Māori health experts say major plans to overhaul the health system and create a Māori health authority don't go far enough.
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The government's Health and Disability Review, out yesterday, includes a suite of recommendations to improve health outcomes for Māori.
But some say the proposals are neither brave nor transformative.
On average, Māori die seven years earlier than their Pākehā counterparts.
Countless reports have identified institutional racism as a contributing factor with Māori facing increased difficulty in accessing care, higher levels of failure to diagnose conditions and an increased reluctance to dispense treatment.
As such Māori are two-and-a-half times more likely to die from diseases that are potentially preventable or curable.
The report recommends setting up a new Māori health authority to monitor such inequities, and give advice on Māori health policy.
But the chief executive of the National Hauora Coalition Simon Royal says it needs more teeth.
"First of all, the functions are not as broad," he said.
"The authority will need to have a full commissioning function, it will need to hold resources allocated at the centre.
"It needs to have a principle accountability back to iwi, hapu and whānau - that is the core principle that was called for in the Waitangi Tribunal."
Royal is one of those asking the Tribunal to rule on the Crown's continued inaction on Māori health. The claimants have called for an independent health authority lead by Māori.
Health advisor Gabrielle Baker said what the government has proposed lacks vision and bravery.
"What the report recommends is something that is many steps back from that," she said.
"What I see is just the creation of another Crown organisation that is not much different from things like the Māori Health Directorate already within the Ministry of Health."
But she said there are some exciting elements to the review, including a recommendation to update health laws to give stronger effect to Te Tiriti o Waitangi.
And holding each level of the system accountable for reducing inequities.
It also sets up equal representation of Crown and Māori in a proposed Health NZ Board, the members will be appointed by the minister.
Te Puna Ora o Mataatua chief executive Chris Tooley said those elements will work in the favour of Māori.
"There is a component that the authority is advisory only... but there are other statutory or regulatory triggers in there that allows Māori to create leverage to bring about that kind of change," he said.
"For the first time, we have got a report that covers all the main issues for Māori and so that has got to be a win in itself."
Tooley said he was pleased to see the recommendation for funding formulas change to acknowledge inequity in communities.
New Zealand Nurses Organisation kaiwhakahaere Kerri Nuku agreed and said that would see more money going into services in poorer areas.
The authority would also be in charge of increasing kaupapa Māori services and developing the Māori workforce.
Nuku hopes that means there will be more muscle behind moves to tackle long-standing issues in the health service.
She said health workers at Māori providers earn less than those at district health boards.
"This funding must recognise that Māori health workers deserve to be paid equally," she said.
"It's not okay - equity has to be about not just equity in service delivery and accessibility but equity in the way that we recognise and pay our workforce within the system."
Associate Health Minister Peeni Henare said the recommendations in the review will provide a generational change in Māori health.
But some members on the review panel have their doubts.
Buried at the back of the report is an alternative view - the Māori health authority's scope and budget is too small. They call for an authority designed and lead by Māori with power to commission health services.
The minister said he understands the view and is continuing to work with the tribunal claimants.
"I have heard some of the people who have said that it doesn't go quite far enough," he said.
"I am confident that as we continue to work through the review and its recommendations, it will land in a place in the near future that will serve our people as best we can."
Decisions on individual recommendations will be taken to Cabinet over coming months and into the next term of Parliament.
