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This karakia comes from Kāi Tahu traditions and is used in relation to new life, to begin something and to clear
the way. It refers to babies crying, dawn breaking and birds calling, signaling that day has arrived. It is an appropriate
introduction to our first Best Practice Journal dedicated to Māori Health.
The Māori population is as diverse and dynamic as any other population and can be described and defined in a number
of ways. The 2006 census told us that:1
- 565,329 (15%) of the total population identified themselves as belonging to the Māori ethnic group.
- 643,977 people (18%) of the total population indicated they had Māori ancestry.
- The Māori population is young - 53% are aged less than 25 years.
- Māori birth rates are higher than non-Māori and well above replacement level, contributing to a growing
- After a widening of the gap in life expectancy between Māori and non-Māori over the 1990s, the gap has stabilised
and is currently about 7.6 years (Table 1).
|Table 1: Life table for the Māori and non-Māori population
|Expected years of life remaining
|Expected years of life remaining
|Non- Māori female
Māori continue to have the poorest health status of any ethnic group in New Zealand. This is not acceptable and
reducing health inequalities that affect Māori is a key priority for the government and sector.2
Research shows that primary care services have not addressed these ongoing inequalities.3,4 Māori have
received fewer referrals, fewer diagnostic tests and less effective treatment plans from their doctors compared to non-Māori.5 Primary
care services therefore have an excellent opportunity to make a significant contribution to reducing these inequalities.
A strong primary health care system is central to improving the health of New Zealanders and to addressing and removing
inequalities in health. The vision for primary health care, from Whakatātaka Tuarua - the Māori Health Action
Plan 2006-2011, is to ensure Māori participate in easily accessible local primary health care services that improve
their health, keep them well, and co-ordinate their ongoing care.6
He Korowai Oranga, the Māori Health Strategy, provides a framework for the sector to take responsibility for supporting
the health status of whānau rather than just individuals. The overall aim of He Korowai Oranga is whānau ora:
Māori families supported to achieve their maximum health and wellbeing.8
|Cultural competence standards
The Health Practitioners Competence Assurance Act 2003 requires registration authorities to set
standards of cultural competence, review and maintain the competence of health practitioners and set standards to ensure
The Medical Council of New Zealand has defined cultural competence as:
"Cultural competence requires an awareness of cultural diversity and the ability to function effectively and respectfully,
when working with and treating people of different cultural backgrounds. Cultural competence means a doctor has the
attitudes, skills and knowledge needed to achieve this. A culturally competent doctor will acknowledge:
- That New Zealand has a culturally diverse population.
- That a doctor's culture and belief systems influence his or her interactions with patients and accepts this may
impact on the doctor-patient relationship.
- That a positive patient outcome is achieved when a doctor and patient have mutual respect and understanding."9
He Taru Tawhiti
A weed from far away. A metaphor for the unfamiliar diseases that arrived with the early settlers.
Māori have poorer health outcomes, die younger and have higher rates of chronic disease than other New Zealanders.
There is a growing body of evidence showing that poorer access to health services for Māori, relative to health need,
is one of the contributing factors to the inequalities in outcomes. Improving access to services is vital and will lead
to a reduction in the health inequalities between Māori and other New Zealanders.6
As Dr Peter Jansen (Ngāti Raukawa, GP and Māori health leader) states "the healthcare system reflects its
origins in a dominant European culture, which values individualism and self-advocacy, and provides care in a manner which
advantages certain groups including higher socioeconomic groups, non-Māori, non-Pacific groups and those without
There are around 240 Māori health providers delivering a range of health and disability services through out New
Zealand. These services, often characterised by Māori delivery frameworks, are however not the exclusive domain of
Māori. They are available to and accessed by others who also benefit from this method of service delivery.6
Ko te kokomuka te rākau i tunua ai te moa
Kokomuka is the wood that was used to cook the moa. There is a proper thing for every purpose.
The development of Māori health providers ensures that Māori have the right to a choice of service provider.
Whilst Māori health providers will continue to develop and play a more significant role towards health equity and
parity of outcomes, they do not remove the onus from mainstream providers to deliver services that are equally as effective
for Māori. Mainstream providers continue to deliver the majority of services to Māori and play a vital role
in ensuring Māori have access to appropriate, timely and effective primary care services.7
One of the consistent components of cultural competence is the ability to establish a good rapport and effective communication
with every patient and their whānau.
Māori, like all other cultures, are a dynamic and diverse group. Different Iwi, hapu and whānau have different
traditions, beliefs and dialects. In addition, since the earliest contact, Māori have intermarried with other cultures
and recent statistics show that half of all Māori have partners from another culture. It is important providers do
not reinforce, or assume anyone fits into, what might be considered a typical stereotype.10
Māori sit on a continuum from those with more traditional lifestyles, beliefs and values through to those with
lifestyles, beliefs and values dominated by more contemporary western influences. ACC guidelines state "If a person wears
a tā moko this may not mean they want to converse in Te Reo Māori, or conversely that someone wearing a suit
and tie has rejected traditional Māori cultural values".10 Be guided by the patient and whānau about
what cultural, spiritual and other practices are appropriate for them.
Kei a koe te tikanga
It is up to you
It is up to the health professional, as the expert, to learn the preferences of each patient, Māori or non-Māori,
and strive to put them at ease in order to create and sustain a respectful, trusting therapeutic relationship.11
- Robson B, Harris R. (eds). Hauora: Māori Standards of Health IV. A study of the years 2000-2005. Wellington:
Te Rōpū Rangahau Hauora a Eru Pōmare; 2007.
- Ministry of Health. Tatau kahukura: Māori Health Chart Book. Public Health Intelligence Monitoring Report no.5.
Wellington: Ministry of Health; 2006
- Crengle S. The development of Māori primary care services. Pac Health Dialog 2000; 7:48-53.
- Baxter J. Barriers to health care for Māori with known diabetes. NZ National Working Group on Diabetes and Te
Rōpū Rangahau Hauora a Ngāi Tahu; 2002.
- Gribben B. Ethnicity and resource use in general practice in West Auckland. Experience in Practice. Health care review
- Ministry of Health. Whakatātaka Tuarua: Māori Health Action Plan 2006-2011. Wellington: Ministry of Health;
- Jansen P, Smith K. Māori experiences of primary health care: Breaking down the barriers; NZ Fam Prac 2006; 33(5):
- Ministry of Health. He Korowai Oranga: Māori Health Strategy. Wellington: Ministry of Health; 2002
- Medical Council of New Zealand. Statement on cultural competence. Available from
- ACC. Summary Guidelines on Māori Cultural Competencies for Providers. Available from
- Medical Council of New Zealand. Best Health Outcomes for Māori: Practice Implications. Available from