Oranga and Māori Health Inequities, 1769–1992

Oranga represents a Māori worldview of wellness, emphasizing a necessary equilibrium between the natural, spiritual, cultural, social, and political environments. This balance is considered essential for the overall wellbeing of Māori individuals and communities.

Key determinants of oranga include whakapapa (genealogy), whenua (land), and whānau (family). These three elements are foundational to Māori identity and wellbeing.

Whakapapa serves as the organizing device that connects all living things within the iwi Māori structure. It meticulously records the interrelationships and genealogical links to Atua, who are deities associated with various aspects of the natural environment. These narratives reinforce the interconnectedness of all life.

Whenua, or land, is not only a source of sustenance but also provides identity, a place to stand (tūrangawaewae), and a vital connection to ancestors (wāhi kāinga). The land carries deep cultural and historical significance, embedding Māori in their heritage.

Whānau functions as the primary social, living, and learning unit in Māori society. The wellness of each member is intricately linked to their ability to fulfill caring roles within the family, supporting and nurturing each other.

The concept of tapu is crucial for regulating and maintaining harmony and balance in all aspects of life. This is facilitated through tikanga (customs), ture (laws), ritenga (practices), kawa (rituals), rāhui (resource management), and karakia (incantation), all of which work together to preserve sacredness and order.

Oranga is distinct from Western views of health, although Māori have integrated Western theories and practices into their worldview. This integration reflects the adaptability and resilience of Māori in navigating different cultural perspectives.

Māori concepts of health have evolved over time, with terms like 'waiora', 'hauora', 'rapuora' and 'whakaoranga' used to describe wellbeing. These terms reflect a dynamic understanding of health that has adapted to changing social and environmental conditions.

Key Māori health models include:

• Te Whare Tapa Whā: This model identifies four cornerstones of Māori health: physical wellbeing, spiritual wellbeing, family wellbeing, and mental wellbeing. Each cornerstone is essential for overall health and is interconnected with the others.

• Te Wheke: This model uses the eight tentacles of an octopus to represent specific dimensions of health, such as spirituality, mind, physical wellbeing and unique identity. Each tentacle represents a different aspect of health, highlighting the holistic nature of Māori wellbeing.

• Te Pae Māhutonga: This model focuses on elements of modern health promotion, including cultural identity, physical environment, healthy lifestyles, and societal participation, emphasizing leadership & autonomy. It integrates contemporary health strategies with traditional Māori values.

The report focuses on the period from 1769 to 1992, examining how Māori defined oranga, responded to various challenges, and why health inequities emerged following the signing of Te Tiriti o Waitangi (The Treaty of Waitangi in 1840). This historical analysis provides critical insights into the factors affecting Māori health over time.

The narrative of oranga illustrates how the Māori past was shaped by a holistic view of wellbeing, called oranga Māori. It also charts Māori responses to challenges, highlighting their efforts to maintain or nurture a state of wellbeing based on the pillars of whakapapa, whenua and whānau. This narrative underscores the resilience and adaptability of Māori in the face of adversity.

Colonization is identified as the overarching framework that significantly undermined oranga through assimilative policies and practices. These policies disrupted traditional Māori ways of life and had lasting negative impacts on health.

Trauma resulting from colonization has intergenerational impacts, leading to whakamā (cultural shame). This cultural shame is a significant barrier to wellbeing and requires ongoing efforts to address.

The historiography is oranga-centric, emphasizing the importance of whenua and incorporating historical contexts often overlooked in discussions of ‘Māori health’. This approach provides a more comprehensive understanding of the factors shaping Māori health.

Pre-1769, oranga was central to Māori society, which had a population estimated between 80,000 to 150,000 by the late eighteenth century, potentially descended from a migrant population of 100-200 people that arrived between 1230-1280AD. The population growth was likely due to a birth rate exceeding the death rate and effective resource management practices.

Māori developed a sophisticated ‘public health’ system that regulated daily life and resource use (kaitiakitanga), ensuring the sustainability and wellbeing of the community.

Archaeological evidence indicates that early Māori were generally strong and healthy, with an average height of 5'9'' (175 cm) for men and 5'3'' (160 cm) for women. Labor-intensive activities, however, led to degenerative diseases such as osteoarthritis. Dental disease was also common due to a gritty diet. Non-communicable diseases like cancer, gout, kidney, and heart disease were also present (Hanham, 2003, p.32).

Life expectancy was around 30–35 years.

Tohunga (experts) used herbal remedies and spiritual practices (karakia) to heal illnesses caused by disruptions to tapu (sacredness), integrating both physical and spiritual dimensions of healing.

Māori adapted agricultural practices to suit New Zealand's climate, including innovative methods for storing kūmara (sweet potato) over winter, ensuring food security.

Women and men held complementary roles in society, with women playing a key role in linking the past, present, and future. Childbirth was tapu and took place in specific locations, reflecting the sacredness of life.

Early encounters with Pākehā (Europeans) noted good Māori health and rapid healing ability, highlighting the initial robustness of Māori health systems.

Structure of the Report: Chapter 2 (1769-1859) focuses on impacts of diseases, influence of Christianity, and health policies. Chapter 3 (1860-1900) discusses war, land loss, and population decline. Chapter 4 (1900-1945) explores recovery efforts and the impact of racist policies. Chapter 5 (1945-1975) examines urban migration and government policies. Chapter 6 (1976-1992) outlines socio-economic disparities and the push for autonomy. Each chapter includes tupuna voices and summaries, providing a comprehensive historical overview.

Key themes include Māori assertions of rangatiratanga (sovereignty), autonomy, and the profound impact of land and health policies on men, women, and children. These themes underscore the ongoing struggle for self-determination and health equity.

Te Hura, an elderly woman in Heretaunga (Hawke’s Bay) in late 1850, received a calling to heal Māori by drawing on powers of Christ and traditional healing methods, blending spiritual and traditional healing practices.

By the time Te Hura ascended Pukekohe Hill, Pākehā people outnumbered Māori, marking a significant demographic shift.

With Pākehā came a foreign culture replete with its own language, economy, social ideals, religion, technologies and diseases. Māori concern about the impact of new illnesses ravaging their communities spread apace, leading to significant social and health challenges.

The Māori population dropped from no more than 100,000 in 1769 to between 70,000 and 90,000 by 1840, and further to around 60,000 by the late 1850s, reflecting the devastating impact of introduced diseases and social disruption.

In the nineteenth century, Te Hura and others emerged as prophets and healers as a cultural response to missionary teachings, war, disease, and death, and as Oranga came under attack, demonstrating the resilience and adaptability of Māori culture.

Colonizers brought notions of their own racial superiority, starting with Christian missionaries trading, preaching, and teaching designed to civilize, assimilate, and convert Māori to Christianity, imposing foreign values on Māori society.

The Crown’s proclamation of sovereignty in the English version of the Treaty of Waitangi was also underpinned and driven by notions of racial superiority alongside Western philosophy, laws and values. These shaped the assimilationist health legislation and policies that then came, embedding systemic biases in governmental structures.

The arrival of Pākehā and processes of colonization brought both negative and positive encounters and outcomes. Some Māori selectively acquired and incorporated new commodities, technologies and ideas, such as livestock to bolster protein-poor diets, and alcohol and tobacco. New diseases, however, brought nothing but misery and a receptiveness for engagement with Missionaries and the Crown.

Between 1769 and 1859, tens of thousands of Māori men, women and children died due to wave upon wave of infectious diseases due to a lack of Māori immunity and an inability to treat these diseases, and by changing social and economic times that made Māori more susceptible to disease, causing immense suffering and societal disruption.

The report discusses colonization as an historical process predicated on assumptions of racial, religious, cultural and technological superiority, beginning in the nineteenth century and continuing into the twentieth century, impacting all aspects of society including oranga and ‘Māori health’.