Pitched as putting Māori health back in Māori hands, Te Pāti Māori wants to rebuild a standalone, Māori-led health authority to close a life-expectancy gap that has persisted for generations.

The Policy: Te Pāti Māori Health Policy →

Neutrality note: This policy sits within a contested debate about Te Tiriti o Waitangi and "by Māori, for Māori" service delivery. Positions below are attributed to the people and bodies that hold them; the framing is not an endorsement.

What it does:

• Commits to "re-build and strengthen" a Māori-led health authority and Māori-led solutions, after the original body, Te Aka Whai Ora, was disestablished on 30 June 2024. The party's health policy page leads with the line that a system that "does not understand Māori will keep failing Māori".
• Te Aka Whai Ora was created by the previous government under the Pae Ora (Healthy Futures) Act 2022 and began operating on 1 July 2022, with about $188 million allocated in Budget 2022 for commissioning services.
• At the 2023 election Te Pāti Māori went further, pledging to channel 25% of all health funding to the Māori Health Authority and free GP and dental care for whānau earning under $60,000, alongside $1 billion a year for health workforce development and a kaupapa Māori mental health service.
• The case rests on a stubborn equity gap: Stats NZ and the Ministry of Health record Māori life expectancy at roughly 7 years below non-Māori, a disparity the 2019 Waitangi Tribunal Wai 2575 health inquiry said justified a dedicated Māori body.

The result: The rebuild is, for now, an unfulfilled opposition pledge, which is why the commitment is tracked as broken. The National-led coalition abolished Te Aka Whai Ora through the Pae Ora (Disestablishment of the Māori Health Authority) Amendment Bill, passed under urgency on 28 February 2024. Health Minister Dr Shane Reti argued the authority was "a bureaucratic anchor" and that solutions should be "made closer to the home and hapū", with functions moving to Health New Zealand, the Ministry of Health, Iwi-Māori Partnership Boards and a Hauora Māori Advisory Committee. Te Pāti Māori co-leaders Rawiri Waititi and Debbie Ngarewa-Packer, Māori health leaders Lady Tureiti Moxon and Janice Kuka (who lodged the urgent claim), and the Waitangi Tribunal oppose the move: the Tribunal's November 2024 "Hautupua" report found the disestablishment breached Treaty principles of partnership and active protection and was driven by "political ideology, rather than evidence". The coalition rejects that finding; National says an independent review showed the authority was failing to deliver. Restoring it would require new legislation and is not government policy, so it depends on a future change of government.

How would it actually be delivered?

A common gap in public debate is the "how" — whether a Māori Health Authority means a separate parallel hospital system, or something else entirely. The evidence from Te Aka Whai Ora's design and TPM's stated policy points to a commissioning and accountability model, not a duplicate infrastructure.

Commissioning, not a parallel hospital network. Te Aka Whai Ora was primarily a commissioning authority: it funded kaupapa Māori health providers, set Māori health priorities, and co-commissioned services alongside Health New Zealand / Te Whatu Ora. It did not run hospitals or clinics directly. The same public hospitals remain the delivery sites — the authority's lever was deciding what gets funded, who provides it, and holding the mainstream system accountable for Māori outcomes.

Iwi-Māori Partnership Boards at the local level. Fifteen Iwi-Māori Partnership Boards (IMPBs) cover every region of Aotearoa. Under the Pae Ora Act they assess local Māori health needs, collaborate with Health NZ on priorities, and report on how well the system is serving Māori communities. The coalition's model (after abolishing Te Aka Whai Ora) leaves these boards as the primary Māori voice — but critics including Green MP Hūhana Lyndon argue they remain advisory rather than genuinely commissioning, without dedicated budgets. From mid-2025 Health NZ has been exploring giving IMPBs stronger strategic commissioning roles, though the extent of real resourcing remains contested.

What changes for a patient in practice. The model targets change at several points:

• *Kaupapa Māori primary care:* Dedicated hauora Māori providers (such as Te Kōhao Health, Tūranga Health, and marae-based clinics) offer care grounded in te ao Māori — whānau-centred, holistic, and without the cultural disconnection many Māori report in mainstream services. A 2023 peer-reviewed study found participation in kaupapa Māori-centred initiatives "enhanced whānau sense of self-determination and confidence in accessing different health services."
• *Māori health navigators and Whānau Ora:* Navigators help whānau find and engage with services; the Whānau Ora commissioning approach funds providers to work across health, social, and economic needs as a family unit.
• *Cultural safety in mainstream services:* The Medical Council of NZ adopted a cultural safety standard in 2019, requiring all registered doctors to practise in a culturally safe way — going beyond cultural competency to put the patient's sense of safety at the centre. A Māori Health Authority was designed to monitor and enforce these standards in the mainstream system.
• *More Māori clinicians:* Māori make up about 17% of the population but only 5.1% of registered doctors and 7.3% of nurses (2024 Medical Council data). TPM's policy includes $1 billion a year for health workforce development, explicitly targeting this gap — recognising that clinical care from a Māori clinician, or within a culturally grounded setting, removes a documented barrier to seeking help.
• *Rongoā Māori:* Traditional Māori healing practices, where appropriate and desired, funded alongside clinical medicine.

How accurate is the "same hospital, Māori doctors, tikanga way, no racism" model? This framing captures something real — the goal is not a separate healthcare infrastructure but transforming *who provides care* and *how it feels* to receive it. However, the delivery mechanism is broader than swapping out individual clinicians: it operates through funding (commissioning kaupapa Māori providers), accountability (monitoring mainstream performance for Māori), governance (Māori-led authority setting priorities), and workforce (growing the Māori clinical pipeline). Where TPM's published policy detail remains genuinely thin is on the operational specifics: exactly how commissioning decisions would be made, how the authority would measure and enforce cultural safety in mainstream hospitals, and what accountability mechanisms would exist if the mainstream system continued to produce unequal outcomes.

The model already proved itself: the Covid response

The clearest real-world test of by-community health delivery came during the pandemic, when mainstream channels struggled to reach Māori and Pacific whānau but community-led providers did. By November 2021, during the Delta outbreak, Pacific peoples had the highest COVID-19 testing rate of any ethnic group — about 170 tests per 100 people, more than double the roughly 80 per 100 for European and other groups — driven by trusted, culturally grounded providers such as South Seas Healthcare in Ōtara, even as Pacific communities at the centre of a church-linked outbreak were enduring public racial abuse. This is the "by community, for community" model delivering precisely where the mainstream system could not reach.

It also showed the state can move quickly when it chooses to. In February 2022, facing Omicron, the government found $140 million almost overnight for Māori and Pacific community providers — including $40.6 million for Whānau Ora commissioning — to mobilise those same community networks.

The contrast with everyday funding is the heart of the equity case. For roughly a decade the Crown left baseline Māori primary care structurally underfunded — only $28.7 million of the $167 million allocated for Māori primary care actually reached Māori primary health organisations (the Wai 2575 finding detailed below). The money and the delivery model both exist, and both demonstrably work, when there is the political will to fund them; the open question the policy raises is whether that becomes sustained, everyday investment — or stays something the system reaches for only in a crisis.

Why the gap exists — and what it shares with the prisons story

The real drivers of the 7-year gap. The Tatau Kahukura Māori Health Chart Book 2024 records a roughly 6.6–7 year Māori life expectancy gap compared with non-Māori/non-Pacific New Zealanders. The Ministry of Health's Global Burden of Disease analysis shows the leading contributors to Māori years of life lost are cancers (29%) and cardiovascular diseases (22%) — both at roughly twice the non-Māori rate. Chronic kidney disease and diabetes rates are over four times higher for Māori than non-Māori. COPD (respiratory disease) causes twice the rate of years of life lost. These are predominantly chronic conditions — preventable and treatable — which points directly to access barriers and quality-of-care disparities rather than any inherent biological difference.

Amenable mortality: the clearest measure of the system's failure. Amenable mortality — deaths from conditions that should be preventable or treatable with adequate healthcare — is where the disparity is sharpest. Research published in *The Lancet Regional Health* found Māori experience more than twice the amenable mortality rate of non-Māori (standardised incidence rate ratios of 2.34–2.45), in both urban and rural settings. This is the health system failing to deliver timely, appropriate care — not a story about lifestyle or individual choices.

The connection to the prisons pipeline. Prison deaths are not a primary driver of the Māori average life expectancy gap — chronic disease and healthcare access are. But the over-incarceration of Māori (roughly 50% of the prison population, despite being 17% of the general population) and the health gap share the same upstream causes: colonisation, intergenerational poverty, and institutional racism operating across multiple systems simultaneously. There is also direct evidence of the physical health toll of incarceration: a national University of Otago record-linkage study found that people released from prison face an overall standardised mortality ratio of 3.3 compared to the general population, with the first month post-release the most dangerous. For Māori, who make up half the incarcerated population, this compounds an already elevated health risk. The structural pipeline that feeds Māori into prisons at disproportionate rates is the same pipeline that underlies the health gap — as documented in Te Pāti Māori's prison abolition policy.

The institutional racism that keeps people away from care

What the Waitangi Tribunal found. The 2019 Wai 2575 Hauora report — the Tribunal's major health inquiry — found the Crown had "systematically contravened obligations under te Tiriti" in primary health care, legislation, and health policy. It established that Māori primary health organisations were "underfunded from the outset," receiving only NZ$28.7 million of NZ$167 million allocated for Māori primary care over a decade. The report concluded that institutional racism operates throughout the health sector as "a key determinant of health inequalities," and that structures had failed to provide "Treaty-consistent control of decision-making" in health design and delivery. The Tribunal made five substantive recommendations, including embedding anti-racism into the health sector and strengthening Māori authority over health — the foundation on which Te Aka Whai Ora was built.

The evidence of differential treatment. Peer-reviewed research documents a pattern of unequal care. A national study led by Elana Curtis and Papaarangi Reid at Te Kupenga Hauora Māori, University of Auckland, found Māori patients had 1.6 times higher odds of death within 10 days of leaving an emergency department compared to non-Māori — a gap that persisted after adjusting for comorbidities, suggesting the system itself is a cause. A separate study by Ricci Harris, Donna Cormack and colleagues at the University of Auckland and Otago found that New Zealand medical students hold measurable implicit bias: on average a "moderate" implicit preference for NZ Europeans over Māori, and an implicit association between "compliant patient" and NZ European patients. Research on pain management shows Māori are underrepresented at chronic pain services and face documented barriers to accessing pain relief. These findings are attributed by the researchers to systemic and structural factors — provider bias, referral patterns, and institutional culture — not to individual clinicians acting with conscious prejudice.

Why people avoid or delay care. Research on Māori patient experience documents "disrupted mana" — a sense of personal disempowerment when interacting with the health system — characterised by receiving limited tailored support, conflicting information, and feeling that providers distrust patients' accounts of their own condition. Microaggressions, prior negative experiences, and a historically grounded distrust of institutions compound cost and distance as access barriers. The result is later presentation, delayed diagnosis, and worse outcomes for conditions that are treatable early. A Māori-led, tikanga-grounded health authority is designed specifically to address this: by funding services people trust enough to use, and by holding the mainstream system accountable for the cultural safety standard the Medical Council requires but that is not consistently delivered.

The impacts to watch:

• Whether Iwi-Māori Partnership Boards gain real commissioning power and budgets, or remain advisory, as Green MP Hūhana Lyndon's charge of "recolonisation of hauora Māori" implies.
• Constitutional friction: the Tribunal's Treaty-breach finding sharpens the wider co-governance debate the coalition campaigned against.
• Fiscal scale: diverting 25% of health funding to a Māori authority would be a multi-billion-dollar reallocation that critics say is unaffordable and supporters say is overdue.
• Measurable outcomes: future Tatau Kahukura data will show whether dismantling the body widens or narrows the Māori-non-Māori health gap.