Dr Heather Came is a seventh generation Pākehā New Zealander. She has worked for 30 years in public health and has a long involvement in social justice activism. Heather is a founding member and co-chair of STIR: Stop Institutional Racism. As an activist scholar she has prepared evidence for Waitangi Tribunal, has led shadow reports to United Nations human rights committees and is co-convener of Te Tiriti based futures: a series of open-access virtual conferences. She is currently an independent academic and previously worked at Auckland University of Technology where she won a Vice Chancellor’s Teaching Excellence Award. In 2021 she was joint winner of Kāhui Hauora Tūmatanui Public Health Champion Award for her lifetime contribution to public health. She is currently co-Principal Investigator on a Marsden Grant focusing on re-imaging antiracism theory. Her research focuses on critical policy analysis, Te Tiriti o Waitangi, antiracism and institutional racism in the health sector. Phone: +6421539063
The second wave feminist dream of smashing the patriarchy remains a task yet to be completed on a... more The second wave feminist dream of smashing the patriarchy remains a task yet to be completed on a complex to do list. Women, particularly able-bodied cis-gendered white women however do enjoy the privilege of living longer than men. But our longer lives take place within patriarchal-capitalist systems where many women's social and cultural rights continue to be compromised. How do we ensure that all women can exercise our right to health and wellbeing? In this paper, the authors examine, critique, review and re-vision the dynamics of power and patriarchy over three distinct time periods - 1999, 2019 and 2039. We look to the past to track progress; we look to the present to see what we have achieved and look to the future for what might be. This conceptual paper is informed by the authors' expert knowledge, a review of the literature and the novel use of speculative ethnography. The authors conclude that patriarchy remains not only a negative determinant of women's health that needs to be smashed, but is also a threat to all people and to planetary health.
The New Zealand state developed from a treaty between the British Crown and hapū (sub-tribes) in ... more The New Zealand state developed from a treaty between the British Crown and hapū (sub-tribes) in 1840. The te Reo (Māori language) text and the English version of the agreement are fundamentally different. Breaches of this treaty and tension over how the political relationship between Māori and the Crown should proceed are ongoing. In 2019, the Cabinet Office issued a Circular instructing bureaucratic advisers of the questions they should address when providing advice to ministers on the agreement’s contemporary application. In this article, we use Critical Tiriti Analysis (CTA) – an analytical framework applied to public policies – to suggest additional and alternative questions to inform bureaucratic advice. The article defines CTA in detail and shows how using it in this way could protect Māori rights to tino rangatiratanga (a sovereignty and authority that is not subservient to others) and substantive engagement, as citizens, in the formation of public policy. This article’s cen...
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.
Cultural safety is a keystone reform concept intended to improve First Nations Peoples’ health an... more Cultural safety is a keystone reform concept intended to improve First Nations Peoples’ health and wellbeing. Are definitions of cultural safety, in themselves, culturally safe? A purposive search of diverse sources in Australian identified 42 definitions of cultural safety. Structuration theory informed the analytical framework and was applied through an Indigenist methodology. Ten themes emerged from this analysis, indicating that cultural risk is embedded in cultural safety definitions that diminish (meddlesome modifications and discombobulating discourse), demean (developmentally dubious and validation vacillations), and disempower (professional prose, redundant reflexivity, and scholarly shenanigans) the cultural identity (problematic provenance and ostracised ontology) of First Nations Australians. We offer four guidelines for future definitional construction processes, and methodology and taxonomy for building consensus based of definitions of cultural safety. Using this appr...
AlterNative: An International Journal of Indigenous Peoples, 2020
This pilot study explored Māori (Indigenous peoples of Aotearoa (New Zealand)) and Tauiwi (non-Mā... more This pilot study explored Māori (Indigenous peoples of Aotearoa (New Zealand)) and Tauiwi (non-Māori) nurses’ perspectives of anti-racism. A critical qualitative design was utilised, informed by kaupapa Māori (Māori philosophical approaches). Senior nurses with more than 7 years experience were recruited for focus groups. Two focus groups, one Māori ( n = 5) and one Tauiwi ( n = 4), were conducted September 2019 in Auckland. Data were analysed using the framework of a continuum of praxis which included themes of (a) problematic or racist, (b) variable and (c) proactive or anti-racism. Problematic praxis included examples of racism and White fragility. Variable praxis included Māori language and commitment to professional development. Proactive praxis included Māori workforce and reflexivity. These overarching themes illustrate a broad spectrum of anti-racism praxis within nursing. This continuum illustrated with examples is a potentially useful tool to assess and build proactive ant...
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...
The Health and Disability System Review (the 'Simpson Review') was an opportunity for hea... more The Health and Disability System Review (the 'Simpson Review') was an opportunity for health sector transformation, particularly in light of the recent damning WAI 2575 Waitangi Tribunal report released during the review process. There appears to have been a concerted effort to engage with the sector, an impressive Māori Expert Advisory Group and an extensive body of available scholarship documenting where improvements could be made. In this viewpoint, the authors, tangata whenua (Indigenous people of the land) and tangata Tiriti (people of te Tiriti) and health scholars and leaders undertook a high-level review of the Simpson Review report and analysed it against key elements of te Tiriti o Waitangi. The Simpson Review was an opportunity to share power, commit to Māori health and embed structural mechanisms, such as the proposed Māori health authority, to uphold te Tiriti o Waitangi. It was also an opportunity to recommit to health equity and eliminate institutional racism....
International Journal of Critical Indigenous Studies, 2020
New Zealand Governments have longstanding policy commitments to equal employment practices. Littl... more New Zealand Governments have longstanding policy commitments to equal employment practices. Little attention has been paid to ethnic pay disparities in recent years. Informed by a series of official information act requests, we were interested to find out what extent, ethnic pay disparities existed within the core public sector and district health boards (DHBs). We examined the population proportions of Māori, Pasifika and Other ethnicities earning over $NZ100,000 over five year intervals between 2001 to 2016, using linear regression analysis. The analyses showed a statistically significant pattern of ethnic pay disparities across the public sector. There were fewer Māori and Pasifika staff employed in DHBs than their population proportion. The failure to promote Māori and Pasifika to the upper tiers of public sector is consistent with definitions of institutional racism. The authors call for more research to understand the dynamics of ethnic pay disparity and the drivers of this...
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.
Prior to colonisation, Māori had a well-developed holistic health system based on maintaining bal... more Prior to colonisation, Māori had a well-developed holistic health system based on maintaining balance between people, place and spirit. The colonial imposition of British economic, religious, educational, legal, health and governance, through warfare, immigration, legislation and social coercion had a devastating effect on Māori health outcomes. With the release of the WAI 2575 Waitangi Tribunal report exposing the failings of our health system in relation to Māori health, the need to decolonise our health system becomes more pressing. A key difficulty in this work is the poverty of transformative language, concepts and frameworks in our workforce. This paper is the product of an anti-racism think tank that occurred in April 2019. While working through a system change analysis on our colonial health system, Māori and Tauiwi activists and scholars created an allegory-from gorse to ngahere. The allegory depicts the ongoing impact of the colonial health system as represented by gorse, ...
Upholding te Tiriti o Waitangi should eliminate institutional racism against Māori and contribute... more Upholding te Tiriti o Waitangi should eliminate institutional racism against Māori and contribute to the achievement of health equity. Given the Waitangi Tribunal is investigating health-related breaches of te Tiriti o Waitangi, we argue institutional racism, a key determinant of health inequalities, needs to be acknowledged and addressed within the health sector. Historically the Crown response can be characterised by denial and inaction. The Crown has the power and resources to take action through mechanisms such as those they are currently applying to child poverty and gender pay inequity. Anti-racism literature recommends planned, systems-based approaches to eradicate the problem. We need the government to uphold our Tiriti responsibilities and we require a plan to end racism in the New Zealand health system.
Te Tiriti o Waitangi, a treaty negotiated between Māori (the Indigenous peoples of Aotearoa) and ... more Te Tiriti o Waitangi, a treaty negotiated between Māori (the Indigenous peoples of Aotearoa) and the British Crown, affirmed Māori sovereignty and guaranteed the protection of hauora (health). The Waitangi Tribunal, established in 1975 to investigate alleged breaches of the agreement, released a major report in 2019 (registered as WAI 2575) about breaches of te Tiriti within the health sector in relation to primary care, legislation, and health policy. This article explores the implications of this report for the New Zealand health sector and the decolonial transformation of health systems. The tribunal found that the Crown has systematically contravened obligations under te Tiriti across the health sector. We complement the tribunal’s findings, through critical analysis, to make five substantive recommendations: (1) the adoption of Tiriti-compliant legislation and policy; (2) recognition of extant Māori political authority (tino rangatiratanga); (3) strengthening of accountability ...
Within Aotearoa (New Zealand) there are systemic health inequities between Māori (the Indigenous ... more Within Aotearoa (New Zealand) there are systemic health inequities between Māori (the Indigenous people of Aotearoa) and other New Zealanders. These inequities are enabled in part by the failure of the health providers, policy and practitioners to fulfil treaty obligations to Māori as outlined in our foundational document, te Tiriti o Waitangi (te Tiriti). Regulated health professionals have the potential to play a central role in upholding te Tiriti and addressing inequities. Competency documents define health professionals' scope of practice and inform curriculum in health faculties. In this novel study, we critically examine 18 regulated health practitioners' competency documents, which were sourced from the websites of their respective professional bodies. The competencies were reviewed using an adapted criterion from Critical te Tiriti Analysis, a five-phase analysis process, to determine their compliance with te Tiriti. There was considerable variation in the quality o...
Issue/problem Te Tiriti o Waitangi (te Tiriti) was negotiated between the British Crown and Indig... more Issue/problem Te Tiriti o Waitangi (te Tiriti) was negotiated between the British Crown and Indigenous Māori in 1840. Māori understood the agreement as an affirmation of political authority and a guarantee of British protection. The Crown understood it as a cession of sovereignty. Te Tiriti places a mandatory obligation on the Crown to protect and promote Māori health that has not been upheld. Description of the problem Ethnic inequities in health outcomes have been allowed to flourish in Aotearoa. We explored to what extend te Tiriti could be a anti-racism tool that health policy could be usefully evaluated against? Results We introduce Critical Tiriti Analysis (CTA) a new form of critical policy analysis. CTA involves reviewing policy documents against the Preamble and the Articles of the Māori text of te Tiriti o Waitangi. The review process has five defined phases: i) orientation; ii) close reading; iii) determination; iv) strengthening practice; and v) Māori final word. We pres...
The second wave feminist dream of smashing the patriarchy remains a task yet to be completed on a... more The second wave feminist dream of smashing the patriarchy remains a task yet to be completed on a complex to do list. Women, particularly able-bodied cis-gendered white women however do enjoy the privilege of living longer than men. But our longer lives take place within patriarchal-capitalist systems where many women's social and cultural rights continue to be compromised. How do we ensure that all women can exercise our right to health and wellbeing? In this paper, the authors examine, critique, review and re-vision the dynamics of power and patriarchy over three distinct time periods - 1999, 2019 and 2039. We look to the past to track progress; we look to the present to see what we have achieved and look to the future for what might be. This conceptual paper is informed by the authors' expert knowledge, a review of the literature and the novel use of speculative ethnography. The authors conclude that patriarchy remains not only a negative determinant of women's health that needs to be smashed, but is also a threat to all people and to planetary health.
The New Zealand state developed from a treaty between the British Crown and hapū (sub-tribes) in ... more The New Zealand state developed from a treaty between the British Crown and hapū (sub-tribes) in 1840. The te Reo (Māori language) text and the English version of the agreement are fundamentally different. Breaches of this treaty and tension over how the political relationship between Māori and the Crown should proceed are ongoing. In 2019, the Cabinet Office issued a Circular instructing bureaucratic advisers of the questions they should address when providing advice to ministers on the agreement’s contemporary application. In this article, we use Critical Tiriti Analysis (CTA) – an analytical framework applied to public policies – to suggest additional and alternative questions to inform bureaucratic advice. The article defines CTA in detail and shows how using it in this way could protect Māori rights to tino rangatiratanga (a sovereignty and authority that is not subservient to others) and substantive engagement, as citizens, in the formation of public policy. This article’s cen...
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.
Cultural safety is a keystone reform concept intended to improve First Nations Peoples’ health an... more Cultural safety is a keystone reform concept intended to improve First Nations Peoples’ health and wellbeing. Are definitions of cultural safety, in themselves, culturally safe? A purposive search of diverse sources in Australian identified 42 definitions of cultural safety. Structuration theory informed the analytical framework and was applied through an Indigenist methodology. Ten themes emerged from this analysis, indicating that cultural risk is embedded in cultural safety definitions that diminish (meddlesome modifications and discombobulating discourse), demean (developmentally dubious and validation vacillations), and disempower (professional prose, redundant reflexivity, and scholarly shenanigans) the cultural identity (problematic provenance and ostracised ontology) of First Nations Australians. We offer four guidelines for future definitional construction processes, and methodology and taxonomy for building consensus based of definitions of cultural safety. Using this appr...
AlterNative: An International Journal of Indigenous Peoples, 2020
This pilot study explored Māori (Indigenous peoples of Aotearoa (New Zealand)) and Tauiwi (non-Mā... more This pilot study explored Māori (Indigenous peoples of Aotearoa (New Zealand)) and Tauiwi (non-Māori) nurses’ perspectives of anti-racism. A critical qualitative design was utilised, informed by kaupapa Māori (Māori philosophical approaches). Senior nurses with more than 7 years experience were recruited for focus groups. Two focus groups, one Māori ( n = 5) and one Tauiwi ( n = 4), were conducted September 2019 in Auckland. Data were analysed using the framework of a continuum of praxis which included themes of (a) problematic or racist, (b) variable and (c) proactive or anti-racism. Problematic praxis included examples of racism and White fragility. Variable praxis included Māori language and commitment to professional development. Proactive praxis included Māori workforce and reflexivity. These overarching themes illustrate a broad spectrum of anti-racism praxis within nursing. This continuum illustrated with examples is a potentially useful tool to assess and build proactive ant...
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...
The Health and Disability System Review (the 'Simpson Review') was an opportunity for hea... more The Health and Disability System Review (the 'Simpson Review') was an opportunity for health sector transformation, particularly in light of the recent damning WAI 2575 Waitangi Tribunal report released during the review process. There appears to have been a concerted effort to engage with the sector, an impressive Māori Expert Advisory Group and an extensive body of available scholarship documenting where improvements could be made. In this viewpoint, the authors, tangata whenua (Indigenous people of the land) and tangata Tiriti (people of te Tiriti) and health scholars and leaders undertook a high-level review of the Simpson Review report and analysed it against key elements of te Tiriti o Waitangi. The Simpson Review was an opportunity to share power, commit to Māori health and embed structural mechanisms, such as the proposed Māori health authority, to uphold te Tiriti o Waitangi. It was also an opportunity to recommit to health equity and eliminate institutional racism....
International Journal of Critical Indigenous Studies, 2020
New Zealand Governments have longstanding policy commitments to equal employment practices. Littl... more New Zealand Governments have longstanding policy commitments to equal employment practices. Little attention has been paid to ethnic pay disparities in recent years. Informed by a series of official information act requests, we were interested to find out what extent, ethnic pay disparities existed within the core public sector and district health boards (DHBs). We examined the population proportions of Māori, Pasifika and Other ethnicities earning over $NZ100,000 over five year intervals between 2001 to 2016, using linear regression analysis. The analyses showed a statistically significant pattern of ethnic pay disparities across the public sector. There were fewer Māori and Pasifika staff employed in DHBs than their population proportion. The failure to promote Māori and Pasifika to the upper tiers of public sector is consistent with definitions of institutional racism. The authors call for more research to understand the dynamics of ethnic pay disparity and the drivers of this...
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.
Prior to colonisation, Māori had a well-developed holistic health system based on maintaining bal... more Prior to colonisation, Māori had a well-developed holistic health system based on maintaining balance between people, place and spirit. The colonial imposition of British economic, religious, educational, legal, health and governance, through warfare, immigration, legislation and social coercion had a devastating effect on Māori health outcomes. With the release of the WAI 2575 Waitangi Tribunal report exposing the failings of our health system in relation to Māori health, the need to decolonise our health system becomes more pressing. A key difficulty in this work is the poverty of transformative language, concepts and frameworks in our workforce. This paper is the product of an anti-racism think tank that occurred in April 2019. While working through a system change analysis on our colonial health system, Māori and Tauiwi activists and scholars created an allegory-from gorse to ngahere. The allegory depicts the ongoing impact of the colonial health system as represented by gorse, ...
Upholding te Tiriti o Waitangi should eliminate institutional racism against Māori and contribute... more Upholding te Tiriti o Waitangi should eliminate institutional racism against Māori and contribute to the achievement of health equity. Given the Waitangi Tribunal is investigating health-related breaches of te Tiriti o Waitangi, we argue institutional racism, a key determinant of health inequalities, needs to be acknowledged and addressed within the health sector. Historically the Crown response can be characterised by denial and inaction. The Crown has the power and resources to take action through mechanisms such as those they are currently applying to child poverty and gender pay inequity. Anti-racism literature recommends planned, systems-based approaches to eradicate the problem. We need the government to uphold our Tiriti responsibilities and we require a plan to end racism in the New Zealand health system.
Te Tiriti o Waitangi, a treaty negotiated between Māori (the Indigenous peoples of Aotearoa) and ... more Te Tiriti o Waitangi, a treaty negotiated between Māori (the Indigenous peoples of Aotearoa) and the British Crown, affirmed Māori sovereignty and guaranteed the protection of hauora (health). The Waitangi Tribunal, established in 1975 to investigate alleged breaches of the agreement, released a major report in 2019 (registered as WAI 2575) about breaches of te Tiriti within the health sector in relation to primary care, legislation, and health policy. This article explores the implications of this report for the New Zealand health sector and the decolonial transformation of health systems. The tribunal found that the Crown has systematically contravened obligations under te Tiriti across the health sector. We complement the tribunal’s findings, through critical analysis, to make five substantive recommendations: (1) the adoption of Tiriti-compliant legislation and policy; (2) recognition of extant Māori political authority (tino rangatiratanga); (3) strengthening of accountability ...
Within Aotearoa (New Zealand) there are systemic health inequities between Māori (the Indigenous ... more Within Aotearoa (New Zealand) there are systemic health inequities between Māori (the Indigenous people of Aotearoa) and other New Zealanders. These inequities are enabled in part by the failure of the health providers, policy and practitioners to fulfil treaty obligations to Māori as outlined in our foundational document, te Tiriti o Waitangi (te Tiriti). Regulated health professionals have the potential to play a central role in upholding te Tiriti and addressing inequities. Competency documents define health professionals' scope of practice and inform curriculum in health faculties. In this novel study, we critically examine 18 regulated health practitioners' competency documents, which were sourced from the websites of their respective professional bodies. The competencies were reviewed using an adapted criterion from Critical te Tiriti Analysis, a five-phase analysis process, to determine their compliance with te Tiriti. There was considerable variation in the quality o...
Issue/problem Te Tiriti o Waitangi (te Tiriti) was negotiated between the British Crown and Indig... more Issue/problem Te Tiriti o Waitangi (te Tiriti) was negotiated between the British Crown and Indigenous Māori in 1840. Māori understood the agreement as an affirmation of political authority and a guarantee of British protection. The Crown understood it as a cession of sovereignty. Te Tiriti places a mandatory obligation on the Crown to protect and promote Māori health that has not been upheld. Description of the problem Ethnic inequities in health outcomes have been allowed to flourish in Aotearoa. We explored to what extend te Tiriti could be a anti-racism tool that health policy could be usefully evaluated against? Results We introduce Critical Tiriti Analysis (CTA) a new form of critical policy analysis. CTA involves reviewing policy documents against the Preamble and the Articles of the Māori text of te Tiriti o Waitangi. The review process has five defined phases: i) orientation; ii) close reading; iii) determination; iv) strengthening practice; and v) Māori final word. We pres...
The transformation of health inequities between indigneous and non-indigneous people
is necessary... more The transformation of health inequities between indigneous and non-indigneous people is necessary to any just society. Health promotion that addresses these injustices thus must be inherently political work particularly in colonial contexts with systemic inequities. Aotearoa New Zealand is one such context. We take as our starting point a commitment to implement bicultural praxis informed by interpretations of the articles of Te Tiriti o Waitangi (1840). This treaty sets in place governance arrangements between the indigenous people (Māori) and the Crown of Great Britain. This paper explores the application of this praxis within health promotion from a settler standpoint. Firstly, it revisits the timeline leading to the signing of Te Tiriti, reviews the significance of Te Tiriti to health promotion practice in Aotearoa New Zealand and proposes four propositions to inform a bicultural praxis which, the authors argue, has an application internationally where indigenous and settler values must come into a just relationship.
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
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.
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.
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Papers by Heather Came
is necessary to any just society. Health promotion that addresses these injustices thus
must be inherently political work particularly in colonial contexts with systemic inequities.
Aotearoa New Zealand is one such context. We take as our starting point a commitment
to implement bicultural praxis informed by interpretations of the articles of
Te Tiriti o Waitangi (1840). This treaty sets in place governance arrangements between
the indigenous people (Māori) and the Crown of Great Britain. This paper explores the
application of this praxis within health promotion from a settler standpoint. Firstly, it revisits
the timeline leading to the signing of Te Tiriti, reviews the significance of Te Tiriti
to health promotion practice in Aotearoa New Zealand and proposes four propositions
to inform a bicultural praxis which, the authors argue, has an application internationally
where indigenous and settler values must come into a just relationship.
T.N.McCreanor@massey.ac.nz
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.
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.