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Te Tiriti o Waitangi, a treaty negotiated between Māori (the Indigenous peoples of Aotearoa) and the British Crown, affirmed Māori sovereignty and guaranteed the protection of hauora (health). The Waitangi Tribunal, established in 1975 to investigate alleged breaches of the agreement, released a major report in 2019 (registered as WAI 2575) about breaches of te Tiriti within the health sector in relation to primary care, legislation, and health policy. This article explores the implications of this report for the New Zealand health sector and the decolonial transformation of health systems. The tribunal found that the Crown has systematically contravened obligations under te Tiriti across the health sector. We complement the tribunal’s findings, through critical analysis, to make five substantive recommendations: (1) the adoption of Tiriti-compliant legislation and policy; (2) recognition of extant Māori political authority (tino rangatiratanga); (3) strengthening of accountability mechanisms; (4) investment in Māori health; and (5) embedding equity and anti-racism within the health sector. These recommendations are critical for upholding te Tiriti obligations. We see these requirements as making significant contributions to decolonizing health systems and policy in Aotearoa and thereby contributing to aspirations for health equity as a transformative concept.

Restrictions on Indigenous peoples’ contributions to policymaking pervade post-settler societies like Australia, Canada and Aotearoa. Such effects are observed in spite of agreements like Te Tiriti o Waitangi in Aotearoa and the United Nations’ Declaration on the Rights of Indigenous Peoples. Te Tiriti, negotiated between the British Crown and Māori (Indigenous peoples of Aotearoa), may have been entered into honourably by both parties, but the Crown has consistently resisted its implementation. Contemporary colonialism is characterised by the entrenched and on-going displacement of Indigenous people’s authority by settler states, rationalised by race as a determinant of human worth. Impacts include land alienation, unsustainable resource exploitation and marginalising Indigenous voices from opportunities to make policy consistent with Indigenous values and preferred ways of living. Colonialism normalises institutional racism so that public policy outcomes are persistently unjust. This article describes Critical Tiriti Analysis (CTA), an original contribution to transforming colonial policy, which retrospectively evaluates whether any specific policy document is consistent with Te Tiriti. Substantial interest in CTA from policymakers, practitioners, and scholars led to the development of the tool as a prospective guide to making policy that is consistent with authoritative interpretations of Te Tiriti, and therefore, more likely effective in producing public policies which eliminate inequities. CTA was initially focused on health policy and built on a series of questions that arise from our interpretations of the text of Te Tiriti, contemporary Tiriti scholarship and jurisprudence, and our observations of the ways in which the method is being used by ourselves and others. Although deeply grounded in Aotearoa, we argue that CTA may be transferable to other colonial contexts, such as the Australian where treaties between First Nations and the state are being contemplated, and Canada which has passed legislation to implement the Declaration on the Rights of Indigenous Peoples.

The New Zealand state developed from a treaty between the British Crown and hapū (sub-tribes) in 1840. The te Reo (Māori language) text and the English version of the agreement are fundamentally different. Breaches of this treaty and tension over how the political relationship between Māori and the Crown should proceed are ongoing. In 2019, the Cabinet Office issued a Circular instructing bureaucratic advisers of the questions they should address when providing advice to ministers on the agreement’s contemporary application. In this article, we use Critical Tiriti Analysis (CTA) – an analytical framework applied to public policies – to suggest additional and alternative questions to inform bureaucratic advice. The article defines CTA in detail and shows how using it in this way could protect Māori rights to tino rangatiratanga (a sovereignty and authority that is not subservient to others) and substantive engagement, as citizens, in the formation of public policy. This article’s central argument is that the Circular reflects an important evolution in government policy thought. However, in showing how the Circular privileges the English version (the Treaty of Waitangi) over the Māori text (Te Tiriti o Waitangi), the article demonstrates how Māori political authority remains subservient to the Crown in ways that Te Tiriti did not intend. We show through the conceptual illustration of the care and protection of Māori children, despite the significant evolution in government thought that it represents, these rights are not fully protected by the Circular. This is significant because it was Te Tiriti, with its protection of extant Māori authority and sovereignty, that was signed by all but 39 of the more than 500 chiefs who agreed to the British Crown establishing government over their own people, but who did not agree to the colonial relationship which may be read into the English version.

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.

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.