Universal healthcare for all? Ma?ori health inequalities in Aotearoa New Zealand, 1975-2000

Despite establishing a so-called universal, taxpayer funded health system from 1938, New Zealand's health system has never delivered equitable health outcomes for its indigenous population, the Ma over line ori people. This article, using a case study approach focusing on Ma over line ori, documents these historic inequalities and discusses policy attempts to address them from the 1970s when the principles of the Treaty of Waitangi were first introduced in legislation. This period is one of increasing self-determination for Ma over line ori, but notwithstanding this, Ma over line ori continued to have significantly shorter life expectancy than the population as a whole and suffered poor health at much higher rates.Neo-liberal policies were introduced and expanded during the 1980s and 1990s in New Zealand, including in healthcare from the early 1990s. The introduction of the purchaser-provider split in health services and the focus on devolving responsibility to communities provided an opportunity for Ma over line ori health providers to be established. However, the neo-liberal economic and social welfare policies implemented during this time also worked against Ma over line ori and adversely affected their health.By analysing attempts to reduce inequity in health outcomes for Ma over line ori, we explore why these collective at-tempts, including by Ma over line ori themselves, did not result in overall improved health and increased life expectancy for Ma over line ori. There was often a significant gap between government rhetoric and action, and we suggest that a predominantly universal healthcare system did not accommodate cultural and ethnic differences, and this is a potential explanation for the failure to reduce inequities. While this is true for all minority ethnic groups it is even more crucial for Ma over line ori as New Zealand's tangata whenua (first people) who had been progressively disadvantaged under colonialism. However, the seeds of ideas around Ma over line ori-led healthcare were planted in this period and have become part of the current Labour Government's policy on health reform.

Automated summary

Despite the establishment of a taxpayer funded health system in 1938, New Zealand's health system has failed to provide equitable health outcomes for its indigenous population, the Ma over line ori. This article examines historic inequalities and policy attempts to address them, but despite increased self-determination for Ma over line ori, they still have shorter life expectancy and poorer health compared to the overall population. Neo-liberal policies implemented in the 1980s and 1990s further disadvantaged Ma over line ori and hindered their efforts for improved health.