83 • Māori, on average, receive shorter consultations from doctors, “Pākehā doctors typically spend 17 percent less time (2 minutes out of a 12-minute consultation) interviewing Māori than non-Māori” (Houkamau, 2016, p. 127). • Māori are less likely to receive chemotherapy, and where they do, are likely to experience “a delay of at least eight weeks” (Houkamau, 2016, p. 126). • Similarly, Māori are likely to experience differential care through “inadequate pain relief during labour and childbirth; and diagnosis and treatment of depression; and diabetes screening and management” (Reid and Robson, 2007, p. 7). • Māori men are less likely to receive care for cardiac disease (Houkamau, 2016, p. 126), leading to a disproportionate number of Māori dying from cardiovascular disease. Ischaemic heart disease is the principal cause of this, with 40.2 percent for under 65 year old Māori, compared to 10.5 percent for Pākehā (MinerWilliams, 2017, p. 23). Māori men are also more likely to receive poorer quality care for prostate cancer (Houkamau, 2016, p. 127). • Māori women have “lower breast and cervical cancer screening coverages” (Harris et al, 2018, p. 3). • Doctors are “less likely to prescribe prophylactic therapy to Māori and Polynesian children with asthma” (see Houkamau, 2016, p. 126) because doctors make “assumptions about the appropriateness of prescribing asthma prophylactic therapy for ethnic minority groups” (Mitchell, 1991, p. 835 in Houkamau, 2016, p. 126) amounting to a form of racial stereotyping and unconscious bias. These inequities are the result of a white-dominated health system never designed to promote and nurture Māori health and wellbeing. The systemic underfunding of Māori Primary Health Organisations is exemplary of this (Waitangi Tribunal, 2019, p. xiii), where less than 0.1 percent of the $200 billion spent on health since 2012 has gone to supporting Māori patients (Came, O’Sullivan, Kidd & McCreanor, 2020, p. 212). Human Rights Commission As the Waitangi Tribunal made clear in WAI 2575, the New Zealand Public Health and Disability Act “simply does not go far enough in ensuring that the whole health system complies with the Treaty” (2019, p. xiii). Similarly, the consistent absence of treatyspecific references in operational documents in the health sector “amounts to a concerning omission of the health sector’s Treaty obligations” (Waitangi Tribunal, 2019, p. 162). To properly address these inequities, there is an urgent need to expand Māori health services (Goodyear-Smith and Ashton, 2019). The more Māori health inequities persist, however, the more funding will be required to address these disparities in future (Came et al, 2020, p. 217; see also New Zealand Herald, 2004). The underinvestment in Māori health is a result of, and intensified by, colonisation and racism. “Colonisation created an environment that’s designed to ensure Pākehā power and control at the expense of Māori indigenous rights and good health” (Curtis, 2020). This is seen through institutional racism across the health system, including at the decision-making table. Māori priorities are often excluded from the policy agenda and flawed consultation processes, asking the wrong people the wrong questions, within the wrong timeframes. The policymakers are familiar only with Pākehā models of health lack and cultural competence (Came and Humphries, 2014, pp. 104–5). The Crown’s management and administration of public health funding repeatedly disadvantages Māori health providers and patients (Came, 2013, p. 3). The marginalisation of te ao Māori in the health system The marginalisation of Māori concepts of health and wellbeing in the health system, similarly, reflects racism and white supremacy. Western understandings of health and medicine remain ‘the norm’ in our health model, where bio-medical evidence is prioritised at the exclusion of kaupapa Māori concepts of health (Came and Humphries, 2014, pp. 104–5; Came, 2012). This has seen the criminalisation of Māori health practices through instruments such as the Tohunga