budget analysis By Matt Roskruge
B
udget 2020 was always going to be one to watch. With the Labour-led Government seeking re-election and national coffers in excellent shape, economists and pundits alike were predicting notable spending and investment in core services. The health sector, stressed from prolonged under-investment, was looking likely to be the next in line for a significant boost, following several budgets focused on education. The spending was needed broadly. Much of our health infrastructure was crumbling, operating budgets were beyond stressed, payroll remained lean and there was little left for innovation and technologies, including those which addressed inequalities and improved health access. Some dreamers might also have hoped for a rollback of the contracting and privatisation which has been a feature of the health sector in recent decades. But then COVID-19 happened. Modern, open economies were ill prepared for the sort of economic devastation COVID-19 would bring, while health systems across the world found themselves deeply stressed or overwhelmed. New Zealand rightly went into lockdown and the Government was left to prepare an urgent financial response.
Did Budget 2020 deliver for Mâori? Will Mâori benefit equally from the spoils of Budget 2020?
abroad of overflowing health facilities, rationed access to care and mortuaries unable to cope made politicians and planners alike suddenly wonder if there hadn’t been a few too many corners cut, budgets reduced and issues overlooked. Money was needed from the Budget to prepare the health system for the worst, be it COVID-19 or some future pandemic. So, where does this leave Mâori? Mâori were not only entering 2020 under the ongoing cloud of poor health outcomes, but were also likely to be the worst hit by COVID-19. The budget process might be somewhat of a relic, ill-suited to enabling Mâori to realise aspirations of self-governance, with the power to prioritise sitting firmly in government hands. But Budget 2020 needed to deliver for Mâori. Without that support, inequalities will deepen, while Mâori become disproportionately unwell and die. So, did it deliver? Sort of. Unfortunately, within the cacophony of Budget 2020, it seems Mâori were largely overlooked, receiving $900 million in targeted funding, with the $136 million boost to Whânau Ora being the main contribution within the health sector. This funding was The budget process might be somewhat certainly welcome and will help of a relic, ill-suited to enabling Mâori to provide short-term operational realise aspirations of self-governance . . . needs. However, we’re left with the Over the next six weeks, Budget 2020 impression that government spent little went from something that was expected time considering Mâori needs specifically. to be substantial, to something that Budget 2020 is a good budget, and will help Mâori get through, but does little to needed to be remarkable, spending at address long-term and complex issues of a level which enabled the economy to inequity in health outcomes. survive and provided emergency repairs The investment in Whânau Ora is a to areas of the public service whose fragility was suddenly exposed. promising start. Whânau Ora enables COVID-19 brought into stark focus the Mâori to make decisions and prioritise essential and risky role of health workers, investment into culturally appropriate too often taken for granted. The poor initiatives able to penetrate into rural or shape of our health system went from isolated areas where the health system being tomorrow’s problem to one which has failed in the past. While the exact needed to be addressed yesterday. Scenes level is light of what is likely needed and
will largely support business as usual, rather than enable long-term strategic initiatives, it is still encouraging. Looking beyond 2020, hopefully COVID-19 will help focus the minds of decision-makers on investing in health, rebuilding infrastructure, paying fair salaries and improving our health technology uptake. While these priorities are being set, we need to see strong Mâori voices and work to invest in infrastructure and technologies which are inclusive, facilitate the participation of Mâori in the health system and keep in mind rural, isolated, disadvantaged and discriminated populations. These populations often struggle to access affordable, timely care.
Initiatives needed
Initiatives which increase capacity, create spaces which are culturally supportive, both visually and structurally, reduce out-of-pocket costs in transport and services, have more by-Mâori, for-Mâori interventions and invest in technologies which address the morbidities that disproportionately affect Mâori, are important places to start. A final note to consider. The Government mobilised remarkable resources to face a massive crisis, one which threatened to harm the general population to the extent they would experience many of the socio-economic outcomes already experienced by Mâori. The response to COVID-19 was absolutely appropriate. But Mâori may be justified in wondering why the Government wasn’t already making every attempt to address the existing crisis, and whether recovery will be as equally felt as the crisis seems to be. • Matthew Roskruge, PhD, Te Âtiawa, Ngâti Tama, is the co-director of Te Au Rangahau and a senior lecturer, School of Economics and Finance, Massey Business School, Massey University.
Kai Tiaki Nursing New Zealand * vol 26 no 5 * June 2020
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