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To understand the health status of New Zealanders, immigrants to NZ and health professionals need to understand the Treaty of Waitangi. We need to know what the patterns of illness and injury are and the nature of disparities. To understand disparities, you have to understand the historical context of New Zealand. Disparities don’t develop overnight; they arise out of historical events. Learning about the Treaty is learning about our patients, their context and how best to support their health and wellness.

At the time the Treaty was signed in New Zealand, there were about 2000 Pakeha and a Māori population estimated to be about 100,000. A sound economic base in international trade was established, and Māori was not under any threat. The signing of the Treaty was more an act of economic growth and diplomacy rather than survival.

The Treaty of Waitangi was drafted in English and then translated into Māori by the missionary Henry Williams and his son Edward.

Article One in the English version uses the word Sovereignty. Williams used the word Mana in 1835 when he translated the Declaration of Independence. Mana carries the idea of power authority, control, prestige and if taken it to its logical extent the idea of sovereignty. In 1840 when Williams translated the Treaty he used the word kawanatanga. Kawanatanga is a made up word. It’s a Māori way of saying Governorship. If he had put the word Mana into the Treaty, the Chiefs give up to the Queen of England their Mana; I don’t think any of them would have signed. Sovereignty is the most contentious part of the Treaty. Almost all the Māori chief signed the Māori version and agreed to Governorship, and I think that is significantly different from the idea of being ruled.

There is a clear difference in the interpretation of the Māori and English text particularly around words such as sovereignty, the governorship, and tino rangatiratanga and these concepts and understandings are fundamental to interpreting the intention of the Treaty itself.

Article Two says the same thing in English and Māori. It states that Māori will keep their lands, forests, homes and fisheries and their treasures. Māori certainly didn’t benefit from the protection promised in the Treaty Preamble. Within a short period, Māori health rapidly deteriorated due to introduced diseases. Lands and resources were taken possession of by the Crown and Maori were forced to move from their traditional base into the towns and cities to survive. Poverty, disease, illness, loss of ability to look after their wellbeing and future, contributes to understanding Maori health today.

If you don’t understand New Zealand history and how Maori autonomy has changed over the years, then you won’t understand Māori issues or concerns and will likely end up treating Māori the same as everyone else. But we know people aren’t the same.

They don’t all come in with the same backgrounds and issues and concerns.

Article three speaks of rights and privileges. This Article is about equal outcomes.

In the 1980’s New Zealand implemented a publicly funded health education campaign to reduce smoking and tobacco use. It was enormously successful for non-Māori, but it didn’t make any difference to Māori smoking rates. In part, this had to do with how the Campaign was designed and delivered. It didn’t resonate with Māori audiences.

In contrast, in the late 1900’s, a publicly funded health campaign developed by Māori and targeting Māori resonated with Maori audiences. It didn’t mention smoking. It was called ‘It’s about whanau’ and was very successful in reducing Māori smoking rates. The cultural concepts, language, brands, values, norms were employed to catch the attention of Māori, and this resulted in a greater response and behavioural changes.

Article Three is about equal outcomes, and it doesn’t matter whether it’s a health education campaign or a cardiac procedure or access to disability allowances. In all of these areas Māori has not received equal treatment or equal access. Māori

The Treaty of Waitangi recognises indigenous peoples full rights and privileges. The Treaty of Waitangi is different from the Treaties signed in other parts of the world. Unfortunately, the Treaty has been applied in an ad hoc way, and that’s given rise to the Māori health disparities we deal with today in New Zealand.

Article Four was announced to everybody in attendance at the hui in Waitangi in 1840. Article Four confirms that people can access any of, the new religions, the introduced modern churches or to maintain their traditional spirituality. Article Four is about inclusivity concerning spiritual things and includes wider domains for Māori.

One example is the GP and patient consultation. Māori patients often come with other members of their family. If you say it’s OK to bring the family in then, you might find there are quite a lot of people involved and in that context appropriate for Māori. It might be that family members have a view about the treatment of their mother, or their sister, or their niece. They might have some questions for you, but they will want to be involved. Working with the whole family is a more effective use of time.

It means you can talk about healthy diet and healthy exercise and medications and complications of treatment with the family. Philosphically this aligns with the ‘Whare Tapa Wha’ Māori model of Health which includes the physical dimension taha tinana and the family dimension taha whanau and also includes the taha wairua, the spiritual dimension.

All people are entitled to have their religious and spiritual beliefs accommodated as much as possible in the health care environment before a procedure or a visit from a priest or halal meal or all of those if that’s what they want. It’s up to us as health care professionals to be as accommodating as possible. The Auckland District Health Board has implemented Article Four by creating a safe pathway for tūpāpaku (deceased)in the hospital. Two designated lifts for the deceased and family are provided with specific lifts, which are accessible from any ward to the mortuary services or a hospital exit. Regarding these hospital lifts; no food, no dirty linen, no dirty hospital equipment enters these lifts to ensure that the mana and the tapu of the deceased person are protected and that they are shown utmost respect.

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