Increasing health outcomes through equity and kotahitanga

By Justin Butcher (Pinnacle CEO) and Amit Prasad (Pinnacle Chair) 

As a primary health organisation, we see firsthand the challenges faced by our communities, particularly those most vulnerable. 

Te Tiriti o Waitangi has long served as a foundation for addressing inequities in Aotearoa New Zealand, particularly in healthcare. Its principles, including partnership, participation, protection and redress, have been developed through legal interpretations, Waitangi Tribunal findings, and policy frameworks. These principles help guide our work to improve health outcomes for Māori and reduce disparities. 

The Treaty Principles Bill, in our view, proposes a narrower interpretation, focusing on sovereignty, property rights, and formal equality. While these ideas may seem appealing, they fail to address systemic inequities that the original Treaty principles seek to rectify. While we have generally maintained a neutral stance on political matters this issue calls for a stronger response. We do not support the Bill!  

Approximately 21 per cent of Pinnacle’s enrolled population are Māori, and Te Manawa Taki – the region we serve – has the largest Māori population in Aotearoa including almost 95,000 who are not enrolled with a general practice. 

As an organisation committed to the principles of hauora and whose strategy puts health equity at the heart of our work, we believe the Bill falls short in recognising the rights and mana of Māori, and does not reflect the commitments made under Te Tiriti o Waitangi. 

We are concerned about the potential ramifications of the Treaty Principles Bill, which had its first reading in Parliament on 14 November. The societal implications of this Bill are significant. A referendum could fuel mounting public debate, creating further division at a time when Kotahitanga (unity) is essential. 

For the health sector, this represents another distraction from the critical challenges we face; workforce shortages, funding shortfalls, rising demand, and delivering equitable care.  

Another concern is the Bill’s focus on "equality before the law." Equality means treating everyone the same, but fairness requires acknowledging that people start from different places. Equity addresses these differences, ensuring resources and support are distributed to provide equal opportunities. 

In healthcare, this means targeting interventions to reduce the unique challenges faced by Māori, such as poorer access to care and higher rates of chronic illness. Ethnicity is a critical determinant of need in health, and acknowledging this allows general practice to prioritise resources effectively to address disparities.  

The Bill’s approach also limits "active protection" to physical property, sidelining cultural and collective taonga that are central to the Treaty. Māori language, traditions, and collective wellbeing are at risk of losing the protections they need in order to endure, undermining the partnership between Māori and the Crown. 

Te Tiriti o Waitangi principles are intended to evolve, addressing not just legal obligations but also social and cultural responsibilities. The Treaty Principles Bill risks undermining these principles, potentially harming both Māori rights and the broader social fabric. Equity is a unifying concept—it ensures everyone has the opportunity to thrive, regardless of their starting point. 

As a mainstream organisation, we recognise we may not always get it right, but we are committed to becoming – and being – good partners under Te Tiriti o Waitangi. We’ve taken steps we’re proud of to support initiatives that promote trust and healing. Therefore, whichever way the Treaty Principles Bill falls, we will not backtrack on that commitment now, or in the future! 

Pinnacle’s vision is “Kia hauora te katoa, kia puaawai te katoa — Everyone healthy, everyone thriving”. We urge decision-makers to prioritise equity, collaboration and solutions that strengthen — rather than fragment —our society.