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M?ori in Aotearoa have higher incidence, prevalence and mortality from chronic disease. The dominant narrative in Aotearoa about the reasons for M?ori ill health neglects to acknowledge the history of colonisation and failures of the health system, alongside the holistic view of health taken by M?ori focusing on collective, wh?nau-based outcomes. In this article, we review health interventions for chronic disease that have a kaupapa M?ori philosophical basis. Our findings demonstrate that there is no clear process in health service design, delivery, research and funding that values and understands m?tauranga M?ori. Western knowledge systems are inadequate for collecting and presenting M?ori knowledge. Overall, we highlight that the tension between acknowledging that a ?by M?ori, for M?ori? approach is best, and the difficulty in defining appropriate evidence collection methodology and outcome measures when funders and policy makers continue to require Western-centric interventions is an obstacle to improving M?ori health outcomes.
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Co-designed research is gaining prominence within the health care space. Community engagement is a key premise of co-design and is also particularly vital when carrying out kaupapa Māori research. Kaupapa Māori describes a “by Māori, for Māori” approach to research in Aotearoa/New Zealand. This article discusses the research process of Hā Ora: a co-design project underpinned by a kaupapa Māori approach. The objective was to explore the barriers to early presentation and diagnosis of lung cancer, barriers identified by Māori. The team worked with four rural Māori communities, with whom we aimed to co-design local interventions that would promote earlier diagnosis of lung cancer. This article highlights and unpacks the complexities of carrying out community- engaged co-design with Māori who live in rural communities. In particular, we draw attention to the importance of flexibility and adaptability in the research process. We highlight issues pertaining to timelines and budgets, and also the intricacies of involving co-governance and advisory groups. Overall, through this article, we argue that health researchers need to prioritise working with and for participants, rather than on them, especially when working with Māori communities.
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The majority of Indigenous health models do not directly acknowledge that health is a contested political space. Providing a Foucauldian analysis, this article suggests a function of biopower is to naturalise discourses such as the poor M?ori health statistic to appear based on factual evidence and thus are apolitical. Employing Foucault?s triad of power?sovereign, disciplinary and biopower?to understand the genealogy of M?ori health, this article proffers mana motuhake (M?ori political self-governance) as an appropriate health analytic because it, first, identifies Indigenous health as political and, second, because it recognises the disempowering role that colonialism has played in relation to M?ori biopolitical self-governance. Hence, we suggest M?ori health will be enhanced by mana motuhake and that research underpinned by Indigenous agency and self-governance resists biopower. The article references two Ageing Well National Science Challenge?funded research projects because they innovatively fundamentalise mana motuhake and politics to Indigenous health.
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Health inequities experienced by kaumātua (older Māori) in Aotearoa, New Zealand, are well documented. Examples of translating and adapting research into practice that identifies ways to help address such inequities are less evident. The study used the He Pikinga Waiora (HPW) implementation framework and the Consolidated Framework for Implementation Research (CFIR) to explore promising co-design and implementation practices in translating an evidence-based peer-education programme for older Māori to new communities.
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Topic
- co-governance (1)
- health (1)
- health equity (1)
- health inequity (2)
- kaupapa māori (2)
- mana motuhake (1)
- māori health (1)
- research (2)
Resource type
- Journal Article (4)