81 Human Rights Commission The period between the wars of the 1860s and the end of the century saw the loss of much of the land, the foundation of Māori subsistence and social cohesion. The result was that most Māori existed on the margins of the New Zealand economy. Their low standard of living had a direct effect on their health. In addition, the lack of cash income meant there was little possibility of capital expenditure or sanitary works, water supplies or housing improvements (Lange, 1999, p. 28). Deficit thinking in health The upheaval to Māori society and economic structure, in addition to the passing away of many prohibitions and observances, such as those associated with tapu, meant many safeguards around Māori health were lost. Māori customs around tapu and noa had protected Māori kāinga for centuries. Māori had exacting standards of sanitation and cleanliness. This included separating sick people from healthy people because sick and dying people were tapu. In 1902, when the government began its sanitary campaign, Te Whiti o Rongomai (who established Parihaka) told Māui Pōmare (the first Māori doctor of Western medicine) that the idea of maintaining sanitary environments was nothing new as Māori traditions already possessed a well-established system to keep kāinga clean (Lange, 1999, p. 5). Despite the prior evidence of Māori wellbeing and highly effective sanitary standards, Pākehā attributed Māori dire health statistics to an inherent dirtiness, drawing attention away from the structural racism of the society that created these realities. The role of Pākehā and the Crown in creating these conditions through colonisation and land alienation was ignored. This is the early onset of colonial amnesia about the constitutive role of colonisation upon the impact on Māori health (Lange 1999, pp. 21-26). In 1902, Māui Pōmare in frustration, pointed to the social determinants of health, and the structural racism embedded in health outcomes for Māori as the reasons behind these statistics: If Pākehās were exposed in the same way as Māoris, they would disappear just as fast and perhaps a little faster. Put the Māori in good healthy surroundings and he will thrive (Lange, 1999, p. 30). Although the social determinants of health did later become a focus, the racist rhetoric did not change. Barriers to health care Access to medical care for Māori was almost non-existent at the turn of the nineteenth century. Protracted exposure to disease, economic destitution through land dispossession, and the lack of knowledge about the causes and spread of illness, eventually became the main causes of Māori morbidity and mortality. Most Māori lived beyond Pākehā medical services located in towns. Few hospitals were situated in areas with high Māori populations. And although cost-free treatment was a legal entitlement, many hospitals would not admit Māori patients. Hospitals refused to meet their legislated duty of care to Māori (Lange, 1999, pp. 233–4). For Māori by Māori In response, Pōmare launched a campaign to build a network of hospitals for and by Māori. These were to be new, culturally specific and innovative, training Māori staff and accommodating Māori patients and whānau. Māori and Pākehā politicians supported the proposal. In a first for New Zealand, Māori contributed money and the land on which the new hospitals would stand. The first Māori hospital was planned for Dargaville and was ready for construction in 1904. All the project required was the final government funding. Despite years of campaigning by Pōmare and James Carroll, government funding never arrived. Not one hospital was built. The Crown’s duty to protect the health of Māori was not honoured (Lange, 1999, p. 235).