Bringing healthcare back to the marae: A powerful solution to inequity

The Spinoff

27-05-2025

In 1979, Tāhuna Marae launched a mission to provide whānau with healthcare tailored to Māori. Here's a look at where that vision is today.
Being sick can be a real pain. From the expense of a doctor's visit, to taking time off work and the pressure this puts on family, the sickness itself can often feel like less of a stress than its flow-on effects.
This knock-on stress is considerably greater for those without easy access to GPs, hospitals, gyms and other sources of healthcare. Due to decades of structural racism, and the persistent effects of colonisation, Māori are often the ones suffering from these inequities. Without community and grassroots efforts to address them, these gaps in our healthcare system's vision would only grow wider.
But what does equitable access to healthcare actually mean, or look like in Aotearoa? It's about looking at the context of how people actually live, says Kim Arrowsmith, researcher and project lead at the National Hauora Coalition (NHC).
'The policy around transport [for example] in New Zealand is very equality based: 'we will give everybody the same resources, regardless of what they actually have.' It's this idea of fairness, and 'I can't watch somebody else receive something more than me, because it feels unfair'.'
But equity, Arrowsmith says, is about 'taking into account and providing resources accordingly to provide equal outcomes.'
A clear and illuminating example of inequity can be seen in the age of eligibility for a SuperGold Card in Aotearoa. It's currently 65. Shannon Leilua, pou tikanga at the NHC, says in his experience, many pakeke Māori 'don't even make it over 60'. According to Te Ara Ahunga Ora Retirement Commission, 'A significant share of Māori die between ages 50 and 65, and so a larger share of Māori than the population at large therefore will have an active working life but not receive retirement benefits.'
Even for Māori who do age beyond 65, the benefits of things like the SuperGold Card may not be accessible. While it provides free off-peak public transport and discounts in shops, many Māori communities live rurally. Where public transport options are few and far between, the benefits of the card aren't nearly as useful as they are for, say, Auckland city retirees who can use it for free weekday ferry trips to Waiheke Island. Such is the need for community led efforts to address the inequities that continue to negatively impact Māori health outcomes.
Health Through the Marae (HTTM) is one of these community-empowered solutions. Based at Tāhuna Marae in Waiuku, South Auckland, HTTM is one of the NHC's primary healthcare providers. HTTM's goal is to provide whānau previously disconnected from the healthcare system with equitable healthcare options, tailored to Māori.
CEO Piritania Minhinnick moved home to Waiuku to take over HTTM when her brother, founder Tahuna Minhinnick, passed away in 2016. His vision, born in 1979, was to connect the marae, a place of community and whānau, with wellbeing initiatives that ensured his community was staying active, fit and healthy.
'People like him only come around every 100 years, so I'm definitely not him, but I understand exactly where he was headed in terms of his vision for his people, and we haven't swayed from that kaupapa,' says Minhinnick.
The first Whare Oranga was created in 1980 on Tāhuna Marae, Waiuku, and was a physical embodiment of this idea. The Whare Oranga is a core wing of Tāhuna Marae, and has been serving that community for over 40 years with a free health clinic and full gym. Free podiatry, social and Rongoā Māori services are also available.
The mission of HTTM, Minhinnick says, is to create programmes using the resources at the Whare Oranga that respond to specific needs within the community – it's all about equity, not equality.
'Tahuna knew that the best way to improve Māori health was to take it back to the marae,' she says. 'We determine what wellness looks like to us. Whānau tell us what their needs are, what whānau priorities are, and then we come home and we sit down and nut those out, and work out how to respond.' The importance of this culturally led and tailored care is reflected in the results it brings for whānau.
For those without access to transport to get to and from appointments, HTTM's Hauora Hoppers programme supports pakeke to access healthcare in a cost effective and culturally safe way. Three times a week, a van picks up and drops off pakeke to the Whare Oranga at Tāhuna Marae. This service was created on the back of whānau voicing their needs to the HTTM team.
Minhinnick says part of the reason Hauora Hoppers has been so successful in driving change in their marae community is that it requires its users to get health checks. 'To be a part of the programme, you need to get a health check. So for those who were, for 10 years plus, not wanting to go to the doctors, they had to go to the doctor as part of the programme.' The Whare Oranga is a powerful platform, Minhinnick says, where whānau can share their experiences, learn from one another and overcome past negative healthcare experiences together. The mission doesn't stop at the door, though. It's also about building up whānau with knowledge, resources and confidence they can take home and share with their wider community.
HTTM won the NHC's Mahia Kia Ea, Kia Toa (Can Do Attitude) award for their Hauora Hoppers programme. The award was an acknowledgement of the service they provide to the whānau in their area, but Minhinnick says the team aren't doing it for the accolades.
'We're grateful for the acknowledgement. But it's normal. It's just what we do, and you have to do that work if you want to see the best outcomes you could possibly achieve for our whānau.'
Haumaru Panuku Oranga, a University of Otago funded project, looked into the transport habits of pakeke Māori. Arrowsmith and other researchers on the project found that kaumātua and their whānau are underserved by the transport system and are less able to get around in both urban and rural settings.
The research found that kaumātua feel forgotten, isolated and struggle to be part of their own society due to travel constraints. 'Transport poverty is really real. Without transport you don't have access to healthcare, education or work that you might need, and that causes further inequities,' Arrowsmith says.
Programmes like Hauora Hoppers are bridging this divide, but there needs to be more support from government and funding bodies for this kind of thing to exist across Aotearoa.
'Because a lot of Māori communities are rural and coastal, it's just by virtue of living coastally you experience those inequities. It is the government's role to make that equitable.'
Leilua says while many Māori communities could benefit greatly from a Hauora Hoppers programme of their own, it's not possible without funding. 'Who is going to provide the van, the petrol for the van? Who is going to go and pick up kuia and kaumātua? Can it be done? Of course, it can be done. But it will always come back to the money factor,' he says.
In the meantime, Minhinnick and her team at HTTM are continuing to service their community in ever-evolving ways, fulfilling the healthcare needs of a portion of Aotearoa society that needs greater care.
She's certain that with her brother's vision, and the support of the community, the NHC, and all the partners of HTTM, the mahi will keep paying off through the improvement of Māori health at Tāhuna Marae and across the motu.
'The marae is the perfect platform to embed messages to whanau, to use tikanga and culture as a medium for reaching whanau and to implement change. It gives whanau the opportunity to learn for themselves what suits them best, and be responsible for their own health.'