ISSN 1178-6191

Maori Health Review

Making Education Easy Issue 103 – 2023

Maori Health Review
Maori Health Review

A critical Tiriti analysis of Te Pae Tata: the Interim New Zealand Health Plan

Authors: Rae N et al.

Summary: Claims of engagement with Te Tiriti have been reviewed in a desktop critical Tiriti analysis (CTA) of Te Pae Tata: the Interim New Zealand Health Plan. The CTA followed five stages from orientation, close reading, determination, strengthening practice, to the Māori final word. Results showed that Te Pae Tata proactively engaged with Te Tiriti across the entirety of the plan. Te Tiriti elements of the preamble were assessed as follows: kāwanatanga and tino rangatiratanga (“fair”), ōritetanga (“good”) and wairuatanga (“poor”). The authors noted that engaging more substantively with Te Tiriti requires the Crown to recognise that Māori never ceded sovereignty and treaty principles are not equivalent to the authoritative Māori text. To allow monitoring of progress, recommendations of the Waitangi Tribunal WAI 2575 and Haumaru reports must be explicitly addressed.

Comment: As the authors allude to here, the interpretation and application of Te Tiriti principles must be clear, accurate and pono/genuine. It was interesting to see tino rangatiratanga being assessed as “fair” – I’m aware of some fantastic work underway to consolidate this in policy and practice. However, given the “poor” rating for wairuatanga, perhaps we need more mahi here too.

Reference: N Z Med J. 2023;136(1573):88-93.


Interventions designed to improve uptake of allopurinol for gout treatment in Aotearoa New Zealand

Authors: Ofanoa S et al.

Summary: Gout interventions in New Zealand do not sustain retention, completion, and engagement for certain population groups, particularly Māori and Pasifika, according to a recent scoping review. Intervention studies aiming to improve allopurinol uptake for gout treatment were identified via a systematic search of Medline, Scopus, Embase, CINAHL Plus and grey literature, and 18 were included in the review. Interventions were clustered into three domains: multifaceted or multi-practitioner; gout app; and online booklets or fact sheets. Most interventions used multifaceted or multi-practitioner approaches, and these approaches were able to improve serum urate levels. The gout app was only able to improve patients’ awareness and understanding of gout and medications. Online fact sheets and booklets need more active utilisation by health professionals to improve patient health literacy.

Comment: Great to see a review of all the evidence in one place for gout prevention treatment – especially for people like me who see it every day in clinic. There is increasing evidence for considering allopurinol in people with elevated urate and high cardiovascular risk too. Given higher cardiovascular disease rates for Māori and Pacific people, we need to address the gaps identified here.

Reference: J Prim Health Care. 2023;15(1):48-58.


Late presentation of HIV infection among adults in New Zealand from 2011 to 2020

Authors: Bateman JP et al.

Summary: A study of routine surveillance data has found that New Zealand continues to have a high proportion of late HIV diagnoses. In the study, ‘late presentation’ was defined as a CD4 count 2 years ago, were more likely to present late and have advanced disease. Amongst heterosexuals, factors associated with late presentation were older age, testing due to symptoms, and Pacific ethnicity; factors associated with advanced disease were Māori, Pacific or Asian ethnicity. The study authors suggested that identifying barriers for testing and opportunities for screening could help to reduce the burden of late presentation - particularly among heterosexual individuals, non-Europeans, and older people

Comment: Often forgotten, HIV requires early diagnosis to successfully treat, and prevent spread. We often talk about layers of discrimination that impact on health outcomes, some of which are evident here (MSM, ethnicity, ageism).

Reference: Int J STD AIDS. 2023;34(5):332-337.


Indigenous adaptation of a model for understanding the determinants of ethnic health inequities

Authors: Curtis E et al.

Summary: An Indigenous adaptation of the ‘Williams model’, known as the Te Kupenga Hauora Māori modified model, has been developed to understand the causes of racial/ ethnic disparities in health. The modified model spearheads colonisation as a critical determinant of health inequities, underpinning all levels from basic to surface causes. It also attempts to reflect the dynamic interplay between causes at different levels. The influence of worldviews/positioning is included as a cause of health inequities, and privilege alongside racism is emphasised. The model creators provide a critique of its limitations, and indicate areas for further strengthening.

Comment: Many years in the ‘writing’, this is an important resource/reference for those of us who are teaching, researching and planning.

Reference: Discov Soc Sci Health. 2023;3(1):10.


Maori Health Review