The development of Maori health models

This report focuses on how the Hauora will conceptualise and measure wellness. This is not the first report to consider Maori wellness and its measurement; it is however the first for the Hauora, as a starting point it is useful to consider existing ideas around health and wellness.

Kiro et al (2004) note that definitions of health “cannot be confined to the absence of disease or survival alone… definitions of what constitutes a healthy life are subject to personal interpretations of culture, class, ethnicity, gender, age and similar factors…commonly accepted views of wellness include being able to function in society, achieving personal expression, achieving physical, mental, spiritual and cultural fulfilment, living without the threat of violence, being able to love and be loved, having a secure home and a sense of belonging within family, community and culture”.

The “1988 Royal Commission on Social Policy, guided by Maori expertise, identified… four prerequisites of Maori health… whanaungatanga – kinship relationships; taonga tuku iho – cultural heritage; te ao turoa – environment and turangawaewae – land base” (Ratima et al 2006).

These prerequisites have provided an excellent platform for the development of Maori health models since then. Ratima et al (2006) identify the common features of these models, they are “holistic in nature, locating individuals within the family context, recognising determinants of health (spiritual, cultural, social and biological), emphasising continuity between the past and the present, and viewing good health as a balance between interacting variables”. They also note that maintaining access to cultural resources and having a secure Maori identity are central to wellness.

Professor Durie (cited in Smith 2000) states that “unless Maori themselves are active in developing policies for health and bringing effective health services to their own people, then no amount of expert advice will provide the conviction of ownership”. It is from thinking like this that the kaupapa Maori health revolution has drawn. Pihama and Gardiner (2005) identify the need for Maori to develop initiatives for change that are located within Maori frameworks, to them kaupapa Maori is work that involves Maori and Maori approaches by and for Maori.

A key to understanding kaupapa Maori is accepting that “te reo Maori me ona tikanga are viewed as valid and legitimate” (Smith 2000) and that to be Maori is the norm. Although one must also recognise that Maori are not a singular people, the diversity within Maori (whanau, hapu, iwi, kaumatua, rangatira, pakeke, rangatahi, tamariki, tane, wahine, takatapui, urban Maori) must be recognised in order for kaupapa Maori to be available to all (Smith 2000). Having raised these questions, I will leave the reader to consider whether this report describes a kaupapa Maori research project.

I do not believe it is my place as Pakeha to label this process, to do so would be to dishonour the right of Maori to define kaupapa Maori research. Maori have many terms associated with wellness; the term hauora has risen in prominence in recent years in both te ao Maori and the Pakeha world. Hauora is “an encompassing concept which includes various life aspects such as the spiritual, mental, physical, familial and environmental” (Kiro et al 2004), models such as Te Wheke (Pere 1997), Te Whare Tapa Wha (Durie 1994) and Nga Pou Mana (BOPDHB 2006) express this well.

The proliferation of Maori models in Pakeha strategic documents is seen by many as an acceptance of the Maori view of wellness however models can be “restrictive and promote stereotypical and simplistic approaches to understanding health” (Kiro et al 2004). As noted previously, needs assessments produced by Pakeha agencies continue to focus on ill health rather than wellness confirming the notion that these agencies have failed to grasp Maori concepts of health whilst at the same time they play lip service to the various models.

People’s own ideas and perceptions about health are mediated by their experiences and the various influences in their lives. Various determinants of health have been acknowledged by both Pakeha and Maori academics (Kiro et al 2004, National Health Committee 1998), these include socio-economic conditions, gender, culture and lifestyle. Inclusion of a spiritual dimension is also important to a Maori understanding of wellness (Durie 1994, Kiro et al 2004, Kruger et al 2004, Ratima et al 2006).

National Health Committee 1998 Nga Puhi kaumatua and kuia have defined Hauora as “an impression of wellness and everything about wellness… health in a wide sense… including more spiritual and mental aspects of health… being holistic and more concerned with wellness” (Kiro et al 2004). They also noted that hauora and health were related but separate concepts. Central to the interviewees’ concept of hauora was “an overall concern for family life…

Maori being responsible for their health and the health of their whanau”. This concern with whanau is increasingly articulated in the health literature (Kruger et al 2004, MoH 2002b, Pihama & Gardiner 2005). The whanau is the basis of Maori society, providing a principal source of strength, support, security and identity, it must play a key role in the wellbeing of Maori individually and collectively (MoH 2002b, Smith 2000).

Ngati He and Ngai Te Ahi are two hapu in Tauranga Moana. Together they have formed Ngati He, Ngai Te Ahi Hauora (the Hauora), a kaupapa Maori health organisation to drive improvement in the health and wellness of their whanau. …

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