From Strategy to Reality - The WAVE ProjectFull text version
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Treaty of Waitangi Implications of Health Information
Tai Kake | 
Gwen Tepania Palmer |
E nga mana, e nga reo, e nga waka, e nga hau e wha
Tena koutou, tena koutou, tena koutou katoa
Maori have been frustrated by the inefficiencies, inconsistencies, and general lack of responsiveness of
current health information systems. Providers, policy makers, researchers, iwi, hapu, whanau, and individuals are all concerned about accessing health information, privacy issues, and the poor coverage of health areas crucial to Maori (1). Maori models of health (2) emphasise the importance of integrating information about health with the wider social and economic context. Current health information systems are fragmented, however, with different providers using different standards and IT systems that impede - rather than facilitate - the integration of health care. Our current systems do not effectively support Maori models of healthcare. The ethnicity definition used by different agencies and providers is inconsistent, so the data produced is poor. Gaps in data collections hinder sound analysis, policy and strategy development, and decision-making. This is the most important issue to tackle for Maori .
Maori providers don’t have access to update or use ethnicity and other demographic components of National Health Index (NHI) numbers, yet collection of this information is crucial in improving NHI data quality.
Data - anonymous or not - has enormous spiritual and cultural significance for Maori , so may require more attention and protection than generally given. This has been a significant factor in the cervical and breast screening programmes. Data about the female reproductive parts of the body, whare tangata, is considered tapu therefore requires respectful treatment.
Kawanatanga (Crown Obligations)
The Treaty of Waitangi established a Crown obligation for Maori to enjoy a health status at least as good as that enjoyed by non-Maori . The Government is committed to fulfilling its obligations to Maori to support self-determination for whanau, hapu, iwi and Maori organisations. This is impossible without reliable health ethnicity data, as this is a fundamental building block to improve the health of Maori in planning and providing appropriate services. Meaningful data and information can be used to empower Maori communities, thereby facilitating rangatiratanga. The inadequacy of current information systems (especially in primary care) (3) for collecting ethnicity data is an extreme concern. The Crown cannot monitor its progress in meeting Treaty obligations without reliable ethnicity data.
Tino Rangatiratanga (Empowerment)
Health information and IT management systems can be powerful tools for addressing health issues (4). For this power to be harnessed to benefit Maori, there must be more Maori actively working in all areas of the health information system, from operational through to strategic decision-making; in the collection, transmission, and storage of health information through to its analysis and dissemination. A robust highly integrated health information system is one tool for Maori to address effectively the long-standing health disparities they have endured.
The WAVE plan is an important development in highlighting and addressing Maori concerns about current health information systems. If the WAVE plan achieves only one thing - the collection of reliable ethnicity data - it will be a major advance for Maori. Implementation of the plan is a challenge, but also an obligation, for both Treaty partners.
Gwen Tepania-Palmer & Tai Kake
WAVE recommends
1. Collection of reliable ethnicity data;
2. An annual audit of ethnicity data in health information systems;
3. Establishing a reliable baseline for Maori IT workforce capacity in the health and disability sector; and
4. Promotion of integrated health information systems.
1 Maori Standards of Health III - Pomare et al, Hauora 1995
2 Maori Health & Development - Durie, Whaiora 1994
3 The Collection of Patient Ethnicity Data in General Practice, prepared for Te Kete Hauora, MoH 1998
4 New Zealand Health Strategy, MoH 2000
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