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Expert Mechanism on the Rights of Indigenous Peoples: Study on the right to health and indigenous peoples [2016] NZHRCSub 7 (11 March 2016)

Last Updated: 4 June 2016

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Expert Mechanism on the Rights of Indigenous Peoples:
Study on the right to health and indigenous peoples


11 March 2016

Introduction

  1. The New Zealand Human Rights Commission (“Commission”) welcomes the Expert Mechanism’s study on the right to health and indigenous peoples with a focus on children and youth, and appreciates the opportunity to contribute.

  1. This submission outlines implementation of the right to health of indigenous peoples in Aotearoa New Zealand, with reference to:

Indigenous Peoples’ Right to Health

  1. The right to health is a fundamental and universal human right.[1] How the right to health is delivered is considered in relation to the availability, accessibility, acceptability and quality of health services.[2] The right to health encompasses not just the absence of disease or infirmity but “complete physical, mental and social well being.”[3] It includes access to both timely and appropriate health care as well as the underlying social and economic determinants of health, such as conditions of work and adequate food and shelter.[4]

  1. The UN Committee on the Rights of the Child has emphasised that for children, the right is inclusive and includes the “right to grow and develop to their full potential and live in conditions that enable them to attain the highest standard of health through the implementation of programmes that address the underlying determinants of health”.[5] It has also highlighted particular issues for indigenous children, including: the need for special measures to address inequalities; the importance of disaggregated data collection; the interdependence of the right to health with other rights; the need for special attention to the needs of indigenous children with disabilities; the critical importance of cooperation and participation of indigenous peoples in the design and implementation of policies and programmes.[6]

  1. Indigenous concepts of health encompass individual and collective wellbeing, and are interconnected to the realisation of a range of rights, including: self-determination, development, culture, language, land and the natural environment.

  1. The right to health for indigenous peoples is affirmed in articles 21, 23, 24 and 29 of the UN Declaration on the Rights of Indigenous Peoples (UNDRIP). Article 22 emphasises the need for specific focus on children and young people, as well as women, older people and disabled people in the implementation of the Declaration.

  1. In Aotearoa New Zealand, the right to health is reflected and affirmed in the Treaty of Waitangi (the Treaty). The Treaty was signed in 1840 between representatives of the British Crown and Māori rangatira (leaders). The human rights obligations it contains may be summarised as:

  1. Alongside the human rights instruments which protect the universal right to health, the Treaty and UNDRIP affirm the rights of New Zealand’s indigenous people to:


Implementation in New Zealand

Data and research

  1. There is considerable, good quality, publicly available data on Māori health (although, not always to the same extent in relation to Māori children and young people or for disabled people). Data on Māori health outcomes includes:

  1. In addition, specific data that reflects Māori perspectives on the right to health is available through Statistics NZ surveys:

  1. A range of further data collection and monitoring initiatives is also underway, including:

  1. New Zealand’s commitment to realising the UN Sustainable Development Goals, including through the development of indicators could further contribute to the monitoring and tracking of Māori health outcomes.

Health Equity

  1. The data shows that Māori continue to experience entrenched inequalities in the enjoyment of the right to health. A snapshot of some key statistics is attached as appendix 1. Overall, Māori have higher rates for most health risks and conditions, and also are more likely than non-Māori to have unmet health needs.[21] In relation to the broader determinants of health, Māori also experience disadvantage across all socio-economic indicators. These include higher rates of poverty and deprivation, family violence, and poorer outcomes in education, employment and justice.[22] Disparities, particularly for Māori women and children, are also evident in family violence data. Family violence directly contributes to and accompanies a wide range of health (physical, sexual and mental) and social issues (employment and education) and discrimination.[23] Māori women who are victims of family violence are more likely to experience racist attitudes and indifference when seeking help from agencies and services.

  1. Around one in four Māori identify as disabled, and disabled Māori are particularly vulnerable to poor outcomes.[24] Almost a third (32%) of disabled Māori reported their state of health as fair or poor (compared with 6% of non-disabled Māori).[25]

  1. There is a growing body of research that links discrimination to inequitable health outcomes.[26] [27] Experience of racial discrimination is associated with poor health outcomes and has impact on a wide range of risk factors. Of note, studies have found that racism, as a particular and ongoing stressor, may have a greater impact than more general factors. [28]

  1. Recent data shows that Māori adults were almost twice as likely as non-Māori adults to have experienced any type of racial discrimination in the areas of health care, work or housing.[29] Māori adults were almost three times as likely as non-Māori adults to have experienced any unfair treatment on the basis of ethnicity.

Law and policy responses

  1. New Zealand has a publicly funded health system underpinned by a clear legislative framework, and numerous strategies and policies. These include the New Zealand Public Health and Disability Act 2000, which governs public health services and which has among its key objectives: to reduce health disparities by improving the health outcomes of Maori and other population groups. The Act also makes explicit reference to the Treaty of Waitangi, and provides for mechanisms to enable Māori to contribute to decision-making on, and to participate in the delivery of, health and disability services.[30]

  1. Responsibilities of District Health Boards under the Act include reducing disparities, improving Māori health and ensuring that Māori are involved in both decision-making and service delivery.

  1. The New Zealand Health Strategy (currently being reviewed) deals with the health system as a whole. The consultation draft of the updated Health Strategy includes the following guiding principles:[31]

  1. The primary policy document for Māori health is He Korowai Oranga / The Māori Health Strategy (2014).[32] The Strategy sets the overarching framework to guide the Government and the health and disability sector to achieve the best health outcomes for Māori. The Pae Ora framework that underpins the Strategy reflects Māori concepts of health and wellbeing, and includes three elements: mauri ora – healthy individuals; whānau ora – healthy families; and wai ora – healthy environments. The framework and strategy is intended to “encourage everyone in the health and disability sector to work collaboratively, to think beyond narrow definitions of health, and to provide high-quality and effective services”.[33]

  1. Significantly, the Strategy refers explicitly to:

  1. Case studies of promising and successful Māori health initiatives are profiled on the Ministry of Health website.[34]


Whānau Ora

  1. Whānau Ora is a cross-government programme that aims to improve the provision of government services to Māori, by making them whānau focussed and whānau-led. The approach is significant in that it is underpinned by Māori values and concepts, and seeks to empower families as a whole, rather than focusing separately on individual members and their problems. The programme operates through a system involving:

Māori health services

  1. There are approximately 72 Māori health providers contracted to district health boards throughout the country to provide kaupapa Māori services (ie, based on indigenous knowledge and values).[35] In addition, many iwi (Māori tribes) and other Māori organisations implement their own health strategies and programmes, and operate kaupapa Māori health services.[36] A number of these are funded through Whānau Ora.

Māori health workforce

  1. Key to the success of initiatives for Māori health, is a workforce that is diverse and reflective of its communities, and which has the cultural capability to meet communities’ needs. Increasing and adequately valuing and supporting the Māori health workforce, is vital.

  1. Māori are under-represented in all regulated health occupations. Māori make up 5% of the total health workforce; around 3% of doctors, 6.5% of nurses and 9% of midwives. [37]

  1. The national organisation representing Māori nurses has, over recent years, repeatedly raised concerns about the difference in pay rates available to nurses working for Māori health services and those employed by DHBs.[38] While the discrepancy relates to the different contractual arrangements operating in the different sectors, it has been an issue of concern to the NZNO for over a decade, with little progress apparent.

Rongoā Māori – Traditional health practices

  1. Article 24 of the UNDRIP affirms the right of indigenous peoples to traditional medicines, health practices, and the conservation of their medicinal plants and natural resources.

  1. The Waitangi Tribunal[39] has examined issues relating to traditional knowledge, health practices and medicines in its long-running inquiry into the place of mātauranga Māori (traditional knowledge and culture) in New Zealand law, policy and practice. In its 2011 report, Ko Aotearoa Tēnei, the Tribunal discussed the nature of traditional Māori health practices, and noted that “[t]he practice of rongoā and the knowledge and concepts that underpin it are vital aspects of Māori culture itself”.[40] The Tribunal confirmed that rongoā Māori is a taonga under the Treaty, requiring active protection by the Crown, and further noted that “even if rongoā was not the subject of Treaty rights, supporting it would be justified for its potential contribution to Māori health”.[41]

  1. The Tribunal noted the significant impact of environmental and social changes upon rongoā, as well as attempts by colonial governments to suppress it through legislation. The Tohunga Suppression Act 1907 (which remained in force until 1962) which banned the activities of tohunga (expert healers) was, the Tribunal found, a clear breach of the Treaty. The practice of rongoā has also been severely affected by environmental and social changes which have cut Māori off from the sources of rongoā.

  1. The Tribunal noted that in spite of these factors, rongoā Māori continues to be practised. However the support from government, while an improvement on the past, still “lacked urgency and remains inadequate and in breach of the Crown’s Treaty obligations”. Specifically, the Tribunal noted the “tiny” proportion of government funding allocated to Māori healing, the growing demand for rongoā and need for the expansion of rongoā services.

  1. The Tribunal concluded that:

Māori are facing a health crisis. Rongoā has significant potential to help address that crisis, because of its spiritual and biomedical qualities, and because of its potential to bring sick people into contact with the health system.

The Crown has suppressed rongoā in the past and currently fails to support it with the energy or urgency required by both the Treaty and the Māori health crisis.

  1. The Tribunal’s recommendations included that the Crown:

  1. The government has not yet formally responded to the Tribunal’s report with a timetable for implementation.

  1. A 2013 survey of Māori engagement in cultural practices found that 11 percent of Māori adults took part in traditional Māori healing or massage.[42] Another 2013 survey of rongoā (traditional healing) practitioners highlighted a pressing need for expansion of the rongoā Māori workforce and training/service funding, to sustain rongoā practice.[43]

Health issues for Māori children and young people

  1. Māori children and young people are over-represented in negative health outcomes. For example, around one in five Māori children has asthma – a rate 1.4 times that of non-Māori children.[44] Māori children are almost twice as likely to be either obese or morbidly obese compared with non-Māori children.[45] Māori young people have a suicide rate that is 2.8 times higher than that of non-Māori youth.[46] Māori children have a higher rate of unmet health needs: Māori children were 1.4 times more likely not to have accessed primary health when they needed it than non-Māori children.[47] Māori children are also more likely to be exposed to the risk factors linked to poor health, social, educational and developmental outcomes.[48]

Wider determinants of health

  1. Key issues affecting the health of Māori children and young people, include poverty, material deprivation and poor quality housing. Poverty rates for Māori children are consistently higher than for European children.[49] Over the three years 2012–2014, on average, around 33% of Māori children lived in poor households, compared to an average of 16% of European children. The higher rates of poverty and material deprivation seen in Māori children potentially reflect the relatively high proportion of Māori children living in sole parent beneficiary households. On average, during 2012 to 2014, just under half (46%) of children living in poverty were Māori or Pacific.

  1. Disabled Māori children are particularly vulnerable; experiencing higher rates of socio-economic disadvantage. Within the Māori population, disabled people were more likely than others to live in the most deprived areas and less likely to live in the least deprived areas.[50] Disabled Māori also tend to have lower levels of educational attainment, and disabled children face specific barriers in relation to education.[51] Other groups that are particularly vulnerable to poorer outcomes include: children in state care, children of prisoners and children in gang families.

  1. Māori children are also more likely to live in poor housing conditions. While Māori make up 14% of the New Zealand population, they comprise 35% of those living in severe housing deprivation. Twenty-three percent of Māori children live in over-crowded households.[52] Housing issues are further exacerbated for disabled Māori children: 45 % living in houses considered cold, 39 % in houses regarded as damp, and 16% in houses that were considered not large enough.[53]

  1. In December 2012 the Expert Advisory Group on Solutions to Child Poverty (“EAG”) – a group of independent experts commissioned by the Children’s Commissioner – issued a report containing 78 recommendations that covered a range of areas, including social security benefits and tax credits, housing policy, legislative mechanisms, education and child care, health, employment and community strategies.[54] The report highlighted the need to give specific attention to overcoming inequalities for Māori and Pacific children, and the need to consider the issues against the backdrop of colonisation and its lasting impacts.[55]

  1. The government has introduced new policy measures that reflect the EAG recommendations. These have included support for food-in-schools programmes and increasing the age threshold for free primary healthcare for children from 6 years to 13 years. However, to date the government is yet to take any steps towards developing a systemic approach to reducing household income poverty and its impact on child health and well-being. The EAG recommended that the Government develop a systemic, whole-of-government strategy underpinned by legislation as “a first step” in addressing child poverty.[56] Parliament’s Health Committee has also recommended that the government develop an action plan for reducing child poverty, with annual targets and a transparent monitoring system.[57] In its response to the Health Committee, the government did not address this recommendation directly but instead pointed to various other existing actions.[58]


Inquiry into determinants of health for Māori children

  1. From 2011-2013 a Parliamentary Select Committee Inquiry was conducted into the ‘determinants of health for Tamariki Māori (Māori children)’. The Committee’s report was released in 2014, and included over 40 recommendations relating to: research and policy; health services; education; employment and incomes.[59]

  1. Key principles identified included:

  1. The government response to the Inquiry was issued in 2014, and referred to various government programmes and initiatives such as He Korowai Oranga / The Māori Health Strategy and Whānau Ora.[60]

Climate change

  1. The UN Committee on the Rights of the Child has highlighted the relevance of the environment, and specifically climate change, to children’s health.[61] The Committee has stated:

Environmental interventions should, inter alia, address climate change, as this is one of the biggest threats to children’s health and exacerbates health disparities. States should, therefore, put children’s health concerns at the centre of their climate change adaptation and mitigation strategies.

  1. This call has been echoed by health professionals in New Zealand; 16 health professional groups issued a joint statement, calling for stronger action across government.[62] The ‘Joint Call for Action’ noted (among other points) that:

  1. The actions called for by the coalition of health professionals included:

Conclusion

  1. Māori experience entrenched health inequalities, and Māori children and young people and disabled Māori are particularly vulnerable in this respect. In response, a range of initiatives are attempting to address these. There is increasing understanding and awareness of structural barriers; widening acceptance of the fact that one size doesn’t fit all; and a range of policies and programmes that incorporate and provide for Māori values and world views. He Korowai Oranga / The Māori Health Strategy is key among these, and is significant in the extent to which it reflects and is underpinned by Māori values and concepts. It also makes explicit references to the Treaty of Waitangi and to human rights concepts including self-determination and participation.

  1. There is some government support also for traditional Māori health practices, although a recent Waitangi Tribunal report found that the nature and level of support needs considerable strengthening.

  1. Māori children and young people are particularly vulnerable to poor health outcomes. Poverty, substandard housing conditions and the impacts of climate change are key issues affecting the health of Māori children. Climate change poses a further threat to indigenous children’s health, although there is also potential for strong responses to climate change which could provide opportunities to address (rather than exacerbate) existing health disparities.

  1. Māori concepts of health and well-being are holistic, encompassing physical, spiritual, emotional, environmental, individual and collective wellbeing. Enjoyment of the right to health is inextricably linked to the realisation of a range of rights. Advancing indigenous people’s right to health requires a systemic response to implementation of the UNDRIP, and an approach which encompasses the full range of human rights. The participation of indigenous peoples, and support for the indigenous health workforce are key to achieving progress. Addressing the health of indigenous children and young people must be a particular priority, and should not be in isolation of their family and community.

  1. The Commission appreciates the opportunity to make this submission and would welcome the opportunity to engage further with EMRIP as it continues its study on the right to health.

Appendix: Data


The life expectancy gap between Māori and non-Māori has been steadily narrowing, but remains significant: in 2013, life expectancy at birth was 73.0 years for Māori males and 77.1 years for Māori females; it was 80.3 years for non-Māori males and 83.9 years for non-Māori females.[63]

Māori have higher rates than non-Māori for many health conditions and chronic diseases, including cancer, diabetes, cardiovascular disease and asthma. Māori also experience higher disability rates.[64] The 2013 Disability Survey identified one in four Māori as disabled.[65]

A recent international cancer study found that:[66]


Māori adults and children were also more likely than their non-Māori counterparts to have unmet health needs. [67] Identified barriers where the difference was significant included in relation to cost, childcare availability and transport.

[1] The right to health is expressly referred to in a number of core human rights instruments which have been ratified by New Zealand:

In addition, New Zealand has also committed to the Sustainable Development Goals, which include Goal 3: Ensure healthy lives and promote wellbeing at all ages, along with a range of related targets.
[2] UN Committee on Economic, Social and Cultural Rights, (2000), General Comment No. 14: The right to the highest attainable standard of health, E/C.12/200/4.
[3] Preamble to the Constitution of the World Health Organisation. Accessible online at http://www.who.int/about/definition/en/print.html
[4] UN Commission on Human Rights (2003), Economic, social and cultural rights: The right of everyone to the enjoyment of the highest attainable standards of physical and mental health: Report of the Special Rapporteur, Paul Hunt, (E/CN.4/2003/58,13 February). Accessible online at http://ap.ohchr.org/documents/dpage_e.aspx?m=100 979.pdf
[5] UN Committee on the Rights of the Child, (2013), General Comment No. 15 on the rights of the child to the highest attainable standard of health, CRC/C/GC/15. Accessible at: http://tbinternet.ohchr.org/_layouts/treatybodyexternal/Download.aspx?symbolno=CRC%2fC%2fGC%2f15&Lang=en
[6] UN Committee on the Rights of the Child, (2009), General Comment No.11: Indigenous children and their right to health under the Convention, CRC/C/GC/11. Accessible at: http://tbinternet.ohchr.org/_layouts/treatybodyexternal/Download.aspx?symbolno=CRC%2fC%2fGC%2f11&Lang=en.
[7] Waitangi Tribunal 1992 Te Roroa Report. Brooker and Friend p 210.
[8] See: http://www.health.govt.nz/publication/dhb-maori-health-profiles
[9] See: http://www.health.govt.nz/publication/annual-update-key-results-2014-15-new-zealand-health-survey
[10] See: http://www.health.govt.nz/about-ministry/corporate-publications/health-and-independence-reports
[11] See: http://www.health.govt.nz/publication/tatau-kahukura-maori-health-chart-book-2015-3rd-edition
[12] See: http://www.stats.govt.nz/maori#health
[13] See: http://www.health.govt.nz/publication/report-performance-general-practices-whanau-ora-collectives-june-2015. See below at p 6 for further information on Whānau Ora.
[14] See: http://www.stats.govt.nz/tekupenga
[15] See: http://www.stats.govt.nz/browse_for_stats/snapshots-of-nz/te-ao-marama-2014.aspx
[16] See: http://www.stats.govt.nz/browse_for_stats/people_and_communities/maori/te-kupenga/determinants-life-satisfaction-maori.aspx
[17] See: http://www.treasury.govt.nz/abouttreasury/higherlivingstandards
[18] http://www.stats.govt.nz/browse_for_stats/snapshots-of-nz/integrated-data-infrastructure.aspx
[19] http://www.treasury.govt.nz/publications/research-policy/ap/2015 and http://www.treasury.govt.nz/publications/research-policy/ap/2016
[20] http://npa.hrc.co.nz/#/
[21]Ministry of Health, (2015), Annual Update of Key Results 2014/15: New Zealand Health Survey, at p viii. Accessible at: http://www.health.govt.nz/publication/annual-update-key-results-2014-15-new-zealand-health-survey
[22] Eg, Ministry of Health (2015), Health and Independence Report 2015, (Wellington: MoH), at p6. http://www.health.govt.nz/system/files/documents/publications/health-and-independence-report-2015-oct15.pdf.
[23] Family Violence Death Review Committee, (2016), Fifth Report: January 2014 to December 2015. Accessible at: http://www.hqsc.govt.nz/our-programmes/mrc/fvdrc/publications-and-resources/publication/2434/
[24] Statistics NZ, (2013), He Hauā Māori: Findings from the 2013 Disability Survey. Accessible at: http://www.stats.govt.nz/browse_for_stats/health/disabilities/He-haua-maori-findings-from-2013-disability-survey.aspx .
[25] Ibid.
[26] Moewaka Barnes, A., et al, (2013), ‘Māori experiences and responses to racism in Aotearoa New Zealand’, MAI Journal Vol.2, 2, pp 64-77. Accessible online at: http://www.journal.mai.ac.nz/sites/default/files/MAI%20Journal%20Vol.2_2%20pages%2063-77%20Moewaka%20Barnes%20et%20al..pdf. At p 73
[27] Ministry of Health, (2015). Tatau Kahukura: Māori Health Chart Book 2015 (3rd edition). Wellington: Ministry of Health. At pp 14-15.
http://www.health.govt.nz/publication/tatau-kahukura-maori-health-chart-book-2015-3rd-edition
[28] Moewaka Barnes, A., et al, (2013), ‘Māori experiences and responses to racism in Aotearoa New Zealand’, MAI Journal Vol.2, 2, pp 64-77. Accessible online at: http://www.journal.mai.ac.nz/sites/default/files/MAI%20Journal%20Vol.2_2%20pages%2063-77%20Moewaka%20Barnes%20et%20al..pdf. At p 73
[29] Ministry of Health, (2015). Tatau Kahukura: Māori Health Chart Book 2015 (3rd edition). Wellington: Ministry of Health. At pp 14-15.
http://www.health.govt.nz/publication/tatau-kahukura-maori-health-chart-book-2015-3rd-edition
[30] New Zealand Health and Disability Act 2000. Accessible at: http://legislation.govt.nz/act/public/2000/0091/latest/DLM80051.html
[31] Ministry of Health, (October, 2015), Update of the New Zealand Health Strategy: All New Zealanders live well, stay well, get well: Consultation draft, at p 9. Accessible at: http://www.health.govt.nz/system/files/documents/publications/update-new-zealand-health-strategy-consultation-draft-oct15_0.pdf.
[32] S. 22(1), New Zealand Health and Disability Act 2000.
[33] http://www.health.govt.nz/our-work/populations/maori-health/he-korowai-oranga
[34] See: http://www.health.govt.nz/our-work/populations/maori-health/maori-health-case-studies
[35] See: http://www.health.govt.nz/our-work/populations/maori-health/maori-health-providers
[36] For example: http://www.waipareira.com/index; http://www.ngatiwhatua.iwi.nz/manaakitanga/te-ha-oranga; http://www.raukura.org.nz/index.asp?pageID=2145877094.
[37] Ministry of Health, (2016), Health of the Health Workforce 2015. Accessible at: http://www.health.govt.nz/publication/health-health-workforce-report-2015. Medical Council of NZ, (2015), The New Zealand Medical Workforce 2013-14, at p 24. Accessible at: https://www.mcnz.org.nz/assets/News-and-Publications/Workforce-Surveys/2013-2014.pdf. Ahuriri-Driscoll A et al., (2015), ‘Mā mahi, ka ora: by work, we prosper – traditional healers and workforce development’, NZ Medical Journal, 2015;128(1420):34-44. Accessible at: http://www.nzma.org.nz/__data/assets/pdf_file/0007/43954/Ahuriri-Driscoll-13661420.pdf.
[38] ‘Māori Nurses Missing Out’, Waatea News, 15 August 2013. Accessible at: http://www.waateanews.com/Waatea+News.html?story_id=NTE1MA. See also: http://www.parliament.nz/en-nz/pb/presented/petitions/48DBHOH_PET2921_1/petition-of-ngaitia-nagel-and-11370-others-requesting.
[39] The Waitangi Tribunal is a permanent Commission of Inquiry mandated to consider claims relating to Government actions or omissions which may breach the principles of the Treaty.
[40] Waitangi Tribunal, (2011), Ko Aotearoa Tēnei: Factsheet 8 – Rongoā (Traditional Māori Healing). Accessible at: http://www.justice.govt.nz/tribunals/waitangi-tribunal/documents/generic-inquiries/flora-and-fauna/wai-262-rongoa-traditional-maori-healing.
[41] Ibid.
[42] Statistics NZ, (2014), Te Kupenga 2013, at p 6. Accessible at: http://www.stats.govt.nz/browse_for_stats/people_and_communities/maori/TeKupenga_HOTP13.aspx
[43] Ahuriri-Driscoll A et al., (2015), ‘Mā mahi, ka ora: by work, we prosper – traditional healers and workforce development’, NZ Medical Journal, 2015;128(1420):34-44. Accessible at: http://www.nzma.org.nz/__data/assets/pdf_file/0007/43954/Ahuriri-Driscoll-13661420.pdf.
[44] Ministry of Health, (2015), Annual Update of Key Results 2014/15: New Zealand Health Survey, at p 51. Accessible at: http://www.health.govt.nz/publication/annual-update-key-results-2014-15-new-zealand-health-survey
[45] Ibid., at p 17.
[46] Ibid., at p 19.
[47] Ibid., at p viii.
[48] Ministry of Health, (2015), Health and Independence Report 2015, at pp 32-33. Accessible at: http://www.health.govt.nz/system/files/documents/publications/health-and-independence-report-2015-oct15.pdf.
[49] Simpson J, Duncanson M, Oben G, Wicken A, Pierson M., (2015), Child Poverty Monitor 2015 Technical Report, Dunedin: NZ Child and Youth Epidemiology Service, University of Otago; 2015. Accessible at: http://www.nzchildren.co.nz/#.
[50] Statistics NZ, (2013), He Hauā Māori: Findings from the 2013 Disability Survey. Accessible at: http://www.stats.govt.nz/browse_for_stats/health/disabilities/He-haua-maori-findings-from-2013-disability-survey.aspx.
[51] Ibid.
[52] Simpson J, Duncanson M, Oben G, Wicken A, Pierson M., (2015), Child Poverty Monitor 2015 Technical Report, Dunedin: NZ Child and Youth Epidemiology Service, University of Otago; 2015. Accessible at: http://www.nzchildren.co.nz/#.
[53] Statistics NZ, (2013), He Hauā Māori: Findings from the 2013 Disability Survey. Accessible at: http://www.stats.govt.nz/browse_for_stats/health/disabilities/He-haua-maori-findings-from-2013-disability-survey.aspx.
[54] Children’s Commissioner’s Expert Advisory Group on Solutions to Child Poverty, (2012), Solutions to Child Poverty in New Zealand: Evidence for Action. Accessible at: http://www.occ.org.nz/assets/Uploads/EAG/Final-report/Final-report-Solutions-to-child-poverty-evidence-for-action.pdf
[55] Ibid., at p13.
[56] Ibid., at p vii.
[57] Health Committee, (2014), Report of Health Committee on Inquiry into improving child health outcomes and reducing child abuse with a focus on preconception until three years of age, Recommendation 5. Accessible at: http://www.parliament.nz/en-nz/pb/sc/business-summary/00DBSCH_INQ_11221_1/inquiry-into-improving-child-health-outcomes-and-preventing.
[58] Government response to Report of Health Committee on Inquiry into improving child health outcomes and reducing child abuse with a focus on preconception until three years of age, (2014), at page 9. Accessible at: http://www.parliament.nz/en-nz/pb/presented/papers/50DBHOH_PAP25992_1/government-response-to-report-of-the-health-committee-on.
[59] Māori Affairs Committee, (2014), Inquiry into the Determinants of Health for Tamariki Māori. Accessible at: http://www.parliament.nz/resource/en-nz/50DBSCH_SCR6050_1/bbe4e16f5d440017fd3302f051aca3edff179b7f.
[60] Government Response to Māori Affairs Select Committee Inquiry into the Determinants of Wellbeing for Tamariki Māori, (2014). Accessible at: http://www.parliament.nz/resource/en-nz/50DBHOH_PAP26103_1/2e33f98fcf911cafeb661335e2c181cea9164a11
[61] UN Committee on the Rights of the Child, (2013), General Comment No. 15 on the rights of the child to the highest attainable standard of health, CRC/C/GC/15. Accessible at: http://tbinternet.ohchr.org/_layouts/treatybodyexternal/Download.aspx?symbolno=CRC%2fC%2fGC%2f15&Lang=en
[62]See: http://www.orataiao.org.nz/joint_nz_health_professional_s_call_for_action_on_climate_change_and_health
[63] NZ Social Indicators – health: http://www.stats.govt.nz/browse_for_stats/snapshots-of-nz/nz-social-indicators/Home/Health.aspx
[64] Ministry of Health, (2015). Tatau Kahukura: Māori Health Chart Book 2015 (3rd edition). Wellington: Ministry of Health.
http://www.health.govt.nz/publication/tatau-kahukura-maori-health-chart-book-2015-3rd-edition
[65] Statistics New Zealand (2015). He hauā Māori: Findings from the 2013 Disability Survey. Available at: http://www.stats.govt.nz/browse_for_stats/health/disabilities/He-haua-maori-findings-from-2013-disability-survey.aspx at pp11-12
[66] http://www.scoop.co.nz/stories/GE1510/S00079/reducing-cancer-inequalities-in-maori-a-priority.htm 21 October 2015
[67] Ministry of Health, (2015). Tatau Kahukura: Māori Health Chart Book 2015 (3rd edition). Wellington: Ministry of Health. http://www.health.govt.nz/our-work/populations/maori-health/tatau-kahukura-maori-health-statistics/nga-ratonga-hauora-kua-mahia-health-service-use/primary-health-care

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