Tū Kōkiritia - Advancing hauora in the management of communicable diseases

To support the Crown’s relationship with Māori in te Tiriti o Waitangi (te Tiriti), we need to include the perspective of the Crown’s partner on public health. This chapter seeks to provide an indigenous perspective of public health, targeting communicable diseases in hapori Māori (Māori communities), hapū (sub-tribe) and iwi (tribe). The balance of Māori perspectives and knowledge within our organisation grows the seed our tūpuna (ancestors) planted, creating Pae Ora (healthy futures) for all people of Aotearoa New Zealand.

This chapter re-affirms and guides Communicable Disease Control Manual users to be responsive to te Tiriti as part of improving health outcomes for all New Zealanders. Our Communicable Disease Control Manual:

• empowers and champions Māori governance, leadership and voice relating to all aspects of managing communicable diseases to enhance the Māori Crown partnership in the Preamble and Article I of te Tiriti
• champions tino rangatiratanga (self-determination) from Article II particularly in relation to Mātauranga Māori — encompassing traditional, contemporary, and future Māori knowledge — in a communicable disease response
• prioritises equitable health outcomes for Māori to realise the Article III rights.

As the indigenous people of Aotearoa New Zealand, Māori rights to good health are protected by te Tiriti and reaffirmed in the United Nations Declaration on the Rights of Indigenous Peoples (external link). Te Tiriti forms the basis of partnership between Māori and the Crown, within Article III of this agreement the Government has responsibility to protect Māori rights to equal citizenship including the right of parity to equal health outcomes [1]. Unfortunately, like many other indigenous people, Māori experience disparities in health outcomes indicative of the breaches of te Tiriti and the way in which colonisation, ethnicity and health interact to create and maintain inequities in health outcomes [2]. The National Public Health Service has a part to play in rebalancing these approaches in our journey to achieve Pae Ora through implementation of the actions within this chapter.

This section provides guidance on how the National Public Health Service (NPHS) can give effect to te Tiriti and achieve equitable health outcomes for Māori whānau and hapori.

Examples of specific actions, across 4 key themes, are described below. This should not be considered an exhaustive list, but rather a starting point to build on in partnership with Māori.

Aligning with, Priority 5 of Pae Tū the prioritisation, collection and stewardship of comprehensive Māori health data, is treated as a living taonga (treasure). Implementation of the Māori Data Governance Model (2023) [4] ensures Māori data sovereignty and control over its collection, ownership, and use. This guides the co-design process with Māori, enabling informed health policies and effective monitoring. Monitoring systems are strengthened to assess the effectiveness of policies for Māori in real time, ensuring accountability and responsiveness to te Tiriti obligations. Additionally, collaboration with Māori will determine what key elements of the communicable disease response should be monitored and reported.

In alignment with the Government Policy Statement for Health (2024-2027) (external link) and our legislation, the NPHS will ensure health entities actively address disparities in health outcomes by cultivating health equity through intentional and context-specific actions. This section speaks specifically to Māori health equity, for further guidance on achieving equitable health outcomes in communicable disease management refer to the Achieving equitable outcomes in communicable disease management preliminary chapter.

Informing whānau with the right information at the right time can support individual protective strategies and is an important component in safeguarding individual wellbeing, public health and containment of communicable diseases. To achieve this, proactive communicable disease management will provide whānau and hāpori Māori with the knowledge and tools to support their own wellbeing. Building trusting relationships between public health services and Māori communities through whakawhānaungatanga (building relationships) is essential for promoting effective health protection practices.

Mātauranga Māori encompasses both traditional and contemporary knowledge systems, which are intergenerational and continuously evolving. It is not solely confined to traditional knowledge but includes contemporary applications and has the potential to influence future knowledge. Mātauranga Māori is holistic, integrating wairuatanga (spirituality), te reo Māori, tikanga Māori, and kaitiakitanga (guardianship), with its expression shaped by the diverse geographies and environments of iwi and hapū.

Māori models of care often reflect this holistic view commonly encompassing taha tinana (physical wellbeing), taha hinengaro (intellectual and emotional wellbeing), taha whānau (social wellbeing), taha wairua (spiritual dimension) and a connection to te taiao (environment) firmly and inherently connecting us to our whenua (land).  

Māori have many expressions that assert their connection to the whenua that are derived from te ao Māori narratives of creation and whakapapa (genealogical) relationships to the universe and beyond. Our opening karakia emphasises this and acknowledges Ranginui and Papatūānuku and the gifts of life they provide to sustain us. The ties between the people and the whenua show oranga whenua, oranga tāngata (when the land is well, the people are well). From this perspective, for Māori their connection as kaitiaki (guardians) to the whenua and the taiao is eternal and enduring.

The Aotearoa New Zealand health system acknowledges this relationship as demonstrated through the vision of Pae Ora and the element of Wai Ora. This intrinsic connection is reflected in 2 fundamental cultural principles, kaitiakitanga and manaakitanga (bespoke care, enhancing mana). To give effect to these principles, Māori will have the opportunity to exercise the right to have:

• access to all relevant information
• their views respected
• their intellectual property handled with sensitivity
• authority over areas that directly impact their wahi tapu (sacred sites), taonga, water and ancestral land.

The following principles guide our efforts to maintain our commitments under te Tiriti in the management of communicable diseases, aiming to achieve the overarching goal of Pae Ora as outlined in Pae Tū: Hauora Māori Strategy (external link) and embedded within the legislation [5].

Empowering Māori providers to create health aspirations and practices alongside their communities, supports their autonomy towards making better decisions related to the care of their communities.

Expected outcomes: manaaki is an approach not a service; mana motuhake and mātauranga are trusted and privileged.

Supporting innovative approaches that rapidly adapt to the unique cultural, social, and economic demands influencing hauora, including the use of technology and community-based solutions through flexible commissioning and contracting arrangements.

Expected outcomes: workforce is adaptable; contracts are flexible; practices are advanced, rapid and enduring.

Recognising the value of collaboration across existing networks and relationships among Māori providers and their kaimahi aligns with the Whānau Ora model, which places collective approaches at the core of healthcare and social services.

Expected outcomes:  diverse networks and relationships are a strength; community intelligence and resources are engaged.

Addressing systemic barriers by going ‘over and above’ the call of duty to ensure that healthcare services are accessible to Māori and tailored to meet the needs of specific whānau and communities, thereby reducing health disparities.

Expected outcomes: recognition that systemic barriers exist and doing what is needed to remove barriers.

Incorporating cultural competencies in health care that are ground in te ao Māori, that acknowledge the value of traditional healing practices and the role that Māori concepts and values, such as manaaki, play in hauora and wellbeing.

Expected outcomes: cultural competence pathways are clear; people are actively learning about te Tiriti.

Acknowledging the interconnectedness of whānau with their communities and the environment is crucial to ensuring good manaaki. A ‘targeted populations’ approach to service delivery ensures that kaupapa is tailored to the population it supports.

Expected outcomes: affirming outcomes-based contracting; greater coverage of services and improved capturing of data.

Central to effective manaaki responses in healthcare is the contribution of leadership. Adopting a servant leader model were those who inspired their colleagues, whānau and communities during the pandemic.

Expected outcomes: confidence in health system and direction; readiness for the next significant event.

The Manaaki Framework is available as an operational document for use by public health services here (external link).