Thesis for Doctor of Health Science at Auckland University of Technology, 2023
This thesis presents the theory of Reconfiguring Life which explains how adults live with moderat... more This thesis presents the theory of Reconfiguring Life which explains how adults live with moderate to severe lower limb lymphoedema. Lymphoedema is a long-term, progressively deteriorating condition; with associated symptoms such as limb swelling, heaviness, changes in personal appearance, reduced mobility and complications that are disruptive,
Te Tiriti o Waitangi [te Tiriti] articulates the relationship between the government and Māori [I... more Te Tiriti o Waitangi [te Tiriti] articulates the relationship between the government and Māori [Indigenous New Zealanders]. Universities have a responsibility to prepare graduates to work with te Tiriti. The literature on teaching te Tiriti is sparse. In this conceptual paper, we propose he hokinga ki te mauri [a return to vibrancy] as a framework for teaching te Tiriti. First, te upoko involves using intellectual rationale and covering core te Tiriti curriculum related to issues such as He Whakaputanga [the Declaration of Independence] and the texts of te Tiriti. Second, it offers strategies for te ngākau – involving heart and wairua [spirit]. Finally, ngā ringa – involves practical application. The authors maintain this novel approach supports teachers to depart from the weighty requirements of advanced technical expertise, providing flexibility to scaffold curriculum. Across the world, working with the ongoing impacts of colonisation gives rise to a range of politically and emotionally charged topics, we hope that our method might strengthen the teaching and learning associated with decolonisation.
Public institutions within New Zealand have long been accused of mono-culturalism and institution... more Public institutions within New Zealand have long been accused of mono-culturalism and institutional racism. This study sought to identify inconsistencies and bias by comparing government funded contracting processes for Māori public health providers (n = 60) with those of generic providers (n = 90). Qualitative and quantitative data were collected (November 2014–May 2015), through a nationwide telephone survey of public health providers, achieving a 75% response rate. Descriptive statistical analyses were applied to quantitative responses and an inductive approach was taken to analyse data from open-ended responses in the survey domains of relationships with portfolio contract managers, contracting and funding. The quantitative data showed four sites of statistically significant variation: length of contracts, intensity of monitoring, compliance costs and frequency of auditing. Non-significant data involved access to discretionary funding and cost of living adjustments, the frequency of monitoring, access to Crown (government) funders and representation on advisory groups. The qualitative material showed disparate provider experiences, dependent on individual portfolio managers, with nuanced differences between generic and Māori providers’ experiences. This study showed that monitoring government performance through a nationwide survey was an innovative way to identify sites of institutional racism. In a policy context where health equity is a key directive to the health sector, this study suggests there is scope for New Zealand health funders to improve their contracting practices.
Abstract
Objectives. New Zealand has a unique tool, Te Tiriti o Waitangi, the Treaty of Waitangi... more Abstract
Objectives. New Zealand has a unique tool, Te Tiriti o Waitangi, the Treaty of Waitangi, for addressing health disparities. Indigenous Māori have compromised health status compared to other groups. This paper investigates ways in which public health units (PHUs) and non-governmental organisations (NGOs) use Te Tiriti o Waitangi in service delivery to Māori.
Design. A nationwide telephone survey of primary health providers (n=162) was conducted in 2014-15. Participants were asked about effectiveness and monitoring of their service delivery to Māori.
Results. PHUs reported actively working with Māori, and Te Tiriti o Waitangi to reduce health disparities. Direct Māori engagement with development and delivery of programmes was viewed as essential. Strategies included designated PHU staff in positions of responsibility, formal partnerships with Māori, and providing operational and strategic guidance. Some PHUs supported development of cultural competencies. NGO responsiveness to Māori was variable. Some NGOs described prioritising service delivery and programmes for Māori. Others reported the focus of their service was European or other non-Māori ethnicities. Lack of resources or past difficulties engaging with Māori were barriers.
Conclusion. Public health has an ethical commitment to reduce health disparities. Advancing Te Tiriti obligations in everyday practice has the potential to address inequalities.
New Zealand’s core health policy document—the New Zealand Health Strategy (NZHS)—was released in ... more New Zealand’s core health policy document—the New Zealand Health Strategy (NZHS)—was released in its final form in April 2016. This paper provides a critique of the strategy in particular, as it relates to health equity particularly for Māori. We introduce the five NZHS themes of—people powered, closer to home, value and high performance, one team and smart system—to focus on the aspirational goal of eliminating health inequities. Our critical framework is informed by Te Tiriti o Waitangi. We identified that the NZHS relies on the isolated efforts of committed individuals and organisations to achieve health equity and Te Tiriti engagement, rather than through a planned systems viewpoint. Evidence on health equity and Te Tiriti application suggests efforts need to be sustained, systematic and multi-levelled to be successful, rather than ad hoc and piecemeal. T.N.McCreanor@massey.ac.nz
In the 1980s public servants exposed systemic
institutional racism within the administration
of... more In the 1980s public servants exposed systemic
institutional racism within the administration
of the public sector through a series of reports,
the most well-known of which being Puao te Ata
tu (Ministerial Advisory Committee on a Māori
Perspective on Social Welfare, 1988). The health
sector had earlier drawn a line in the sand with a
memo from the then Director-General of Health, Dr
George Salmond (1986), requiring sector engagement
with the Treaty of Waitangi. More than twenty
years on, the health system continues to produce
inequitable health outcomes between Māori and
non-Māori (Robson and Harris, 2007), in part
because of persistent institutional racism within the
administration of the health system itself (Came,
2012). Last year the Public Health Association (PHA)
(September 2012) passed a remit at the Annual
General Meeting (AGM) committing us (the public
health sector) to take action to address institutional
racism within our sector. The costs of inaction are
high and fundamentally incongruent with the stated
values of the public health sector (Public Health
Association, 2012). It is time for courage and to draw
a new line in the sand - let’s eliminate institutional
racism within our sector by 2017.
Webinar
Venue: University “Access Grid Room” or your desktop
Start date: 12/11/2014
End date: 12... more Webinar
Venue: University “Access Grid Room” or your desktop Start date: 12/11/2014 End date: 12/11/2014
Time: 1 – 3pm
Description: The challenge in being an activist scholar is not so much in describing the problem, but in permanently transforming /realigning/eliminating it. Some time ago now a gang of committed public health practitioners started announcing to the world that we would end institutional racism within the public health sector by 2017. This has inspired and excited some people and terrified others.
Needless to say we have been quite busy. Within this interactive webinar Heather and Claire will share what happened next with our campaign of awareness raising, advocacy and research activities. We have attempted to influence how public health services are purchased, developed a policy position, mobilised allies, done media work and got people debating institutional racism.
As well as sharing our stories will also solicit your expert ideas to the challenging questions of what would a public sector look like without institutional racism? If we are committed to evaluating our anti-racism efforts what should we be measuring?
Te Tiriti o Waitangi legitimises settler presence in Aotearoa and governance by the British Crown... more Te Tiriti o Waitangi legitimises settler presence in Aotearoa and governance by the British Crown. Therefore, te Tiriti must lie at the heart of ethical health promotion in this country. This resource, inspired by activist scholarship, explores the ways in which senior health promoters work with the articles of te Tiriti and its aspirations.
This resource builds upon recognition of the Māori text of te Tiriti and offers guidance for those that work in the health sector to manage and develop their Treaty based practice in ways that recognise the power relationships it enshrines. It acknowledges, as did the original philosophical underpinnings of cultural safety that those relationships are not merely therapeutic or health-centred but are also historical, political, and economic.
Māori women with advanced breast cancer are less than half as likely as their Pākehā counterparts... more Māori women with advanced breast cancer are less than half as likely as their Pākehā counterparts to reach the five-year survival mark. We argue that this inequity is unacceptable. We trace the inequity back to i) inadequate screening and risk assessment, ii) lack of support for patient navigation, iii) failure to offer accessible state-of-the-art treatments, and iv) delays in receiving life-prolonging care. We posit that each of these factors is a site of institutional racism and privilege as they cause Māori women to experience significantly worse outcomes than non-Māori. In the active pursuit of justice, cancer survivors, women living with cancer and their supporters across the country have been engaging in passionate advocacy to address inequities. As the Ministry of Health develops a new cancer control plan, in this viewpoint opinion piece, we seek to amplify these distressing inequities and offer evidence-based recommendations to improve the quality of care and ultimately survival rates. Breast cancer inequities are modifiable. We recommend prioritising breast cancer screening and risk assessments for Māori women, reducing treatment delays, providing Māori-centered patient navigation, increasing funding for treatments and drugs to align with the OECD standard of care, and holding health providers accountable for ethnic inequities. We call on policy makers drafting the new cancer control strategy, and those working across the cancer continuum, to take action to improve breast cancer outcomes so Māori women will gain valuable life-years.
Health & Social Care in The Community, May 10, 2021
Primary health is at the forefront of efforts to address health inequities. Effective primary hea... more Primary health is at the forefront of efforts to address health inequities. Effective primary health care keeps people well and improves longevity and quality of life. The persistence of health inequities, particularly between Indigenous peoples and non-Indigenous peoples globally, suggests that there is a need to strengthen policy and practise. Unique to Aotearoa (New Zealand) is te Tiriti o Waitangi, a treaty negotiated in 1840 between the British Crown and hapū (Māori [Indigenous] subtribes). This treaty is foundational to public policy in Aotearoa and requires the Crown (New Zealand government) to uphold a set of responsibilities around protecting and promoting Māori health. This paper examines to what extent Primary Health Organisations are upholding te Tiriti o Waitangi. The study utilises data from a nationwide telephone survey of public health providers conducted in 2019-2020 recruited from a list on the Ministry of Health website. This paper focuses on data about te Tiriti application from 21 Primary Health Organisations from a sample size of thirty. Critical te Tiriti analysis, an emerging methodology, was used to assess to what extent the participating primary health organisations were te Tiriti compliant. The critical te Tiriti analysis found poor to fair compliance with most elements of te Tiriti but good engagement with equity. Suggestions for strengthening practise included examining relationships with Māori, utilising a planned approach, structural mechanisms, normalising Māori world views and consistency in application. The onus needs to be on non-Māori to contribute to the cultural change and power-sharing required to uphold te Tiriti. Critical te Tiriti analysis is a useful methodology to review te Tiriti compliance and could be used in other contexts to review alignment with Indigenous rights and aspirations.
Te Tiriti o Waitangi legitimises settler presence in Aotearoa and governance by the British Crown... more Te Tiriti o Waitangi legitimises settler presence in Aotearoa and governance by the British Crown. Therefore, te Tiriti must lie at the heart of ethical health promotion in this country. This resource, inspired by activist scholarship, explores the ways in which senior health promoters work with the articles of te Tiriti and its aspirations. This resource builds upon recognition of the Māori text of te Tiriti and offers guidance for those that work in the health sector to manage and develop their Treaty based practice in ways that recognise the power relationships it enshrines. It acknowledges, as did the original philosophical underpinnings of cultural safety that those relationships are not merely therapeutic or health-centred but are also historical, political, and economic.
Te Tiriti o Waitangi legitimises settler presence in Aotearoa and governance by the British Crown... more Te Tiriti o Waitangi legitimises settler presence in Aotearoa and governance by the British Crown. Therefore, te Tiriti must lie at the heart of ethical health promotion in this country. This resource, inspired by activist scholarship, explores the ways in which senior health promoters work with the articles of te Tiriti and its aspirations. This resource builds upon recognition of the Māori text of te Tiriti and offers guidance for those that work in the health sector to manage and develop their Treaty based practice in ways that recognise the power relationships it enshrines. It acknowledges, as did the original philosophical underpinnings of cultural safety that those relationships are not merely therapeutic or health-centred but are also historical, political, and economic.
Primary health is at the forefront of efforts to address health inequities. Effective primary hea... more Primary health is at the forefront of efforts to address health inequities. Effective primary health care keeps people well and improves longevity and quality of life. The persistence of health inequities, particularly between Indigenous peoples and non-Indigenous peoples globally, suggests that there is a need to strengthen policy and practise. Unique to Aotearoa (New Zealand) is te Tiriti o Waitangi, a treaty negotiated in 1840 between the British Crown and hapū (Māori [Indigenous] subtribes). This treaty is foundational to public policy in Aotearoa and requires the Crown (New Zealand government) to uphold a set of responsibilities around protecting and promoting Māori health. This paper examines to what extent Primary Health Organisations are upholding te Tiriti o Waitangi. The study utilises data from a nationwide telephone survey of public health providers conducted in 2019-2020 recruited from a list on the Ministry of Health website. This paper focuses on data about te Tiriti ...
ABSTRACT Te Tiriti o Waitangi [te Tiriti] articulates the relationship between the government and... more ABSTRACT Te Tiriti o Waitangi [te Tiriti] articulates the relationship between the government and Māori [Indigenous New Zealanders]. Universities have a responsibility to prepare graduates to work with te Tiriti. The literature on teaching te Tiriti is sparse. In this conceptual paper, we propose he hokinga ki te mauri [a return to vibrancy] as a framework for teaching te Tiriti. First, te upoko involves using intellectual rationale and covering core te Tiriti curriculum related to issues such as He Whakaputanga [the Declaration of Independence] and the texts of te Tiriti. Second, it offers strategies for te ngākau – involving heart and wairua [spirit]. Finally, ngā ringa – involves practical application. The authors maintain this novel approach supports teachers to depart from the weighty requirements of advanced technical expertise, providing flexibility to scaffold curriculum. Across the world, working with the ongoing impacts of colonisation gives rise to a range of politically and emotionally charged topics, we hope that our method might strengthen the teaching and learning associated with decolonisation.
Thesis for Doctor of Health Science at Auckland University of Technology, 2023
This thesis presents the theory of Reconfiguring Life which explains how adults live with moderat... more This thesis presents the theory of Reconfiguring Life which explains how adults live with moderate to severe lower limb lymphoedema. Lymphoedema is a long-term, progressively deteriorating condition; with associated symptoms such as limb swelling, heaviness, changes in personal appearance, reduced mobility and complications that are disruptive,
Te Tiriti o Waitangi [te Tiriti] articulates the relationship between the government and Māori [I... more Te Tiriti o Waitangi [te Tiriti] articulates the relationship between the government and Māori [Indigenous New Zealanders]. Universities have a responsibility to prepare graduates to work with te Tiriti. The literature on teaching te Tiriti is sparse. In this conceptual paper, we propose he hokinga ki te mauri [a return to vibrancy] as a framework for teaching te Tiriti. First, te upoko involves using intellectual rationale and covering core te Tiriti curriculum related to issues such as He Whakaputanga [the Declaration of Independence] and the texts of te Tiriti. Second, it offers strategies for te ngākau – involving heart and wairua [spirit]. Finally, ngā ringa – involves practical application. The authors maintain this novel approach supports teachers to depart from the weighty requirements of advanced technical expertise, providing flexibility to scaffold curriculum. Across the world, working with the ongoing impacts of colonisation gives rise to a range of politically and emotionally charged topics, we hope that our method might strengthen the teaching and learning associated with decolonisation.
Public institutions within New Zealand have long been accused of mono-culturalism and institution... more Public institutions within New Zealand have long been accused of mono-culturalism and institutional racism. This study sought to identify inconsistencies and bias by comparing government funded contracting processes for Māori public health providers (n = 60) with those of generic providers (n = 90). Qualitative and quantitative data were collected (November 2014–May 2015), through a nationwide telephone survey of public health providers, achieving a 75% response rate. Descriptive statistical analyses were applied to quantitative responses and an inductive approach was taken to analyse data from open-ended responses in the survey domains of relationships with portfolio contract managers, contracting and funding. The quantitative data showed four sites of statistically significant variation: length of contracts, intensity of monitoring, compliance costs and frequency of auditing. Non-significant data involved access to discretionary funding and cost of living adjustments, the frequency of monitoring, access to Crown (government) funders and representation on advisory groups. The qualitative material showed disparate provider experiences, dependent on individual portfolio managers, with nuanced differences between generic and Māori providers’ experiences. This study showed that monitoring government performance through a nationwide survey was an innovative way to identify sites of institutional racism. In a policy context where health equity is a key directive to the health sector, this study suggests there is scope for New Zealand health funders to improve their contracting practices.
Abstract
Objectives. New Zealand has a unique tool, Te Tiriti o Waitangi, the Treaty of Waitangi... more Abstract
Objectives. New Zealand has a unique tool, Te Tiriti o Waitangi, the Treaty of Waitangi, for addressing health disparities. Indigenous Māori have compromised health status compared to other groups. This paper investigates ways in which public health units (PHUs) and non-governmental organisations (NGOs) use Te Tiriti o Waitangi in service delivery to Māori.
Design. A nationwide telephone survey of primary health providers (n=162) was conducted in 2014-15. Participants were asked about effectiveness and monitoring of their service delivery to Māori.
Results. PHUs reported actively working with Māori, and Te Tiriti o Waitangi to reduce health disparities. Direct Māori engagement with development and delivery of programmes was viewed as essential. Strategies included designated PHU staff in positions of responsibility, formal partnerships with Māori, and providing operational and strategic guidance. Some PHUs supported development of cultural competencies. NGO responsiveness to Māori was variable. Some NGOs described prioritising service delivery and programmes for Māori. Others reported the focus of their service was European or other non-Māori ethnicities. Lack of resources or past difficulties engaging with Māori were barriers.
Conclusion. Public health has an ethical commitment to reduce health disparities. Advancing Te Tiriti obligations in everyday practice has the potential to address inequalities.
New Zealand’s core health policy document—the New Zealand Health Strategy (NZHS)—was released in ... more New Zealand’s core health policy document—the New Zealand Health Strategy (NZHS)—was released in its final form in April 2016. This paper provides a critique of the strategy in particular, as it relates to health equity particularly for Māori. We introduce the five NZHS themes of—people powered, closer to home, value and high performance, one team and smart system—to focus on the aspirational goal of eliminating health inequities. Our critical framework is informed by Te Tiriti o Waitangi. We identified that the NZHS relies on the isolated efforts of committed individuals and organisations to achieve health equity and Te Tiriti engagement, rather than through a planned systems viewpoint. Evidence on health equity and Te Tiriti application suggests efforts need to be sustained, systematic and multi-levelled to be successful, rather than ad hoc and piecemeal. T.N.McCreanor@massey.ac.nz
In the 1980s public servants exposed systemic
institutional racism within the administration
of... more In the 1980s public servants exposed systemic
institutional racism within the administration
of the public sector through a series of reports,
the most well-known of which being Puao te Ata
tu (Ministerial Advisory Committee on a Māori
Perspective on Social Welfare, 1988). The health
sector had earlier drawn a line in the sand with a
memo from the then Director-General of Health, Dr
George Salmond (1986), requiring sector engagement
with the Treaty of Waitangi. More than twenty
years on, the health system continues to produce
inequitable health outcomes between Māori and
non-Māori (Robson and Harris, 2007), in part
because of persistent institutional racism within the
administration of the health system itself (Came,
2012). Last year the Public Health Association (PHA)
(September 2012) passed a remit at the Annual
General Meeting (AGM) committing us (the public
health sector) to take action to address institutional
racism within our sector. The costs of inaction are
high and fundamentally incongruent with the stated
values of the public health sector (Public Health
Association, 2012). It is time for courage and to draw
a new line in the sand - let’s eliminate institutional
racism within our sector by 2017.
Webinar
Venue: University “Access Grid Room” or your desktop
Start date: 12/11/2014
End date: 12... more Webinar
Venue: University “Access Grid Room” or your desktop Start date: 12/11/2014 End date: 12/11/2014
Time: 1 – 3pm
Description: The challenge in being an activist scholar is not so much in describing the problem, but in permanently transforming /realigning/eliminating it. Some time ago now a gang of committed public health practitioners started announcing to the world that we would end institutional racism within the public health sector by 2017. This has inspired and excited some people and terrified others.
Needless to say we have been quite busy. Within this interactive webinar Heather and Claire will share what happened next with our campaign of awareness raising, advocacy and research activities. We have attempted to influence how public health services are purchased, developed a policy position, mobilised allies, done media work and got people debating institutional racism.
As well as sharing our stories will also solicit your expert ideas to the challenging questions of what would a public sector look like without institutional racism? If we are committed to evaluating our anti-racism efforts what should we be measuring?
Te Tiriti o Waitangi legitimises settler presence in Aotearoa and governance by the British Crown... more Te Tiriti o Waitangi legitimises settler presence in Aotearoa and governance by the British Crown. Therefore, te Tiriti must lie at the heart of ethical health promotion in this country. This resource, inspired by activist scholarship, explores the ways in which senior health promoters work with the articles of te Tiriti and its aspirations.
This resource builds upon recognition of the Māori text of te Tiriti and offers guidance for those that work in the health sector to manage and develop their Treaty based practice in ways that recognise the power relationships it enshrines. It acknowledges, as did the original philosophical underpinnings of cultural safety that those relationships are not merely therapeutic or health-centred but are also historical, political, and economic.
Māori women with advanced breast cancer are less than half as likely as their Pākehā counterparts... more Māori women with advanced breast cancer are less than half as likely as their Pākehā counterparts to reach the five-year survival mark. We argue that this inequity is unacceptable. We trace the inequity back to i) inadequate screening and risk assessment, ii) lack of support for patient navigation, iii) failure to offer accessible state-of-the-art treatments, and iv) delays in receiving life-prolonging care. We posit that each of these factors is a site of institutional racism and privilege as they cause Māori women to experience significantly worse outcomes than non-Māori. In the active pursuit of justice, cancer survivors, women living with cancer and their supporters across the country have been engaging in passionate advocacy to address inequities. As the Ministry of Health develops a new cancer control plan, in this viewpoint opinion piece, we seek to amplify these distressing inequities and offer evidence-based recommendations to improve the quality of care and ultimately survival rates. Breast cancer inequities are modifiable. We recommend prioritising breast cancer screening and risk assessments for Māori women, reducing treatment delays, providing Māori-centered patient navigation, increasing funding for treatments and drugs to align with the OECD standard of care, and holding health providers accountable for ethnic inequities. We call on policy makers drafting the new cancer control strategy, and those working across the cancer continuum, to take action to improve breast cancer outcomes so Māori women will gain valuable life-years.
Health & Social Care in The Community, May 10, 2021
Primary health is at the forefront of efforts to address health inequities. Effective primary hea... more Primary health is at the forefront of efforts to address health inequities. Effective primary health care keeps people well and improves longevity and quality of life. The persistence of health inequities, particularly between Indigenous peoples and non-Indigenous peoples globally, suggests that there is a need to strengthen policy and practise. Unique to Aotearoa (New Zealand) is te Tiriti o Waitangi, a treaty negotiated in 1840 between the British Crown and hapū (Māori [Indigenous] subtribes). This treaty is foundational to public policy in Aotearoa and requires the Crown (New Zealand government) to uphold a set of responsibilities around protecting and promoting Māori health. This paper examines to what extent Primary Health Organisations are upholding te Tiriti o Waitangi. The study utilises data from a nationwide telephone survey of public health providers conducted in 2019-2020 recruited from a list on the Ministry of Health website. This paper focuses on data about te Tiriti application from 21 Primary Health Organisations from a sample size of thirty. Critical te Tiriti analysis, an emerging methodology, was used to assess to what extent the participating primary health organisations were te Tiriti compliant. The critical te Tiriti analysis found poor to fair compliance with most elements of te Tiriti but good engagement with equity. Suggestions for strengthening practise included examining relationships with Māori, utilising a planned approach, structural mechanisms, normalising Māori world views and consistency in application. The onus needs to be on non-Māori to contribute to the cultural change and power-sharing required to uphold te Tiriti. Critical te Tiriti analysis is a useful methodology to review te Tiriti compliance and could be used in other contexts to review alignment with Indigenous rights and aspirations.
Te Tiriti o Waitangi legitimises settler presence in Aotearoa and governance by the British Crown... more Te Tiriti o Waitangi legitimises settler presence in Aotearoa and governance by the British Crown. Therefore, te Tiriti must lie at the heart of ethical health promotion in this country. This resource, inspired by activist scholarship, explores the ways in which senior health promoters work with the articles of te Tiriti and its aspirations. This resource builds upon recognition of the Māori text of te Tiriti and offers guidance for those that work in the health sector to manage and develop their Treaty based practice in ways that recognise the power relationships it enshrines. It acknowledges, as did the original philosophical underpinnings of cultural safety that those relationships are not merely therapeutic or health-centred but are also historical, political, and economic.
Te Tiriti o Waitangi legitimises settler presence in Aotearoa and governance by the British Crown... more Te Tiriti o Waitangi legitimises settler presence in Aotearoa and governance by the British Crown. Therefore, te Tiriti must lie at the heart of ethical health promotion in this country. This resource, inspired by activist scholarship, explores the ways in which senior health promoters work with the articles of te Tiriti and its aspirations. This resource builds upon recognition of the Māori text of te Tiriti and offers guidance for those that work in the health sector to manage and develop their Treaty based practice in ways that recognise the power relationships it enshrines. It acknowledges, as did the original philosophical underpinnings of cultural safety that those relationships are not merely therapeutic or health-centred but are also historical, political, and economic.
Primary health is at the forefront of efforts to address health inequities. Effective primary hea... more Primary health is at the forefront of efforts to address health inequities. Effective primary health care keeps people well and improves longevity and quality of life. The persistence of health inequities, particularly between Indigenous peoples and non-Indigenous peoples globally, suggests that there is a need to strengthen policy and practise. Unique to Aotearoa (New Zealand) is te Tiriti o Waitangi, a treaty negotiated in 1840 between the British Crown and hapū (Māori [Indigenous] subtribes). This treaty is foundational to public policy in Aotearoa and requires the Crown (New Zealand government) to uphold a set of responsibilities around protecting and promoting Māori health. This paper examines to what extent Primary Health Organisations are upholding te Tiriti o Waitangi. The study utilises data from a nationwide telephone survey of public health providers conducted in 2019-2020 recruited from a list on the Ministry of Health website. This paper focuses on data about te Tiriti ...
ABSTRACT Te Tiriti o Waitangi [te Tiriti] articulates the relationship between the government and... more ABSTRACT Te Tiriti o Waitangi [te Tiriti] articulates the relationship between the government and Māori [Indigenous New Zealanders]. Universities have a responsibility to prepare graduates to work with te Tiriti. The literature on teaching te Tiriti is sparse. In this conceptual paper, we propose he hokinga ki te mauri [a return to vibrancy] as a framework for teaching te Tiriti. First, te upoko involves using intellectual rationale and covering core te Tiriti curriculum related to issues such as He Whakaputanga [the Declaration of Independence] and the texts of te Tiriti. Second, it offers strategies for te ngākau – involving heart and wairua [spirit]. Finally, ngā ringa – involves practical application. The authors maintain this novel approach supports teachers to depart from the weighty requirements of advanced technical expertise, providing flexibility to scaffold curriculum. Across the world, working with the ongoing impacts of colonisation gives rise to a range of politically and emotionally charged topics, we hope that our method might strengthen the teaching and learning associated with decolonisation.
Māori women with advanced breast cancer are less than half as likely as their Pākehā counterparts... more Māori women with advanced breast cancer are less than half as likely as their Pākehā counterparts to reach the five-year survival mark. We argue that this inequity is unacceptable. We trace the inequity back to i) inadequate screening and risk assessment, ii) lack of support for patient navigation, iii) failure to offer accessible state-of-the-art treatments, and iv) delays in receiving life-prolonging care. We posit that each of these factors is a site of institutional racism and privilege as they cause Māori women to experience significantly worse outcomes than non-Māori. In the active pursuit of justice, cancer survivors, women living with cancer and their supporters across the country have been engaging in passionate advocacy to address inequities. As the Ministry of Health develops a new cancer control plan, in this viewpoint opinion piece, we seek to amplify these distressing inequities and offer evidence-based recommendations to improve the quality of care and ultimately surv...
New Zealand's core health policy document-the New Zealand Health Strategy (NZHS)-was released... more New Zealand's core health policy document-the New Zealand Health Strategy (NZHS)-was released in its final form in April 2016. This paper provides a critique of the strategy in particular, as it relates to health equity particularly for Māori. We introduce the five NZHS themes of-people powered, closer to home, value and high performance, one team and smart system-to focus on the aspirational goal of eliminating health inequities. Our critical framework is informed by Te Tiriti o Waitangi. We identified that the NZHS relies on the isolated efforts of committed individuals and organisations to achieve health equity and Te Tiriti engagement, rather than through a planned systems viewpoint. Evidence on health equity and Te Tiriti application suggests efforts need to be sustained, systematic and multi-levelled to be successful, rather than ad hoc and piecemeal.
New Zealand's core health policy document-the New Zealand Health Strategy (NZHS)-was released... more New Zealand's core health policy document-the New Zealand Health Strategy (NZHS)-was released in its final form in April 2016. This paper provides a critique of the strategy in particular, as it relates to health equity particularly for Māori. We introduce the five NZHS themes of-people powered, closer to home, value and high performance, one team and smart system-to focus on the aspirational goal of eliminating health inequities. Our critical framework is informed by Te Tiriti o Waitangi. We identified that the NZHS relies on the isolated efforts of committed individuals and organisations to achieve health equity and Te Tiriti engagement, rather than through a planned systems viewpoint. Evidence on health equity and Te Tiriti application suggests efforts need to be sustained, systematic and multi-levelled to be successful, rather than ad hoc and piecemeal.
Objectives. New Zealand has a unique tool, Te Tiriti o Waitangi, the Treaty of Waitangi, for addr... more Objectives. New Zealand has a unique tool, Te Tiriti o Waitangi, the Treaty of Waitangi, for addressing health disparities. Indigenous Māori have compromised health status compared to other groups.This paper investigates ways in which public health units (PHUs) and non-governmental organisations (NGOs) use Te Tiriti o Waitangi in service delivery to Māori. Design. A nationwide telephone survey of primary health providers (n=162) was conducted in 2014-15. Participants were asked about effectiveness and monitoring of their service delivery to Māori. Results. PHUs reported actively working with Māori, and Te Tiriti o Waitangi to reduce health disparities. Direct Māori engagement with development and delivery of programmes was viewed as essential. Strategies included designated PHU staff in positions of responsibility, formal partnerships with Māori, and providing operational and strategic guidance. Some PHUs supported development of cultural competencies. NGO responsiveness to Māori wa...
Māori women with advanced breast cancer are less than half as likely as their Pākehā counterparts... more Māori women with advanced breast cancer are less than half as likely as their Pākehā counterparts to reach the five-year survival mark. We argue that this inequity is unacceptable. We trace the inequity back to i) inadequate screening and risk assessment, ii) lack of support for patient navigation, iii) failure to offer accessible state-of-the-art treatments, and iv) delays in receiving life-prolonging care. We posit that each of these factors is a site of institutional racism and privilege as they cause Māori women to experience significantly worse outcomes than non-Māori. In the active pursuit of justice, cancer survivors, women living with cancer and their supporters across the country have been engaging in passionate advocacy to address inequities. As the Ministry of Health develops a new cancer control plan, in this viewpoint opinion piece, we seek to amplify these distressing inequities and offer evidence-based recommendations to improve the quality of care and ultimately survival rates. Breast cancer inequities are modifiable. We recommend prioritising breast cancer screening and risk assessments for Māori women, reducing treatment delays, providing Māori-centered patient navigation, increasing funding for treatments and drugs to align with the OECD standard of care, and holding health providers accountable for ethnic inequities. We call on policy makers drafting the new cancer control strategy, and those working across the cancer continuum, to take action to improve breast cancer outcomes so Māori women will gain valuable life-years.
Teaching in higher education: Critical perspectives, 2019
Te Tiriti o Waitangi [te Tiriti] articulates the relationship between the government and Māori [... more Te Tiriti o Waitangi [te Tiriti] articulates the relationship between the government and Māori [Indigenous New Zealanders]. Universities have a responsibility to prepare graduates to work with te Tiriti. The literature on teaching te Tiriti is sparse. In this conceptual paper, we propose he hokinga ki te mauri [a return to vibrancy] as a framework for teaching te Tiriti. First, te upoko involves using intellectual rationale and covering core te Tiriti curriculum related to issues such as He Whakaputanga [the Declaration of Independence] and the texts of te Tiriti. Second, it offers strategies for te ngākau – involving heart and wairua [spirit]. Finally, ngā ringa – involves practical application. The authors maintain this novel approach supports teachers to depart from the weighty requirements of advanced technical expertise, providing flexibility to scaffold curriculum. Across the world, working with the ongoing impacts of colonisation gives rise to a range of politically and emotionally charged topics, we hope that our method might strengthen the teaching and learning associated with decolonisation.
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Publications by Claire Doole
Objectives. New Zealand has a unique tool, Te Tiriti o Waitangi, the Treaty of Waitangi, for addressing health disparities. Indigenous Māori have compromised health status compared to other groups. This paper investigates ways in which public health units (PHUs) and non-governmental organisations (NGOs) use Te Tiriti o Waitangi in service delivery to Māori.
Design. A nationwide telephone survey of primary health providers (n=162) was conducted in 2014-15. Participants were asked about effectiveness and monitoring of their service delivery to Māori.
Results. PHUs reported actively working with Māori, and Te Tiriti o Waitangi to reduce health disparities. Direct Māori engagement with development and delivery of programmes was viewed as essential. Strategies included designated PHU staff in positions of responsibility, formal partnerships with Māori, and providing operational and strategic guidance. Some PHUs supported development of cultural competencies. NGO responsiveness to Māori was variable. Some NGOs described prioritising service delivery and programmes for Māori. Others reported the focus of their service was European or other non-Māori ethnicities. Lack of resources or past difficulties engaging with Māori were barriers.
Conclusion. Public health has an ethical commitment to reduce health disparities. Advancing Te Tiriti obligations in everyday practice has the potential to address inequalities.
T.N.McCreanor@massey.ac.nz
institutional racism within the administration
of the public sector through a series of reports,
the most well-known of which being Puao te Ata
tu (Ministerial Advisory Committee on a Māori
Perspective on Social Welfare, 1988). The health
sector had earlier drawn a line in the sand with a
memo from the then Director-General of Health, Dr
George Salmond (1986), requiring sector engagement
with the Treaty of Waitangi. More than twenty
years on, the health system continues to produce
inequitable health outcomes between Māori and
non-Māori (Robson and Harris, 2007), in part
because of persistent institutional racism within the
administration of the health system itself (Came,
2012). Last year the Public Health Association (PHA)
(September 2012) passed a remit at the Annual
General Meeting (AGM) committing us (the public
health sector) to take action to address institutional
racism within our sector. The costs of inaction are
high and fundamentally incongruent with the stated
values of the public health sector (Public Health
Association, 2012). It is time for courage and to draw
a new line in the sand - let’s eliminate institutional
racism within our sector by 2017.
Venue: University “Access Grid Room” or your desktop
Start date: 12/11/2014
End date: 12/11/2014
Time: 1 – 3pm
Description: The challenge in being an activist scholar is not so much in describing the problem, but in permanently transforming /realigning/eliminating it. Some time ago now a gang of committed public health practitioners started announcing to the world that we would end institutional racism within the public health sector by 2017. This has inspired and excited some people and terrified others.
Needless to say we have been quite busy. Within this interactive webinar Heather and Claire will share what happened next with our campaign of awareness raising, advocacy and research activities. We have attempted to influence how public health services are purchased, developed a policy position, mobilised allies, done media work and got people debating institutional racism.
As well as sharing our stories will also solicit your expert ideas to the challenging questions of what would a public sector look like without institutional racism? If we are committed to evaluating our anti-racism efforts what should we be measuring?
Expect to be either inspired or terrified.
http://esocsci.org.nz/campaign-update-challenging-institutional-racism-public-health-sector/
Books by Claire Doole
This resource builds upon recognition of the Māori text of te Tiriti and offers guidance for those that work in the health sector to manage and develop their Treaty based practice in ways that recognise the power relationships it enshrines. It acknowledges, as did the original philosophical underpinnings of cultural safety that those relationships are not merely therapeutic or health-centred but are also historical, political, and economic.
Papers by Claire Doole
Objectives. New Zealand has a unique tool, Te Tiriti o Waitangi, the Treaty of Waitangi, for addressing health disparities. Indigenous Māori have compromised health status compared to other groups. This paper investigates ways in which public health units (PHUs) and non-governmental organisations (NGOs) use Te Tiriti o Waitangi in service delivery to Māori.
Design. A nationwide telephone survey of primary health providers (n=162) was conducted in 2014-15. Participants were asked about effectiveness and monitoring of their service delivery to Māori.
Results. PHUs reported actively working with Māori, and Te Tiriti o Waitangi to reduce health disparities. Direct Māori engagement with development and delivery of programmes was viewed as essential. Strategies included designated PHU staff in positions of responsibility, formal partnerships with Māori, and providing operational and strategic guidance. Some PHUs supported development of cultural competencies. NGO responsiveness to Māori was variable. Some NGOs described prioritising service delivery and programmes for Māori. Others reported the focus of their service was European or other non-Māori ethnicities. Lack of resources or past difficulties engaging with Māori were barriers.
Conclusion. Public health has an ethical commitment to reduce health disparities. Advancing Te Tiriti obligations in everyday practice has the potential to address inequalities.
T.N.McCreanor@massey.ac.nz
institutional racism within the administration
of the public sector through a series of reports,
the most well-known of which being Puao te Ata
tu (Ministerial Advisory Committee on a Māori
Perspective on Social Welfare, 1988). The health
sector had earlier drawn a line in the sand with a
memo from the then Director-General of Health, Dr
George Salmond (1986), requiring sector engagement
with the Treaty of Waitangi. More than twenty
years on, the health system continues to produce
inequitable health outcomes between Māori and
non-Māori (Robson and Harris, 2007), in part
because of persistent institutional racism within the
administration of the health system itself (Came,
2012). Last year the Public Health Association (PHA)
(September 2012) passed a remit at the Annual
General Meeting (AGM) committing us (the public
health sector) to take action to address institutional
racism within our sector. The costs of inaction are
high and fundamentally incongruent with the stated
values of the public health sector (Public Health
Association, 2012). It is time for courage and to draw
a new line in the sand - let’s eliminate institutional
racism within our sector by 2017.
Venue: University “Access Grid Room” or your desktop
Start date: 12/11/2014
End date: 12/11/2014
Time: 1 – 3pm
Description: The challenge in being an activist scholar is not so much in describing the problem, but in permanently transforming /realigning/eliminating it. Some time ago now a gang of committed public health practitioners started announcing to the world that we would end institutional racism within the public health sector by 2017. This has inspired and excited some people and terrified others.
Needless to say we have been quite busy. Within this interactive webinar Heather and Claire will share what happened next with our campaign of awareness raising, advocacy and research activities. We have attempted to influence how public health services are purchased, developed a policy position, mobilised allies, done media work and got people debating institutional racism.
As well as sharing our stories will also solicit your expert ideas to the challenging questions of what would a public sector look like without institutional racism? If we are committed to evaluating our anti-racism efforts what should we be measuring?
Expect to be either inspired or terrified.
http://esocsci.org.nz/campaign-update-challenging-institutional-racism-public-health-sector/
This resource builds upon recognition of the Māori text of te Tiriti and offers guidance for those that work in the health sector to manage and develop their Treaty based practice in ways that recognise the power relationships it enshrines. It acknowledges, as did the original philosophical underpinnings of cultural safety that those relationships are not merely therapeutic or health-centred but are also historical, political, and economic.