Māori health for healthcare providers

Key points about Māori health

  • Māori health is an important area of focus for all health services and providers within Aotearoa New Zealand. 
  • This page outlines some resources that can help to enhance tino rangatiratanga and strengthen mana motuhake for hauora Māori.
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Equity is defined by the World Health Organization as the absence of avoidable or remediable differences among groups of people. The concept acknowledges that not only are differences in health status unfair and unjust, but they are also the result of differential access to the resources necessary for people to lead healthy lives.

Within New Zealand, more work needs to be done to achieve health equity for Māori. Te Aka Whai Ora | Māori Health Authority notes the following inequities: 

  • Māori die at twice the rate as non-Māori from cardiovascular disease.
  • Māori tamariki have a mortality rate 1.5 times the rate for non-Māori children.
  • Māori are more likely to be diagnosed and die from cancer.
  • Māori die on average 7 years earlier than non-Māori.

A Health and Disability System Review in 2019/2020 identified that Aotearoa has unacceptable Māori health inequities, institutional racism and general health systems that haven't improved Māori health outcomes. The government has acknowledged that the current system needs to change in order to address the avoidable unjust and unfair levels of health experienced by people in New Zealand.

Recommendations made by Te Aka Whai Ora | Māori Health Authority include to:

  • Embed mātauranga Māori (Māori knowledge systems) in our health system.
  • Invest more in kaupapa Māori health services and providers.
  • Further develop our Māori health workforce, including strategies and funding for Māori providers to increase innovation.
  • Create stronger leadership and direction at the highest system level.

Video: Improving Māori health outcomes – Pen Blackmore and Shane Rakei | LTC Forum 2020

(Healthify, NZ, 2020)

He Korowai Oranga: Māori Health Strategy sets the overarching framework that guides the Government and the health and disability sector to achieve the best health outcomes for Māori.

Whakapapa of He Korowai Oranga: Māori Health Strategy

He Korowai Oranga was published in 2002 to establish a new direction for Māori health development in the health and disability system. The initial aim of He Korowai Oranga was whānau ora (Māori families supported to achieve their maximum health and wellbeing). 

Whakatātaka: Māori Health Action Plan 2002–2005 is a companion publication to He Korowai Oranga, framing DHB policies and programmes as they set out to fulfil their responsibilities in relation to achieving the aims of whānau ora. 

Whakatātaka Tuarua: Māori Health Action Plan 2006–2011 is also a companion publication to He Korowai Oranga, building on the gains from Whakatātaka 2002–2005. 

The refresh of He Korowai Oranga: Māori Health Strategy 2014 was a refresh of the original He Korowai Oranga to ensure its relevance for the future. 

Pae ora (health futures for Māori) is the Government’s vision and aim for the refreshed strategy. Pae ora encourages everyone in the health and disability system to work collaboratively, to think beyond narrow definitions of health and to provide high-quality and effective services.

It builds on the initial foundation of whānau ora (healthy Māori families) to include mauri ora (healthy Māori individuals) and wai ora (healthy environments). 

Whakamaua: Māori Health Action Plan 2020–2025 gives practical effect to He Korowai Oranga 2014. The plan is underpinned by Te Tiriti and the principles of tino rangatiratanga, equity, active protection, options and partnership. 

The plan outlines a suite of high-level outcomes, objectives, priority areas, actions and measures to monitor progress over a 5-year period. It provides an important focus for Māori health development. It is a living document with the ability to evolve to meet existing and emerging health and wellbeing needs and achieve the aims of He Korowai Oranga.

Whakamaua is underpinned by the Ministry’s Te Tiriti o Waitangi Framework(external link)(external link), which provides a tool for the health and disability system to fulfil its stewardship obligations and special relationship between Māori and the Crown.

Whakamaua outlines a suite of actions that will help to achieve 4 high-level outcomes. 

  • Iwi, hapū, whānau and Māori communities exercising their authority to improve their health and wellbeing.
  • Ensuring the health and disability system is fair and sustainable and delivers more equitable outcomes for Māori.
  • Addressing racism and discrimination in all its forms. 
  • Protecting mātauranga Māori throughout the health and disability system.

This direction is supported by the final report of the Health and Disability System Review.

Whakamaua has been shaped by feedback provided through an extensive engagement process. Whatua: Engagement for the development the Māori Health Action Plan 2020-2025(external link)(external link) has been published as a companion document to Whakamaua – giving visibility to the voices of Māori communities and the health and disability sector. This report provides a summary of key themes from the Ministry’s engagement process with key stakeholders in 2019.

The Ministry will measure and report progress regularly as Whakamaua is implemented. 

Te ao Māori framework 

The Health Quality & Safety Commission has developed a Te ao Māori framework in partnership with Māori health providers, Whānau Ora providers and participating district health boards across Aotearoa New Zealand. 

The aim of the framework is to improve the quality of care afforded to whānau Māori across Aotearoa New Zealand and advance the uptake and implementation of te ao Māori and mātauranga Māori concepts into general health system design and health practice for all. 

Find out more here: Te ao Māori framework(external link)

Promoting Māori mental health

Mauri ora – promoting Māori mental wellbeing factsheet(external link) Mental Health Foundation, NZ, 2023

References

  1. Whakamaua: Māori Health Action Plan 2020–2025(external link)(external link) Ministry of Health, NZ, 2020
  2. Whatua: Engagement for the development the Māori Health Action Plan 2020–2025(external link)(external link) Ministry of Health, NZ, 2020
  3. Whakamaua: the Māori Health Action Plan 2020–2025 summary (pdf)(external link)(external link) Ministry of Health, NZ, 2020
  4. Te Tiriti o Waitangi(external link)(external link) Ministry of Health, NZ, 2020
  5. Whakamaua: Māori Health Action Plan 2020–2025 (pdf)(external link)(external link) Ministry of Health, NZ, 2020
  6. He Korowai Oranga(external link)(external link) Ministry of Health, NZ, 2014
  7. Whakatātaka Tuarua – Māori health action plan 2006–2011 [PDF, 1.2 MB] Ministry of Health, NZ, 2006
  8. He Korowai Oranga: Māori Health Strategy(external link)(external link) Ministry of Health, NZ, 2002 

Te Whare Tapa Whā – Mason Durie

The four cornerstones (or sides) of Māori health in the Te Whare Tapa Whā model of health are:

  • Taha tinana (physical health – capacity for physical growth and development)  
  • Taha wairua (spiritual health – the capacity for faith and wider communication)
  • Taha whānau (family health – the capacity to belong, to care and to share)
  • Taha hinengaro (mental health – the capacity to communicate, to think and to feel mind and body are inseparable) 

Image credit: Health New Zealand | Te Whatu Ora

The cornerstones interlock and together provide stability. Each is essential for maintaining health and wellbeing. Damage to any of these may result in an individual or collective becoming ‘unbalanced’ and unwell. Read more about the Te Whare Tapa Whā model of health.(external link) 

Meihana model – Pitama, Robertson, Cram, Gillies, Huria and Dallas-Katoa

Image credit: University of Otago, NZ

This builds on the Te Whare TapWhā model, adding two extra elements, to form a mental health practice model for working with Māori.  

 The additional elements are: 

  • Taiao (physical environment, eg, warmth of housing, access to services) 
  • Iwi Katoa (societal context, eg, societal values, laws and beliefs about appropriate behaviour). 

Pitama and colleagues describe it as “a framework that facilitates fusion of clinical and cultural competencies to better serve Māori within mental health service delivery. It has six dimensions that interconnect to form a multidimensional assessment tool. It is intended to be used from the start of the first contact with a client and their whānau and builds a comprehensive picture of whānau circumstances and how the client’s presenting issues fit within the picture. 

A full description of the model, its development and how it is designed to be used can be found here.(external link)   

Te Wheke – Rose Pere

In this model of Māori health, the dimensions are based on Te Wheke, the octopus and the 8 tentacles that collectively contribute to waiora or total wellbeing:

  • Te whānau – the family 

  • Waiora – total wellbeing for the individual and family 
  • Wairuatanga – spirituality 
  • Hinengaro – the mind 
  • Taha tinana – physical wellbeing 
  • Whanaungatanga – extended family
  • Mauri  life force in people and objects 
  • Mana ake – unique identity of individuals and family 
  •  a koro ma, a kui ma - breath of life from forbearers 
  • Whatumanawa – the open and healthy expression of emotion. 

Read more about the Te Wheke(external link) model.

Te Pae Māhutonga – Mason Durie

Te Pae Māhutonga (Southern Cross star constellation) brings together elements of modern health promotion.

Image credit: Health New Zealand | Te Whatu Ora

The four central stars represent: 

  • Mauriora – cultural identity 
  • Waiora – physical environment 
  • Toiora - healthy lifestyles 
  • Te Oranga – participation in society 

The two pointers represent Ngā Manukura (community leadership) and Te Mana Whakahaere (autonomy). Read more about the Te Pae Māhutonga(external link) model.

Learn more

Māori models of health(external link) Ministry of Health, NZ
Te Wheke(external link) Ministry of Health, NZ 
Lecture on Meihana method for better understanding Māori patients’ health needs(external link) University of Otago, NZ 
Piripi T, Body V. Tihei-wa mauri ora(external link) NZ J Couns. 2010;30(1):34-46.
Durie M. Te Pae Māhutonga – a model for Māori health promotion(external link) Health Promotion Forum of New Zealand Newsletter 49

References

Māori models of health(external link) Ministry of Health, NZ, 2017 
Pitama S, Robertson P, Cram F. et al. Meihana model – a clinical assessment framework(external link) NZ J Psycol. 2007;36(3):118-125. 
Piripi T, Body V. Tihei-wa mauri ora(external link) NZ J Couns. 2010;30(1):34-46.
Tihei-wa Mauri Ora(external link)   

Three models of practice were described by Te Rau Matatini in Indigenous Insight, Inspiring Innovation - Kaupapa Māori Models of Practice Series 1. The aim was to enhance knowledge of Māori models of practice and demonstrate the strengths of Māori in Aotearoa. 

1. Te Ahikaa – Elaine Ngamu

A practice model for working with methamphetamine ‘P’ users in a residential setting. The model has four aspects: raising awareness; learning and support, whānau involvement and intervention, and new possibilities.

It is based on the principles/values of: 

  • Whanaungatanga – make connections, engage with and get support from others 
  • Manaakitanga – make sure the children and taken care of and help whanau to health 
  • hiotanga – know what you are dealing with and know when to do what 
  • Kaha – doing whatever it takes.

2. Tihei-wa Mauri Ora! – Teina Piripi and Vivienne Body

Informed by the writings of Rev. Māori Marsden, the “kaupapa of this framework is in the ‘knowing’ that the Māori worldview holds the knowledge for Māori to make sense of their own existence and life to begin their own healing journey”. Tihei-wa Mauri Ora is a narrative suicide risk assessment tool originally developed for at-risk teenagers.  

Image credit: https://tihei-wamauriora.mystrikingly.com/

 It is based on the Māori worldview of creation which has 5 realms as follows: 

  • Te Kore Kore – The vast mass of potential being, imbued with divine essences (conception)  
  • To  Realms  Darkness and night stages of growth and development (the child grows within the mother’s womb) 
  • Ki Te Whai-Ao – The realm of coming into being, critical changes and transition, glimmer of light (mother goes into labour in process of birthing) 
  • Ki Te-Ao Marama The realm of light and being, this world, mortality (child is born into the realm of light) 
  • Tihe-wa Mauri Ora – The breath of life. 

These stages of being represent any aspects of our lives that can be represented metaphorically with Māori cultural understandings of growth, development, life and being. For example, how we feel, our relationships and our health and wellbeingBy understanding the concepts and the stories behind them people can apply them to what is happening in their own lives  

It is based on the principles of: 

  • Whāia Te Oranga – willingness to grow/change, wellbeing 
  • Mātauranga Māori – provides meaning and understanding, purpose 
  • Kia Ū Ki Te Rongomau – healing and wellbeing. 

There are no specific guidelines for its application, but further information(external link) is available.  

3. Te Pito Whānau Healing Model – Kim Whaanga-Kipa and MannKipa 

Te Pito - As an analogy, Te Pito (umbilical cord) is the lifeline that connects us to our past and future. Te Pito provides sustenance and has the ability to protect whakapapa. It has the ability to cleanse the impurities when contaminated. However, when abused it too can become the vehicle to alter whakapapa. This is likened to the healing journey of whānau who have been impacted due to historical grief and trauma which can lead to addictions, violence and suicide. Healing needs a process of understanding what transformation means, not only to the individual, but also to the collective or whanau” (p. 17). 

The kaupapa of Te Pito is about a healing model for whānau led by whānau with experience of addictions, mental health and violence. It acknowledges the process that happens when a person is transforming and learning to move from being an individual to being part of a collective. This process was seen to be missing from other practice models. Based on whakaaro Māori  (Māori thinking) it is a healing model for those in addiction recovery. It acknowledges that ‘getting straight is one thing but there is a need to learn to live and restore relationships. It was developed to meet the ongoing need for support following treatment.  

The model focuses on 5 states of being where whānau determine where they are at, at any given moment or in any given state: 

  1. Kahupō, being a state of spiritual blindness or oppression 
  2. Whakaoho, being the awakening, realising that change needs to occur 
  3. Whakawātea, being about dispelling the illusion, creating a safe place to be, creating opportunity to talk together and finding support 
  4. Te Pūtake, being a state of readiness to change 
  5.  Wawata, being a state that focuses on future planning and aspirations. 

The principles it is based on are: 

  • Whanaungatanga - restoring relationships, weaving people together  
  • Manaakitanga - nurture and support people to ‘be’ and ‘become’. 

Webinar: Te Pā Harakeke | Nurturing care in the first 1000 days(external link)

Lisa Kahu, Ngapuhi, Ngai Tahu, Ngati Whakaue Kaiawhina, Mama & Pepi Te Tai O Marokura Health & Social Services , Kaikoura | Dr Peter McIlroy, General Paediatrician Te Whatu Ora Health NZ Nelson/Marlborough

Pēpi experience the world through the relationship they have within their whānau, and these early experiences set them up for how they interpret the world as they grow older. It is imperative, therefore, that both pēpi and whānau are supported during this crucial period so that pēpi, and our communities, can truly thrive. Kaupapa Māori informed practices understood through matauranga Māori (Māori ways of knowing, being and doing) recognise pēpi and tamariki as taonga. Adopting this world view to inform and underpin service design and delivery for infant mental health ensures whānau and  community are partners in the design, development and delivery of services.

Te Pā Harakeke | Nurturing Care in the First 1000 Days framework outlines fundamental principles and recommendations to improve service delivery for vulnerable pēpi in the first 1000 days. People  from across the health, social and community sector who work with pēpi and their whānau are invited to join us for this webinar which will:

• Describe the current situation from the voice of the pēpi
• Provide an overview of the evidence for nurturing care in the First 1000 Days
• Discuss key recommendations to improve pēpi and whānau outcomes

You can watch the video, answer questions and claim hours with a certificate. 

(My Health Hub, NZ, 2023)

Māori health strategy

Māori health action plans

These action plans outline what the government will do to implement the Māori Health Strategy.

Māori health profiles and statistics

Māori cultural perspective

Māori Health Review

  • The Māori Health Review(external link) is a regular update that features the latest research in the area of Māori health. It costs nothing to subscribe to and is available for health professionals and anyone with an interest in Māori health.

Aging

Child health

Disability

Healthy living

Training

Whānau ora

Other resources

Cultural competence, partnership and health equity symposium(external link) NZ Medical Council and Te Ora, NZ, 2019

He ara hauora Māori – a pathway to Māori health equity(external link) NZ Medical Council, NZ, 2019

Te Aka Whai Ora | Māori Health Authority(external link) was established in 2022. Its goal is to lead and monitor transformational change in the way the entire health system understands and responds to the health and wellbeing needs of whānau. 

Getting better – a year in the life of a Māori medical student(external link) is a podcast in which trainee doctor and award-winning writer Emma Espiner (Ngāti Tukorehe, Ngāti Porou) travels to the front lines of healthcare in New Zealand, where life and death decisions are made every day and where the statistics clearly show Māori are suffering: Māori die younger, get chronic illnesses earlier and receive less care than non-Māori.

Whiti Te Rā – a guide to connecting Māori to traditional wellbeing pathways(external link) A thematic analysis produced 6 themes or pathways towards wellbeing for Māori: te reo Māori (Māori language), taiao (connection with the environment), wairua (Māori spiritual beliefs and practices), mahi-a-toi (Māori expressive art forms), take pū whānau (Māori relational values) and whakapapa (intergenerational relationships). Journal of Indigenous Wellbeing, Feb 2021.

Te Reo Hāpai – the language of enrichment(external link) A Māori language glossary for use in the mental health, addiction and disability sectors.

Whakamahia | support, information(external link) Te Aka Whai Ora | Māori Health Authority, NZ, 2022

Credits: Healthify editorial team. Healthify is brought to you by Health Navigator Charitable Trust.

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