Māopoopo : a socio-cultural and collective understanding to improve wellbeing amongst Pacific people in Aotearoa/New Zealand : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Public Health at Massey University, Wellington, New Zealand

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The Aotearoa/New Zealand (NZ) healthcare system, has, like many other colonising ‘Western’ societies, placed a strong emphasis on biomedical models and the physical aspects of ‘disease’. Yet, it is the more encompassing and holistic worldviews of wellbeing that historically and currently resonate most strongly with Indigenous peoples. As a South Pacific country, there are many Pacific peoples who now live in Aotearoa/NZ with multiple generations having migrated from their island homelands over a period of some 80 years. However, there are significant health inequities among Pacific peoples compared with other ethnic groups in Aotearoa that have been ongoing for decades – notably those conditions related to non-communicable disease. This thesis explores the socio-cultural and historical perspectives of Pacific peoples in order to expand understanding about how they view health and wellbeing, an area about which relatively little is known. These understandings have the potential to lead to improved service delivery models and contribute to better health outcomes for Pacific peoples in Aotearoa/NZ. The overall objective of the study is to identify and articulate the values and principles that promote and enable Pacific peoples’ wellbeing and health in Aotearoa/NZ. The aims of the study are to: • draw on Tokelau knowledge of the cultural, historical, and social environment to better understand the influences on Pacific health and wellbeing • examine strategies of health empowerment and wellbeing among Pacific youth, and • examine service delivery models that can lead to improved Pacific health outcomes. The Tokelau worldview of māopoopo was used as an overall principle to inform all phases of this study. Conceptually, māopoopo serves as a cultural connector with people, a motivator of action, and informs principles that guide behaviour in practice. Māopoopo as a practice in action is to restore peace and wholeness and to inform future thinking (lumanaki), which includes an inseparable relationship with te fenua (land) e laga kita ko te fenua (to be determined to look after the land). Māopoopo as a metaphysical state is described in relation to levels of the individual (te tino), the family (Kāiga), the village (te Nuku). Semi-structured interviews and focus groups were carried out with a total of 37 participants including Tokelau elders, Tokelau community leaders, Tokelau adults, Pacific youth, and Pacific health and policy workers between July 2016 and January 2017. The data were analysed using thematic analysis and the emergent themes applied in relation to māopoopo. There were seven key themes identified from this research. The first theme, kāiga (family), was interrelated with the values of loto alofa (kindness), fai kāiga (family orientated), fakaaloalo (respect), loto maualalo (humility), and loto fehoahoani (helping others). The second theme, duty of care (tiute tautua), related to traditional knowledge and the intergenerational transfer of that knowledge, particularly in relation to culture, land, and language. Maintaining family relationships (loto fai kāiga) was the third identified theme and fundamentally underpins and is interrelated with all the first five themes identified. The fourth theme, interconnectedness (fehokotakiga), highlights the breadth of relationships between people and understandings of interdependence as opposed to independence. The fifth theme, spirituality (olaga faka-te-agaga), recognizes the centrality of the church in Pacific communities. Health advocacy was the sixth key theme with the final key theme being the impact of inequities on Pacific wellbeing. This thesis identifies Māopoopo as being an inclusive research approach that can have benefits for Pacific peoples while also having the potential to be developed within health policies to facilitate focus on collective action through effective cross-government and intersectoral approaches. In this way, it could be utilized to ensure effective approaches to collaboration between the health care system and the social, housing, employment, and education sectors. This work highlights the value and utility of applying Pacific understandings of wellbeing to support and empower communities through their active inclusion from the design through to the implementation of services. There is a great need for increased reciprocity in the relationships between government agencies and Pacific communities. There was recognition of the need for the application of cultural practices and concepts into service delivery for Pacific peoples, such as provision of on-site bilingual health workers, and it is therefore imperative that core health delivery services are brought closer into alignment with the realities of Pacific communities, for example, through active engagement with churches. There are significant gaps in health services for Pacific youth. This population group are an energetic group and, most importantly, the fastest growing population in Aotearoa. This current generation plays a significant role in terms of health advocacy, thus, to ensure relevant and effective impact within communities, they must be central players and key informers in the development of any interventions/strategies focussed on Pacific health and wellbeing. Further studies may well be useful to scope or investigate the healthcare services available for Pacific youth. Associated with the position and role of youth within Pacific communities, is the largely untapped potential to utilise the unique skills and knowledge available through intergenerational approaches where the grandparents are the educators in terms of the passing on of cultural knowledge and values. Health services can be made aware of this important pathway by which knowledge is transferred and of the critical role grandchildren could have to change their grandparents’ attitudes towards health.
Pacific Islanders, Tokelauans, Health and hygiene, Social life and customs, Public health, Well-being, New Zealand