I have been asking myself, yet again, ‘Where does a ‘whole person-centred’ approach fit in modern New Zealand?’ The Government has taken the plunge. Our indigenous Maori people are getting a well-funded opportunity to organise a more ‘wholistic’ healthcare system, for themselves, through the establishment of a new entity, the Maori Health Authority.
Our current health system, based almost entirely on the Eurocentric biomedical model, with its narrow focus on diseases, diagnoses, and evidence-based pharmacological and technological treatments, is certainly not working for Maori. Their health statistics are terrible.
The belief that more billions of dollars invested in more science, more drugs, more technologies, will make the difference to Maori health statistics has proved to be an elaborate fantasy, energised by our (not mine, actually) biomedical model of health and illness. Our model is a pot pourri of biomedical assumptions, truth as defined by scientific measurement, a focus on the individual over communal understandings of illness, a hefty overlay of mercantilism and capitalism, a privileging of the body and medical diagnoses, permeated by a patronising and hubristic belief in our effectiveness, or potential effectiveness. This manifestly fails for Maori.
But what isn’t being said is that it isn’t working well for the rest of us either. That’s what ‘whole person-centred’ healthcare is about. We know that for all the good that the best of biomedical care does (and that’s a great deal), it is fundamentally flawed, because of its relative, and often absolute, neglect of those other aspects of our personhood, which include our ‘stories’, the un-measurable bits, our meanings, our relationships, our families, our loves and hates, our abuses and traumas, and matters of occupation, employment, cultural values, spirituality, and our attitudes to, and place in, our land, our natural world.
This adds up to a massive and scandalous inattention to what is involved in being an ill human. These elements are so obviously important in Maori concepts of wellness and illness, that not including them is a fundamental error. To its credit, the present Government has realised this failure, in respect of Maori, and thus, via the Maori Health Authority, they are provided with the opportunity to devise their own healthcare provision, for their people, according to these important wider parameters, though still accessing the benefits of the biomedical model.
They are getting the chance to expand their healthcare to encompass ill persons constituted as ‘wholes’, within larger ‘wholes’ such as family and community, and even the wider concepts of being, of spirituality, of generational influence, and culture. I look forward to seeing what transpires. There are many difficulties to overcome. But it is so interesting to me, because my concepts of whole person healthcare, derived over four decades of addressing the ‘non-whole’ emphases of the Eurocentric system, overlap in so many ways with Maori values.
In a sense the Government (or the Crown) is enabling Maori to address the ‘whole’ in their own way. What the Government is not seeing or saying is that the Eurocentric model is not working very well for Pakeha either, especially in regards to chronic disorders, because we lack an orientation to wholes. Apparently, we will trundle on trying to resolve health problems the same old biomedical way, wasting more and more billions of dollars, in the hope that these new technologies, perhaps 5-10 years away, increasingly beyond the reach of all but the wealthy, and at the expense of many other possibilities, will make all the difference. It is not going to happen. This is not the way for us. We need change too. The pot pourri is not as fragrant as we thought it would be, once upon a time.
Hopefully the new Maori Health Authority will give rise to ideas that gradually seep into the clinical work of the dominant system. And I see, amongst non-Maori clinicians, a steady rise of interest in Maori language and values, and their conceptualisation of wholes, persons, communities, the importance of place, belonging, land and sea, and spirituality.
Wouldn’t it be good if those of us who have worked to see a ‘whole person-centred’ transformation in the Eurocentric system could find a way to join hands with Maori, in our mutual desire to widen the scope and purview of all healthcare, to take in and work in a newly balanced way with the multidimensional aspects of illness and disease, health and wellness?
Brian Broom, Physician, Clinical Immunologist, Psychotherapist