Realising the Rhetoric: Refreshing Public Health Providers' Efforts to Honour Te Tiriti O Waitangi
Came, H; McCreanor, T; Doole, C; Simpson, T
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Objectives This paper investigates the ways two groupings of public health providers, public health units and non-governmental organisations meet their Te Tiriti o Waitangi obligations in terms of service delivery to Māori. Design A nationwide survey of public health providers (n=162) was conducted between November 2014 and May 2015. Semi-structured telephone interviews were conducted with public health managers. Qualitative and quantitative data was collected. Participants were asked about the effectiveness of service delivery to Māori and how this was monitored. This paper presents a qualitative analysis of the data. Results Some public health units (PHUs) reported actively working with Māori, Te Tiriti o Waitangi and reducing health disparities. Direct Māori engagement with development and delivery of programmes was viewed by many as essential. Strategies included designated PHU staff in positions of responsibility and formal partnerships with mana whenua (local Māori with territorial rights), providing operational and strategic guidance. Some PHUs implemented staff development in cultural competencies. On the other hand non-governmental organisations (NGOs) responsiveness to Māori was variable. Some NGOs described prioritising service delivery and programmes for Māori to reduce health disparities. Others reported that the focus of their service delivery was for European or other non-Māori ethnicities and that a lack of resources or past difficulties engaging with Māori were barriers. Conclusion Māori, in common with other indigenous groups, have compromised health status. Public health has an ethical commitment to reduce health disparities. New Zealand has a unique tool in Te Tiriti o Waitangi for engagement with Māori. Advancing Te Tiriti obligations and tino rangatiratanga (Māori control over things Māori) in everyday practice has the potential to address inequities.