An opportunity to challenge institutional racism within the public health sector

The Ministry of Health are currently consulting on how public health services are purchased. Provided within this blog post are a selection of informative links and the link to a submission template. Help challenge institutional racism within the administration of the public health sector by contributing your voice to the consultation process.- ed.

There has been great consistency in how public health services have been purchased by the Ministry of Health over the last twenty years based around the  Public Health Service Handbook.[1]

The Ministry of Health buy a range of health protection and health promotion services from environmental health, through to tobacco control services, problem gambling and health promoting schools. These services are traditionally brought from Public Health Units (based at District Health Boards), from Non-Governmental Organisations like Mental Health Foundation and the Heart Foundation, through to Primary Healthcare Organisations like Manaia Health and Māori Health Providers like Ngāti Hine Health Trust.

 shopping list

Over the last few years, the purchasing of public health services has been going through a process of reorientation as the public health specifications have been transitioned into the National Service Specification Framework Library (which has recently been made accessible to the public). As part of this reconfiguration, a background paper, Core Functions of Public Health was developed to re-orientate public health services. The new core functions include health promotion, health protection, health assessment and surveillance, public health capacity development and prevention interventions. The Ministry’s intention is that these core functions inform all public health contracts and will be used in conjunction with an overarching tier one (generic) public health service specification.

My understanding is that these core functions of public health were developed by a network of senior (Pākehā) public health staff within District Health Boards and were then adopted by the Ministry of Health. It is unclear what, if any, input Māori public health stakeholders have had into this process. A simple review of the document shows the Treaty of Waitangi is mentioned fleetingly in an appendix and the core functions paper comes strongly from a Western paradigm. Within the document, Māori are not positioned as a Treaty partner, but as a high-needs population needing access to health services (to advance an equity agenda).

Those of you familiar with my research into institutional racism will recall that service specifications (how public health services are purchased) are a site of institutional racism within the administration of the public health sector. Traditionally their framing and content have been strongly influenced by western bio-medical understanding of health and wellbeing at the exclusion of kaupapa Māori worldviews. This occurs despite longstanding traditions of Māori public health (Durie, 1994; Ratima, 2001, 2010). To date, the Ministry of Health has never developed a kaupapa Māori public health service specification; instead Māori providers have had to bend their practise into western-defined paradigms.

Expediently for those of us committed to eliminating institutional racism within the public health sector by 2017, the Ministry of Health are currently consulting on the public health service specifications.[2] If you are interested in this kaupapa, I encourage you to put pen to paper and complete a submission by 16th May 2014.

We are encouraging people to raise three key points in their submission:

  • Firstly, the urgent need to develop an overarching tier one kaupapa Māori public health service specification.

  • Secondly, encourage Crown agencies to address institutional racism within the administration of the public health system

  • Thirdly, strengthen the Māori public health content and Te Tiriti o Waitangi responsiveness across all the new proposed tier two service specifications.

Follow this link to a template submission to help you challenge institutional racism within the public health sector. I believe if we are going to transform health inequities in this country we first need to eliminate institutional racism within the health system. Please take this opportunity to take action.

Heather Came


Durie, M. (1994). Whaiora: Māori health development. Auckland, New Zealand: Oxford University Press.

Ratima, M. (2001). Kia urūru mai a hauora: Being healthy, being Maori: Conceptualising Maori health promotion. (Unpublished Doctoral dissertation), Otago University, Dunedin, New Zealand.

Ratima, M. (2010). Māori health promotion - a comprehensive definition and strategic considerations   Retrieved from



[1] Public health services in this context, refers to population based services that keep people well rather than the provision of clinical services through secondary and tertiary settings.

[2] This work is currently been led out by the Public Health Association Special Interest Group on Institutional Racism. For more information contact the author.


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