Māori health workers have called the launch of a dedicated authority one of the biggest steps towards equity, but have also warned its success is far from guaranteed.
The government has hailed the new Māori Health Authority, which came into existence on Friday, as a game-changer.
But on the struggling frontline, no one is expecting change to happen quickly.
In Rotorua, Danny de Lore is one of the country's few Māori paediatricians. He is working in hospitals and a health system that is swamped with COVID-19, a ravaging flu outbreak and a lack of staff.
"It's really stressful at the moment," he said. "The health system is under a lot of pressure, huge demand, acute demand. There's a lot of pressure just day-to-day, hour-to-hour at the moment.
"But there's also a lot of people feeling encouraged by the possibility," he added, referring to the biggest change to the health system in a generation.
In particular, Dr de Lore was excited about the creation of a specific agency for Māori health, tasked with addressing deep inequities.
The launch today of the Māori Health Authority comes after years of advocacy by the likes of Dr de Lore and many others. It also comes after decades of reports and inquiries that have all come to the same conclusion: the health system is riven with deep inequities.
The chief executive of the interim Māori Health Authority, Riana Manuel, said its purpose was to level the playing field.
"What we have is not working. To stay with it any longer is only going to make that pressure worse," she said. "If we wanted a tree we should have planted it 20 years ago, now we've got to plant the tree."
But the task is daunting.
On average, Māori die younger and suffer more severe illness, often at an earlier age and with a lower chance of survival; there is also poorer access to healthcare - particularly primary care.
Surveys have found Māori often experience racism in the system, there are few Māori doctors and Māori providers have long had inequitable funding.
The authority has been tasked with transformation, on a budget of $168 million.
The chief executive of Gisborne Māori health provider Turanga Health, Reweti Ropiha, said something had to be done to move away from a failing status quo.
"You know, battling with bureaucracy to have an opportunity to have a crack at things and make things happen," he said. "[Lacking] a world view that allowed those spaces to permeate and grow.
"It's a bold move with high expectations," he said. "I admire those who put their hand up, it's not gonna be easy."
He offered an immediate fix: remove the hurdles and trust Māori to help their own.
Manuel said the authority would work alongside the other new agency, Health NZ; it will have its own commissioning powers and programmes with Māori providers like Turanga, but it would also have oversight of the whole system, to ensure equity.
She said some changes would be quick, like improving contracts and access to screening and diagnostics. But she warned other changes would take years, like changing structures and attitudes.
"I'd like to tell you that change will happen overnight, but it won't.
"But there will be a lot done to make sure things that we can do quickly, will be done quickly. We've already started to make those changes, but we'll also be putting those stakes in the ground and planning for big transformation as well."
Dr de Lore said today was the biggest change in his career and he was excited about its potential.
But that's the key word: potential.
"Things I will be looking for: Māori rangatiratanga, so that's the Māori voice saying 'this is what we need, this is how we want our healthcare delivered to us, these are the things we want access to'. That's a really important part of it.
"These are the sort of things that have been missing historically from the design of our health system and from the delivery of our health systems."
Dr de Lore said it was change that was long overdue, but its success was far from guaranteed.
Those are sentiments shared by Reweti Ropiha in Gisborne.
"I'll be watching this over the next six to eight months and looking forward to the wheels starting to turn. Hopefully, rather than red light or amber light, we'll get green lights."
RNZ
