Maori Health Models and Population Diversity

Origins and Rationale for Māori Health Models

Māori health models were developed because Māori understandings, values, and concepts were historically absent from the New Zealand health system. The existing system is characterized by colonial and Western methodologies in both healthcare delivery and governance.

• Problems with the Western/Colonial System:

  • Strained Relationships: Relationships between Māori and health systems have historically been strained.

  • Incapability: Services have been incapable of addressing specific Māori needs, leading to poorer health outcomes.

  • Offensive to Worldviews: The system has frequently been offensive to Māori worldviews, which were excluded from the design and delivery process.

  • Distrust: There is a deep-seated distrust in health services among Māori.

  • Disempowerment: Patients and whānau (extended family) often feel disempowered by diagnostic labels and culturally insensitive therapies.

  • Deficit Focus: There is an overemphasis on Māori health deficits. This focuses on inequities but essentially blames Māori culture rather than addressing structural and interpersonal relationships.

  • Monocultural/Biomedical Dominance: The system relies heavily on biomedical measures (biological factors) rather than spiritual or emotional factors. This creates a clash with Māori values.

  • Oversight of Holistic Health: There is an overemphasis on physical health at the expense of other dimensions of well-being.

Te Wheke: The Octopus Model

Health in this model is represented as an octopus to illustrate the interconnectedness of different aspects of well-being.

• The Head/Body: Represents the whānau (family).

• The Eyes: Represent waiora (total well-being).

• The Eight Tentacles (Dimensions of Well-being):

  • Wairuatanga: Spirituality.

  • Hinengaro: The mind.

  • Taha tinana: Physical well-being.

  • Whanaungatanga: Extended family and the significance of relationships.

  • Mauri: Life force.

  • Mana ake: Unique identity.

  • Hā ā koro mā, ā kui mā: The breath of life from ancestors.

  • Whatumanawa: The healthy expression of emotion.

Te Taha Wairua

This concept focuses on the spiritual dimension of health.

• Identity: It emphasizes the importance of culture to a person's identity.

• Connections: It recognizes the significance of long-standing connections between people, their ancestors, and the natural environment (taiao).

Strengths and Limitations of Māori Health Models

• Strengths:

  • Provide a distinctive Māori voice in the health sector.

  • Reflect Māori cultural values and endorse Māori worldviews.

  • Promote holistic care and support personalized healthcare.

  • Challenge Western biomedical models and support Māori advocacy and leadership.

  • Practical and easily applicable across clinical practice, research, and policy.

• Limitations:

  • Can potentially oversimplify complex health issues if used in isolation.

  • May ignore structural determinants of health, such as colonisation, racism, and discrimination.

  • Risks cultural essentialism by assuming all Māori share identical beliefs, values, or preferences.

  • Cannot achieve health equity alone; broader political, social, and systemic changes are required.

Barriers and Facilitators to Healthcare for Māori

1. Categorization of Barriers

• Organizational Structure: Includes systemic racism, cultural alienation, and a health system designed around Pākehā (European descent) or individualistic approaches.

• Staff Interactions: Characterized by a lack of relational rapport, ineffective communication, and rushed staff interactions.

• Practical Barriers: Includes financial costs, transport issues, and time constraints, which disproportionately affect low-income whānau.

2. Effects of Barriers on Patients

• Perceived staff lack of interest in Māori well-being.

• Devaluation of Māori cultural and spiritual practices.

• Increased anxiety, worry, alienation, and mistrust.

• Inconsistent care and lack of understandable information.

• Self-silencing: Minimizing pain or severity and avoiding asking questions out of fear.

• Delayed or avoided healthcare, resulting in poorer outcomes.

3. Facilitators of Healthcare

Whānau, Māori providers, and health professionals can facilitate access through:

• Financial and transportation support.

• Personal care and emotional support.

• Wairua and Hinengaro support: Spiritual and mental well-being assistance.

• Information, advocacy, and medication support.

• Health-system navigation (helping whānau move through the complex system).

• Trust-Building: Establishing consistency and rapport.

• Positionality: Recognizing that whānau are a critical health resource, not just people accompanying a patient.

Case Study: Sudden Unexpected Death in Infancy (SUDI)

Māori infants are more than five times as likely to die from SUDI compared to non-Māori infants.

The 1991 National SIDS Prevention Campaign

This campaign focused on individual behavior change based on biological risk factors:

• Prone sleeping (on the front).

• Maternal smoking.

• Low breastfeeding rates.

• Bed sharing.

• Smoking cessation and parent education.

Outcomes and Inequity:

• Non-Māori rates: Decreased from $3.6$ to $1.6$ per $1,000$.

• Māori rates: Decreased from $7.4$ to $6.9$ per $1,000$.

• Conclusion: The intervention improved overall health outcomes but failed to produce health equity as the reduction for Māori was minimal compared to non-Māori.

The Wahakura: A Culturally Responsive Intervention

The Māori SIDS Prevention Programme moved away from simply telling whānau to "stop bedsharing." Instead, they developed the wahakura, a safe, separate sleeping space typically woven from harakeke (flax).

• Components of the Wahakura Lens:

  • Clinical expertise: Data on SUDI risk.

  • Cultural practices: Tikanga (customs), karakia (prayer), wānanga (learning forums), waiata (song), and pūrākau (stories).

  • Māori values: Incorporated into the design and distribution.

  • Research evidence: Based on