Journal Articles
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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 Māori food culture and wellbeing on TikTok: a content and thematic analysis(Taylor and Francis Group, 2024-12-17) Renall N; Te Morenga LWe examined content posted on TikTok on the topic of kai Māori (traditional food and associated customs of the indigenous people of Aotearoa New Zealand) to inform strengths-based approaches to health promotion in Māori communities. We conducted a content analysis of 100 unique TikTok videos labelled with the hashtags #kai and #Maori and coded content characteristics and viewer engagement for each video. Twenty foods were determined to be key Māori identity foods from this analysis. We also undertook a reflexive thematic analysis of the content of all videos and user engagement from a sample of 40 videos. Three themes relating to the value of kai Māori were identified: Mauri ora (kai as an expression of pride in Māori identity), Ahikā kai (a means of keeping traditions alive) and Tūhononga (a means of connecting with Te Ao Māori). Māori used TikTok to celebrate Māori identity by sharing and discussing content about kai Māori that was informative and often humorous or self-deprecating. Health promotion in Māori communities should draw on the values of kai as more than food. Kai has an important role in strengthening wellbeing through facilitating cultural connections and linking healthy lifestyles with traditional practices like collecting seafood. Glossary of Māori words: Ahikā kai: keeping Māori traditions alive; Ahuriri: Napier, Aotearoa New Zealand; Aotearoa NZ: Aotearoa New Zealand; aroha: love; atua: deity, ancestor; ehe: e hē: an expression of no in Ngāi Tūhoe Iwi [tribe] dialect; hāngī: food cooked in an earth steam oven or gas steamer; he kai reka tenei: this food is yum or sweet; he tīno reka: very yummy; he reka: yum, sweet; huhu: huhu grub, Prionoplus reticularis; kai: food; kai Māori: traditional food and associated customs; kaimoana: food from the sea including fish and shellfish; kaitiaki: custodians, guardians; kānga wai/ kānga pirau: fermented ‘rotten’ corn; kamokamo: squash, vegetable marrow; kao: no; karakia: blessing, giving thanks; kare: an endearment; karengo /parengo: seaweed; kaupapa Māori: a Māori approach, Māori philosophy and principles guide practice; kia ora: hello, greetings, thank you; kina: sea urchin; koro:grandfather; kumara: sweet potato; kupu: word; kūtai: mussels; inanga: whitebait; mahinga kai: traditional food gathering place; mana whenua: Māori people who have customary authority and rights over identified land; manaakitanga: the act of showing support, caring for others; Māoritanga: Māori culture, way of life; mātua: parents; marae: a place of cultural significance to gather and meet; mauri: spirit, life essence; mauri ora: strong pride in having a unique Māori identity; meke: too much, good; mirimiri: to rub; moana: ocean; Ngāpuhi: northern iwi [tribe] of Aotearoa; noa: ordinary, unrestricted; ora: to be alive, healthy and well; Pākehā: New Zealanders of European descent; paraoa: fry bread; patu: traditional club used in warfare; paua: abalone; pikopiko: young fern shoots; pipi: shellfish, clam; puha: a sow thistle green; Rakiura: Stewart Island; rangatahi: Māori youth; rawe: excellent; reka: sweet; rēwana: fermented bread made with potato; Tā: Sir, Knight; tamariki Māori: Māori children; Tangaroa: the Māori atua (god) for the oceans; tapu: restricted, to be sacred, under atua protection; tautoko: show support; Te Ao Māori: the Māori world and its traditions; te taiao: the natural world; Te Whare Tapa Whā: a model of Māori health developed by Tā Professor Mason Durie; tēnā koe: greetings (speaking to an individual); tikanga: traditional customs or practices; tinana: body, physical self; tino reka: an expression of deliciousness; tino reka te kai: the kai is yum; tītī: mutton bird Puffinus griseus; toa: brave, accomplished, competent; toheroa: large clam;f toroi / whakamara: a fermented dish of cooked mussels and puha; tuatua: shellfish, clam; tūhononga: connecting with Te Ao Māori; tuna: eel; tūpuna / tīpuna: ancestors, grandparents; wahine: woman; Whaea: Mother, Aunty; whakaiti: look down on; whakapapa: lineage, genealogy, ancestry; a central concept in Māori culture of identity, relation and connection to people, place, and culture; whānau: family group, including extended family; whanaunga: relative, kin; whanaungatanga: relationship building; whenua: land, ground.Item Kei te moe te tinana, kei te oho te wairua–As the body sleeps, the spirit awakens: exploring the spiritual experiences of contemporary Māori associated with sleep(Informa UK Limited, trading as Taylor & Francis Group, 2024-08-13) Haami D; Gibson R; Lindsay N; Tassell-Matamua NFor Aotearoa New Zealand Māori, sleep and wairua (spirit) are closely intertwined. During sleep the wairua awakens and journeys across multiple dimensions of time and space to attain the tools and knowledge the individual needs to navigate waking life. While this function of sleep is understood within Mātauranga Māori (bodies of knowledge regarding everything within the universe) (Hikuroa D. 2017. Mātauranga Māori—the ūkaipō of knowledge in New Zealand. Journal of the Royal Society of New Zealand. 47(1):5–10.), it has yet to be explored within psychological sleep research. This qualitative study contributes to addressing this gap by exploring nine Māori participants’ personal experiences of wairua during sleep. A whakapapa thematic analysis identified two interconnected layers. The first layer contributed to a spiritual explanatory framework for sleep, developed to encompass participants’ beliefs regarding wairua, which were utilised to interpret their sleep experiences. The second layer describes these interpretations, comprised of three central themes: (1) Tohu/Guidance; (2) Ako/Space and time for learning; and (3) Tau/Attaining a state of stability, peace, and purpose. These findings suggest that the spiritual experience of sleep supported participants in navigating their waking lives safely, purposefully, and meaningfully, contributing to Indigenous and Māori scholarship regarding the spiritual and cultural purpose of sleep, and with important implications for clinical, social, and academic approaches to understanding and supporting sleep.Item Sleep as a social and cultural practice in Aotearoa: a scoping review(Taylor and Francis Group, 2024-09-22) Ross I; Signal L; Tassell-Matamua N; Meadows R; Gibson RTraditionally, sleep science is grounded in biology, physiology, and medicine. But socio-cultural considerations provide a crucial lens into sleep health. Exploring the sociology of sleep in Aotearoa New Zealand (AoNZ) could broaden our understandings and better represent sleep-related practices among our diverse communities. This scoping review represents the pre-existing literature concerning sleep as a social or cultural practice in AoNZ. The initial search (via Discover and Scopus) search yielded 2,442 results. Of these results, 113 manuscripts were characterised of interest, but only 20 were directly related and included in the review. This literature was presented in relation to Meadows’ (2005) modes of ‘sleep embodiment’ including sleep practice norms, the pragmatics of sleep and social roles, individual experiences and feelings related to sleep, and the visceral need for sleep. The findings highlight the progress of sleep literature in AoNZ. This covers diverse sleep practices, perspectives and experiences of sleep and sleeping, as well as the broader socio-cultural factors and unique AoNZ context that influence sleep. However, gaps in the field of local sleep research are also identified. Findings lay the foundation for further research in AoNZ to explore sleep-related discourses and practices that will ultimately broaden existing perspectives.Item Perception is reality: qualitative insights into how consumers perceive alcohol warning labels(Oxford University Press on behalf of the Medical Council on Alcohol, 2024-09) Kemper J; Rolleston A; Matthews K; Garner K; Lang B; Jiang Y; Ni Mhurchu C; Walker NAIMS: This study explores perspectives of on-pack alcohol warning labels, and how they might influence alcohol purchase and/or consumption behavior to inform culturally appropriate label design for effective behavior change. METHODS: New Zealand participants ≥18 years, who reported having purchased and consumed alcoholic beverages in the last month were recruited via a market research panel and grouped into 10 focus groups (n = 53) by ethnicity (general population, Māori, and Pacific peoples), age group, and level of alcohol consumption. Participants were shown six potential alcohol health warning labels, with design informed by relevant literature, label framework, and stakeholder feedback. Interviews were transcribed and analyzed via qualitative (directed) content analysis. RESULTS: Effective alcohol labels should be prominent, featuring large red and/or black text with a red border, combining text with visuals, and words like "WARNING" in capitals. Labels should contrast with bottle color, be easily understood, and avoid excessive text and confusing imagery. Participants preferred specific health outcomes, such as heart disease and cancer, increasing message urgency and relevance. Anticipated behavior change included reduced drinking and increased awareness of harms, but some may attempt to mitigate warnings by covering or removing labels. Contextual factors, including consistent design and targeted labels for different beverages and populations, are crucial. There was a strong emphasis on collective health impacts, particularly among Māori and Pacific participants. CONCLUSIONS: Our findings indicate that implementing alcohol warning labels, combined with comprehensive strategies like retail and social marketing campaigns, could effectively inform and influence the behavior of New Zealand's varied drinkers.Item Nurses' work in relation to patient health outcomes: an observational study comparing models of primary care.(BioMed Central Ltd, 2024-10-04) Sheridan N; Hoare K; Carryer J; Mills J; Hewitt S; Love T; Kenealy T; Primary Care Models Study GroupBACKGROUND: Māori are over-represented in Aotearoa New Zealand morbidity and mortality statistics. Other populations with high health needs include Pacific peoples and those living with material deprivation. General practice has evolved into seven models of primary care: Traditional, Corporate, Health Care Home, Māori, Pacific, Trusts / Non-governmental organisations (Trust/NGOs) and District Health Board / Primary Care Organisations (DHB/PHO). We describe nurse work in relation to these models of care, populations with high health need and patient health outcomes. METHODS: We conducted a cross-sectional study (at 30 September 2018) of data from national datasets and practices at patient level. Six primary outcome measures were selected because they could be improved by primary care: polypharmacy (≥ 65 years), glucose control testing in adults with diabetes, immunisations (at 6 months), ambulatory sensitive hospitalisations (0-14, 45-64 years) and emergency department attendances. Analysis adjusted for patient and practice characteristics. RESULTS: Nurse clinical time, and combined nurse, nurse practitioner and general practitioner clinical time, were substantially higher in Trust/NGO, Māori, and Pacific practices than in other models. Increased patient clinical complexity was associated with more clinical input and higher scores on all outcome measures. The highest rates of preventative care by nurses (cervical screening, cardiovascular risk assessment, depression screening, glucose control testing) were in Māori, Trust/NGO and Pacific practices. There was an eightfold difference, across models of care, in percentage of depression screening undertaken by nurses and a fivefold difference in cervical screening and glucose control testing. The highest rates of nurse consultations afterhours and with unenrolled patients, improving access, were in PHO/DHB, Pacific, Trust/NGO and Māori practices. Work not attributed to nurses in the practice records meant nurse work was underestimated to an unknown degree. CONCLUSIONS: Transferring work to nurses in Traditional, Health Care Home, and Corporate practices, would release general practitioner clinical time for other work. Worse patient health outcomes were associated with higher patient need and higher clinical input. It is plausible that there is insufficient clinical input to meet the degree of patient need. More practitioner clinical time is required, especially in practices with high volumes of complex patients.Item Germline CDH1 mutations are a significant contributor to the high frequency of early-onset diffuse gastric cancer cases in New Zealand Māori.(Springer Nature, 2018-03-27) Hakkaart C; Ellison-Loschmann L; Day R; Sporle A; Koea J; Harawira P; Cheng S; Gray M; Whaanga T; Pearce N; Guilford PNew Zealand Māori have a considerably higher incidence of gastric cancer compared to non-Māori, and are one of the few populations worldwide with a higher prevalence of diffuse-type disease. Pathogenic germline CDH1 mutations are causative of hereditary diffuse gastric cancer, a cancer predisposition syndrome primarily characterised by an extreme lifetime risk of developing diffuse gastric cancer. Pathogenic CDH1 mutations are well described in Māori families in New Zealand. However, the contribution of these mutations to the high incidence of gastric cancer is unknown. We have used next-generation sequencing, Sanger sequencing, and Multiplex Ligation-dependent Probe Amplification to examine germline CDH1 in an unselected series of 94 Māori gastric cancer patients and 200 healthy matched controls. Overall, 18% of all cases, 34% of cases diagnosed with diffuse-type gastric cancer, and 67% of cases diagnosed aged less than 45 years carried pathogenic CDH1 mutations. After adjusting for the effect of screening known HDGC families, we estimate that 6% of all advanced gastric cancers and 13% of all advanced diffuse-type gastric cancers would carry germline CDH1 mutations. Our results demonstrate that germline CDH1 mutations are a significant contributor to the high frequency of diffuse gastric cancer in New Zealand Māori.Item Estimating the alcohol-related burden of child maltreatment among Māori in Aotearoa, New Zealand.(John Wiley and Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs, 2024-07-21) Huckle T; Barnes HM; Romeo JSIntroduction To assesses the alcohol-related burden of child maltreatment among Māori in Aotearoa New Zealand. We compared the risk of child maltreatment among Māori (0–17 years) exposed to parents with alcohol-related hospitalisation or mental health/addiction service use. We also conducted a sensitivity analysis to estimate the number of cases of maltreatment that could be attributed to alcohol among Māori. Methods A cohort study of 16,617 Māori aged 0–17 and their parents from 2000 to 2017 was conducted using the Statistics New Zealand Integrated Data Infrastructure. A Bayesian piecewise exponential model estimated the risk of time to first child maltreatment event. This analysis used data from child protection, hospital, mortality and police records, and specifically focused on the risk associated with exposure to parents with an alcohol-attributable hospitalisation or mental health/addiction service use event. Potential confounders for both parents and Māori (0–17 years) were included. We calculated a population-attributable fraction to estimate the proportion of maltreatment cases that could be attributed to alcohol in 2017. Results Results showed a 65% increased risk for young Māori exposed to parents with heavy alcohol use. We estimated 17% of substantiated child maltreatment among Māori could be attributed to parental hazardous alcohol consumption. Discussion and Conclusions Severe or hazardous alcohol consumption among parents is a risk factor for child maltreatment among Māori. Māori alcohol consumption and harm are symptomatic of wider inequities related, among other things, to the ongoing effects of colonisation, as well as gaps in the regulation of alcohol sales.Item An intersectional analysis of Aotearoa New Zealand journalists' online and offline experiences of abuse, threats and violence(Taylor and Francis Group, 2024-01-16) Fountaine S; Strong CCriticism towards journalists has increased significantly since the internet created easy and anonymous communication and has turned more abusive and threatening in recent years, becoming a regular feature of journalists’ work environment, particularly for women. This article presents survey data about the amount and nature of online and offline abuse, threats and violence experienced by journalists at Aotearoa New Zealand's largest news media company, Stuff. All respondents had experienced abuse, violence and/or threats, which they widely considered to be part of the job, but women received more identity and appearance-based abuse and men experienced more in-person threats of, and actual violence. Gender plays a part in how the journalists cope with the abrasive abuse received because of their job, with many more women and particularly Māori women considering leaving the profession. In line with calls for more intersectional analysis of journalists’ workplace experiences, our study considers the complex and nuanced ways that ethnicity intersects with gender to shape Māori and Pākehā journalists’ encounters with abuse, threats and violence. For instance, our subset of Māori women journalists experienced the highest rates of offline threats and violence.