data and evidence” is important. There is evidence from all over the world that culture and colonial experiences influence how people see health and wellbeing.

There is also global evidence that racism contributes to poor health. In New Zealand, there is evidence Maori people don’t always have the same access to medicines they need. Te Tiriti won’t explain why this is the case – but it does say we should find out.

Te Tiriti might not tell Pharmac which of two drugs is the better treatment for a given disease. But if “robust data and evidence” show up the underfunding of a drug used to treat an illness disproportionately affecting Māori people, te Tiriti might help fix the problem.

This is because te Tiriti is an agreement concerned with how government actually works. It is about who makes decisions, how and why, and for whom.

Although Pharmac’s Tiriti policy might be criticised for being too long and vague in places, this is not uncommon in policy writing. But it does indicate Pharmac has seriously thought about how te Tiriti can improve health outcomes.

Substance of the Treaty

Pharmac is just one of many public agencies to use “critical Tiriti analysis” to guide its work.

This is a policy development and evaluation method developed by policy scholars Heather Came, Tim McCreanor and me to help policymakers (and anyone who wants to comment on policy) think beyond the vagueness of the treaty principles to the substance of the agreement.

The central argument is that the right to government conferred in article one of te Tiriti was never a right to do harm. The preamble to te Tiriti says the queen’s concern was to:

protect the chiefs and the subtribes of New Zealand and in her desire to preserve their chieftainship and their lands to them and to maintain peace and good order [and] establish a government so that no evil will come to Māori and European living in a state of lawlessness.

The preamble is a clear statement about the distribution of power, authority and responsibility. The powers of government were constrained by the rights and capacities of rangatiratanga in article two, which simply means Māori people making their own decisions.

The idea of government as an exclusive non-Māori power is dismissed by te Tiriti’s promise of citizenship grounded in equal tikanga, or cultural equality.

Te Tiriti and citizenship

Who buys which medicines for whom, and why, concerns Māori citizens as much as any others. How easily accessible those medicines are to which citizens, and why, also concerns them.

As critical Tiriti analysis suggests, it is reasonable to presume all public policy should show evidence of Māori participation and leadership, and acceptance of Māori worldviews and conceptions of wellbeing.

It’s also reasonable to say that when policies are supposed to benefit Māori people as much as everyone else, it is Māori who should be the judge of whether that is actually true.

There are robust data and evidence to show independence and voice – the ability of Māori experts to influence and make policy decisions – contribute to health outcomes. This is why te Tiriti can help.