Tangata Tiriti

Jason Gurney

The boot that is held on the throat of Māori and Pacific people is stubbornly resistant to attempts to shift it.’

– Professor Peter Crampton

I understood very little about the root causes of bad health before starting work in the Department of Public Health at the University of Otago’s Wellington School of Medicine. I had managed to complete a small clinical trial examining the impact of diabetes on lower-limb function for my doctoral thesis, without ever having to consider why I was spending most of my time recruiting patients in clinics around South Auckland, or why nearly all the recruits were either Māori or Pasifika.

My first weeks in the Department were heady. I had moved from a laboratory that studied diseases and their causes in silo, to an environment that considered most diseases as symptoms of one underlying cause: the social determinants of health. Coming to grips with this link was crucial to my acceptance in my new public health world. I needed to learn quickly.

My first teacher was Professor Diana Sarfati. She taught me that it was no accident that my fellow Māori suffered so disproportionately from nearly every disease. She patiently primed me on the link between colonisation, the social determinants of health, and consequent health disparities experienced by Māori. She taught me the term ‘victim blaming’, and the fruitlessness of attempting to bridge the broad health divide between Māori and Pākehā by focussing on individuals, or so-called ‘behavioural factors’. She forced me to think deeper, and to look further upstream.

Within a few weeks of starting with Professor Sarfati, I attended my first Departmental meeting. The Dean of the Wellington School of Medicine came and spoke about the current state of affairs within the School – providing me the privilege, for the first time, of listening to Professor Peter Crampton. I don’t remember what Professor Crampton spoke about, but I do know that his mana captured me. Among other achievements, Professor Crampton was an essential proponent of the ‘mirror on society’ affirmative action policies within the Otago Medical School, helping to ensure that our intake of new doctors-in-training would mirror the ethnic diversity of the patients they would serve once trained – particularly Māori and Pasifika. As a member of the Health and Disability System Review, Professor Crampton argued on the right side of history for the establishment of a Māori health authority with the power and resource to commission services.

A few years into my new job in public health, Professor Sarfati introduced me to her close friend and colleague. She explained that he was an extremely bright medical oncologist from Dunedin who she had met while working on a national research project on colorectal cancer. Most importantly, she explained that he was a staunch ally in the fight for equity in cancer outcomes for Māori. Professor Chris Jackson would go on to be a true brother-from-another-mother, a man who, when it comes to equity for Māori, truly walks his talk. He is unafraid of explaining where his clinical colleagues have it wrong when it comes to the key drivers of health disparities for Māori, extremely happy to use ‘The R Word’ whenever relevant. He’s even less afraid of tackling trolls on social media in much the same way.

Professor Sarfati was born into a New Zealand European whānau, the daughter of one of Wellington’s most beloved GPs, John Sarfati. Professor Crampton was born in England, emigrating to New Zealand when he was twelve, and then growing up in sunny Nelson. Professor Jackson was born in Ōamaru, the child of European teachers. He still practices in Dunedin, where his patients are almost exclusively Pākehā.

Professor Sarfati, Professor Crampton and Professor Jackson share an absence of a compelling reason to fight for better outcomes for Māori. None have lived experience of the kinds of racism or systemic bias that they first reveal to others, and then rally against; yet still, they rally. If you were to ask them why, their answer would probably be brief: because it is the right thing to do. The common thread that binds them together, then, is a relentless thirst for social justice.

These three provide an exemplar of the significant importance to Māori of our Tangata Tiriti partners. As a Māori public health researcher, my voice is often elevated or privileged when it comes to discussing those issues that impact Māori health the most. But the simple truth is that there are not nearly enough Māori doctors, nurses, community health workers, public health researchers or health policy experts to truly realise Professor Crampton’s vision of a health system that mirrors the society that it serves. We need our non-Māori colleagues, at every opportunity, to pick up the ball from the ruck and run with it.

To my Tangata Tiriti colleagues: never underestimate your value or importance as teachers and advocates for Māori health. Your voice can often be heard in ways that Māori voices cannot, and in rooms where Māori are usually absent. Your tireless devotion to doing what is right and just, for no other reason than it is just and right, makes you a crucial and formidable partner in the fight for Māori health equity. And we need you now more than ever.

He rau ringa e oti ai
With many hands the job will be finished

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Associate Professor Jason Gurney (Ngāpuhi) is an epidemiologist and Director of the Cancer and Chronic Conditions (C3) Research Group at the University of Otago, Wellington. His research focuses on identifying and understanding disparities in health outcomes between population groups, with a particular focus on Māori. He lives and works in Tāmaki Makaurau.

In his recently published book about rheumatic fever, The Twisted Chain (Otago University Press, 2024), he recounts his father’s personal battle living with this devastating disease, and critiques the socio-political decisions that allow this preventable illness to flourish in New Zealand.