Indigenous Health Leadership: A Kaupapa MāoriPerspective from Aotearoa – New Zealand (original) (raw)
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Colonisation continues to underpin social identities and relationships in Aotearoa/New Zealand. In this editorial we examine these identities and relationships, pointing out that arguments are frequently made against indigenous Maori rights in favour of the rights of other visibly different communities, such as Pacific ... See Morepeoples and ethnic communities. This construction of competing Others is a key technique through which unequal power relationships and the dominance of white-settler institutions are maintained in Aotearoa/ New Zealand. We suggest that, with our population projections predicted to make Aotearoa/New Zealand browner and our health workforce increasingly di- verse, these social identities and relationships warrant further attention. We advocate for the centrality of Maori rights and the fulfilment of these rights, in order to provide a basis for a broader social justice agenda working for the elimination of both ethnic inequalities in health and racial discrimination more generally. We suggest that, in so doing, the ideal of having a society that is not structured to privilege and advantage one group (white settlers) over others (Maori and other groups, including migrant groups) can occur.
Massey University, 2012
As is characteristic of colonised countries indigenous peoples experience phenomenal cultural and material loss culminating in marginalisation. Despite colonial devastation Māori, the indigenous peoples of Aotearoa/ New Zealand, move forward with ever increasing presence and voice in every institutional sector in this country in an attempt to reclaim and restore Māori wellbeing. While disparities in health continue to demonstrate colonial devastation, health is one such sector where increasing Māori empowerment is evident. The relatively recent legal provision for Māori representation at a District Health Board level offers direct, regional Māori governance input. However, as with other sectors, inevitable neo-colonial vestiges constrain Māori autonomy. Rapidly developing indigenous scholarship opens up previously unavailable paths for indigenous researchers with which to increasingly empower Māori. However, the opportunity to do this within management studies, particularly within the governance field, remains limited. Governance and health governance theory, firmly grounded in Western rationality, has yet to benefit from indigenous challenge. Postcolonial theorists articulate and contest Western dominance in management studies and offer emergent challenge to governance theory. In the desire to know more about director activity and efficacy, current governance theoretical debate in management studies calls for primary or first-order data where directors themselves reflect on their governance experiences. The juxtaposition of legislative changes to health governance and provision, rapidly developing indigenous scholarship, and emergent postcolonial challenge within management studies have given rise to this research question-What is the experience of Māori directors on District Health Boards? This study provides primary or first-order Māori-centric data on intra-board process. Māori research constructs guide the research process methodologically and analytically. Semi-structured interview data generating a thematic analysis reveals Māori not only experience the Western-hypothesised governance complexities and demands but also considerable additional complexity and demand. The assistance of a postcolonial lens brings into sharp focus the nature of these additional complexities and demands and attributes them to a deficit in Pākehā bicultural knowledge and accommodation. The neo-colonial hierarchal construction of Māori as the 'Other' evokes multiple dysfunctional mechanisms such as tokenism, stereotyping, institutional racism, political correctness, and evokes the 'burden of representation'. Mechanisms such as these impede intra-board activity, representing significant governance process loss. In addition the lack of accommodation of Māori cultural governance aspirations also represent governance process loss. The articulation of dysfunctional colonial mechanisms that manifest at the DHB board table is a first step in a reconstruction of a different intra-board functioning. This, in conjunction with due regard to Māori cultural governance contributions and aspirations, suggests transformational possibility.
Māori and Pasifika leaders’ experiences of government health advisory groups in New Zealand
Kōtuitui: New Zealand Journal of Social Sciences Online
Māori and Pasifika populations in New Zealand experience poorer health outcomes than other New Zealanders. These inequalities are a deeply entrenched injustice. This qualitative study explores the experiences of six Māori and Pasifika leaders on health policymaking advisory committees. All had extensive experience in the health system. They were recruited, provided semi-structured interviews, the data coded, and a thematic analysis undertaken. Our findings show that inequalities in the health system are reproduced in advisory committees. Participants noted their knowledge and interests were devalued and they experienced racism and tokenistic engagement. Some indicated it took considerable effort to establish credibility, be heard, have impact, and navigate advisory meetings, but even then their inputs were marginalised. Health policy advisory committees need deeper engagement and more genuine recognition of Māori and Pasifika knowledge. Māori and Pasifika leaders have constructive solutions for eliminating health inequities that could benefit all New Zealanders.
Nursing praxis in Aotearoa New Zealand, 2022
This article builds on current leadership theories and incorporates mātauranga Māori (Māori knowledge systems) and Kaupapa Māori methodology to inform a new model of Indigenous nursing leadership. The development of this model was inspired by one Māori nurse as she navigated her own leadership style that didn't 'neatly fit' within existing theories of leadership. The development of the Whakapapa nursing leadership model recognised her inherent mana and dignity as an Indigenous woman, a nurse, and lesbian; alongside the learned skills, the history, relationships, aspirations, and responsibilities that she negotiated in her role. This model recognises the mauri (essence) of a person, demonstrating that leadership cannot be separated from the whole, that it is dynamic and intrinsically connected through whakapapa (ancestry). The authors propose the weaving together of many strands of leadership; utilising existing mainstream models but with additional strands sourced from mātauranga Māori-mana taurite (pursuing fairness and equity), whakatu tōtika (seeking the best solutions), i te wa tika me te waahi (in the right time and place), whakamana te tāngata (uplifting the dignity of people), ngā piki me ngā heke (embracing the ups and downs), tika, pono, aroha (acting with integrity) and te whānau, te hapū, te iwi (being accountable to the collective). While these strands are not exhaustive, they intertwine with other unique nursing leadership attributes to create a strong and inclusive leadership model. Hence, leadership is like a kete (basket)-each kete is unique, has its own kōrero (story), its own strengths, and weaknesses; and is beautiful in its wholeness. Utilising a Whakapapa nursing leadership approach can enhance outcomes for Māori nurse leaders to be authentically themselves for the betterment of their services, teams, whānau and hapori (communities). Keywords / Ngā kupu matua: disability / te hauā; Indigenous / iwi taketake; Kaupapa Māori; leadership / kaiārahitanga; Māori knowledge systems / mātauranga Māori; nursing / tapuhi ; sexuality / hōkakatanga Please click here to go to our Te Reo Māori glossary Te Reo Māori translation Te tuitui i ngā whenu maha o te hautū mahi tapuhi iwi taketake: Te tārei tauira hautū mahi tapuhi iwi taketake i takea mai i te whakapapa Ngā ariā matua Ka kawea whakamua e tēnei tuhinga ētahi o ngā ariā hautū o nāianei, ka whakauru hoki i te mātauranga Māori (ngā pūnaha mātauranga Māori) me ngā ritenga Kaupapa Māori hei whakamārama i te ara mō tētahi tauira mahi hautū tapuhi iwi taketake hou. I tupu ake te whanaketanga o tēnei tauira i ngā whakaaro o tētahi tapuhi Māori, i a ia e tūhura ana i āna ake tikanga hautū kāore i 'āta haumi rawa' ki roto i ngā ariā hautū o nāianei. Nā te whanaketanga o tana tauira hautū tapuhi i takea mai i te whakapapa, ka whakapūmautia tōna mana hei wahine iwi taketake, hei tapuhi, hei takatāpui; waihoki ngā pūkenga i ākona, ngā ara kua takahia, ngā taura tangata, me ngā haepapa e kawea ana e ia i tōna Citation Wiapo, C., & Clark, T. C. (2022). Weaving together the many strands of Indigenous nursing leadership: Towards a whakapapa model of nursing leadership.
Indigenous Health Leadership : Protocols , Policy , and Practice
2014
This article describes the process of the Vancouver Coastal Health’s Aboriginal Health Practice Council (AHPC) who provide policy direction to Vancouver Coastal Health (VCH). The AHPC operates within the unceded territories of the Xwməθkwəy ̓əm, Skwxwú7mesh, and Tsleil-Waututh Nations in what is now known as British Columbia, Canada. The council consists of Aboriginal Elders, knowledge keepers, community members, and VCH staff who work collaboratively to develop and implement best health care practices for Aboriginal people. Working within local Indigenous protocols to create policy for service delivery this council operates under the assumption that to improve health outcomes it is incumbent for VCH to create appropriate methods of access to Aboriginal health practices. The council facilitates Aboriginal leadership in policy development informing health care practitioners on how they can support Aboriginal clients’ right to culturally appropriate Aboriginal health care services. Th...
2006
HE MIHI 'E koeko te tūī, e ketekete te kākā, e kūkū te kereru' 'Ehara taku toa i te toa takitahi engari he toa takitini' Nei aku mihi e rere ana ki a koutou katoa i whāngai i ahau ki te kai a te miro. I whakarauikatia ki taku hiahia, koutou i whakaaro nui ki te tohatoha i tā koutou mātauranga hei whāngai i taku hinengaro, e kore aku mihi e pau ki tēna, ki te kore ko koutou, kua kore ko ahau. Ki tēnā, ki tēnā Tēnā tātou katoa. There are many people to thank for their contribution and support for this research, otherwise it would not have been completed. First of all I would like to acknowledge the people and organisations who participated in the study, gave of their time, and shared their knowledgengā whānau whānui of Tipu Ora Trust, Vision 2020, Te Rau Puawai, and Māori health protection. Special thanks to Esther Tinirau, and Margaret Forster for being there right to the end, Hine Waitere-Ang my writing buddy-kia kaha e hoa, Jean & Erik Vanags who supported in many ways, Huia Jahnke for continued encouragement and confidence, Sharon Taite for providing motivation, Shirley Barnett for just being so positive about everything, John Waldon and Fiona kia ora korua Rawiri Tinirau and Noreen Mako for their confidence and support, Farah Palmer, Tania Jahnke, Marianne Tremaine, Malcolm Mulholland, and the rest of my Te Au Rangahau colleagues I look forward to celebrating your successes too, my colleagues and friends at Te Pūtahi-ā-Toi, and Pūmanawa Hauora where this all started many thanks for your support and friendship. Many thanks to my colleagues in the department of Management and to the PhD support group Robyn Walker, Colin Higgins, Jo Cheyne, Warren Smith, John Downey for the wonderful discussions and our ventures to interesting writing spots. Special thanks to Tony Vitalis and the department administration team Josie Grace, Brigit Eames, Catherine Toulis, & Janet Toogood. To the team in the Office of the Deputy Vice Chancellor Māori Casey Te Rangi, Marley Jenkins, Kiri Pohe-Thackeray, Karyn Kee and Frances White thank you for the Manaaki, and last to Buck and Deidre arohanui. I would like to make special mention of my brothers and my sister and their children, and all my cousins for keeping up with whānau responsibilities while I have been distracted. Also my love to Nan, a tower of strength and love, I miss you. Finally, my children Hepa and Naha, their partners, and my mokopuna, those I have now, Alexcia and Reremoana Keeri, and those to come, you all make this worthwhile, thank you. Thanks also need to go to the Health Research Council of New Zealand for their initial support and ongoing encouragement. Finally, my supervisor: there is a saying that goes-don't walk in front of me I may not follow, don't walk behind me I may not lead, walk beside me and we will go forward together. Thank you Mason for your guidance, encouragement, and for letting me walk beside you for a time, nei anō āku mihi. This thesis is dedicated to my parents Alex and Anne (Keeri), forever in my heart. Nō reira, tēnā koutou katoa.
The ‘Treaty’ and ‘treating’ Māori health: politics, policy and partnership.
This paper seeks to engage in the Treaty of Waitangi and its relationship in improving Māori health outcomes in Aotearoa New Zealand. The current literature about this relationship, although useful, finds Māori and their health in a very precarious and vulnerable position. At an institutional level, the ability to ‘break through’ many of the social and political barriers that constrain Māori from being able to exercise their ‘tino rangatiratanga’ (self-management) remains clearly visible. Despite the legal obligation of health institutions to uphold the principles of the Treaty of Waitangi, Māori are not enjoying the same health standards as non-Māori. The paper posits that the health sector continues to perpetuate notions of ‘treating’ Māori more so than Māori navigating the process of health ‘revitalisation’. A major shift institutionally is required to re-assert Māori health as a basic human right and to re-configure Māori health gains as part of being a healthy nation.
Nursing Praxis Aotearoa New Zealand
Historical experience from previous pandemics, together with knowledge of significant and perpetuating health inequities, led to predictions that Māori and Pacific peoples would experience greater morbidity and be hardest hit economically. Steadfast is the rock describes the mahi (work and actions) of three Māori nurse leaders through the first COVID-19 lockdown in Aotearoa New Zealand in 2020. Through kōrero (discussion and dialogue), this article draws on their experiences of working in a large mainstream primary health entity working across the Northland region of Aotearoa as they navigated their way within and across health sector providers and organisations to protect the health and wellbeing of whānau (families). They used their knowledge of mātauranga Māori (Māori knowledge and tradition), to ensure Māori whānau were prioritised in the pandemic response in the region. They faced adversity and resistance in a fragmented system where competition and power interfered with collaborative practices. Throughout, they remained courageous and resilient, holding true to mātauranga Māori as nurses and Māori wāhine (women) to promote equity. Yet much of their work went unnoticed and unacknowledged. Māori nurse leaders hold a necessary role in providing an equityfocused response across mainstream and Māori health providers, through their abilities to maintain relationships, find mutually agreeable strategies, and work collaboratively across the health sector. Keywords / Ngā kupu matua: COVID-19; dialogue / whakawhiti kōrero; Indigenous / Iwi taketake; inequities / ngā korenga e ōrite; Māori; nursing leadership / kaihautū tapuhi; pandemic / mate urutā; primary health care / taurimatanga hauora tuatahi For Māori terms, please see the Nursing Praxis Te Reo Glossary Te Reo Māori translation He toka tū moana: Ka whakawhiti kōrero ngā kaihautū tapuhi Māori taurima hauora tuatahi mō te āmimai, te ātete, me ā rātou mahi arotahi ki ngā hapori me ngā whānau i te wā o COVID-19 Ngā ariā matua Nā ngā wheako o ngā urutā o tau kē, nā te mātauranga hoki mō ngā korenga e ōrite o ngā āhuatanga hauora nui, e haere tonu nei kāore he mutunga, kua ara ake ngā matapae tērā pea ka kaha ake te mate rawa me te pā nui hoki o ngā raru hauora ki ngā iwi Māori me ngā iwi o Te Moana-nui-a-Kiwa. Ko tā tēnei puka Steadfast is the rock he whakaahua i ngā mahi me ngā kōkiri a ētahi kaihautū tapuhi Māori i
Using a framework of Mãori models for health to promote the health of Mãori
2009
This paper examines three Mãori health models for promoting the health of Mãori. They are applied to a case study, the growing crisis of type 2 diabetes in Mãori communities in Aotearoa me Te Wai Pounamu (New Zealand). In the paper indigenous health models are used to reflect on modern health problems of indigenous peoples through the eyes of indigenous peoples. Firstly, using The Treaty of Waitaki as a model we are able to create the policy framework that will enable the health system to promote appropriate policies and programmes for Mãori. Secondly, using Whare Tapa Wha (the four cornerstones of health) we are able to tease out the cultural, social, psychosocial and physical determinants of health. This model of health enables the development of health promotion programmes that respond to these key health determinants and therefore are more likely to be effective. Finally, using Mason Durie’s Te Pae Mahutoka (the Southern Cross) we are able to identify and implement the essential...
Hauora Māori – Māori health: a right to equal outcomes in primary care
Background For more than a century, Māori have experienced poorer health than non-Māori. In 2019 an independent Tribunal found the Government had breached Te Tiriti o Waitangi by “failing to design and administer the current primary health care system to actively address persistent Māori health inequities”. Many Māori (44%) have unmet need for primary care. Seven models of primary care were identified, including Māori-owned practices. We hypothesised patient health outcomes for Māori would differ between models of care. Methods Cross-sectional primary care data were analysed at 30 September 2018. National datasets were linked to practices at patient level, to measure associations between practice characteristics and patient health outcomes. Primary outcomes: polypharmacy (≥55 years), HbA1c testing, child immunisations, ambulatory sensitive hospitalisations (0-14, 45-64 years) and emergency department attendances. Regressions include only Māori patients, across all models of care. Re...