The treaty of Waitangi: a framework for Maori health development.
The Treaty of Waitangi is often described as New Zealand's founding document. However, and since its first signing on 6 February 1840, confusion and debate has often surrounded its interpretation and application, its value as an historical manuscript and its broader significance to the contemporary development of New Zealand. While there is unlikely to be any clear consensus on the application of the Treaty of Waitangi or what its original intent may have been, this paper considers the relationship between the Treaty and Maori health. How Maori health issues fundamentally informed the shape and design of the Treaty, how these connections have gradually been lost, but how it may provide a framework for contemporary Maori health development.
Maori health, Treaty of Waitangi
Kingi, T R. (2007). The Treaty of Waitangi: A framework for Maori health development. New Zealand Journal of Occupational Therapy, 54(1), 4-10
In considering Maori health issues and how therapists might better engage Maori clients and the Maori community I decided to frame the issues within the broader context of the Treaty of Waitangi. Using the Treaty as a framework for any type of discussion or dialogue presents many challenges and indeed opinions and ideas on the Treaty are often formed even before discussions take place. The unfortunate reality, however, is that our views on the Treaty are often informed by the media or even worse through political debate. And, as a consequence, broad understandings of the Treaty and Treaty related issues are not always derived from an informed base.
Regardless of these concerns, there is some general agreement that the Treaty holds some special significance--as the founding document of our country and as an agreement which formalised the initial relationship between Maori and the Crown. Signed on the 6th of February 1840 the Treaty was made up of five parts, a pre-amble, three articles, and a post-script (all translated from English into Maori). The Treaty of Waitangi was essentially a treaty of cessation and as such resulted in a transfer of sovereignty (or absolute control) from Maori to the British Crown (Orange, 1987). While the Maori version of the Treaty placed some restrictions on this notion of sovereignty, the Treaty nevertheless facilitated British rule, colonisation, and the establishment of British systems of governance, land tenure, law, and social development. In effect, it legitimised Crown intervention and therefore permitted the creation of many of the Western institutions and structures we now take for granted.
Insofar as the Treaty facilitated Crown intervention, it was also, and perhaps more fundamentally, an exchange. Indeed these transfers of authority were not unconditional in that the expectations of Maori at the time were quite considerable. There is of course some debate as to whether or not Maori actually understood the Treaty and what was being negotiated. The Treaty itself was poorly translated and even less well explained. In the Maori version of the Treaty the idea of sovereignty (for example) was interpreted as governorship and meant that those who signed it not only anticipated crown management but also some form of Maori control. As well, there was a broader expectation, that in exchange for Maori signatures, the interest of Maori would also be protected in order to make good the agreement (Durie, 1998).
The extent to which these Treaty based exchanges have been met has been the subject of some considerable debate and from the outset. The obligations agreed to by Maori (and more) have largely been met. However, there is less agreement on the extent to which the Crown has matched these, whether or not mechanisms for Maori self-governance have been made, and the level to which Maori interests have been protected.
Putting aside the multiple interpretations of the Treaty, the position advanced within this paper is that a fundamental intent of the Treaty was centred around a desire to promote and protect Maori health. Of course this is not typically the way in which the Treaty is described and indeed my views are not always consistent with other interpretations. However, the purpose of this paper, is to unravel and explore the Treaty of Waitangi, its background and history, the principles and text, its interpretation and application and how this is all connected to Maori health. In this regard the broader objective is to create an understanding of the relationship between the Treaty of Waitangi and Maori health and to likewise establish a platform through which interactions with Maori, at a personal, organisational, or community level, may be improved.
A Treaty is planned
To begin with, and despite my own views on this subject, there is no single opinion on what was the original intent of the Treaty of Waitangi. However, an analysis of its wording reveals that there were at least three broad objectives--first, (and already mentioned) the cession of sovereignty, second, absolute control (by the Crown) of land matters, and lastly, law and order equally for Maori and settlers. William Hobson was responsible for drafting the Treaty, however, he was guided by a set of instructions from Lord Normanby, who in turn was influenced by various other reports on the New Zealand situation.
These reports were based on what was observed here during the early 1800s and in particular the impact unmanaged colonisation was having on the indigenous Maori population. In an 1832 report to his superiors in England, James Busby (the official New Zealand Resident) made light of the "miserable condition of the natives" which "promised to leave the country destitute of a single aboriginal inhabitant". Even then, the population was in sharp decline and expectations were that this would continue unless there was some form of active intervention (School of Maori Studies, 2005).
The type of intervention initially recommended by Busby was a "protectorate" where the Crown would administer the affairs of the country in the interest of all inhabitants--Maori and European. William Hobson, New Zealand's first Governor, promoted an alternative 'factory' plan. This would have led to the establishment of European type settlements, with British laws in place, within certain geographical locations. Maori settlements would similarly be established and likewise see the application of Maori laws and customs within these boundaries (School of Maori Studies, 2005).
Despite this, the Colonial Office in England determined that the only way to protect Maori interests (including health) was to annex the country--transferring sovereignty (absolute control) from Maori to the Crown. For this to occur, a Treaty of cessation (the Treaty of Waitangi) was required. In this regard, my main point is that while the Treaty is at times difficult to interpret there is certainly little doubt that the issue of Maori health or welfare formed much of the background to the Treaty and was significant in terms of both shaping and selling the Treaty to Maori. Indeed, and when we look at the English version of the Treaty it makes specific reference to the idea of 'Royal Protection' as well desire the 'to avert the evil consequences that must result from the absence of necessary laws and institutions' (State Services Commission, 2005).
A people in decline
While the objectives of the Treaty were in part designed as a platform for Maori health development, based on the continued population decline, it proved to be less than successful. In fact, the 1800's was a century characterised by significant and sustained Maori de-population. Although accurate population figures were not available it was estimated that Maori numbered about 150,000 in 1800. Yet when an actual census was conducted in 1896, the figure was just 42,000.
The reasons for this decline and change in health profile are complex, though are not difficult to identify. The land and tribal wars during the 1800s had a particularly negative impact on the Maori population. Estimates on the number of Maori lost during tribal conflicts vary considerably--however, the most recent lowest 'guesstimate' is about 20,000 (Dalley & McLean, 2005). Putting this figure in perspective, it exceeds the total number of New Zealand casualties in either of the two World Wars. Certainly the introduction of the musket was a critical tool in this process and resulted in a level of devastation hitherto impossible.
The Land Wars (between Maori and Pakeha) had a similar effect as did of course the introduction of diseases that Maori had little biological protection from. Isolation from other parts of the world, allowed a unique culture to develop and flourish, but it also made Maori susceptible to many of the diseases which had ravaged other parts of the world. The population was unprepared, biologically and socially, the effects therefore were often quite devastating (Durie, 1994).
Cultural decay had a comparable, though perhaps less obvious impact. As colonization took effect, cultural decay resulted in the abandonment of many of the social structures and practices which for hundreds of years had been used to promote and protect Maori health (Kingi, 2002).The traditional Pa for example had evolved into a complex series of physical and social structures. Deliberate mechanisms were put in place and in order to ensure that fresh food and clean water was available, people were protected from the elements, waste was disposed of and in order to prevent contamination a range of other health based practices were also adopted. However, these mechanisms were in many ways inconsistent with how the new colony was developing and in the end were abandoned as other opportunities and lifestyles were explored.
While traditional ways of living would eventually have been lost, the rate at which this occurred was the real issue especially as Maori moved directly from traditional systems to western based environments. This cultural transfer often resulted in traditional mechanism and safeguards being abandoned. It the end it wasn't that western systems were bad for Maori, but, that appropriate mechanisms for health and safety were displaced--and not replaced.
While it is difficult to say with any certainty how each issue directly impacted on Maori health, the cumulative effect of these changes was a dramatic decline in the Maori population and with it a corresponding loss of Maori land, Maori control, and Maori culture.
By the end of the 1800s, and even well before, it was clear that Maori expectations of the Treaty were unlikely to be met. Insofar as providing a framework for Maori health development the offerings of the 1840 agreement had failed to materialise. Though this is perhaps not a fault of theTreaty itself, but more a reluctance by the Crown to fully implement its many provisions --including those directly connected to Maori health.
With the beginning of the 1900s, there seemed little reason to develop any plans for Maori health, Treaty based or otherwise, when in fact many believed the population was doomed to extinction. The only plan required was that which would manage the demise of this once noble race. In what was to become a somewhat famous quote, Dr Isaac Featherstone summed up what was perhaps the prevailing attitude of the day; "The Maoris are dying out, and nothing can save them. Our plain duty, as good compassionate colonists, is to smooth down their dying pillow. Then history will have nothing to reproach us with." (Te Ara, 1966).
Others held similar views and even went so far as to suggest that the population decline was an inevitable process--consistent with Darwinian theories of natural selection and in particular the survival of the fittest. 'Just as the Norwegian rat has displaced the Maori rat, as introduced plants have replaced native plants, so the white man will replace the Maori' (cited in Ramsden, 2003).
Of course, the population did recover, and in dramatic fashion. And while the 1800s were characterised by depopulation, despondency, and despair, the 1900s illustrated Maori resilience and resolve, a determination which was to eventually result in one of the greatest and perhaps most un-expected recoveries in human history. Again however, the Treaty and the Crown played only a minimal role in this and in fact it was largely due to the determination of Maori and a desire to address their own health problems that a platform for Maori health development was established.
The efforts of Pomare, Buck, Ngata, Te Puia, Ratana, and organisations such as the Maori Woman's Health and Welfare leagues require particular mention in this regard. Indeed their role in responding to the health needs of Maori at a time of absolute crisis deserves more popular recognition. Of added interest is the fact that these health gains were often achieved in spite of limited government assistance and in the face of what must have seemed to be insurmountable odds. For example when describing the work of Pomare and Buck, McLean (1964) notes that:
In the six years between 1904 and 1909 they saw to it that some 1,256 unsatisfactory Maori dwellings had been demolished. Further, 2,103 new houses and over 1,000 privies were built. A number of villages had also been moved to higher ground. He notes that all this had been done at the cost of the Maori themselves without a penny of Government assistance or compensation. What had been achieved was due to the personal efforts of Pomare and Buck and a small bank of inspectors.
The role of the Treaty
While I have argued that the Treaty was initially (in part at least) designed as a platform for Maori health development, concerns over land confiscations and other acquisitions saw to it that the Treaty soon became an outlet for Maori frustrations. In fact, for much of the 19th and 20th Century the Treaty had evolved into a document which served only to highlight a series of broken promises, particularly with respect to land, but also unmet expectations for Maori control and governance.
These concerns were complicated further by a general reluctance by the Crown to recognise the Treaty as anything other than an historical curiosity. Indeed, in less than 40 years after it's signing, Judge Prendergast notably described the Treaty as a 'simple nullity'--and since 'Treaties entered into with primitive barbarians lacked legal validity'. This served as the prevailing legal position on the Treaty for nearly 100 years. It also reinforced the position of successive governments, and judges alike, and that the Treaty of Waitangi was of little importance and certainly irrelevant to legal issues (Durie, 1998).
The Waitangi Tribunal
Over the years the legal position of the Treaty has changed, as a result of various court cases. These decisions have often resulted in legal comment on the constitutional position of the Treaty, how each version (Maori or English) should be treated, and its relationship to legislation. These cases did much to reinforce the idea that the Treaty was primarily a tool to consider and potentially resolve historical conflicts or grievances--though were less useful in determining how the Treaty could inform contemporary and future development. For Maori also, the courts had often proved to be a fruitless and expensive exercise as debates were often limited to the English version of the Treaty and to the few instances where it actually appeared within legislation.
A significant change occurred however, with the establishment of the Waitangi Tribunal in 1975. Initially criticised due to the fact that it could only make non-binding recommendations, the Tribunal did at least provide a forum through which Treaty related concerns could be raised outside of the courts and in a way that provided greater flexibility in terms of how the Treaty could be interpreted. To this end the Waitangi Tribunal is not a court, but a commission of inquiry. While its hearings are based on a format which mirrors courtroom procedure and process (complete with judges and lawyers), unlike a court, the rulings are not binding on the crown--they may in fact choose not to accept the tribunals findings or only partly implement what recommendations are made.
Other interesting features of the Tribunal are that only Maori can bring a claim to it, but these must be against the crown and not individuals or third parties. Despite a drive to wind up the Tribunal in order to settle historical treaty claims it is also important to note that most claims of this type are not actually settled through the tribunal process. In addition--settlement negotiations are not typically delayed by the reluctance of Maori to settle--but by the rigid settlement framework imposed by the Crown.
When further examining the Act under which the Tribunal was established it states that both versions of the Treaty should be regarded equally when considering claims brought to it. Additionally, the Tribunal focuses on the 'principles' or 'spirit' of the Treaty as opposed to the actual text (School of Maori Studies, 1995).
The use of 'principles' was designed to avoid the obvious problem of having two different versions of the Treaty. They also provided a more flexible framework for the interpretation of Treaty related concerns and obligations. Whereas in the past the Treaty (particularly within the courts) had been applied to physical resources, such as land, forest, and fisheries, the principles were broader and therefore not as restrictive. Adding to this was the opportunity to consider specific words such as Taonga and Tino Rangatiratanga as contained within the Maori version of the Treaty. It seemed therefore, only a matter of time before the link between Maori health and the Treaty would be established or at least re-established.
The Treaty text and Mori health
In considering how the Treaty may be applied to health there are (therefore) at least two broad approaches--one which is founded on the text or wording of the Treaty, and the other which is based on broader and more interpretive principles--such as those mentioned within the Treaty of Waitangi/ Waitangi Tribunal Act.
By first examining the Treaty text it is clear that both versions (Maori and English) make particular references to health which is again consistent with the various concerns that originally informed the Treaty in 1840. In the English version of the Treaty, Article 2 emphasises property rights and Article 3 stresses individual rights. There is a guarantee of 'royal protection' and that Maori will be afforded the same 'Rights and Privileges of British Subjects'. As well, the pre-amble to the Treaty further sets out the desire to 'protect' Maori rights and "to secure the enjoyment of peace and good order". The pre-amble also highlights the need for intervention and the fact that un-managed colonisation is unlikely to result in a positive outcome--for Maori at least.
The Maori version of the Treaty has similar objectives although, due to translation differences, Article 2 places added emphasis on Maori control over 'things Maori' and further uses the words 'Tonga katoa' implying a connection between the Treaty and Maori social and economic development.
As noted, these statements reflected the contemporary concerns of 1840 and would have done much to encourage Maori agreement by offering protection, certain rights, and an expectation that the outcomes for Maori would be at least as good as that of non-Maori. However as shown, Maori outcomes have seldom (if ever) matched those of non-Maori, especially in health, but within a full range of socio-economic indices.
It is little wonder, therefore, that Maori have come to view The Treaty as an ideal framework for Maori health development. While some have interpreted the Treaty as affording Maori additional rights or privileges it is clear that above all else it is concerned with equity and the promise that Maori can enjoy, at the very least, the same health and well-being as non-Maori, this is clear from an examination of both the Maori and English text of the Treaty.
Confusion arises however, when attempts are made to ensure that existing inequalities are eliminated. Some are uncomfortable with considering the Treaty in a contemporary setting even though it was never designed to sit within an 1840 vacuum. Others fail to see how it could relate to health, despite the fact that Maori health and well-being was crucial to the Treaty's design and promotion.
Official plans for Maori health have not always embraced the Treaty as an appropriate start-point or as a suitable framework from which to begin. Nevertheless, this has not prevented Maori from aligning these policies or plans with Treaty related obligations. Indeed, regardless of whether or not targeted plans are based on need, equity, or disparities, it is clear that these are consistent with the Treaty. On the other hand, specific Treaty related plans are often framed within the notion of Maori privilege, when essentially they are about equality and balance.
In an), event, my main point is that the Treaty text (both Maori and English) make clear references to Maori health and place obligations on the crown to ensure that Maori health interest are actively protected. Further, while the Crown has not always employed the Treaty as an appropriate framework for health policy, this has not prevented Maori from aligning targeted approaches (in whatever context) with Treaty related obligations.
The principles of the Treaty and Mori health
Despite textual references to health, debate as to the actual wording of the Treaty, and it's meaning, has not always resulted in a consistent view (even amongst Maori). Some, for example, feel that the idea of Tino Rangatiratanga (as defined in the Maori version of the Treaty) is adequately met through the development of Maori specific health services and that this provides a reasonable degree of self-determination. Others are less convinced and feel that until Maori have full control of health funding and service delivery (outside of the present framework) then true Tino Rangatiratanga remains an unrealised dream.
These types of debates again highlight the variety of ways in which the Treaty may be interpreted--the meaning of certain words--in Maori and English, their historical intent and contemporary application. As noted, the Treaty of Waitangi principles were introduced (partly at least), to somehow mitigate these difficulties, to arrive at a common understanding based on both versions of the Treaty, and to allow it to be considered in a variety of settings.
The difficulty however, is that these principles, while frequently referred to, are mentioned nowhere within the Treaty (Maori or English) and therefore it has been difficult to say with any degree of certainty what these principles are--other than to state that they originate or are derived from the two Treaty text. Even the legislation which led to formation of the Waitangi Tribunal is unclear about this issue and while the Act clearly refers to the principles of the Treaty, it is silent on what these actually are.
So as to better elucidate what these principles were The Waitangi Tribunal, The New Zealand Government, the Court of Appeal, and The New Zealand Maori Council, have all developed their own set of principles and usually as a result of claims to the Waitangi Tribunal (School of Maori Studies, 2005). These principles were broadly consistent with each other and the Treaty, though were considered within the context of a particular tribunal claim. In 1988 however, the relationship between the Treaty and health was clarified through a set of principles identified by the Royal Commission on Social Policy. Although in 1975 the Tribunal had made way for the broader interpretation of the Treaty, it wasn't until 1988 that a set of principles, directly applicable to health and social policy, were developed (Royal Commission on Social Policy, 1988).
Partnership, protection and participation
Like other Treaty principles, the Commission's principles of Partnership, Protection, and Participation are drawn from both versions of the Treaty and are used to better understand how the Treaty maybe applied.
The principle of Partnership is derived from the original Treaty Partnership and from a health perspective places an obligation on the Crown to include Maori in the design of health legislation, policies, and strategies. It draws on the idea that Maori should play an active role in whatever plans for Maori health are devised. Further, that these relationships extend beyond central government, to local government, and how interactions with local iwi can be improved.
This principle is in part designed to address concerns that health strategies are out of sync with contemporary Maori realities and that any targeted approach should be informed by the target group. This is not only true for Maori health strategies, but any situation where disparity and where development is required. In the past Maori health issues were addressed through generic frameworks and an approach derived from the notion that cultural factors played only a minor role in the delivery of health services. As a consequence Maori health gains were limited and it was only when cultural factors were introduced (as part of the strategies developed by Pomare and Buck) that significant health gains were achieved. Certainly current Maori health discrepancies will benefit from targeted approaches, but as discussed, these must be informed by Maori and Maori realities and be consistent with the principle of Partnership.
The principle of Protection is in direct reference to the Preamble, Article 2 and 3 of the Treaty. It reflects on the Crown's duty to actively protect Maori interests and to ensure that Maori are able to enjoy (at the very least) the same level of well-being as non-Maori. As noted, this principle is not designed to promote Maori privilege or to create an inequitable environment. In fact, the more fundamental objective of this principle is to eliminate inequities at all levels and to ensure that health outcomes for Maori and non-Maori are the same. In doing so two possible approaches exist. The first is to somehow slow or regress non-Maori health gains. The second, and more reasonable approach, is to lift the health status of Maori, through a range of mechanisms, and in a manner consistent with the notion of active protection.
Targeting Maori health, in away which leads to a reduction in disparities is another issues which has resulted in much debate about the best approach. Again, strategies which focus on a particular ethnic group appear to be falling out of favour and are reflected in approaches which focus primarily on socio-economic factors or contributors. These ideas are based on good science and research and are consistent with what we know about the precipitators or poor health. However, a focus on socio-economic factors alone may fail to appreciate the role of culture as a determinant of health. The fact that strategies for health promotion, public health, health protection, and even primary health care can all be enhanced through cultural means. Moreover, while socio-economic and demographic factors are major determinants of health, they do not fully explain why disparities exist across different ethics groups.
The principle of Participation is linked to the principle of Partnership and Protection, but also the idea of Tino Rangatiratanga and the obligation to ensure that Maori are able to participate in the delivery of health services. For much of the last century, Maori participation within the health sector was largely confined to the role of consumer and even then access was not always guaranteed. Viewed from a health perspective, the principle of Participation is designed to encourage Maori involvement in the delivery of health services, but also in the planning and design of these and associated policies (Royal Commission on Social Policy, 1988). At present access difficulties play a significant role in the perpetuation of Maori health disparities. Addressing these require a range of strategies including the development of Maori health services giving effect to the principle of participation. In addition, it places an associated emphasis on mainstream providers and in order to ensure that at risk populations (such as Maori) have the opportunity to access the type of care they need. The fact remains that the majority Maori access the health system through conventional mainstream health service. Despite efforts to improve access (particularly by Primary Health Organisations, PHOs) research suggests that care pathways are uneven and that in many cases Maori do not receive the type of care they require.
As seen, these principles are not discrete or mutually exclusive and in fact none of the principles can be applied in isolation without considering how one affects the other. To this end the principles of Partnership, Protection, and Participation, while derived from the Treaty have a more fundamental objective to promote and sustain positive Maori development. Indeed, when plans for Maori health are developed, they must consider the broader issues of Maori employment, education, social and cultural well-being.
Application of the Treaty to health
The extent to which these principles have been applied has varied and has largely depended on the willingness of successive governments to utilise the Treaty (principles or text) within the planning process. Needless to say, a consistent approach has yet to emerge. A major development occurred with the introduction of the Public Health and Disability Act 2000. The Act was responsible for ushering in the current set of health reforms. For Maori the Act represented the first piece of social policy legislation to include references to the Treaty principles. In fact, in so far as the Treaty is described within legislation, it is the principles, as opposed to the Treaty itself, which are used.
The inclusion of Treaty principles had a predictably negative impact on the legislation's passage through parliament and even now there is a move to have all references to Treaty principles removed from legislation. At the time the bill was being debated in parliament some were critical in that it would somehow afford Maori special privileges, though at the same time little had been made of the obvious disparities which led to its introduction in the first place. In this regard the Act (and in particular the Treaty principles) has been caught up in the unfortunate debate over political correctness and ethnic privilege, when it's more fundamental purpose (to improve Maori health outcomes and reduce disparities) seems to have been lost.
Nevertheless the Act was eventually passed, though in a somewhat watered-down version. Also, in order to establish clear parameters for the interpretation of these principles the Act is fairly prescriptive in terms of how these principles should be interpreted. This was in part to allay the fears of some that the Treaty would not over-ride any other sections of the legislation but also to ensure that these principles did in fact facilitate a quantifiable outcome. For example (with respect to the principles) the Act requires a minimum Maori membership on District Health Board (DHB) boards, and the provision for Maori membership on DHB committees. As well, it requires board members to be familiar with the Treaty of Waitangi and Maori health issues (Bennion, 2001).
Nearly six years on, and despite the initial fears of some, the principles within the Act did not push Maori to the head of the queue nor did they miraculously transform our poor health statistics. What the Act proved however, was that the Treaty did have legislative relevance to social policy and health. Despite conflicting views on how the Treaty should be interpreted and applied it was nevertheless possible to use the Treaty without too much conflict or compromise. In hindsight, the Act also proved that applying the Treaty did not necessarily mean that the rights of others had to be compromised or eroded.
This presentation has given a brief and albeit simplistic perspective on the connections between the Treaty of Waitangi and Maori health. Of course there are other issues which potentially could inform this discussion, however, added detail does not always bring with it added enlightenment. Certainly, an overly prescriptive and detailed discussion often results in the main issues or singular point being lost.
With this in mind, if it is not already clear, there are at least seven points which have hopefully been made and which may potentially improve your interactions with Maori. The first is that the Treaty of 1840 was a contemporary response to the issues of the day and was a necessary mechanism in the face of significant and inevitable change.
The second is that Maori would not have signed the Treaty unless they could see some benefit from it. In 1840, New Zealand was in fact made up of numerous and independent states, geographically defined by tribal boundaries, and well accustomed to negotiations, trade and debate. Maori were politically astute, a fact not missed by the Crown, and which would have influenced the overall design of the Treaty. To this end, signatures would not have been given lightly or without an expectation of something in return.
The third point is that while the Treaty was signed in 1840 it was always designed as a platform for future development. This is clear, not only from the language which was used, but also from the way in which Maori have always viewed it, as a mechanism for contemporary development. Certainly, a number of issues have shifted the focus from the future to the past as a consequence of numerous breaches and broken promises. Nevertheless, the opportunities presented by the Treaty still remain and may yet form a platform for mutual development and advancement.
The fourth point is that despite difficulties over the interpretation and meaning of the Treaty it has a clear and explicit relationship to health. Whether examining the Maori or English text, the provisions or principles, the outcomes and conclusion are the same. Over time, and largely as a result of broken promises, this connection has been lost against the backdrop of land confiscations, indigenous rights and desires for self-determination. I am certainly not suggesting that these issues are not important or that Maori well-being was the only feature of the Treaty. However, when the multiple applications of the Treaty are explored, then the issue of Maori health must, at the very least, be considered.
The fifth point is that the Crowns approach to the Treaty (and with respect to health) is neither clear nor consistent. The health reforms of 2000 did however illustrate a willingness to at least explore, within legislation, how the Treaty could influence the shape and design of the New Zealand health infrastructure. Some, especially Maori, were initially of the opinion that it would amount to little. If there is one thing that will prevent the Treaty from being included within future plans or legislation it is the idea that it will somehow negatively impact on non-Maori, create division and Maori privilege. However, while this Act could have made a more forceful Treaty statement, the fact that the predicted social fallout did not eventuate provides clear evidence that the seamless integration of the Treaty (within legislation) is quite possible If anything, the Act strengthens the argument for greater use of the Treaty throughout all legislation.
The sixth point is that the Treaty may be applied in a variety of ways, at different levels, and in multiple settings. As described, the Treaty has been used to guide both health policy and health legislation. At another level it can also be used to assist health service delivery and more focused interactions between health professionals and clients. Despite confusion as to how the Treaty may be applied (especially to health) it is clear that once all perspectives are considered it is essentially about promoting or providing the best possible outcomes. In fact, this singular objective is perhaps the easiest way to understand the Treaty, which reflects its fundamental intent.
Of course promoting the best outcomes at an individual level is the ultimate challenge, and there is no simple way of doing so. However, some useful, pragmatic, and cost effective mechanisms have been developed which may usefully guide clinical interactions with Maori and assist with promoting health gains. Maori signage, posters, or information booklets are fairly simple ways of adding a Maori feel to any environment and which make health services (in particular) more welcoming. While most patients are unlikely to be fluent (or even competent) speakers of Maori--information presented in Te Reo is likely to be of greater interest and likewise reveals a desire to at least consider Maori perspectives.
It is well known that Maori may require more time in order to reveal the precise nature of their health problem or in fact what their specific needs are. This may manifest in a way that means other, associated issues, are discussed first and before the more relevant concern is considered. In some cases it may also result in several consultations taking place, until an appropriate relationship is developed, at which time the individual feels comfortable to discuss the actual issue.
Other sensitivities and behaviours may also be required. For example, immediately asking a client to reveal their name, without any preliminary remarks, could make some Maori feel apprehensive. As well, expecting Maori to engage in direct eye-to-eye contact could be interpreted as an invitation to demonstrate bad manners as looking at an older person in the eye could be viewed as a sign of disrespect. Alternatives to the way in which health information is provided can also be explored. There is some evidence to suggest that non-compliance issues are directly linked to what and how information is presented (Durie, 1994). Again, these are but some examples of simple approaches, but which may lead to measurable improvements in assessment, planning, compliance, recovery, and health outcomes.
The fundamental task of health professionals is to promote and protect health and well-being, to assist and aid recovery, and to ensure that the best possible health outcomes are achieved. This is a constant and indiscriminate objective, one which is blind to ethnicity or nationality, culture or identity, socio-economic or demographic profiles. The mistake however, is when these generic objectives for health and well-being are translated into generic approaches for health service delivery, treatment, and care. Aligned with this is the flawed assumption that treating people the same will somehow translate into similar health outcomes.
The reality is that treating people the same is unlikely to result in similar outcomes and that ignoring cultural or ethic factors will only serve to widen existing disparities. This is sometimes difficult to fully appreciate and indeed seems counterintuitive to the ideals of a country which has often taken pride in its non-discriminatory approach to welfare and social service delivery. However, it is perhaps time to re-focus our lens and place greater emphasis on achieving equity from the outcomes of care as opposed to neutrality in the delivery of health services.
The seventh, and final point, is that the Treaty is not about Maori privilege or a desire to erode non-Maori rights. What it is however, is about equality and balance, an expectation by Maori of equal access to health services, appropriate outcomes, in the design and delivery of health policies and services. These issues are of course also based on need, Maori health inequalities, and any number of well-considered disparities. However, a needs based analysis is but one framework through which Maori health concerns can be addressed and in reality differs little from an approach derived from the Treaty. The only difference is that a Treaty based approach is likely to have broader Maori appeal--in part because it avoids a deficits based model, but fundamentally because it is aligned with Maori development, Maori advancement and a desire to focus on solutions rather than negative statistics. In this regard the Treaty may be considered as an appropriate framework for Maori health development.
Kia ora koutou.
This article is based on a plenary address to the New Zealand Association of Occupational Therapists Conference in Wellington in September 2006.
Bennion, T (2001), Maori law review: A monthly review of law affecting Maori. (September), Wellington: Author.
Dailey, B. & McLean, G. (2005). Frontier of dreams: The story of New Zealand, Auckland: Hodder Moa.
Durie, M. H. (1998). Te Mana to Kawanatanga: The politics of Maori self-determination. Melbourne: Oxford University Press.
Durie, M. H. (1994). Whaiora: Maori health development. Auckland: Oxford University Press.
Kingi, Te K. R. (2002). Hua Oranga: Best health outcomes for Maori, Unpublished doctoral thesis, Massey University, Wellington, New Zealand.
MacLean, F. S. (1964). Challenge for health: A history of public health in New Zealand. Wellington: Government Printer.
Orange, C. (1987). The Treaty of Waitangi, Wellington: Port Nicholson Press.
Ramsden, I. (2003). Cultural safety. Retrieved November 7, 2005, from Massey University, School Public Health Web site: http://culturalsafety. massey.ac.nz/ChapterFive.htm
Royal Commission on Social Policy. (1988). The April Report. Wellington: Author.
School of Maori Studies, (2005). Treaty of Waitangi in contemporary society: 150:202 Study Guide, Massey University, Palmerston Nth.
State Services Commission, (2005). The Treaty of Waitangi Information Programme. Wellington: Author.
Te Ara. (1966). Dr Isaac Earl Featherston. Retrieved November 7, 2005 from http://www.teara.govt.nz/1966/F/FeatherstonDrIsaacEarif FeatherstonDrIsaacEarl/en
DrTe Kani Kingi B Soc Sci, M Soc Sci, PhD Te Pumanawa Hauora Research Centre for Maori Health and Development Massey University Private Box 756,Wellington Email: t.r.kingi @,masseyac.nz
|Printer friendly Cite/link Email Feedback|
|Title Annotation:||RESEARCH ARTICLE|
|Author:||Kingi, Te Kani|
|Publication:||New Zealand Journal of Occupational Therapy|
|Date:||Mar 1, 2007|
|Next Article:||Autonomy, accountability, and professional practice: contemporary issues and challenges.|