82 Maranga Mai! Influenza pandemic (1918) The disastrous state of Māori health meant Māori were far more vulnerable to the 1918 Influenza Pandemic than Pākehā. The pandemic (the Spanish flu) killed over 50 million people worldwide, including 9,000 in New Zealand. Māori died at a rate nine times higher than Pākehā (Rice, 2018; Ministry for Culture and Heritage, 2020). Kāinga across the motu were affected. With a death toll so high, few were well enough to look after the sick or bury the dead. Māori MPs put aside their parliamentary duties to help their people through the pandemic. Pōmare returned to medicine and treated the sick and organised Māori councils to action. Many Māori people turned their homes into a hospital and tended to the sick. Many Māori parents died. Many babies were orphaned and had to be cared for by wider whānau. In Waikato, for example, Te Puea took personal responsibility for 100 orphaned tamariki. The loss was even more poignant, as it meant tamariki lost access to their whakapapa, reo, customs and mātauranga due to their tīpuna, parents, uncles and aunties dying. We can now only wonder what difference Pōmare’s proposed network of Māori hospitals might have made to those tamariki and whānau and those generations still to come. Racism and Māori health today Considerable research has been conducted about the link between racism and health. This makes it clear that racism is “an underlying cause of ethnic health inequalities in Aotearoa New Zealand” (Talamaivao, Harris, Cormak, Paine & King, 2020, p. 55; Human Rights Commission, 2012, p. 18; Harris, Stanley & Cormack, 2018, p. 2). Māori disproportionately experience racism across the health system (Talamaivao et al, 2020, p. 63). This effect is felt across the sector since Māori patients presenting to the health system, as well as Māori health workers working in the system, experience it. One Māori Registered Nurse reported being patronised by some of her patients, who would “speak slowly and enunciate their words more clearly as if I were stupid and didn’t understand them”. Another described “two geriatric patients who just didn’t want to be attended by me because I was black” (Huria et al, 2014, p. 368). The feeling of being spoken down to, or thought of somehow being ‘less than others’, is how Māori have long felt in their engagements with the health system. A collection of Māori experiences in health services shows this (Jansen, Bacal & Crengle, 2008, p. 44): Māori feel clinicians think, ‘Oh, there they are again, bludgers. No Māori wants to feel as if he’s a bludger’. White medical staff all look at us in that way. They’re always asking if you’ve got a community card. If you are Māori, you get asked if you’ve got a card. Have you got a community card? I said to one doctor, ‘Would you have been so rude if I was Pākehā?’ Inequities in health outcomes for Māori For the Waitangi Tribunal in Hauora: Report on Stage One of the Health Services and Outcomes Kaupapa Inquiry (WAI 2575), the Crown’s failures in protecting Māori health are irrefutable, exacerbated by inadequate policy and legislative infrastructure (Waitangi Tribunal, 2019, p. 161). These findings are evident in the inequitable health outcomes for Māori, where: • Māori, in general, experience reduced healthcare across “primary and pre-primary through to secondary or tertiary [care] services and beyond” (Jansen, Bacal & Crengle, 2008, p. 17). • Māori “obtain fewer diagnostic tests, less effective treatment plans and are referred for secondary or tertiary procedures at lower rates than nonMāori patients”, despite comparable attendance at GP appointments (Jansen and Jansen, 2011, p. 53, in Human Rights Commission, 2012, p. 20). This is also apparent in comparatively low hospitalisation rates for Māori who are highly represented in certain disease categories (Reid and Robson, 2007, p. 7).