Zealand Health System Research Articles

New Zealand Health and Safety System in 2024

New Zealand Health and Safety System in 2024

A trade union perspective on the New Zealand health and safety system

A trade union perspective on the New Zealand health and safety system

A self-assessment maturity matrix to support large-scale change using collaborative networks in the New Zealand health system

BackgroundA maturity matrix can be a useful tool for organisations implementing large-system transformation (LST) initiatives in complex systems. Insights from implementation of a local LST initiative using collaborative networks, known as Alliances, highlighted a tool was needed to help health system leaders prompt discussions on how and where to focus their change efforts. In the New Zealand (NZ) health system, Alliances were introduced to integrate the planning and delivery of health care between primary and hospital care.MethodsThe aim of this research was to use insights from Alliance members to develop a learning tool that collaborative networks could use to assess and improve their readiness for change. We constructed a maturity matrix using the knowledge of senior NZ health system leaders, in a workshop setting. The maturity matrix was empirically tested and refined with three Alliances and with feedback from the NZ Ministry of Health Māori Health Strategy and Policy team.ResultsThe maturity matrix described the 10 key elements that had been found to support successful implementation of LST initiatives in the NZ health system, along with success indicators and different stages of maturity from beginning to excellence. Testing of the maturity matrix with three Alliances suggested that it functioned as a learning tool and stimulated collective thinking and reflection. The Māori Health Strategy and Policy team commented on the importance of such a tool to increase health system leaders’ responsiveness to improving Māori health outcomes. Comparisons with similar international matrices revealed common elements with ours. A strength of our maturity matrix is that it is specific to the NZ context and is the first practical tool to implement large-scale change in the health system that incorporates principles of the Government’s treaty with Māori, the indigenous people of NZ.ConclusionsThrough a regular self-assessment process, use of the maturity matrix may create feedback loops to support deliberate learning and knowledge sharing for senior health system leaders and collaborative networks. The maturity matrix fills an important gap in the NZ health system and contributes to implementation science literature internationally.OtherThis study was approved by the Victoria University of Wellington Human Ethics Committee (Ethics Approval Number 27,356). The research was supported by the Victoria University of Wellington research grant (222,809) and from the University of Auckland Department of Medicine research fund (H10779).

Supporting whānau during COVID-19 pandemic in Aotearoa New Zealand: a systems thinking case study

BackgroundThe Aotearoa New Zealand COVID-19 pandemic response has been hailed as a success story, however, there are concerns about how equitable it has been. This study explored the experience of a collective of Māori health and social service providers in the greater Wellington region of Aotearoa New Zeland delivering COVID-19 responses.MethodsThe study was a collaboration between a large urban Māori health and social service provider, Tākiri Mai Te Ata whānau ora collective, and public health researchers in Aotearoa New Zealand. Two online workshops were held with staff of the Māori service provider, collectively developing a qualitative causal loop diagram and generating systemic insights. The causal loop diagram showed interactions of various factors affecting COVID-19 response for supporting whānau (Māori family/households) at a community level. The iceberg model of systems thinking offered insights for action in understanding causal loop diagrams, emphasizing impactful changes at less visible levels.ResultsSix interacting subsystems were identified within the causal loop diagram that highlighted the systemic barriers and opportunities for effective COVID-19 response to Māori whānau. The medical model of health service produces difficulties for delivering kaupapa Māori services. Along with pre-existing vulnerability and health system gaps, these difficulties increased the risk of negative impacts on Māori whānau as COVID-19 cases increased. The study highlighted a critical need to create equal power in health perspectives, reducing dominance of the individual-focused medical model for better support of whānau during future pandemics.ConclusionsThe study provided insights on systemic traps, their interactions and delays contributing to a relatively less effective COVID-19 response for Māori whānau and offered insights for improvement. In the light of recent changes in the Aotearoa New Zealand health system, the findings emphasize the urgent need for structural reform to address power imbalances and establish kaupapa Māori approach and equity as a norm in service planning and delivery.

Hidden costs of providing care: a pilot study of Japanese migrant care workers’ experiences in Aotearoa New Zealand during the COVID-19 pandemic

ABSTRACT Recognising the increasingly vital yet precarious role that Asian migrant care workers (MCWs) play within Aotearoa New Zealand (Aotearoa) health system, this paper delves into the qualitative exploration of the experiences encountered by Japanese MCWs amidst everyday challenges and injustices during the COVID-19 pandemic in Aotearoa. Gaining in-depth understanding of their lived experiences, encompassing challenges inherent in their care roles and racial/social injustices outside their care roles, holds the potential to establish a sustainable care workforce capable of delivering quality health care while also attracting and retaining MCWs in Aotearoa. Employing the perspective of Critical Migration Studies (CMS), this pilot study explores the hidden costs of care provision, drawing insights from in-depth interviews conducted with 10 Japanese MCWs in late 2022 and early 2023, and presents mixed findings. The data indicates intersecting challenges in their work, including unfair treatment, linguicism, labour market inequality and various forms of social injustices. However, most Japanese MCW participants had developed robust resilience in dealing with these perceived challenges and injustices in Aotearoa, stemming from their previous experiences of gender, cultural and other forms of oppression in their workplace and everyday life in Japan.

"I lost my first tooth here": Syrian former refugees' experiences of oral healthcare in Dunedin, New Zealand.

Oral health conditions are highly prevalent among former refugees; however, little is known about their experiences of accessing dental care. We aimed to explore Syrian former refugees' experiences of oral healthcare in New Zealand. Thirty-nine Syrian former refugees resettled in Dunedin, New Zealand participated in nine focus group discussions. The interviews were audio-recorded, transcribed verbatim and thematically analysed. Almost all participants reported motivation to care for their teeth but multiple factors facilitated or hindered their ability to address their oral health needs, including financial factors, communication issues and dental care provider cultural safety. Most participants arrived with high expectations of New Zealand's health system. Oral healthcare providers and policymakers need to expect and accept their patients' past experiences and emotions, and consider their cultures, languages and backgrounds.

Key elements and contextual factors that influence successful implementation of large-system transformation initiatives in the New Zealand health system: a realist evaluation

BackgroundDespite three decades of policy initiatives to improve integration of health care, delivery of health care in New Zealand remains fragmented, and health inequities persist for Māori and other high priority populations. An evidence base is needed to increase the chances of success with implementation of large-system transformation (LST) initiatives in a complex adaptive system.MethodsThis research aimed to identify key elements that support implementation of LST initiatives, and to investigate contextual factors that influence these initiatives. The realist logic of enquiry, nested within the macro framing of complex adaptive systems, formed the overall methodology for this research and involved five phases: theory gleaning from a local LST initiative, literature review, interviews, workshop, and online survey. NVivo software programme was used for thematic analysis of the interview, workshop, and the survey data. We identified key elements and explained variations in success (outcomes) by identifying mechanisms triggered by various contexts in which LST initiatives are implemented.ResultsThe research found that a set of 10 key elements need to be present in the New Zealand health system to increase chances of success with implementation of LST initiatives. These are: (i) an alliancing way of working; (ii) a commitment to te Tiriti o Waitangi; (iii) an understanding of equity; (iv) clinical leadership and involvement; (v) involved people, whānau, and community; (vi) intelligent commissioning; (vii) continuous improvement; (viii) integrated health information; (ix) analytic capability; and (x) dedicated resources and time. The research identified five contextual factors that influenced implementation of LST initiatives: a history of working together, distributed leadership from funders, the maturity of Alliances, capacity and capability for improvement, and a continuous improvement culture. The research found that the key mechanism of trust is built and nurtured over time through sharing of power by senior health leaders by practising distributed leadership, which then creates a positive history of working together and increases the maturity of Alliances.DiscussionTwo authors (KMS and PBJ) led the development and implementation of the local LST initiative. This prior knowledge and experience provided a unique perspective to the research but also created a conflict of interest and introduced potential bias, these were managed through a wide range of data collection methods and informed consent from participants. The evidence-base for successful implementation of LST initiatives produced in this research contains knowledge and experience of senior system leaders who are often in charge of leading these initiatives. This evidence base enables decision makers to make sense of complex processes involved in the successful implementation of LST initiatives.ConclusionsUse of informal trust-based networks provided a critical platform for successful implementation of LST initiatives in the New Zealand health system. Maturity of these networks relies on building and sustaining high-trust relationships among the network members. The role of local and central agencies and the government is to provide the policy settings and conditions in which trust-based networks can flourish.OtherThis study was approved by the Victoria University of Wellington Human Ethics Committee (Ethics Approval Number 27,356). The research was supported by the Victoria University of Wellington research grant (222,809) and from the University of Auckland Department of Medicine research fund (H10779).

Self-care in New Zealand: The role of the community pharmacy

Self-care is a growing area in community pharmacy globally. In a time where people are taking control over their own health care, the question of the degree of self-care available from community pharmacies is pertinent. New Zealand is a country that has publicly funded healthcare; with over 1000 community pharmacies catering to a population of 5 million people. Despite the availability and accessibility of community pharmacies, much remains unknown about how self-care is offered in community pharmacies and the extent to which it is provided. In addition to this lack of clarity, is the current period of reorganisation occurring in the New Zealand healthcare system. The current changes involve dis-establishing district health boards (DHBs) and unifying the New Zealand health system into one streamlined system. It leads us to question whether this move will change funding allocations and health priorities as well as how they affect service provision in community pharmacy. While research has shown that New Zealand is paving the way in medicines reclassification making medicines more accessible, other research shows a fragmentation exists in services provided by community pharmacies in the area of self-care. This article will highlight what is currently known about self-care in New Zealand, the gaps that exist and the current challenges in this area.

It's a family affair: Confucian familist philosophy's potential to improve mental health care for ethnic Chinese in Aotearoa New Zealand.

Many ethnic groups traditionally value familism, which emphasises interdependence and the extended family unit. However, Aotearoa New Zealand's health system remains largely individual-oriented, with the implementation of family-centred care remaining inconsistent. This is known to have negative effects on Māori healthcare experiences and outcomes. Our research, exploring the experiences of ethnic Chinese using mental health services in Aotearoa New Zealand, indicated that this could also be a barrier for ethnic Chinese, who have similarly strong cultural links to familism, accessing mental health care. To balance the cultural importance of family involvement with the protection of individual patient autonomy, we propose a moderate Confucian familist approach, encouraging family involvement and participation in individual patients' care, with patients' consent. The approach acknowledges individual patients as interconnected members of a wider family unit, emphasising their reciprocal, mutual responsibility in maintaining a well-functioning, harmonious family. We highlight Whānau Ora as a potential exemplar for a culturally grounded, family-centred approach to mental health care which could be feasibly implemented and deliver positive outcomes. Parallels between Māori and ethnic Chinese cultural views around whānau, community, and collectivism suggest a Kaupapa Māori approach could also be beneficial to Aotearoa New Zealand's ethnic Chinese populations. However, ethnic Chinese lack the specific legal obligations empowering the implementation of interventions such as Whānau Ora. This is an obstacle which remains to be addressed before mental health services which are sensitive to the needs of ethnic Chinese or of other ethnicities can be effectively implemented.

Understanding how whānau-centred initiatives can improve Māori health in Aotearoa New Zealand.

This article highlights the significance of prioritizing Indigenous voices and knowledge systems, using whānau-centred initiatives (a concept that encompasses the broader family and community) as a foundation for health promotion within an Indigenous context. Tū Kahikatea, a conceptual framework, is used to demonstrate the relationship between the values underpinning different whānau-centred initiatives and their corresponding outcomes. The framework highlights the capacity of whānau-centred initiatives to support whānau in attaining mana motuhake, which represents collective self-determination and the ability to exercise control over their own future. By doing so, these initiatives contribute to the improvement of whānau health outcomes. With recent changes to Aotearoa New Zealand's health system, the findings underscore the benefits and potential of whānau-centred initiatives in enhancing whānau health outcomes, and advocate for continued strengths-based practices in Aotearoa New Zealand's health system. By bridging the gap between academia and grassroots community action, the article demonstrates the potential of whānau-centred initiatives and contributes to a global call for integrating Indigenous viewpoints and practices into Westernized healthcare, in order to improve Indigenous health outcomes.

Towards a national equitable and sustainable clinical research infrastructure for Aotearoa New Zealand.

Clinical trials are a critical element of a modern, high-functioning, learning healthcare system. Clinical trials provide access to novel, as yet unfunded treatments, and deliver cutting-edge healthcare. Evidence from clinical trials ensures appropriateness of healthcare, allows disinvestment from practices that are found not to improve outcomes or be cost-effective, and supports the introduction of new approaches, all of which leads to improvement in health outcomes. In 2020, Manatū Hauora - Ministry of Health and The Health Research Council of New Zealand funded a project to understand the current state of clinical trial activity in Aotearoa New Zealand and to propose the infrastructure required to support equitable clinical trial activity, in order to ensure that trials benefiting from publicly funded infrastructure are responsive to the needs of New Zealanders and ultimately enable equitable delivery of the best healthcare we can achieve to all New Zealanders. This viewpoint reports the process that was undertaken to develop the final proposed infrastructure and the rationale for the approach. The restructuring of the Aotearoa New Zealand health system into Te Whatu Ora - Health New Zealand and Te Aka Whai Ora - Māori Health Authority that will both operate hospital services and commission primary and community healthcare at a national level provides the ideal opportunity to integrate and embed research into Aotearoa New Zealand's healthcare system. Integration of clinical trials and research more broadly into the public healthcare system will require a significant shift in the culture within our healthcare system. Research must be recognised and promoted as a core activity for clinical staff at all levels of the healthcare system, rather than something to be tolerated or even hindered. Strong leadership will be required from the top of Te Whatu Ora - Health New Zealand down to ensure the required cultural shift to recognise the value of clinical trials to all aspects of the healthcare system, and to grow capability and capacity of the health research workforce. The investment required by the Government to implement the proposed clinical trial infrastructure will be substantial, but now is the ideal time for investment in clinical trials infrastructure in Aotearoa New Zealand. We urge the Government to be bold and invest now to ensure the benefits can be reaped for all New Zealanders in years to come.

Heart Failure Rehabilitation Impacts Quality of Life and Readmissions: Breathlessness Rehabilitation Classes Integrating Heart Failure and Pulmonary Rehabilitation Made Positive Impact on Quality of Life, Health Literacy, and Readmissions

Heart Failure (HF) patients often have limited exercise capacity due to dyspnoea and fatigue. Despite the availability of effective treatment, HF is associated with poor quality of life (QOL), high morbidity and mortality. Māori are twice as likely to die and four times as likely to be hospitalised for HF. Heart failure hospitalisations cost an estimated 2% to the New Zealand health system. Until the late 1980s, exercise was considered unsafe for HF; since then, considerable research evidence has suggested that exercise is safe and provides substantial physiological and psychological benefits. Whilst potential benefits are clear, there were no guidelines or resources available for HF patients in Hawkes Bay. With aim of improving functional capacity and QOL for HF patients and reduce readmissions, rehabilitation space was explored. Fiscal budgets and need of a multidisciplinary team were barriers to idealistic HF rehabilitation. The HF rehabilitation was integrated into pulmonary rehabilitation, with modification as per HF guidelines on exercise, content, and training of all staff regarding cardiology. The HF rehabilitation classes commenced in rural and urban regions (four regions in total). Patients were selected as per referral criteria and the first assessment was completed by the cardiologist/nurse practitioner/clinical nurse specialist and referred to an 8-week rehabilitation program. QOL tools were used to measure the before and after outcomes. More than 200 patients were referred and evaluated for results. Twenty-five HF patients were interviewed to understand enablers and barriers to rehabilitation. The HF patients who attended the program were almost 50% less likely to be readmitted, had reduced breathlessness, and improved fitness. Self-management skills and health literacy were also improved. Heart failure rehabilitation has proven to be a low-cost, high-value intervention, but is generally underused.

The 2022 restructure of Aotearoa New Zealand's health system: Will it succeed in advancing equity where others have failed?

Aotearoa New Zealand has restructured its health system with the objective of addressing inequitable access to health services and inequitable health outcomes, particularly those affecting the indigenous Māori population. In July 2022, two new organisations were created to centralise planning, funding and provision responsibilities for publicly funded health services in Aotearoa New Zealand. Health New Zealand and the Māori Health Authority have been created to drive transformational change within the national health system and monitor and improve the health and wellbeing of Māori. At the local level, new Localities are to be formed with the aim of integrating services between government and non-government health and social services providers, while incorporating local Māori and local communities in co-design of services. These changes will be of interest to those in many other countries who are grappling with their own colonial histories and struggling to provide health services in ways that are equitable and contribute to positive health outcomes for their whole population. Although key aspects of the reforms are well supported within the health sector, the ambitious scope and timing of their introduction in the context of the COVID-19 pandemic and health workforce shortages can be expected to generate significant implementation challenges.

The ownership elephant is becoming a mammoth: a policy focus on ownership is needed to transform Aotearoa New Zealand's health system.

Explicit government policy about ownership of health services is an important yet missing element in Aotearoa New Zealand's health system. Policy has not systematically addressed ownership as a health system policy tool since the late 1930s. It is timely to revisit ownership amid health system reform and increasing reliance on private provision (for-profit companies), notably for primary and community care, and also as an integral part of digitalisation. Simultaneously, policy should recognise the importance and potential of both the third sector (NGOs, Pasifika, community-owned services), Māori ownership and direct government provision of services to address health equity. Iwi-led developments over recent decades, along with the establishment of the Te Aka Whai Ora (Māori Health Authority), and Iwi Māori Partnership Boards provide opportunities for emerging Indigenous models of health service ownership, more consistent with Te Tiriti o Waitangi and mātauranga Māori. Four ownership types relevant to health service provision and equity are briefly explored: private for-profit, NGOs and community, government and Māori. These ownership domains operate differently in practice and over time, influencing service design, utilisation and health outcomes. Overall, the New Zealand state should take a deliberate strategic view of ownership as a policy instrument, in particular because of its relevance to health equity.

The place of rural hospitals in New Zealand's health system: an exploratory qualitative study.

In Aotearoa New Zealand (NZ) there is a knowledge gap regarding the place and contribution of rural hospitals in the health system. New Zealanders residing in rural areas have poorer health outcomes than those living in urban areas, and this is accentuated for Māori, the Indigenous people of the country. There is no current description of rural hospital services, no national policies and little published research regarding their role or value. Around 15% of New Zealanders rely on rural hospitals for health care. The purpose of this exploratory study was to understand national rural hospital leadership perspectives on the place of rural hospitals in the NZ health system. A qualitative exploratory study was undertaken. The leadership of each rural hospital and national rural stakeholder organisations were invited to participate in virtual semi-structured interviews. The interviews explored participants' views of the rural hospital context, the strengths and challenges they faced and how good rural hospital care might look. Thematic analysis was undertaken using a framework-guided rapid analysis method. Twenty-seven semi-structured interviews were conducted by videoconference. Two broad themes were identified, as follows. Theme 1, 'Our place and our people', reflected the local, on-the-ground situation. Across a broad variety of rural hospitals, geographical distance from specialist health services and community connectedness were the common key influencers of a rural hospital's response. Local services were provided by small, adaptable teams across broad scopes and blurred primary-secondary care boundaries, with acute and inpatient care a key component. Rural hospitals acted as a conduit between community-based care and city-based secondary or tertiary hospital care. Theme 2, 'Our positioning in the wider health system', related to the external wider environment that rural hospitals worked within. Rural hospitals operating at the margins of the health system faced multiple challenges in trying to align with the urban-centric regulatory systems and processes they were dependent on. They described their position as being 'at the end of the dripline'. In contrast to their local connectedness, in the wider health system participants felt rural hospitals were undervalued and invisible. While the study found strengths and challenges common to all NZ rural hospitals, there were also variations between them. This study furthers understanding of the place of rural hospitals in the NZ healthcare system as seen through a national rural hospital lens. Rural hospitals are well placed to provide an integrative role in locality service provision, with many already long established in performing this role. However, context-specific national policy for rural hospitals is urgently needed to ensure their sustainability. Further research should be undertaken to understand the role of NZ rural hospitals in addressing healthcare inequities for those living in rural areas, particularly for Māori.

Universal healthcare for all? Māori health inequalities in Aotearoa New Zealand, 1975-2000.

Despite establishing a so-called universal, taxpayer funded health system from 1938, New Zealand's health system has never delivered equitable health outcomes for its indigenous population, the Māori people. This article, using a case study approach focusing on Māori, documents these historic inequalities and discusses policy attempts to address them from the 1970s when the principles of the Treaty of Waitangi were first introduced in legislation. This period is one of increasing self-determination for Māori, but notwithstanding this, Māori continued to have significantly shorter life expectancy than the population as a whole and suffered poor health at much higher rates. Neo-liberal policies were introduced and expanded during the 1980s and 1990s in New Zealand, including in healthcare from the early 1990s. The introduction of the purchaser-provider split in health services and the focus on devolving responsibility to communities provided an opportunity for Māori health providers to be established. However, the neo-liberal economic and social welfare policies implemented during this time also worked against Māori and adversely affected their health. By analysing attempts to reduce inequity in health outcomes for Māori, we explore why these collective attempts, including by Māori themselves, did not result in overall improved health and increased life expectancy for Māori. There was often a significant gap between government rhetoric and action, and we suggest that a predominantly universal healthcare system did not accommodate cultural and ethnic differences, and this is a potential explanation for the failure to reduce inequities. While this is true for all minority ethnic groups it is even more crucial for Māori as New Zealand's tangata whenua (first people) who had been progressively disadvantaged under colonialism. However, the seeds of ideas around Māori-led healthcare were planted in this period and have become part of the current Labour Government's policy on health reform.

Asian migrants navigating New Zealand primary care: a qualitative study.

Introduction Information on the responsiveness of the New Zealand (NZ) health system to Asians to enable navigation of healthcare services is currently lacking. Barriers experienced by Asian patients to enable optimal navigation of, and engagement with, healthcare services are also sparse. Aim This research aimed to: (1) document and analyse resources available on the websites of general practices that aid in optimal health care navigation for NZ Asians; and (2) explore the barriers perceived by Asian migrants to navigating the NZ Health System, particularly primary care. Methods This study involved qualitative document analysis of existing resources on general practice websites. Information on perceived barriers and experiences of navigating the health system was collected through semi-structured interviews (n = 9). Results Overall, 293 general practice websites were analysed. The themes from content analysis were: availability of basic information, linguistic accessibility, and culturally appropriate support for patients. Relevant and reliable information facilitating effective navigation of the NZ health system by Asians was lacking. Interview data supported the findings about the general practices, with participants reporting significant difficulties navigating and understanding NZ primary care services. Discussion Current navigational resources presume knowledge that Asian migrants do not often possess. Participants felt this lack of accessible information acutely, and it influenced how they perceived and engaged with healthcare services. Increased accessibility through resources in Asian languages, including an overview of how Health NZ functions in providing health care and professional interpreter services, would be critical to increase appropriate engagement with healthcare services and thus contribute to better health outcomes for Asians.

The Impact of Policies and Legislation on the Structure and Delivery of Support Services for Children With Cerebral Palsy and Their Families in Aotearoa New Zealand: A Professional Perspective

The Aotearoa New Zealand (NZ) Health system currently provides disability support services to children living with cerebral palsy (CP) and their families built on key policy and legislation which has created two distinct disability support pathway. One pathway is provided through the Accident Compensation Corporation and the other through Te Whatu Ora (Health New Zealand) districts. There is consensus that these pathways result in significant inequities in terms of support service delivery. Māori and Pacific People are particularly impacted by this inequity. In the absence of literature that critically analyses this situation, the purpose of this paper is to examine, understand and critique how disability support services are structured and delivered to children living with cerebral palsy and their families in Aotearoa New Zealand. Two clinical vignettes illustrate the challenges and inequities faced by families and demonstrates how the two separate pathways impact service delivery, opportunities to thrive and health outcomes. This paper will highlight that there is a need for a review of the current system which is timely considering the recent establishment of Te Whatu Ora - Health New Zealand, Te Aka Whai Ora - Māori Health Authority, and Whaikaha - the Ministry for Disabled Peoples. TE REO MĀORI TRANSLATION Te pānga o ngā kaupapa here me ngā ture ki te hanganga me te horanga o ngā ratonga tautoko mō ngā tamariki kua pāngia e te mate whakatīmohea, me ō rātou whānau i Aotearoa: He tirohanga ngaio Ngā Ariā Matua Ko tā te pūnaha Hauora o Aotearoa o tēnei wā he hora ratonga tautoko ki ngā tamariki kua pāngia e te mate whakatīmohea me ō rātou whānau. E rua ngā ara tautoko hauātanga motuhake kua waihangatia, i roto i ngā whakatau kaupapa here me ngā ture matua. Ko tētahi ara he mea whāngai ki te pūtea, he mea hora hoki mā roto i te Kāporeihana Āwhina Hunga Whara, he Whakahaere Karauna; ko tētahi ka horaina mā ngā rohe o Te Whatu Ora (Health New Zealand). Ko te whakaaro o te nuinga, nā ēnei ara e rua he maha ngā korenga e ōrite o ngā horanga ratonga tautoko. Ko ngāi Māori me Ngā Iwi o Te Moana-nui-a-Kiwa te hunga ka tino pāngia e ēnei korenga e ōrite. Mā ētahi pūrākau poto taurima tūroro e rua, kotahi pūrākau mō tētahi, mō tētahi, e whakaahua ngā rerekētanga o te wātea me te horanga i ngā ratonga hauora, tautoko hoki. E anga ana tēnei pepa ki te whakaahua he pēhea te waihanga o ngā ratonga tautoko hauātanga ki ngā tamariki kua pāngia e te mate whakatīmohea me ō rātou whānau i Aotearoa, me te whakakite i ngā taumahatanga me ngā korenga e ōrite kei mua i ngā whānau, e pēhi nei i ō rātou whāinga wāhi kia puāwai, me ō rātou pūtanga hauora. E akiaki ana tēnei pepa kia whakahoutia wawetia te pūnaha o nāianei, ā, he mea tika mō tēnei wā, i muri i te whakatūranga i tēnei tau o Te Whatu Ora, o Te Aka Whai Ora (Māori Health Authority) me Whaikaha (Ministry of Disabled People). Ngā kupu matua: te mate whakatīmohea, tamariki, ngā whānau, ture, kaupapa here

Ngā whakāro hauora Māori o te karu: Māori thoughts and considerations surrounding eye health

ABSTRACT Clinical Relevance Research highlighting Indigenous patient perspectives is essential in the pursuit of understanding and addressing longstanding health inequities. Background Evidence indicates that disparities in ocular health outcomes between Māori and non-Māori are pervasive in the New Zealand health system. Evidence shows the cause of these inequities is often multifactorial; due to factors such as colonisation, ongoing marginalisation, racism, socioeconomic status, poverty and culturally unsafe practice between health professionals and Māori patients. Methods This project used kaupapa Māori methodology to identify the perceptions of Māori surrounding ocular healthcare within a Māori context in Aotearoa New Zealand. Three focus groups with Māori community members and three individual interviews with Māori eyecare practitioners were conducted. Participants discussed sub-topics relating to Māori health, ocular health consultations, ocular examination and access to ocular health services in Aotearoa New Zealand. Reflexive thematic analysis was undertaken using NVivo qualitative research software. Results Five key themes were derived from the data: (1) the importance of effective clinician-patient communication; (2) historical experiences of patients inform their health attitudes; (3) barriers to access are systemic; (4) Māori health is important to Māori and (5) Te Ao Māori, Tikanga and Tapu are significant cultural concepts for Māori. Overall, Māori patients recognise the value of ocular healthcare and the importance of acknowledging Māori models of health within services. Conclusion The key issues Māori patients face within ocular health services resonate strongly with wider concepts intrinsically important to Māori. These are the right to cultural safety within clinical settings, the right to accurate and pertinent communication of information between clinician and patient and the respect of cultural beliefs and acknowledgement of power imbalances within the wider healthcare system. Participant discussions and suggestions raise possible pathways to begin addressing ocular ethnic disparities in healthcare delivery.

A tangata whenua (people of the land) approach to conceptualising Māori health and wellbeing.

From a Māori (Indigenous to New Zealand) perspective, health is not confined to the treatment of illness but also includes the philosophical concepts, structures and cultural practices which reinforce health and wellbeing. The ill-health of Māori is often the focus of health initiatives, particularly if there is an equity approach that centres on disparities between ethnic groups. However, an Indigenous approach prioritises health and wellbeing aspirations through strengthening self-determination, identity and connection with the environment. This article synthesises knowledge from Indigenous and Māori rights, mātauranga (Māori ways of knowing) expressed in pūrākau (epistemological narratives), tikanga (Māori principles), te reo (Māori language) and lived experience to reflect a shared understanding of Māori health and wellbeing. Consideration is given to the status of Māori pre-colonisation, the ongoing impacts of colonisation, and Māori led responses to contemporary health issues. It is proposed that health for Māori, like many Indigenous peoples, should be informed by an enhanced understanding of Indigenous rights, an Indigenous worldview and notions of wellbeing. We argue that a tangata whenua (people of the land) approach is integral to the effectiveness of health policies and initiatives aimed at improving Māori outcomes sustainably. We propose that the current reorganisation of Aotearoa New Zealand's health system, as well as the COVID-19 pandemic response, provide opportunities to emphasise and embed Māori health leadership and knowledge, as well as a tangata whenua conceptualisation of health and wellbeing.