From the Guidelines
Te Tiriti o Waitangi (the Treaty of Waitangi) should be applied in New Zealand healthcare through partnership, participation, and protection principles to ensure equitable health outcomes for Māori. This approach is supported by recent studies, such as 1, which highlight the importance of culturally safe care and community-led initiatives in improving health outcomes for Indigenous populations.
Key Principles
The application of Te Tiriti o Waitangi in New Zealand healthcare involves several key principles, including:
- Partnership: Establishing genuine partnerships with Māori communities, involving them in decision-making about service design and delivery 1.
- Participation: Creating opportunities for Māori to participate in healthcare decision-making and service delivery, such as through the employment of Māori staff and the support of Māori health providers 1.
- Protection: Safeguarding Māori cultural concepts, values, and practices while actively addressing health inequities through targeted interventions 1.
Practical Applications
Practical applications of these principles include:
- Cultural competency training for all staff to ensure they understand and respect Māori cultural concepts and values 1.
- Collecting ethnicity data to monitor outcomes and identify areas for improvement 1.
- Providing access to traditional healing practices and ensuring informed consent processes respect Māori values 1.
- Supporting Māori health providers and incorporating tikanga (Māori customs) and te reo Māori (Māori language) into services 1.
Addressing Health Inequities
Historical colonization and ongoing systemic racism have contributed to poorer health outcomes for Māori, making it essential to address these inequities through targeted interventions 1. By honoring Te Tiriti obligations, healthcare systems can improve health outcomes for all New Zealanders while respecting the special relationship between Māori as tangata whenua (people of the land) and the Crown.
From the Research
Application of Te Tiriti O Waitangi in New Zealand Healthcare
- The application of Te Tiriti O Waitangi in New Zealand healthcare is crucial for addressing health disparities between Indigenous Māori and other groups 2.
- Public health units (PHUs) and non-governmental organisations (NGOs) have been found to use Te Tiriti O Waitangi in service delivery to Māori, with strategies including designated staff, formal partnerships, and cultural competency development 2.
- However, the responsiveness of NGOs to Māori needs has been found to be variable, with some prioritising service delivery to Māori and others focusing on European or other non-Māori ethnicities 2.
Barriers to Application
- Lack of resources and past difficulties engaging with Māori have been identified as barriers to the application of Te Tiriti O Waitangi in healthcare 2.
- The integration of Te Tiriti O Waitangi principles into policy has not always translated to practice, resulting in ongoing health inequities 3.
- Critical Te Tiriti analysis has been proposed as a useful methodology for reviewing Te Tiriti compliance and identifying areas for improvement 4, 5.
Examples of Successful Application
- A pharmacist-facilitated medicines review intervention for Māori older adults was developed using Te Tiriti O Waitangi principles, resulting in a culturally safe and pro-equity intervention 3.
- The use of Kaupapa Māori theory and critical Te Tiriti analysis has been found to be effective in structuring health intervention development and research 3, 4.
Areas for Improvement
- Primary Health Organisations have been found to have poor to fair compliance with most elements of Te Tiriti O Waitangi, despite good engagement with equity 4.
- Regulated health practitioner competency documents have been found to be largely non-compliant with Te Tiriti O Waitangi, highlighting the need for revised competencies that focus on whanaungatanga, allyship, and decolonisation 5.
- Public health strategies and plans have been found to rarely address Te Tiriti O Waitangi obligations, highlighting the need for strengthened alignment with legislative requirements 6.