Indigenous health: power & politics
AUT recently hosted a public conversation on indigenous health with visiting political scientist Dominic O’Sullivan.
An Associate Professor of Political Science at Charles Stuart University in Australia, his work has had a significant influence on public policy. Much of it focuses on the juxtaposition of liberal political theory and the politics of identity – namely the politics of self-determination in post-colonial settler states. He is currently looking at what liberalism means for indigenous peoples in terms of the opportunities it creates and the constraints it imposes.
Dr Heather Came, Senior Lecturer in Māori health at AUT, maintains that health is all about politics. Last year, she was part of the New Zealand delegation that presented a report on institutional racism in the public health system to the United Nations.
"In New Zealand, we have seen significant and ongoing obstacles to Māori health. As a public health practitioner, I want to clear the decks so people can take control of their own destiny. It's great to have a political scientist in the house who can talk about politics and power, and what it means within the context of indigenous health," says Dr Came.
‘A Conversation with Associate Professor Dominic O’Sullivan’ was hosted by the Taupua Waiora Centre for Māori Health Research and the School of Public Health and Psychosocial Studies at AUT.
Q&A with Associate Professor Dominic O'Sullivan
How well does liberal democracy work for Māori?
Liberalism is very good at saying 'everyone can come to the meeting', but it's not so good at making sure that what happens at the meeting works well for everybody. It doesn't ask 'does everyone actually want to come to the meeting?' and, if not, 'why?'. Does it mean that they're not interested and don't want a say? In which case, it's a legitimate democratic choice. But, if someone doesn't participate because there are obstacles, there's a problem and that's a deficiency in the democratic process.
Liberalism aims to reconcile differences of perspective, opinion or desire. It doesn't say that we all have to be the same. In fact, it presumes that we are not. But, it also presumes that the fact that we're not the same shouldn't be a problem. That's why the Orewa Speech was so illiberal. It assumed that wanting to be a bit different from everybody else – wanting to be us, not wanting to be them – was a problem. And, liberal democracy can't work on its own terms when it thinks and operates like that.
One of the ways in which everyone can participate equally is guaranteed Māori representation. That's certainly about having a Māori voice at parliament and council, but it's more than that. It's about the Māori voter being able to choose their representative through their own cultural lens and evaluate candidates according to values to which one attaches meaning. A Māori voter in a Māori electorate may evaluate candidates in a very different way to a Māori voter in a general electorate.
What is the relationship between Māori health, citizenship and sovereignty?
In Australia, one of the reasons why health policy doesn't work very well for indigenous people is that there is no mechanism for them to be part of the policy development process and limited opportunities to be part of the policy implementation process as professional health workers.
There has been an enormous amount of work done in New Zealand to show the significance of culture in terms of health outcomes. Cultural competence is important, but there's a lot more to culture than the treatment a patient receives in a hospital. There's a lot more to how the health system works than the competence of a practitioner. There's a whole set of institutional values that come before that, which are influenced by policy decisions and who makes those decisions.
It's important that we don't have policy-making systems where it's all left to the policymaker to decide, even if that happens to be a Māori policymaker. Participation needs to be broader.
If there's a substantive share in sovereignty across the whole political system, it means people can genuinely say that a hospital, school or government department works the way it does because we've all been able to participate and had equal capacity to influence.
It doesn't mean that we all get our own way all the time. But, when some of us get our own way none of the time or very little of the time, then that is the kind of system that produces institutional racism.
Find out more
Watch Associate Professor Dominic O’Sullivan talking to TV3 Newshub Nation about how well Māori voices are being represented in New Zealand