Decolonising public health

Decolonising public health

Interview with Emma Rawson-Te Patu, president-elect, World Federation of Public Health Associations

What progress has been made in Āotearoa New Zealand in decolonising public health through education and action?

If we look at Āotearoa New Zealand, several efforts, particularly in the past 10 years, demonstrate the leaps made in the efforts to ‘decolonise’ public health. Āotearoa New Zealand has always been a global leader in race relations, yet the reality is the systemic issues remain and are rife.

Efforts to understand and highlight the places where institutional racism exists and how to address it have increased. The body of robust research has grown appreciably, in particular regarding our Indigenous experiences of institutional racism in policy and within commissioning, the delivery of health services and public health, and broader health workforce capacity. More recently there have been significant reforms to the health system to acknowledge and address the ongoing systemic barriers and to reflect the authentic Tiriti relationship that our government is bound to honour through Te Tiriti o Waitangi, the agreement made in 1840 between Indigenous New Zealanders (Māori) and the Crown.

Politics plays a significant role in how much movement can happen to create authentic sustainable action to decolonise. Unfortunately, the groundbreaking model for health services and delivery recently established by the previous government, which gave Māori the closest model of co-governance within a centralised system of healthcare infrastructure, workforce capacity, service delivery and commissioning, was swiftly deconstructed by a new government with an agenda and politics that are more than demonstrating a significant shift away from evidence-based policy and action, and executing what could be described as contemporary breaches to our Tiriti. The upside is that the efforts of the past 40 years to grow allies in our communities and the private sector as well as in health, education and social services mean we have a much larger community of individuals and organisations that continue to push forward in understanding and executing decolonising practices under the auspices of Tiriti-aligned practice. This is important as this work must continue regardless of national political cycles and short-sighted politics.

What has the World Federation of Public Health Associations contributed to this task?

Since I’ve been involved in the federation – an association of 110 national associations, an equivalent community of 5 million plus individual members – it has made several significant gains in understanding and supporting Indigenous peoples and Indigenous public health needs.

Significant steps forward include the opportunity to have an Indigenous representative from the Public Health Association of New Zealand on the Governing Council for two consecutive terms. This marked a significant step in Indigenous presence and voice at that level of governance and strategic decision-making for the federation. During 2017 at the World Congress on Public Health in Melbourne, a yarning circle was held to enable Indigenous delegates to meet and discuss the desire to form an Indigenous Working Group for the WFPHA. We now have one of the fastest established IWGs at this level. We have been able to increase Indigenous voice and participation through this mechanism. As a result in May 2022, I – an Indigenous woman from Āotearoa – was honoured to be elected to take up the role of president of the federation at the World Health Assembly in Geneva in May 2024. The federation also adopted a new goal in May 2023 of ‘Contributing to systemic change and decolonising public health’. That is a major commitment by an organisation of this nature.

This is a strategic move. The willingness of our key leaders and members to contribute to the global efforts demonstrates the federation’s authentic understanding of the absolute need for our public health community to recognise the inequities and burden of ill health and disease faced by Indigenous populations globally. We embrace and lead efforts to address those issues. In November last year, through the efforts of our IWG, we drafted a definition for the federation of ‘Decolonising public health’. We are clear that this is a working definition as it marks the beginning of our efforts to understand what this looks like for our membership and associations. The IWG will also continue to create opportunities to lead education and socialisation efforts about what it means to decolonise this space and what resources are needed to support this education. We recognise this is no small task, but we also recognise the important opportunity to start moving towards truly dismantling barriers to Indigenous health and reimagining and creating new practices and approaches to decolonise global public health.

What challenges and constraints remain?

The biggest challenge to the efforts to decolonise our society or elements of it is the appetite of individuals to bravely understand and educate themselves on the necessity of this process, and how and why inequities exist – and that it is very possible to address these through this process. It is multifaceted and requires the collective efforts of many. This work has been happening for decades, and will continue for many more to come. However, the more allies we have, the greater the efforts will be and the more success we will have. The beauty of this work is that everyone gains. There is a state of fear that exists when individuals and groups, governments and populations don’t understand the context of how we arrived at this place of significant inequities in health for Indigenous populations. Governments and the systems they facilitate in societies are made up of people who make decisions that either ultimately increase or decrease the well-being and life success of human beings. People are responsible for perpetuating the inequities or for genuinely working on creating new or better ways to reduce harm and increase health for all. Indigenous societies are driven by collective systems that support health and well-being while living and caring for the health of the planet and all the resources within it. We have forever understood about balance and honouring the place we have on the earth. Never more than now do we need to value the place and wisdom of Indigenous populations. A commitment to decolonise public health is a start to valuing our craft of public health differently and truly addressing health inequities and increasing life success for some of our most affected populations.