Achieving equitable outcomes in communicable disease management

The National Public Health Service uses the Ministry of Health’s definition of equity (external link):

"In Aotearoa New Zealand, people have differences in health that are not only avoidable but unfair and unjust. Equity recognises different people with different levels of advantage require different approaches and resources to get equitable health outcomes."

To achieve equitable outcomes in our mahi, John Whaanga, Deputy Director-General, Māori Health, states: “the first thing is to understand that inequities exist… Secondly, I think it is to look at our own practice to say, can we do better?”

(Video available on Youtube | Ministry of Health.) (external link)

This invites us to examine what we believe we know and to reflect on this personally, while the whakataukī (Māori proverb) above reminds us of how we can engage with heart in the communities we serve.

This chapter lays out:

• the systemic practices and processes that have led to different levels of advantage for different populations in communicable disease management
• examples of considerations for these populations to assist with rectifying this disparity
• actions that work towards achieving equitable outcomes in communicable disease management.

Manaakitanga — at the heart of what we do

In communicable disease management, we bring wairuatanga (spirituality) to our mahi by working with heart. Manaakitanga refers to practicing kindness, generosity, respect and care for others. The responsibility to protect and care for people with aroha (compassion) is embedded within the practice of manaakitanga. Practicing and enabling manaakitanga requires trusted relationships to be established with whānau Māori and all communities by assisting them to access the best possible solutions and outcomes for themselves [1].

Traditionally, case interviews have focused on the clinical pathways of a disease. In communicable disease management, applying manaakitanga involves prioritising the wellbeing, dignity, and rights of individuals and communities above all else.

In communicable disease management, whānau cases and contacts need to feel comfortable and at ease when having conversations about their health and experiences. To do this, our conversations must shift from ‘what is the matter?’ to ‘what matters?’

For more information on applying manaaki in communicable disease management, refer to Tū Kōkiritia: advancing hauora in the management of communicable diseases preliminary chapter.

To deliver equitable health outcomes in communicable disease management, public health resources and support must be prioritised for groups most adversely impacted by each disease. Figure 1 depicts the key populations and groups that are most adversely affected by the current health system.

Impacts include historical and ongoing mistreatment under the medical model and distrust of the medical profession, institutional and systemic racism and/or discrimination and the ongoing impact of colonisation.

This guidance is for use by public health services to prioritise resources and support local activities to inform pro-equity and te Tiriti o Waitangi-based decision making. Further information on the disparities experienced by these populations and considerations to assist with rectifying this in communicable disease management is provided below.

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The right to equitable health for Māori is guaranteed in te Tiriti o Waitangi (te Tiriti). To provide a framework and pathway to achieving equitable Māori health outcomes, the Waitangi Tribunal [2] has recommended 5 principles of te Tiriti – tino rangatiratanga, equity, active protection, options and partnership [3,4]. To support the Crown partnership in te Tiriti, the National Public Health Service (NPHS) has a responsibility to achieve equity for Māori.

For more information on te Tiriti and Māori health within the context of communicable disease management, refer to Tū Kōkiritia: advancing hauora in the management of communicable diseases preliminary chapter.

The impact of colonisation has been profound and resulted in the loss of many cultural protective factors for Māori [5,6,7,8]. Māori experience higher rates of infectious diseases than other New Zealanders [9], and do not receive equitable health care in proportion to their needs. Equity and active protection are conditions vital to achieving health equity, and are central to the response to Māori whānau (family), hapū (sub-tribe) and iwi (tribe) who have been in contact with others who have a serious communicable disease. 

Pae Tū: Hauora Māori Strategy (external link) provides public health kaimahi with a framework on how to uphold te Tiriti and achieve Māori health equity. In communicable disease management, this might look like:

• reconfirming with Māori their ethnicity to ensure the public health service is collecting accurate data, providing tailored support to whānau Māori needs and preferences and monitoring Māori health outcomes
• asking cases and contacts if they would like to have a member of their whānau present during conversations 
• providing interpretation and translation services and translated information – this is essential when working in partnership with kaupapa Māori settings such as kohanga reo and kura kaupapa 
• ensuring all public health kaimahi have cultural capabilities to be able to engage with Māori whānau
• working in partnership with hauora Māori partners to design and deliver public health action that is culturally sensitive, such as stool sample testing
• asking whānau Māori cases and contacts if they want the public health service to contact iwi or a local hauora Māori provider, where available 
• ensure the fast dissemination of information to local iwi, hapū and hāpori (communities) by notifying local marae, church, sport groups and kura where appropriate, and working in partnership to help inform the public of health risks and requirements around a communicable disease
• engaging with Hauora Māori Tūmatanui regional and local leads within the NPHS.

Pacific peoples is a collective term used in Aotearoa New Zealand to acknowledge the diverse nationalities, ethnic groups, and languages of people from the Pacific Islands. However, Pacific peoples as a group are notably more susceptible to communicable diseases [10,11,12].

As public health kaimahi, we are guided by Te Mana Ola: The Pacific Health Strategy (external link) and Ola Manuia: Pacific Health and Wellbeing Action Plan 2020-2025 (external link) to achieve better health outcomes for Pacific peoples. To accomplish this, we must begin by acknowledging the diversity of Pacific communities and the cultural factors that are essential in managing communicable diseases. For example, this might look like:  

• developing culturally appropriate health education materials in multiple Pacific languages to ensure effective communication and understanding
• ensuring all public health kaimahi have cultural capabilities to be able to engage with Pacific aiga (family) and work with local pacific kaimahi for advice and guidance where needed
• providing culturally sensitive healthcare that respects Pacific traditions. Ensuring public health actions are appropriate through community consultation on language, practices, values and beliefs
• engaging with Pacific community leaders and influencers within church, sports clubs and other Pacific communities to promote health initiatives and encourage participation in preventative measures.

Tāngata whaikaha | disabled people make up nearly a fifth of New Zealanders [13]. They belong to (or ‘intersect’ with) all age, ethnic and cultural groups, gender identities, sexualities, localities, socio-economic groups and every whānau and community. However, there is a lack of data on disability in the health system, which makes identifying tāngata whaikaha | disabled people difficult, impacting their access to health services.

Tāngata whaikaha | disabled people in Aotearoa New Zealand experience a wide range of inequities when accessing health services and poorer health outcomes compared to non-disabled people. In order to address these inequities, the Health of Disabled People Strategy (external link) sets out 5 key priorities. These align with the principles set out in Te Pae Tata Interim New Zealand Health Plan 2022 (external link) and by Enabling Good Lives (external link).    

Public health kaimahi should consider how best to support disabled cases, contacts and whānau when managing communicable diseases. This may include, for example:

• asking if the case or contact may need accommodations made for access to services
• providing information in alternate formats where appropriate 
• providing options to enable tāngata whaikaha | disabled people and their whānau to choose a model of care that suits their needs
• including disability perspectives in communicable disease management, including outbreak responses, to ensure equitable access and effectiveness for the disability community (as per the NPHS Disability Work Programme (external link))
• asking if a case or contact would like a relative or friend present during conversations 
• using NZ Relay (external link)/interpretation and translation services where appropriate
• other health or disability needs and how the individual’s daily routine may be impacted by public health action 
• how diseases can impact different disabilities in different ways.

Women spend more years in poor health than men and continue to experience gender bias and discrimination in the health system [14]. Women are more likely to be carers, to be sole parents, and to have a low income, all of which can contribute to poorer health outcomes. Inequities and challenges are bigger for many groups of women who intersect with other priority populations, including wāhine Māori, Pacific women, rural women, and disabled women [14].

Women may also experience differences in symptoms, severity of disease and secondary ramifications. There are also increased clinical risks for pre- and post-natal women for various diseases [14].

The Women’s Health Strategy (external link) sets long-term priorities to progress the health system towards equity and healthy futures for women. To achieve equity for women in communicable disease management, consideration should be given to, for example:

• making accommodations for carers or sole parents and the impact public health action will have on them and those they care for
• engaging with maternity kaimahi to manage the clinical risks for women in their care
• working with local communities as well as individuals to actively listen and acknowledge without judgement any concerns about vaccination, especially for pregnant women and young mothers
• finding support services that are accessible (i.e. operate outside of usual working hours or can be accessed virtually).

One fifth of New Zealanders and a quarter of Māori live in rural areas [15]. Compared to urban populations, people living rurally (particularly Māori, Pacific peoples and those on lower incomes) face inequitable access to care [16]. There are also inequities in health outcomes, with Māori more likely to reside in rural areas and have higher health needs, along with tāngata whaikaha | disabled people who live rurally [16].

During the COVID-19 pandemic, rural communities faced different challenges to urban Aotearoa New Zealand. The diversity within rural communities also resulted in different parts of rural communities being affected differently [17]. The COVID-19 response highlighted the strong social networks and sense of responsibility for collective wellbeing that characterise rural communities [18].

The large rural Māori population also meant that rural issues were disproportionately Māori issues, which generated a uniquely Māori response to some of the pandemic’s challenges [18]. Kaupapa Māori approaches that focused on supporting all whānau needs were highly valued when reaching people and getting them vaccinated. For more information on enabling kaupapa Māori approaches, refer to Tū Kōkiritia: advancing hauora in the management of communicable diseases preliminary chapter.

The Rural Health Strategy 2023 (external link) builds on what was learnt during the COVID-19 pandemic and sets long-term direction for improving the health of rural communities. In communicable disease management, kaimahi should consider:

• the impact of rural location on access to services and support 
• supporting individuals to access services at a distance​, where possible (e.g. using digital technology)
• finding services closest to home for cases or contacts, where possible 
• working in partnership with their rural communities, especially iwi, hapū and Māori to design and deliver rural health services. 

The term ‘Rainbow’ encompasses all people who identify as diverse gender, sex, or sexuality, whatever that looks like for them. Rainbow communities make up over 4% of Aotearoa New Zealand’s adult population [19]. It is therefore important that equity for Rainbow communities recognises the diversity of gender and sexual minority communities that may require different approaches and considerations.

For example, transgender and non-binary people are less likely to seek healthcare through concern they will be disrespected or mistreated [20,21]. Men who have sex with men are at greater risk of communicable diseases such as mpox, hepatitis B and human immunodeficiency virus (HIV) due to the mode of transmission for these diseases. More information on which communities are at greater risk of a particular communicable disease can be found in the relevant disease chapter under ‘At risk and priority populations’.

To achieve equity for our Rainbow communities, we must start by recognising the diversity of Rainbow communities and cultural factors that must be considered in communicable disease management. For example, this might look like:

• using gender-neutral language and asking individuals for their pronouns at the beginning of a conversation
• the potential impact of cultural, social, work or home factors on someone’s ability or willingness to provide information and/or follow public health advice, especially for sexually transmitted infections or diseases spread through sexual contact (e.g.  mpox)
• being respectful and aware that a person’s name, gender, sex or other identifying information may vary from that on their National Health Index (e.g. for transgender or gender diverse people)
• considering an individual’s past experience with the healthcare system and how this might have implications for how they respond to public health interventions. 

Ethnic groups such as Asian and Middle Eastern, Latin American and African (MELAA) communities are very diverse in terms of settlement history, health belief, health behaviour and needs, health literacy, digital literacy, faith/religion, living arrangements, culture, and English language capability.

They are amongst the fastest growing population groups in Aotearoa New Zealand, making up over 19% of the total population [22]. Yet these populations continue to be underserved by the health system, despite decades of effort to address inequities [23]. Historically, access to healthcare has been complicated due to financial, geographical, cultural or digital barriers [23].

Considerations for these populations in communicable disease management might look like: 

• recognising the cultural diversity among varying ethnic groups, including beliefs, practices and values and how this might impact how an individual interacts with the healthcare system. For example, some women may feel more comfortable with female health practitioners, some may prefer to be chaperoned, and some may feel shame or secrecy around seeing a healthcare professional 
• ensuring that interpretation and translation services are available and accessible 
• offering additional support and advice from local community providers, where available
• understanding the mistrust of medical practice (especially of immunisation) in some communities propagated by dis/misinformation and ways of counteracting this.

Aotearoa New Zealand welcomes 1,500 refugees a year [24]. Whilst all refugees and asylum seekers via the refugee quota system are offered initial health screening and medical assessments, others (e.g. refugees on the family reunification scheme and Ukrainian refugees) have different pathways, with reduced (sometimes voluntary) screening requirements, and additional barriers regarding payment. Furthermore, experiences of access to healthcare services and support differ greatly once refugees are living in Aotearoa New Zealand. In some locations, refugees will receive 10 years of healthcare coverage, whereas in other locations, this may be as little as 6 months.

Relatives of refugees and asylum seekers and refugees who use other visa categories (such as temporary work or visitor visas) are not eligible for resettlement support. Additionally, refugees on temporary visas for less than 2 years do not have access to funded healthcare.

In communicable disease management, consideration should be given to: 

• the variation in access to healthcare services and support and the implications this will have had on an individual’s health and relationship with the healthcare system
• ensuring that interpretation and translation services are available and accessible 
• possible trauma and/or mental health conditions experienced by refugees and asylum seekers, and the impact public health action may have on them
• recognising different cultural beliefs, practices and values and how this may impact on how refugees or asylum seekers expect to engage with public health kaimahi
• offering additional support and advice from local community providers where available.

Age often defines an individual’s clinical risk of severe disease. For example, babies and children aged under 5 years are at far greater clinical risk of severe disease from measles, whereas elderly people are at far greater clinical risk of severe disease from COVID-19.

However, age may also impact public health risk based on the settings an individual lives, works or plays. For example, older people living in age residential care facilities may be at greater risk due to their inability to isolate from others within the same building or children who attend early childhood education settings or kura may be at greater risk due to their regular close contact with other children.

Communal living is more commonplace in Māori and Pacific households, with often multiple generations living under one roof. Whilst this places all residents at higher risk of contracting a disease, this risk is compounded for pēpi (babies), tamariki (children) and older people who are also at clinical risk of severe disease, resulting in higher risk of poor outcomes. Having more people under one roof also increases living costs for the household which can lead to higher levels of deprivation and over-crowding, further increasing risk for younger and older occupants.

Those who live on their own may also be at greater risk, especially older people who may not have access to digital technology or a carer.

To improve equity in communicable disease management for our younger and older populations, consideration should be given to, for example:

• an individual’s living arrangements and routine and what implications it may have on their ability to follow public health action
• what care or support an individual may be receiving or providing and how this can be received or provided safely
• asking if they would like to have a member of their whānau present during conversations.

Socioeconomic deprivation often intersects with many of the populations described above (as reflected in Figure 1: Communicable Disease and Priority Populations), but can also be an independent risk factor in communicable disease management. Consideration should be given to how a case or contact’s socioeconomic circumstances may impact:

• their ability to isolate, quarantine or restrict contact with others. For example, if they are on a zero-hour contract, they will not receive income for the days they are away from work or if they provide unpaid care to a child, relative or friend, there will be implications for the receiver of that care
• the household they are living in. Individuals experiencing socioeconomic deprivation may be living in multi-generational homes or in a shared housing arrangement, increasing the risk of contracting a disease for all occupants
• their access to a general practitioner, which may prevent them from getting tested and treated for a disease. 

Other priority populations in communicable disease management might include populations who do not usually engage with the health system (e.g. gangs, people moving through the justice system, people in transitional housing, people who are not enrolled with a general practitioner, and people with low health literacy).

Approaches will look different for different populations and in different contexts (e.g. for socioeconomically deprived communities or for immigrant communities). Whilst this chapter provides information on some populations and the systemic practices and processes that have led to different levels of advantage for different populations in communicable disease management, this is not meant as an exhaustive list. Instead, kaimahi should use the information and examples provided to gain a better understanding of the issues our communities face and how a more equitable approach could achieve better health outcomes for them.

Whilst specific groups are detailed as priority populations in this chapter, it is important to recognise that individuals are likely to identify with more than one community or group. Intersectionality recognises that an individual’s identity is multi-layered. Some people may experience many forms of discrimination or mistreatment under the medical model. Likewise, others may experience multiple advantages due to the way the health system is currently structured and functions for their needs. Through considering how each thread of an individual’s identity intertwines, we can tailor our service to deliver the best outcomes for that individual. 

To see intersectionality across all populations, refer to Figure 1: Communicable Disease and Priority Populations guidance. For disease specific priority populations, refer to disease chapters. For further guidance on understanding intersectionality in communicable disease management, refer to Equity in Action section below.

This section provides practical examples of how to achieve equitable outcomes in communicable disease management, based on the 6 principles of the National Public Health Service (NPHS) guidelines for achieving equitable outcomes.

Figure 2 provides a printable visual of the actions described below.

The following actions are designed for both public health kaimahi and public health services. These examples are not exhaustive but provide tangible guidance as we work towards Pae Ora.

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Manaakitanga, as described at the opening of this chapter, is a foundational approach to achieving equity in public health and underpins many of the other actions provided in this section. It enables us to work with heart, building trusted and sustainable relationships. Examples include:

• engaging community providers through understanding what matters to them, strengthening relationships through humility and learning how best we can help
• beginning case or contact interviews acknowledging the wider concepts of hauora (refer to Te Whare Tapa Wha model of Māori health (external link)). This means building a relationship in the beginning through the process of whakawhanaungatanga by asking how they are, what support they might need, discovering any restrictions they may have and how they might want the interview to be approached.

To shift conversations from ‘what is the matter’ to ‘what matters’, engagement must consider and ideally prioritise ‘what matters’ first to those we are engaging. For example, when engaging with Māori, base engagement on the principles of te Tiriti.

When engaging Pacific peoples, it is essential to honour cultural values by showing deep respect for elders and community leaders. This includes actively seeking their guidance, involving them in decision-making processes, and acknowledging their wisdom and leadership in all community interactions.

A successful example of a kaupapa Māori model within a public health service

Marangai Areare in the Waikato was the physical embodiment of a cultural indigenous framework successfully embedded within the health sector. Established to be a flexible multi-disciplinary team during the COVID 19 pandemic, they undertook contact tracing, managed exposure events, provided pastoral care/support, supported enrolment in primary care, provided education and reached populations who have not traditionally been well-served by the system.

Marangai Areare sat within Waikato Public Health Service. They worked across subject matters and supported public health functions through a kaupapa Māori framework. Using their local community connections, they engaged the community with health services and ultimately enabled community resilience.

Containing Delta in Waikato New Zealand - partnering with Maaori for better outcomes – Waikato Public Health Service (external link)

As outlined in the intersectionality section, individual identity can be likened to a rope. Every rope consists of uniquely intertwined threads which bring together different strengths, experiences and perspectives. In communicable disease management, it is important we consider each of these threads and how they are woven together to understand how an individual is protected or at risk of different diseases.

For example, a fully vaccinated male in their 40s who has emigrated from India may not be at risk of vaccine preventable diseases but they may not be eligible for publicly funded health services. This places them at risk of not presenting if they were to get a communicable disease and limits their subsequent access to required treatment.  

Tāngata whaikaha | disabled people often experience intersecting risk. For example, someone who is Deaf and lives in a rural location may have limited access to timely information and care. To mitigate these risks, public health kaimahi could consider having online patient information available that is translated into alternate formats such as New Zealand Sign Language. Being able to send the right information at the right time would help reduce the individual’s culminative risk.

As mentioned in many of the priority population subsections, it is important to consider the impact from historical mistreatment under the medical model and the distrust of the medical profession, and what this means for the communities public health services engage with and serve.

An example of this might be proactively combatting mis- and dis-information by working with local communities to understand their views and integrate their perspectives in public health messaging.

A successful example of this is the Matakaoa community, who worked together and decided collectively that they would embrace vaccination, declaring themselves an ‘immunity community’ during the COVID-19 pandemic. To make sense of information from their own perspectives and community values, the community worked with local storytellers, scientists and doctors to learn more about vaccinations. Using this knowledge, they created a series of short videos encouraging Māori to get vaccinated. Members of the community featured in the videos, explaining why they had chosen to get vaccinated which led to high vaccination rates within their community.  

This action not only enabled the community to get involved, it respected their views and values, strengthening the power and reach of their campaign.

Matakaoa Community: New Zealand Community of the Year 2022 (external link)

We must provide whānau and communities with the information they need to make decisions on what is best for them ahead of a response. Having greater knowledge of communicable diseases will enable self-determination for whānau and communities and provide them with more options.

This could look like providing tailored information to communities that is easy to understand and relatable to the audience.

For example, during the ski season in Queenstown, the town experiences an influx of ski staff who are often young and have come from overseas. To ensure the ski staff are well prepared for the public health risks they will face during their stay and enable them to make informed healthy choices, the public health service conducted face to face sessions covering safe sex, the importance of getting vaccinated against diseases such as measles and how to access healthcare.

Public health services must establish (or re-establish) strong and trusted relationships with local providers, including Māori, Pacific and disability providers, and with communities themselves. This ensures:

• accessible options are available to whānau
• services are joined up and work cohesively
• partnerships with hauora Māori providers support kaupapa Māori led options 
• there is a shared understanding of roles and responsibilities in an outbreak response, when needed.

At the same time, public health kaimahi also need to be cognisant of not over-burdening specific populations (e.g.  Māori community leaders) and need to follow up on actions agreed to during engagement. This will foster trust and demonstrate commitment to the relationship, vital to delivering positive experiences and health outcomes for communities and whānau.

Whilst equity is everyone’s responsibility, part of this responsibility is to ensure leaders in equity are given voice to enable them to design and be part of decision making around communicable disease management as representatives for their communities. This includes engaging with community leaders as well as our own leaders within the NPHS across the Hauora Māori Tūmatanui, Pacific Public Health Directorate and Disability Leads. These leaders must have a seat at the table to provide advice, input and action on behalf of their communities at a national, regional and local level. 

Engage, re-engage or strengthen engagement with communities, particularly with Māori and Pacific peoples, disabled people, rural and isolated populations and other communities who experience barriers to engaging with the health and disability system. This includes looking wider than a disease to consider the wider determinants of health, again shifting the conversation from ‘what is the matter’ to ‘what matters’. For example, improving vaccination coverage or securing housing for people in transitional housing, supporting communicable disease management as well as improving overall health outcomes.

Consideration must be given to the needs of who is being engaged. This might mean meeting in person, arranging a chaperone or contacting cases and contacts outside of their working hours to facilitate timely access to healthcare.

Historically, responsibility for understanding the healthcare system and health advice has sat with the receiver, creating inequities for many of the priority populations detailed above.

To remove this barrier and provide equitable healthcare, the NPHS must take responsibility for communicating in an appropriate language and format. This may include providing information for cases, contacts and communities in accessible formats and translations, and written in plain English. Where possible, communication material should be translated ahead of time into te reo Māori, New Zealand Sign Language, Pacific languages, and other languages, and be available to view in various formats (e.g. video, social media). 

The Notifiable Disease Management System will collect data including ethnicity, disability and sex, which public health services can use to deliver better actions that drive towards better outcomes when responding to cases and outbreaks.

Data can also be used to understand what is happening with diseases in our communities and support a broader understanding of the patterns/epidemiology of a disease. This will also empower our communities to have access to their data through published insights and direct requests to Health New Zealand for collective information.

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[21] Veale J, Byrne J, Tan K, Guy S, et al. 2019. Counting Ourselves: The health and wellbeing of trans and non-binary people in Aotearoa New Zealand. Hamilton: Transgender Health Research Lab, University of Waikato. Available from: https://countingourselves.nz/ (external link) 

[22] Stats NZ. 2024. 2023 Census population counts (by ethnic group, age and Māori descent) and dwelling counts. Available from: https://www.stats.govt.nz/information-releases/2023-census-population-counts-by-ethnic-group-age-and-maori-descent-and-dwelling-counts/ (external link)

[23] Health New Zealand | Te Whatu Ora, Te Aka Whai Ora | Māori Health Authority. 2022. Te Pae Tata | Interim Health New Zealand Plan 2022. Wellington: Te Whatu Ora. https://www.tewhatuora.govt.nz/corporate-information/our-health-system/nz-health-plan/ethnic-communities-in-te-pae-tata (external link)

[24] Immigration New Zealand. 2024. New Zealand Refugee Quota Programme. Available from: https://www.immigration.govt.nz/about-us/what-we-do/our-strategies-and-projects/supporting-refugees-and-asylum-seekers/refugee-and-protection-unit/new-zealand-refugee-quota-programme (external link)

• Pae Ora (Healthy Futures) Act 2022  (external link)
• The New Zealand Health Strategy (external link)
• Whakamaua: Māori Health Action Plan 2020-2025  (external link)
• Pae Tū: Hauora Māori Strategy  (external link)
• Te Mana Ola: The Pacific Health Strategy (external link)
• Ola Manuia Pacific Health and Wellbeing Action Plan 2020-2025 (external link)
• The Health of Disabled People Strategy  (external link)
• The Rural Health Strategy  (external link)
• The Women’s Health Strategy  (external link)
• Te Pae Tata Interim New Zealand Health Plan 2022  (external link)
• Enabling Good Lives  (external link)
• Aotearoa New Zealand Sexually Transmitted and Blood Borne Infection Strategy 2023-2030 (external link)
• UN Convention on the Rights of Persons with Disabilities Articles (external link)
• NPHS Guidelines for achieving equitable outcomes (external link) [PDF]
• Disability Hub (external link) (Te Whatu Ora intranet toolkit)
• NPHS Disability Work Programme (external link) [PDF]
• Te Tiriti Implementation Tool Score Card (external link)
• Critical Treaty Analysis Framework  (external link) [DOCX]
• Health Equity Assessment Tool (external link) [PDF]