Five key elements, outlined in a 2010 paper by Dr Mihi Ratima remain imperative to the success of Māori health promotion today. Commissioned and published by HPF, Dr Ratima’s paper Māori health promotion – a comprehensive definition and strategic considerations looked at what was, at the time, a relatively new field of health promotion. Five years on, HPF Deputy Executive Director Trevor Simpson revisits these key elements as a timely reminder that there is much yet to be done to solidify and affirm Māori health promotion as a discipline and practice.
1. Consistent with Māori World Views
A key facet of the Māori world view is the belief that all things in the universe: animate and inanimate; seen and unseen; are interdependent and interconnected. All things connect to – and are impacted on by – the individual. The individual is not separate from – or “above” – the natural environment.
The Māori storytelling tradition not only provides a foundation for beliefs of origin: it also constructs for the individual a model for behaviour, of collective aspirations and exemplars for human potential (see teara.co.nz website). Clearly there is a correlation here with ecological health promotion. However more is needed to articulate the idea that an understanding, acceptance and incorporation of Māori world views into health promotion approaches can affect Māori health in a positive way.
2. Māori holistic view of hauora- health and wellbeing
If we accept that the Māori view of health and wellbeing is holistic then there is an argument for health promotion to work in a holistic way too. There is a need to investigate how we are designing health promotion interventions. The most problematic thing is the current narrow focus on issues such as tobacco, physical activity and nutrition. Issues-based and results-based accountability contracting present significant challenges to holistic health promotion. Positive health outcomes are often quite difficult to claim when health promoters are working across the wider social determinants of health. A new form of strategic and longer term thinking is required.
There are some parallels between the western model of health and indigenous Māori concepts of hauora – health and wellbeing. Both share the concepts of physical and mental health. But there are two other components of the Māori model of health that need further examination.
Professor Sir Mason Durie’s now widely acclaimed Te Whare Tapa Whā model identifies the two other key facets – whānau (family) and wairua (spirituality). Together with physical and mental health, they make up the four cornerstones of Māori health.
The importance of whānau (immediate and extended whānau) as an indicator for health is now fairly well accepted in the health sector. The Whānau Ora programme was first rolled-out in 2010. As interventions are evaluated, there will be an increasing body of evidence to inform future practice in relation to this aspect of Māori health promotion.
There is also growing acceptance that wairua is critical to Māori health status. Establishing the link between wairua and health outcomes can be difficult to validate, quantify and/or qualify, however and, while there is some research under way more investigation will be needed; particularly from an indigenous Māori perspective.
3. Increased control by Māori (individuals and whānau)
A key tenet of health promotion is empowerment; both of individuals and communities. It is an aspect that comes to the fore when contemplating health promotion work in Māori communities. Gone are the days of doing things “to” Māori communities. Regardless of what the intervention is, if Māori feel that they are not in control of, or party to the process, then the likelihood of success is diminished. Working “with” these communities rather than “on” them will ensure authentic relationships are maintained and nurtured, and increase the likelihood of good outcomes.
4. Foster Māori identity
A strong identity for Māori is critical in all facets of life. Access to te ao Māori (the Māori world), a sense of belonging, marae, knowledge of whakapapa, tikanga and te reo are all part of this. It loosely relates to the notion of tino rangatiratanga, or self-determination, encouraging Māori participation and ownership. Māori health promotion interventions must take this into account. Any interventions must incorporate a clear demonstration that Māori identity is valued and promoted thus increasing feelings of cultural acceptance and support rather than “othering”. Including things such as karakia, powhiri, mihimihi and manaakitanga into a Māori community health promotion programme would assist in assuring success.
5. Interventions are culturally competent
The key issue in developing culturally competent health promotion interventions is that a culturally competent person must be involved throughout the process; ensuring the Māori content of the proposed health promotion project is appropriate. Any human resource component will require a demonstrable level of cultural competence that goes beyond cultural “safety” practices and possibly means more than simply learning and knowing “about” Māori culture. From the point of view of the capacity of the Māori workforce, though; this person may not always be Māori.