Māori Studies Lecture 10

Presenter: Rhys Jones, an experienced public health physician and academic.
Affiliation: Ngāti Kahungunu residing in Wairoa.
Collaborations: Collaborative teaching efforts with Papaarangi Reid and Teopita in health sciences and Māori health for over 1212 years, focusing on systemic change within Medical and Health Sciences education.

Conceptualizing Health: Exploration of Western vs. Indigenous paradigms.
Defining Māori Identity: Navigating the complexities of ancestry, ethnicity, and data classification.
Overview of Māori Health Status: Empirical evidence of health outcomes and disparities.
Drivers of Inequity: Analyzing the role of social determinants, colonisation, and structural bias.
Pathways to Improvement: Solutions focused on equity, Te Tiriti o Waitangi obligations, and decolonization.

Epidemiological Perspective: Focuses primarily on morbidity and mortality. Health is the absence of binary pathological states (0=0= healthy, 1=1= diseased). This model often overlooks the subjective experience of well-being.
World Health Organization (WHO) Definition (19481948): Defines health as a state of complete physical, mental, and social well-being. While revolutionary for its time by moving beyond the biomedical model, it has been criticized for being static (a "state") rather than a process.
Ottawa Charter for Health Promotion (19861986):
- Health is a resource for everyday life, not the objective of living.
- It involves the capacity of individuals or groups to realize aspirations, satisfy needs, and change or cope with the environment.
- Key prerequisites include peace, shelter, education, food, income, a stable ecosystem, and social justice.

Te Whare Tapa Whā (The Four-Sided House):
- Proposed by Professor Sir Mason Durie in 19841984.
- Metaphor: A house requires four strong walls to remain upright; if one is weak, the entire structure is compromised.
1. Taha Tinana: Physical health and biological functioning.
2. Taha Hinengaro: Mental and emotional health, including thoughts and feelings.
3. Taha Whānau: Social health, family connections, and the sense of belonging within a community.
4. Taha Wairua: Spiritual health, encompassing values, beliefs, and the relationship with the environment and ancestors.
Te Wheke (The Octopus):
- Developed by Dr. Rose Pere in the 1980s1980s.
- Uses the octopus metaphor to represent the complexities of health. The head represents the whānau (family) and the eyes represent the total well-being of the family unit.
- The eight tentacles represent different dimensions, including Mauri (life force), Mana ake (unique identity), and Hā a koro ma a kui ma (breath of life from ancestors).
Holistic Shift: These models emphasize that indigenous health is inextricably linked to the land (Whenua) and the collective rather than just the individual atomized self.

Population Health: Focuses on the health outcomes of a specific group and the distribution of those outcomes. It moves from "why did this individual get sick?" to "why does this population have this rate of disease?"
Herd/Population Immunity: A population-level characteristic where a high percentage of vaccinated individuals (≈95%≈95% for measles) protects those who cannot be vaccinated, demonstrating how individual actions affect collective safety.
Planetary Health: A contemporary framework acknowledging that human health is entirely dependent on the health of the Earth's natural systems.
- Addresses the "anthropocene"—an era where human activity is the dominant influence on climate and the environment.
- From a Māori worldview, humans are not separate from nature but are part of the Whakapapa (genealogy) of the natural world; therefore, harming the planet is a direct harm to human health.

Ancestry (Whakapapa): A biological fact of descent. In the NZ Census, this involves a "yes/no" question regarding Māori descent, used primarily for electoral and legal purposes.
Ethnicity: A social construct based on cultural affiliation, shared history, and language. It is fluid and self-defined. In health statistics, ethnicity is prioritized to ensure Māori needs are visible in data analysis.
Social Construction: Ethnic categories are not biological realities but are shaped by social and political power. Moana Jackson's anecdotes often highlight how the "dominant" culture views its own practices as "normal" and others as "ethnic."

Systemic Inequities: Māori health is characterized by consistent disparities compared to non-Māori across almost all health indicators.
Life Expectancy Gap: Historically, there has been a persistent gap of roughly 77 to 88 years in life expectancy between Māori and non-Māori.
Mortality Patterns: Māori often experience "premature mortality." While non-Māori deaths are concentrated in the 80+80+ age bracket, Māori deaths show a significantly higher peak in the 65−6965−69 age bracket, representing years of potential life lost.
Determinants: These inequities are driven by the "Social Determinants of Health"—the conditions in which people are born, grow, live, and work. These include unequal access to quality housing, education, and nutritious food (50−60%50−60% of health outcomes are determined by these factors).

Genetic Myth: There is no "Māori gene" responsible for high rates of diabetes or heart disease. Scientific evidence shows more genetic variation within a single ethnic group than between different ethnic groups.
Environment over Biology: Migration studies (e.g., Japanese populations moving to the US or Tokelauan populations moving to NZ) show that within one generation, migrants take on the health profile of the host country, proving that environmental and social factors override genetic predispositions.
The Role of Colonisation: The historical and ongoing process of land alienation and cultural suppression has direct links to socioeconomic deprivation and chronic stress (allostatic load), which negatively impacts Māori health outcomes.

Institutional Racism: Differential access to the goods, services, and opportunities of society by race. Examples include the "Inverse Care Law," where those with the greatest need have the least access to quality healthcare.
Personally Mediated Racism: Prejudice and discrimination manifested as lack of respect, suspicion, or devaluation. In healthcare, this leads to biased clinical decision-making and poorer treatment for Māori patients.
Internalized Racism: Acceptance by members of the stigmatized race of negative messages about their own abilities and intrinsic worth.

Te Aka Whai Ora (Māori Health Authority): Designed to give Māori leadership and autonomy over health funding and service delivery (Tino Rangatiratanga), though its sustainability is subject to political shifts.
Equity-Centered Design: Moving from "equality" (giving everyone the same thing) to "equity" (giving people what they need to achieve the same outcome).
Decolonization: Actively dismantling the structures that perpetuate Eurocentric dominance in healthcare. This includes incorporating Rongoā Māori (traditional healing) and Māori protocols (Tikanga) into clinical settings.
Upholding Indigenous Rights: Ensuring the obligations of Te Tiriti o Waitangi (Partnership, Participation, and Protection) are met to restore Māori health and well-being.