A director of New Zealand’s medicine funding agency Pharmac has resigned in protest of a government directive telling the agency that it no longer needed to consider the Treaty of Waitangi, the country’s founding document which upholds Māori rights, in its funding decisions.
In a letter to Pharmac, the associate health minister and leader of the libertarian Act party David Seymour set out his expectations of the government agency, including his thoughts on how the principles of Treaty of Waitangi, or Te Tiriti o Waitangi, should be applied.
The treaty was signed by Māori chiefs and the Crown in 1840. The principles that have flowed from the treaty are widely used to help ensure that Māori wellbeing, health, rights and views are factored into policy and decision-making.
The previous Labour government tasked Pharmac with embedding the treaty into its processes following a 2022 report that found the agency had “in all likelihood” contributed to inequitable health outcomes for Māori.
But Seymour said this is not “an appropriate expectation to place on Pharmac”.
“Pharmac’s role should focus on delivering improved health outcomes underpinned by robust data and evidence, in accordance with its statutory responsibilities,” he said in the letter.
“This should serve all New Zealanders based on actual need, without assigning their background as a proxy of need.”
Seymour, who is the leader of the minor libertarian Act party, and is in coalition government with the centre-right major National party and minor populist party New Zealand First, has long campaigned on providing services based on need not race.
He is also the architect of the controversial Treaty Principles Bill, which seeks to redefine the principles that have flowed from the treaty – a move many fear could amount to a modern-day confiscation of treaty rights and prioritise those who already hold power.
Since it came to power the right-wing government has targeted several policies that aim to improve the lives of Māori, including dismantling the Māori Health Authority and reversing the ban on smoking for future generations.
After the directive, Pharmac’s now-former director, Dr Anthony Jordan, said he could not in good conscience continue in his role.
“It definitely didn’t sit well with my own personal beliefs as a clinician and, personally, as a Māori,” Jordan told the Guardian. “This was a really personal decision for me – I didn’t want to stay there and passively endorse [it].”
Jordan believed the government was ignoring “clear evidence” that the agency’s consideration of the treaty had improved health outcomes for Māori.
Pharmac established Te Rōpū – a Māori leadership and advice group – in the wake of the 2022 report. The group oversaw a shake-up in the way diabetes treatments were funded, which has resulted in clear medicine uptake and health improvements for Māori patients, Jordan said.
“It demonstrated evidence that when you consider ethnicity beyond just need, you can actually make a positive difference,” he said.
Jordan, who took up the Pharmac role in 2021, is a senior immunologist and helped lead the Covid-19 response for the Northern region of the country during the pandemic.
Jordan said the government’s directive was an early indication of the direction it was taking around removing references to the Treaty.
“I didn’t think I could continue down this road, given the signposts ahead,” he said.
In a brief statement to the Guardian, Seymour repeated the content of the directive set out in the letter, and said Pharmac should serve all New Zealanders based on need “without assigning their background as a proxy of need via the Treaty of Waitangi”.
He said he welcomed Jordan’s resignation.
“If board members believe the Treaty is more important than equal treatment based on medical need then I think it’s right to go and I respect Dr Jordan for being honest,” he said.
Anaru Waa, a professor in public health at the University of Otago, told the Guardian the state of Māori health “is a shame on this country”, not only in the disparities in health outcomes but in the way Māori are treated within the health system.
Māori have a lower life expectancy compared with non-Māori, face racial discrimination within the system including slower access to care, have higher smoking rates and are more likely to live in substandard or overcrowded households.
The 2022 report into Pharmac recognised the government was failing Māori and the recommendation to consider the treaty during decision-making was meant to address these inequities, Waa said.
“But the current government doesn’t really care about its obligations to Māori,” Waa said, adding that staff within Pharmac who may wish to consider the treaty could now face a hostile environment.
“The end result is that Pharmac will turn into a colour-blind organisation – specifically against Māori, who need to be better served by our health system.”
