Image of Maori mother with her kids at home in Auckland, New Zealand. © nazar_ab/istockphoto.

In the interest of equity: Te Tiriti o Waitangi

6 August 2021
Michelle Mako crop.png

Michelle Mako

Director, Equity, Te Aho o Te Kahu – Cancer Control Agency NZ

Mā te whiritahi, ka whakatūtuki ai ngā pūmanawa ā tangata

Weaving together our expertise, we realise each person’s full potential

In preparing this blog marking the International Day of the World's Indigenous Peoples on 9th August, I find myself reflecting on what I think is important and given the opportunity to share my views with other cancer control leaders, what would I say, and why would they care? So I’ll start from the beginning, with my story.

I am the youngest of five children and the only girl, so I grew up knowing that if something was important you had to be prepared to fight for it and you should never back down. I guess it would be fair to say that strength and determination are built into my DNA and I have never been one to back away from something just because it’s hard. As a Māori woman and a nurse, I am invested in giving service to my community, and identifying and addressing inequities in health care outcomes has become a burning passion for me, one that has driven my health career.

I am currently Director of Equity in Te Aho o Te Kahu, the cancer control agency in Aotearoa/New Zealand (Aotearoa is the Māori name for New Zealand). We are a relatively new Government agency, created to give heightened attention and focus on cancer control activities and to improve cancer treatment and care in Aotearoa. While cancer outcomes are generally improving in New Zealand, we are falling behind other comparable nations in terms of cancer survival, and this is particularly so for Māori, who are 20% more likely to get cancer and twice as likely to die from it.  

As a nation, Aotearoa has dual accountability to address the significant cancer-related inequities for Māori. The obvious one is recognising that inequities in health are avoidable, unfair and unjust, but arguably more important are our commitment and obligation to honour Te Tiriti o Waitangi – the Treaty signed between Māori and the Crown in 1840. The history of Aotearoa in delivering against Te Tiriti has been variable and chequered with failed promises and underperformance, but it would also be fair to say that Te Tiriti is currently in a period of ascendancy and renewed commitment. 

With the establishment of a new independent Māori Health Authority on the near horizon, the opportunity to turn the tide is upon us. This means we need to be working under a Te Tiriti o Waitangi framework and requires us to reflect on the enduring relationship between Māori and the Crown in delivering equitable cancer outcomes for Māori. The principles that form the basis of Te Tiriti o Waitangi include the guarantee of:

  • The guarantee of Tino Rangatiratanga – right to self-determination.
  • Active Protection – ensuring that the nature and outcomes of Māori health are well known and acknowledged, and that actions are taken to achieve health equity.
  • Equity – the right of Māori to receive equitable access to and outcomes from health care services. 
  • Options – ensuring that Māori have access to the full range of health care options, including the ability to access kaupapa Māori services (services delivered by and for Māori). 
  • Partnership – honouring the partnership between Māori and the Crown in the governance, design, delivery and monitoring of health services.
Image of a woven cloak, a metaphor for the New Zealand cancer  control agency called Te Aho o Te Kahu, meaning “to be the binding thread of the cloak”.

As a Government agency we acknowledge that Māori leadership is critical to the work we do and that we cannot do this alone. Accordingly, we work closely with Hei Āhuru Mōwai – the national Māori cancer leadership and a key agency partner who gifted us with our name: Te Aho o Te Kahu. This name gives significance to the work we do; it literally means “to be the binding thread of the cloak”. It symbolises the threads that weave across the cloak connecting and binding the many diverse strands to form a strong and enduring garment that provides warmth and protection. 

Through this journey, we have met and listened to nearly 3,000 Māori and their whānau (families) who have been affected by cancer to hear their experiences, their grief and their aspirations, so that these can guide and be reflected in the future of cancer care in Aotearoa. 

E ngā rau rangatira mā, e ngā mau tangata, nei rā te mihi maioha ki a koutou.

To you many leaders, you gracious and generous people, I send you my words of humble thanks.

Michelle Mako is Director of Equity at Te Aho o Te Kahu, the New Zealand Cancer Control Agency. She started her career in health as a nurse, following the footsteps of both her parents and an older brother. After a stint in cardiac care and deciding that CPR was not the best way to save lives, Michelle moved to the Ministry of Health into a public health policy role.  Over the last 24 years Michelle has worked in public health policy and health promotion leadership roles within the Ministry of Health and Te Hiringa Hauora (the Health Promotion Agency), primarily focussed on Māori health and equity. Prior to joining Te Aho o Te Kahu in 2020, Michelle was privileged to work on the recent Heath and Disability System Review that is driving the current health sector reforms in NZ.

Last update: 
Friday 6 August 2021
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