Time for nurses to speak up for health equity?

October 2015 Vol 15 (5)

TAIMA CAMPBELL argues it is time for nursing as a profession to face up to and speak out about the health inequities that result in poorer health outcomes for Māori.


I was recently fortunate to be exposed to the ideas of a number of indigenous health leaders during the recent symposium on accelerating indigenous health gain. The Counties Manukau Health-hosted symposium (1), a precursor to the APAC forum on healthcare innovation and improvement, was an opportunity to showcase examples of indigenous health excellence. Including examples of indigenous health improvement and innovation sitting alongside development in tribal governance and indigenous leadership; like American Indian and Alaska Natives being able to exercise control over their health system on behalf of their customer-owners i.e. patients.

Common history

The event was inspiring not only for the examples of indigenous health excellence presented, but also for the sharing of common stories and values that remain poorly understood by the mainstream. Like Māori, indigenous peoples share a long-standing bond with ancestral lands, and a common ancestry or whakapapa with unique cultures and language. Like Māori, many indigenous peoples also share a common history of impoverishment, the disruption of traditional economies, and socioeconomic and cultural degradation as a result of colonisation. As a consequence, indigenous peoples suffer from poorer health and are more likely to experience disability, a reduced quality of life and decreased life expectancy (2). Discrimination, structural racism and inadequate healthcare and disease prevention services exacerbate this situation.

Are we doing enough?

Many international speakers leave Aotearoa with the belief that we are leading the way in terms of improving indigenous health and honouring indigenous human rights. As a country, we take pride in our human rights track record and take our international obligations seriously. Yet without exception, all United Nations Treaty body reports have noted poorer health outcomes for Māori, particularly with regard to life expectancy and infant mortality (3). From a state point of view, this is not in dispute and is highlighted in the New Zealand country report (our international report card) to the United Nations Committee on Economic, Social and Cultural Rights (4). So as nurses and citizens, are we doing enough?

The Medical Council recently called on doctors to work in partnership with Māori and address the issues of inequity they face in the health system. Cultural competence and genuine partnership with Māori were identified as important aspects of achieving excellence in clinical practice. The Medical Council restated that health inequities are unacceptable and that doctors have a professional and moral obligation to address inequity. In terms of nursing, cultural safety has been part of clinical practice for decades – so is it time that nursing follows suit and makes a conscious and informed decision to lift standards to ensure the survival, dignity, wellbeing and rights of our indigenous people? The answer must be yes.

Nurses must speak out

If we want to make improvement in long-standing health inequalities for Māori, then we must speak out about structural discrimination in the health system; where rules and practices disadvantage less empowered groups while serving to advantage the dominant group (5). To not address the privileging of one group over another is to remain complicit in the perpetuation of the status quo.

We also need to value and nurture the growing number of Māori nursing and midwifery indigenous leaders. Shortly, over 200 Māori nurses and midwives will have completed the Ngā Manukura o Āpōpō leadership programme. These graduates have been tasked with promoting wider acceptance of Māori thinking, frameworks and ideologies and integration of these into New Zealand’s health system. In turn, this investment will lead to more culturally appropriate services and, in the longer term, more equitable care for Māori (6). It is up to us to seek the talents of these emerging indigenous health leaders and work with them to develop robust models of indigenous health excellence for our customer-owners. That’s the conference I’m looking forward to.

Author: Taima Campbell RGON Ngati Tamatera; Ngati Maru; Ngati Kiriwera is a health consultant and former director of nursing for Auckland District Health Board.


1.   COUNTIES MANUKAU DISTRICT HEALTH BOARD (2015). Indigenous Health Symposium 2015 press release, http://www.scoop.co.nz/stories/GE1508/S00028/indigenous-health-symposium-2015.htm (accessed November 2015).

2. Inter Agency Support Group On Indigenous Peoples’ Issues  Thematic Paper towards the preparation of the 2014 World Conference on Indigenous Peoples The Health Of Indigenous Peoples”. From 20th periodic  report to UN Committee on the Elimination of Racial Discrimination (CERD/C/NZL/20) 162–163, New Zealand.

3.  Report to UN Committee on the Rights of Persons with Disabilities (2014), CRPD/C/NZL/CO/1, October 2014, New Zealand.

4.  Report to UN Committee on Economic, Social and Cultural Rights (2011) 3rd periodic report on implementation of International Convenant on Economic, Social and Cultural Rights, New Zealand.

5. STATE SERVICES COMMISSION (1997). EEO Policy to 2010: Future Directions of EEO in the New Zealand Public Service.

6. BURRELL M, MOORE D, & CUMMING J (2005). The economic and social benefits of increasing the professional Māori health workforce. The Health Workforce Advisory Committee, Wellington.


Southcentral Foundation’s Nuka System of Care, based in Anchorage, Alaska, is a result of a customer driven overhaul of what was previously a bureaucratic system centrally controlled by the Indian Health Service. Alaska Native people are in control as the customer-owners of this healthcare system. The vision and mission focus on physical, mental, emotional, and spiritual wellness and working together as a native community. Coupled with operational principles based on relationships, core concepts and key points, this framework has fostered an environment for creativity, innovation and continuous quality improvement. Alaska Native people have received national and international recognition for their work and have set high standards for performance excellence, community engagement, and overall impact on population health.


GOTTLIEB, K. (2013). The Nuka System of Care: improving health through ownership and relationships. International Journal of Circumpolar Health Vol 72



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