Maori Perspective on Health

Māori cultural safety and competence standard:

To practice effectively in Aotearoa, physiotherapist needs

  • cultural competence

  • understand relevance and demonstrate application of Te Tiriti o Waitangi + 3 articles + declaration of Maori text

  • incorporate 4 cornerstones of Maori Health

Treaty of Waitangi:

Preamble:

“anxious to protect their just Rights and Property and to secure to them the enjoyment of Peace and Good Order has deemed it necessary in consequence of the great number of Her Majesty’s Subjects who have already settled in New Zealand.”

Article 1:

English-sovereignty of tribes goes to the crown

(sovereignty = supreme power or authority = rangatiratanga)

anything bought goes to the crown

Maori - ‘kawangatanga’

governance goes to the crown

(sovereignty stays with Maori)

British provide governance to people

Mana Motuhake

(Self determination)

Article 2:

Tinorangatiratanga -

suggests Maori retained control over Maori resources

Guarantees Maori right to exercise authority over health and wellbeing

Her majesty the queen of england

Article 3:

Guarantees Maori Crown protection and the same rights and privileges as British Subjects

Equitable health outcomes

The crown needs to PROTECT Maori

In consideration thereof her majesty

  • the queen of england extends to the natives of new zealand

  • her royal protection and imparts to them all the rights and privileges of british subjects

Hei wakaritenga mai hoki tenei mo te wakaaetanga ki te kawantanga o te kuini - ka tiakina e te kuini o ingarani nga tangata maori katoa o nu tirani ka tukua ki a ratou nga tikanga katoa rite tahi ki ana mea ki nga tangata o ingarani

To have equal rights - access and achieve equitable health outcomes for all

Ritenga Maori declaration: enable Maori to live thrive and flourish as Maori.

Maori health status

  • Steady decline following european contact. Population from ~ 100,000 - 42,000

  • Introduced diseases, influenza dysentery, TB, whooping cough, measles

  • Wars

  • Poverty

  • 1856 physician and politician Dr Isaac Featherston said it was the duty of Europeans to “smooth down … the dying pillow of the Maori race.”

Dame Whina Cooper (1975)

  • Led hikoi (protest march) from Te Hapua to Wellington

  • Anger about loss of Maori Land

  • People around world noticed the protests.

Waitangi Tribunal

1975 labour government passed the treaty of waitangi act and waitangi tribunal established

  • permanent commission of inquiry tasked with researching breaches of the treaty by the crown or its agents, and suggesting the means of redress.

5 TOW Principles for Healthcare System (TEAOP)

  1. Tino rangatiratanga: guarantees Maori self determination and mana motuhake in the design, delivery, and monitoring of health and disability services.

aims to develop relevant services by Maori, for Maori

  • allow iwi, hapu, whanau, to monitor services

  • facilitates maori wellbeing, acknowledging te ao maori and tikanga held by maori

  1. Equity: Crown to commit to achieving equitable health outcomes for Maori

“ethical principle concerning the absence of systematic disparities in health between groups with different levels of underlying social advantage/disadvantage”

aims to pursue equality in health outcomes for Maori

  • recognise citizen rights of Maori and the rights to equitable access and participation in physiotherapy services and delivery.

  • facilitate access and opportunities for Maori by having maori in all levels of physiotherapy workforce

  • increase maori representation and workforce development

  • culturall appropriate health promotion → improved access

  1. Active Protection: Crown to act to the fullest extent practicable to achieve equitable health outcomes for Maori

aims to achieve posible health outcomes for Maori.

  • recognize maori health worthy of protection

  • ensure health services and delivery are appropriate and acceptable to Maori whanau, recognising maori are a diverse population.

  • cultural competence upskilling and life long learning

  1. Options: Crown to provide for and properly resource kaupapa Maori health and disability services. Crown to ensure all health and disability services provided in culturally appropriate way; recognize and support Hauora Maori models of care.

aims to promote a maori responsive and supportive environment with culturally safe practice and respect

  • available and properly resourced

  • all physiotherapy delivered in culturally appropriate

  • supporting Hauora Maori (Maori health) models of care

  • valuing Maori cultural concepts values, and practices.

  • provide services in accessible ways

  • Te Whare Tapa Wha

  • Mauri

    • vital life force

    • bind agent for wairua, hinengaro, whanau, tinana

    • mauriora occurs when balanced

Maori health models

  1. Te Pae Mahutonga = Matariki, sir masor durie

  2. Te wheke (rose pere)

  3. Meihana model (suz pitama)

  4. Te Whakaaro Pokare Visual Tool (haua mana maori - maori living with disability

  1. Partnership: Crown and Maori to work in partnership: governance, design, delivery, and monitoring of health and disability services. Maori must be co-designers, with the crown, of the primary health system for Maori.

aim to deliver appropriate health and disability services for Maori communities

  • working together with common purpose, interest and co-operation to achieve positive health outcomes for maori

  • ensure integrity and wellbeing of both partners is preserved

  • not acting in isolation/unilaterally in assessment, decision making and planning of services and service delivery.

aims to deliver appropriate health and disability services for maori communities

  • work together with common purpose, interest, and cooperation to achieve positive health outcomes for Maori

  • ensuring integrity and wellbeing of both partners is preserved

  • not acting in isolation/unilaterally in assessment, decision making and planning of services and service delivery.

How does PBNZ adopt 5 TOW principles?

  • founding document of Aotearoa NZ, informs legislation, policy, and practice

  • aims to reduce the health inequalities between Maori and non Maori

  • Recognizes and respects the specific importance of health services for maori as the indigenous people of NZ

key:

  • mutual benefit between maori and tauiwi

  • places particular emphasis on tangata whenua and unique treaty relationship.

Modern Maori Statistics:

  • Higher population with maori ancestry

  • around 1/3 of all children under 15 identify as maori

  • youthful population

  • mortaility positively changing BUT

  • inequities in health include …

    • type 2 diabetes = maori 7 times higher

    • rheumatic heart disease = 5 times higher

    • COPD = 3.5 times higher

    • CVD = 2.3 times higher

    • Stroke = 1.5 times higher

    • Cancer = 1.5 times higher

    • Accidental deaths = 1.5 times higher.

causes of inequities:

  1. differential access to determinants of health

  2. differential access to healthcare

  3. employment

  4. education

  5. socioeconomic position.

Maori perspectives of Wellbeing

  • focus on being well rather than deficit approach focussing on illness/disease/disability

  • centred on whanau health and well-being rather than just the individual

  • cultural concepts and practices (tikanga) are key components for many Maori

  • Maori view of health invariably wholistic

Whanaungatanga - connection to people

  • power from people = manatangata

  • one with ones people = greater manatangata

  • whakapapa/ancestory

Mana

  • prestige, control, power and authority, influence, charisma

  • Whakamana = uphold someones mana

  • Manaaki = hospitality - upholding visitors mana (show respect, care, protect, sustain)

Tapu

  • A status of separateness conferred by ritual to set things apart from ordinary matters

  • Things forbidden or treated differently from things noa

Noa

  • Ordinary

Tikanga

  • correct ways of doing things

    • te ao maori

    • etiquette

    • varies in different areas and people, with each having their own rules

    • safe space

    • whakamana / empowers

Tikaka (SDHB)

summary of practical guidelines to deliver health services responsive to tikanga/tikaka Maori

Aim: improved access to, and effectiveness of, mainstream services to Maori

Reflect Maori concepts but includes best care standards for everyone

Applies to all SDHB facilities, staff and contracted health providers…

  1. Whanau Rooms

    • areas governed by maori tikaka

    • whanau conferences

    • mihiwhakatau

    • maori death, wharekarakia rooms, occupied by the deceased.

  1. Taoka

    • valuables

    • necklaces, pounamu, jewellery

    • be respectful

    • secure with tape rather than removing or obtain consent before removing

    • careful with storage

  1. Karakia

    • Many Maori essential in protecting and maintaining mental, spiritual, emotional, and physical health

    • allow time

    • provide water containers for purpose of spiritual cleansing

  1. Whanau support

    • family actively encourage, supported, and included in aspects of care and decision making

    • patient nominates person to speak on behalf of whanau

  1. Information and support

    • environment culturally safe/sensitive

    • patient understands treatment

    • resources available (te reo speakers, patient advocates, Maori chaplin)

    • pronounce name correctly. Ask if unsure

    • ‘next of kin’ may be broad.

  1. Body parts, tissue, and substances

    • removal, retention, return, or disposal

    • non-judgemental decision

    • record and carry out wishes

    • explain how and where disposal occurs if not retained

  1. Food, Linen, Bedpans

    • avoid using head pillow for body

    • use pillowcases for other purposes

    • sit on tables

    • flannel use

    • food over head NO

    • Keep things in contact body separate from FOOD.

  2. Whanau following death

    • whanau notify immediately

    • be guided by whanau on practices appropriate to them

    • no food and drink

    • transporting deceased predetermined pathway, designated lifts, avoid public places, toilet, food.

    • Ensure room is blessed before being reused.