Journal Articles
Permanent URI for this collectionhttps://mro.massey.ac.nz/handle/10179/7915
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Item A Critical Tiriti Analysis of the New Zealand Disability Strategy 2016-2026(University of Hawai'i Center on Disability Studies, 2022-11-24) Came H; McCreanor T; Manson LHealth policy is one mechanism to address inequities and protect Indigenous people’s access to the shared human right to health. Te Tiriti o Waitangi (the Māori text) negotiated between the British Crown and Māori (the Indigenous peoples of Aotearoa) outlines the social contract between Māori and Non-Māori. It was negotiated in part to protect Māori health. Within Aotearoa there continues to be significant ethnic inequities in disabilities. This paper undertakes a retrospective Critical Tiriti Analysis of the New Zealand Disability Strategy to determine its compliance with Te Tiriti. It also considers whether such an analysis might strengthen responsiveness to Indigenous peoples elsewhere. This analysis involved a five-phase process of review. Through our analysis we identified poor to fair engagement with the responsibilities outlined in Te Tiriti o Waitangi. There were promising statements about the special relationship between the Crown and Māori, conflicting statements about governance and self-determination, and limited engagement with ethnic specific equity concerns or spirituality. To strengthen the Strategy the authors determined Tāngata whaikaha (Māori disabled people’s) views needed to be more strongly centered within the structure and content. The historical and contemporary determinants of Māori health needed to be included along with deeper engagement with intersectionality and Te Tiriti o Waitangi responsibilities. Undertaking critical policy analysis is an effective method to inform and review policy that may be applicable in other settler-colonial contexts with significant ethnic health inequities.Item Ethnic (pay) disparities in public sector leadership from 2001-2016 in Aotearoa New Zealand(Queensland University of Technology, 2020-08-21) Came H; Badu E; Ioane J; Manson L; McCreanor TNew Zealand governments have longstanding policy commitments to equal employment practices. Little attention has been paid to ethnic pay disparities in recent years. Informed by a series of Official Information Act requests, we were interested to find out to what extent ethnic pay disparities existed at senior levels within the core public sector and district health boards (DHBs). We examined the number of employees who earned more than NZ$100,000 by determining the total full-time equivalent staff (FTEs) and the respective proportions of the three ethnicities compared- Māori, Pasifika and Other. The analyses revealed a pattern of ethnic pay disparities across the public sector over the period reviewed. There were fewer Māori and Pasifika staff employed in DHBs than their population proportion. The failure to promote Māori and Pasifika to the upper tiers of the public sector is consistent with definitions of institutional racism. The authors call for more research to understand the dynamics of ethnic pay disparity and the drivers of this disparity.Item New immersive alcohol marketing and commerce in metaverse environments(John Wiley and Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs, 2024-11-04) Huckle T; Mummert K; Lyons A; McCreanor T; Mclellan G; Moewaka Barnes HIntroduction The study aims are to: (i) explore methods for identifying alcohol company marketing in metaverses; (ii) identify current types of alcohol marketing in metaverses; and (iii) identify dominant portrayals and meanings of alcohol marketing in these settings. Methods Our design was exploratory, employing various approaches to identify alcohol company marketing across multiple metaverses. In stage one, we systematically navigated through metaverses as an avatar, documenting and coding all instances of alcohol company marketing. In stage two, the research team collaboratively explored and discussed excerpts of this marketing. The team thematically analysed the transcribed discussion, identifying key meanings and interpretations of immersive and interactive alcohol marketing. Results Stage one: alcohol company marketing was identified in two metaverses, Decentraland and Sandbox. Within those metaverses were five alcohol company marketing experiences: Heineken Silver, Jose Cuervo Tequila, Wisher Vodka, San Matias Tequila, and Mason Martell Cognac. Marketing strategies included immersive commerce, virtual drinking, immersive branding, immersive engagement, gaming, non-fungible tokens (digital assets), education, non-player characters promoting brands and virtual event-based marketing. Stage two: themes identified were: (i) immersive branding, representing continued exposure to brands that were both foregrounded and on the edge of users' awareness; (ii) immersive engagement, including alcohol-related gaming, quests, and alcohol production; (iii) avatars simulating drinking behaviour (virtual drinking); and (iv) immersive commerce representing how metaverse alcohol marketing may drive alcohol transactions. Discussion and Conclusion Alcohol companies are using novel immersive marketing techniques in metaverses. The impact on the experiences and drinking behaviours of users are unknown and require investigation.Item Alcohol marketing on social media: young people’s exposure, engagement and alcohol-related behaviors(Taylor and Francis Group, 2024-07-08) McCreanor T; Moewaka Barnes A; Goodwin I; Carah N; Young J; Spicer J; Lyons ACAim Alcohol promotions in conventional channels are associated with subsequent alcohol consumption in young people, but little is known about young people’s exposure to digital alcohol marketing. This exploratory study investigated young people’s exposure to, and engagement with, alcohol marketing on social media platforms, variations across sociodemographic groups and associations with alcohol-related behaviors. Method An online survey was conducted with 3698 participants aged between 14 and 20 years (M = 17.1; SD = 1.8) in New Zealand. The survey asked about social media use and exposure to and engagement with alcohol product marketing on their preferred platforms, alcohol consumption patterns, hazardous drinking (AUDIT-C scores) and purchasing alcohol online. Results Nearly three-quarters of the sample who responded to questions about exposure to alcohol marketing (70.6%; n = 1541) reported seeing marketing on at least one social media platform, with older respondents (18–20 years) more likely to report exposure than younger respondents (14–17 years); no differences were found across gender, ethnicity or socioeconomic groups. Over one-third of those who responded to questions about engagement (40.7%; n = 850) reported engaging with alcohol marketing and this varied by age, gender and ethnicity. Recall of exposure to alcohol marketing was less strongly associated with online purchase and having ever drunk alcohol than was engagement with alcohol marketing, which was also associated with hazardous drinking. Conclusions Engagement with alcohol marketing was more strongly related to alcohol behaviors, including online purchasing, having ever drunk alcohol, and drinking at hazardous levels, than exposure. These findings also demonstrated inequitable patterns of engagement with alcohol marketing on social media associated with these novel algorithmic marketing methods.Item A Critical Tiriti Analysis of the Pae Ora (Healthy Futures) Bill(New Zealand Medical Association, 2022-03-11) Rae N; Came H; Baker M; McCreanor TAim The Pae Ora (Healthy Futures) Bill is the framework for a reformed health system intended to embed Te Tiriti o Waitangi and centre equity. The Bill is informed by the Wai 2575 Health Kaupapa Waitangi Tribunal Inquiry and the Health and Disability System Review, both of which established an urgent mandate to transform the health sector. This desktop review explores to what extent the proposed Bill is likely to uphold Te Tiriti. Method This paper uses Critical Tiriti Analysis to review the Pae Ora Bill. The analysis involves five phases: (i) orientation; (ii) close reading; (iii) determination; (iv) strengthening practice and (v) Māori final word. As part of that, a determination is made whether the Bill is silent, poor, fair, good or excellent in relation to the Preamble and the four articles (three written, one verbal) of te Tiriti o Waitangi (Māori text). Results The desktop analysis showed fair engagement with most of the Te Tiriti elements; but with good commitment to address equity issues. The Bill was silent in relation to wairuatanga (spirituality) and there is no evidence of Māori values informing it. Conclusion The dominant Crown narrative that interprets kāwanatanga as the right to govern over all peoples pervades this legislation. There are significant power sharing shifts within this Bill and these are welcomed, but whilst the Crown maintains ultimate power and authority only a partial fulfilment of Te Tiriti will be evident within the health system.Item Strengthening public health contracting: findings of a follow-up nationwide survey from Aotearoa(Informa UK Limited, trading as Taylor & Francis Group, 2022-01-01) Came H; Baker M; McKenna B; McCreanor TIn 2010 and 2015 nationwide surveys monitored government management of public health providers. These surveys found evidence of inconsistent management which disadvantaged Māori providers, consistent with institutional racism. In Dec 2019 to March 2020 a follow-up nationwide telephone survey was completed. Public health units, primary health organisations, Māori health providers and non-governmental organisations with public health contracts responded (72%). This paper focuses on the findings about (i) contracts, and (ii) relationships. Descriptive statistical analysis was applied to quantitative responses and explanatory and combinatory analyses informed by thematic analysis were applied to qualitative data. The 2019–2020 quantitative data identified no statistically signficant variations. There was no evidence Māori provider experiences improved, but generic providers reported less favourable conditions. Qualitative data revealed providers remain dependent on individual managers and there was inconsistency across providers that could be addressed by transparent quality assurance. Māori providers were frustrated by contracting environments. They wanted to be recognised as Te Tiriti o Waitangi partners, with flexibility, certainty of investment (longer contracts), support (infrastructure investment) to be able to meet the high needs of their communities. This nationwide survey was completed prior to the current health reforms but implications are considered for the Māori Health Authority.Item ‘Time for a troll’; the standard story propping up the colonial state(Informa UK Limited trading as Taylor & Francis Group, 2022) Nairn R; McCreanor TThis article foregrounds the contribution of the widely available standard story of New Zealand history and Pākehā race-talk, to the social control of Māori and the naturalisation of racism. Assisted by recent studies that show how humour is variously used to encourage compliance with social norms, we focus on an item published as a newspaper column by Sir Robert Jones. The analysis shows how the piece utilises widely familiar themes and resources of Pākehā race-talk to create an allegedly humorous piece that works to maintain the broad status quo of colonising expectations in Aotearoa. Our article revitalises the extensive research, in New Zealand and elsewhere, on the uses and effects of Pākehā/settler race-talk. We conclude by outlining steps needed to displace and depower such colonising talk to enable our thinking and practices to contribute to a more culturally just and equitable society.Item Using vignettes about racism from health practice in Aotearoa to generate anti-racism interventions(John Wiley & Sons Ltd on behalf of Health and Social Care in the Community, 2022-11) Kidd J; Came H; McCreanor TRacism is a key modifiable determinant of health that contributes to health inequities in Aotearoa and elsewhere. Experiences of racism occur within the health sector for workers, patients and their whānau (extended family) every day. This paper uses stories of racism from nurses – reworked into vignettes – to examine the dynamics of racism to generate possible micro, meso and macro anti-racism interventions. A critical qualitative design was utilised, informed by kaupapa Māori approaches. The five vignettes in this paper were sourced from a pair of caucused focus groups with nine senior Māori (Indigenous peoples of Aotearoa) and Tauiwi (non-Māori) nurses held in Auckland Aotearoa in 2019. The vignettes were lightly edited and then critically analysed by both authors to identify sites of racism and generate ideas for anti-racism interventions. The vignettes illustrate five key themes in relation to racism. These include (i) mono-cultural practice, (ii) everyday micro-aggressions; (iii) complexity and the costs of racism, (iv) Pākehā (white settler) privilege and (v) employment discrimination. From analysing these themes, a range of evidence-based micro, meso and macro-level anti-racism interventions were derived. These ranged from engaging in reflective practice, education initiatives, monitoring, through to collective advocacy. Vignettes are a novel way to reveal sites of racism to create teachable moments and spark reflective practice and more active engagement in anti-racism interventions. When systematically analysed vignettes can be utilised to inform and refine anti-racist interventions. Being able to identify racism is essential to being able to effectively counter racism.Item Survival disparities in indigenous and non-indigenous New Zealanders with colon cancer: The role of patient comorbidity, treatment and health service factors(BMJ Publishing Group Ltd, 2010) Hill S; Sarfati D; Blakely T; Robson B; Purdie G; Chen J; Dennett E; Cormack D; Cunningham R; Dew K; McCreanor T; Kawachi IBackground Ethnic disparities in cancer survival have been documented in many populations and cancer types. The causes of these inequalities are not well understood but may include disease and patient characteristics, treatment differences and health service factors. Survival was compared in a cohort of Maori (Indigenous) and non-Maori New Zealanders with colon cancer, and the contribution of demographics, disease characteristics, patient comorbidity, treatment and healthcare factors to survival disparities was assessed. Methods Maori patients diagnosed as having colon cancer between 1996 and 2003 were identified from the New Zealand Cancer Registry and compared with a randomly selected sample of non-Maori patients. Clinical and outcome data were obtained from medical records, pathology reports and the national mortality database. Cancer-specific survival was examined using Kaplan�Meier survival curves and Cox hazards modelling with multivariable adjustment. Results 301 Maori and 328 non-Maori patients with colon cancer were compared. Maori had a significantly poorer cancer survival than non-Maori (hazard ratio (HR)=1.33, 95% CI 1.03 to 1.71) that was not explained by demographic or disease characteristics. The most important factors contributing to poorer survival in Maori were patient comorbidity and markers of healthcare access, each of which accounted for around a third of the survival disparity. The final model accounted for almost all the survival disparity between Maori and non-Maori patients (HR=1.07, 95% CI 0.77 to 1.47).Item Tauiwi general practitioners explanations of Maori health: Colonial relations in primary healthcare in Aotearoa/New Zealand?(SAGE Publications, 2002) McCreanor T; Nairn RThis article reports initial findings from qualitative research investigating how general practitioners talk about Maori health. Transcripts of semistructured interviews with 25 general practitioners from urban Auckland were subjected to critical discursive analyses. Through this process of intensive, analytic reading, interpretative repertoires—patterns of words and images about a particular topic—were identified. This article presents the main features of one such repertoire, termed Maori Morbidity, that the general practitioners used in accounting for poor Maori health status. Our participants were drawing upon a circumscribed pool of ideas and explaining the inequalities in health between Maori and Tauiwi in ways that gave primacy to characteristics of Maori and their culture. We discuss the implications of this conclusion for relations between Maori patients and Tauiwi doctors in primary healthcare settings.