1. Promoting Human Rights and Ethical Care in Practice: Challenges and Opportunities
Martin Woods
Graduate School of Nursing, Midwifery & Health
Victoria University of Wellington
New Zealand

2. Saudações de Nova Zelândia - a terra das longas nuvens brancas
Tena i te Aotearoa - te whenua o nga kapua ma te roa! Greetings from New Zealand – the Land of the Long White Cloud!

3. This presentation…
Examines the promotion of human rights and ethical care in practice via:
an examination of the development of human rights in New Zealand/Aotearoa.
discussion regarding the socio-cultural and socio-economic problems for health in New Zealand.
an overview of the promotion of human rights within the New Zealand health care system.
Finally, ideas regarding ethical care in practice.

4. Human rights in New Zealand
Human rights in New Zealand has an interesting history, in part because no such legislation existed until 1990 (Bill of Rights Act), and 1993 (The Human Rights Act; The Human Rights Amendment Act, 2001).
The Human Rights Act 1993 protects people in New Zealand from discrimination in a number of areas of life.
A Human Rights Commission (and a Commissioner) was established as a result of the Human Rights Act,
and continues to operate.

5. The ‘special relationship’
New Zealand was colonised by European settlers in the late 18th century, and over a few decades a ‘special relationship’ was formed and eventually ratified by the Crown (Great Britain) and with the indigenous people (Māori) whereby their rights are protected by The Treaty of Waitangi.
This is New Zealand’s founding document and is an agreement, in Māori and English, made between the British Crown and about 540 Māori rangatira (chiefs) in 1840.
When interpreting the Treaty of Waitangi, the Waitangi Tribunal has said the principle of contra proferentem applies. This legal principle states when a term is ambiguous, a provision should be construed against the party that drafted it.Jul 1, 2013
Treaty of Waitangi - The Constitution Conversation
…or, in other words, giving the benefit of any doubt in favor of the party upon whom the contract was foisted.

6. Nevertheless…
…in recent times successive governments have recognised the significance of the Treaty in the life of the nation, even if the Treaty of Waitangi is not considered part of New Zealand domestic law (except where its principles are referred to in Acts of Parliament).
Subsequently, human rights in health care are protected by the above legislation and Treaty, but also strengthened by Health & Disability legislation such as the Health and Disability Services Act 1994 (together with the accompanying Code of Consumer Rights); and the Privacy Act 1993 (together with the Health Information Privacy Code 1994).

7. Yet…
Although health outcomes have generally improved in recent years, inequalities still persist – particularly for people with disabilities, those on low incomes, Mäori and Pacific people, and other minority sections of the population.
Entrenched inequalities play a significant role in poor health outcomes for these particular groups.

8. However…In past decades, a number of abuses of the principles of the Treaty have occurred. Māori land, Māori land, 2000

9. …and the effects of inequities in health care for indigenous peoples?
Māori have:
A lower life expectancy, and life expectancy lived free of disability, than non-Māori.
Life expectancy at birth is 77.1 years for Māori females and 73.0 years for Māori males, compared with 83.9 years for non-Māori females and 80.3 years for non-Māori males.
A higher likelihood of belonging to low socio-economic groups than non-Māori.
A greater likelihood of living in areas with higher rates of poverty and lower levels of servicing than non-Māori.
Increasing rates of health diseases (e.g. pneumonia, TB), suicide and hospital admissions for mental illness.

10. Inferences from the statistics
There should not be such health disparities in a country such as Aotearoa.
Access to primary health services is less than estimated need.
There are institutional barriers to secondary and/or tertiary care.

11. Human rights and health care in New Zealand
Human rights in health care in NZ is closely linked to the International Covenant on Economic, Social and Cultural Rights Treaty 1966, Article 12, and to the Declaration of Alma Ata (1978).
In turn, adherence to the above international covenants have resulted in the development of other health related Acts such as the New Zealand Public Health & Disability Act 2000 and the Health Practitioners Competency Act 2003.
The NZ Public Health & Disability Act In order to recognise and respect the principles of the Treaty of Waitangi, and with a view to improving health outcomes for Māori, part 3 provides for mechanisms to enable Māori to contribute to decision making on, and to participate in the delivery of health and disability services (Section 4).
Reduce health disparities by improving health outcomes for Māori and other population groups, and to reduce, with a view to eliminating, health outcome disparities between the various population groups (s 22 (1) (e) (f).

12. If adequately addressing rights in health care…
There will be participation and no discrimination
Health services will be available, accessible, acceptable, and of good quality, for all and especially those most disadvantaged
New initiatives will not work against any one people’s right to health
There should be limited inequities
Where in inequities are identified then steps will
be developed to address the problem.
Link back to critical social theory

13. Barriers to and facilitators of disparities
Population factors
Socioeconomic position
Cost/expense (real or perceived)
Transportation
Family and other supports and
resources
Geographic location
Knowledge, values and experiences
System factors
Organisation, structure, focus of services
Funding and contractual arrangements
Resources
Geographic location and configuration
Availability of information
Provider factors
Sociodemographic characteristics
Training and competence
Provider perceptions and biases
Perceived deservedness and ability to benefit
Knowledge, values and experience
Provider to provider communication and relationships

14. Ethical care in practice
In practice based applications, a number of measures have been undertaken to redress health imbalances:
Increasing the number of Maori health care providers (especially in PHC settings)
Improving mainstream services
Design appropriate health services, e.g.
The introduction of the ‘Whanau Ora’ Programme (empowers families rather than individuals; government agencies have to work together, etc.)
Subsidised services
Targeting specific health care needs in vulnerable populations
Adopting a holistic health model of wellness – Te Whare Tapa Whā – a Māori philosophy of health
—one that moves beyond physical health as the
sole determinant for wellbeing.
Te Whare Tapa Whā describes four cornerstones of Māori health: whānau (family health) tinana (physical health) hinengaro (mental health) and
wairua (spiritual health).

15. In nursing services, human rights are promoted via:
Practicing within the law and an ethical code of ethics
Recognition of the need for cultural safety (NCNZ in particular)
Adapting the notion of social justice within an ethic of care

16. Cultural safety
“The cultural safety model is a broader concept which is focused on understanding the institutional power of the health system and the health professionals within it.....the role of the nurse is pivotal as the focus of social change.”
(Mortensen, 2010)
“In Ramsden’s terms ... ‘cultural safety is about life chances and transcultural nursing is about lifestyles’”

17. …and social justice?
“A nursing approach to relational care with others implies the sharing of power through the empowerment of the recipients of that care. To empower those where there is discrimination or a lack of the necessary resources therefore, is not only to reduce those socio-cultural discrimination processes that have excluded them from decision-making processes, but to encourage an autonomous and identity preserving response in any way that the individual or group regards as culturally appropriate.” (Woods, 2012, p. 61).
Woods, M. (2012). Exploring the relevance of social justice within a relational
nursing ethic. Nursing Philosophy, 13, pp. 56–65

18. Woods, M. (2012). Cultural safety and the socioethical nurse
Woods, M. (2012). Cultural safety and the socioethical nurse. Nursing Ethics 17(6) 715–725.
Woods, 2012.

19. END OF PRESENTATION