Te tini roto, te tini ora : health promotion : purchasing health gains for Maori : a thesis submitted in fulfilment of the requirements for the degree of Masters of Philosophy in Maori Studies at Massey University
The health reforms of the 1990's were in part implemented to develop a more effective, efficient and responsive health system. The reforms were to see major changes introduced into public sector management with a growing emphasis on accountability and responsibility. Competition at all levels of the health sector was to produce more effective purchasing of services, better delivery, and quality health services. More proactive emphasis was to be placed on the Governments goal for Maori health to achieve more equitable health standards for Maori. The reforms saw a greater emphasis being placed on public health strategies including health promotion as an effective means to prevent poor health outcomes, thus improving standards of health including those for Maori. The primary focus of this thesis is an evaluation of the health sectors ability to effect positive changes in Maori health outcomes. Health promotion activities implemented by mainstream public health units are used as a focus point, and to provide some useful detail around the relevant issues. The view presented is that health promotion as an approach at both a provider and policy level - when implemented following effective principles of community development - provides a useful framework for progressing better health outcomes for Maori. The main finding of this study is that health promotion has potential for improving Maori health but needs to focus more on actual outcomes, and community development, with greater local control over priorities.