Table of Contents

The health and well-being of Indigenous Māori communities in New Zealand face ongoing challenges rooted in colonisation and systemic inequities. While advocacy and initiatives have strengthened in recent decades, true partnership and self-determination remain a work in progress, according to insightful analyses. The article analyses the progress made and barriers faced within the nursing profession specifically. While the representation of Māori nurses has grown, underrepresentation limits the ability of Māori voices to shape policy and practice. Structural and interpersonal racism also take both a physical and emotional toll on Māori nurses. International examples then demonstrate the potential of Indigenous-led governance models to strengthen partnerships and outcomes.

In collaboration with Medfuture Medical and Healthcare Agency, this article delves into the ongoing challenges faced by Indigenous Māori communities in New Zealand. This underscores the pivotal role of equitable healthcare and nursing solutions. While acknowledging progress, the imperative for genuine self-determination and intensified anti-racism efforts persists. Notably, Medfuture’s commitment to recruiting nurses emerges as a crucial component in addressing these disparities. It exemplifies a dedicated effort toward achieving comprehensive health equity for Māori communities.

How did colonisation impact Māori health through lost knowledge, social networks, and psychological stress? What insights inform culturally empowering systems today?

To understand current realities, we must acknowledge how colonisation disrupted traditional Māori society and health. The imposition of a foreign system of governance, education, and medicine marginalised Mātauranga Māori knowledge, language, and cultural practices. This contributed to poor health outcomes and a lack of power over their well-being. While the Treaty of Waitangi aimed to protect Māori rights and interests, in practice, colonisers did not prevent land confiscations and cultural oppression. These damaged the fabric of whānau, hapū, and iwi structures. The intergenerational impacts of these historical traumas remain embedded in contemporary systems and communities. Health inequities between Māori and non-Māori persist as a result.

How does the underrepresentation of Māori in the nursing workforce impact policy-shaping, and what challenges persist in achieving equitable health outcomes?

Advocacy efforts over decades have led to some gains. The nursing workforce has grown to around 7.5% identifying as Māori, compared to 17% of the overall population. However, this underrepresentation limits the ability of Māori voices, needs, and knowledge to shape policy and practice. Until recently, few held governance roles like the Nursing Council of New Zealand. While cultural competency training and curricula have strengthened, top-down approaches have faced resistance without addressing systemic barriers faced by Māori. Disparities also persist in health outcomes. For example, the life expectancy of Māori is around 7 years lower than that of non-Māori (Ministry of Health, 2020). If the goal is equitable health and well-being, more self-determined solutions are needed.

How does ongoing racism affect Māori nurses structurally and interpersonally, and what impact does it have on workforce dynamics and Indigenous self-determination?

The examination of the experiences of Māori nurses reveals pervasive racism. Structurally, obstacles to career advancement arise from a lack of Māori educators and leaders in the nursing field. On an interpersonal level, microaggressions and unequal treatment exact both physical and emotional tolls. A study conducted by Waitemata DHB affirmed these challenges, with Māori nurses expressing feelings of cultural disrespect and inferior treatment. The absence of meaningful consequences for racism poses a risk of normalising oppression within the profession, potentially alienating Māori nurses. International instances highlight the positive impact of Indigenous self-determination on workforce development and governance, demonstrating improved partnerships and outcomes.

How can co-designed nursing strategies and co-governance models, centered on Māori priorities, be effectively implemented to dismantle racism and improve health outcomes?

To achieve equitable health and well-being for Māori, self-determination must be central rather than an afterthought. This could take the form of co-designed nursing strategies and co-governance models that centre Māori priorities, knowledge, and decision-making power. The Whānau Ora approach empowers community-led solutions and has shown success in improving health outcomes when resourced appropriately. Long-term funding and political will are needed to support robust partnerships between Māori, district health boards, educators, and other stakeholders. If implemented with integrity, co-governance, and co-design, they have the potential to dismantle racism and close disparities by strengthening the role of Mātauranga Māori across the system.

How can international frameworks inspire effective Indigenous governance while adapting to Māori’s unique context?

Other countries provide frameworks that could strengthen self-determination in Aotearoa. In Canada, Inuit Tapiriit Kanatami advocates for Inuit health through a national Inuit organisation (Inuit Tapiriit Kanatami, 2022). In the United States, the Indian Health Service is led by the Assistant Secretary for Health, who is recommended by tribes (Indian Health Service, 2022). In Australia, Aboriginal Community-Controlled Health Services are owned and operated by local Aboriginal communities (NACCHO, 2022). While international models require adaptation to the unique context of Māori, they demonstrate the impact of centring Indigenous governance.

How can the nursing profession urgently demonstrate commitment to anti-racism and partnership for equitable Māori health, ensuring meaningful representation and support?

While progress has undoubtedly occurred, the nursing profession must demonstrate urgent commitment to truth, partnership, and anti-racism if the vision of equitable Māori health is to be realised. Non-Māori allies also have a role in listening, supporting, and following Māori leadership without co-opting the movement. With openness to learn from challenges of the past and present, the future depends on walking together along a shared path of progress, dignity, and well-being for all. Leadership must demonstrate this through the representation of Māori voices in decision-making, equitable resourcing of iwi-led initiatives, and zero tolerance of racism. If implemented, a co-governance approach has the potential to strengthen the health system for current and future generations.

In conclusion, this article emphasises the persistent challenges faced by Indigenous Māori communities in New Zealand, particularly in the realm of healthcare and nursing. Colonisation’s historical impacts on Māori health, including the loss of knowledge, social networks, and psychological stress, continue to shape contemporary disparities. The underrepresentation of Māori in the nursing workforce limits their influence in policy-shaping, and ongoing structural and interpersonal racism takes a toll on Māori nurses and impedes Indigenous self-determination.

The article calls for a paradigm shift towards co-designed nursing strategies and co-governance models that prioritise Māori priorities, knowledge, and decision-making power. It highlights the potential success of international Indigenous governance frameworks, urging adaptation to Māori’s unique context. The nursing profession is urged to urgently commit to anti-racism and partnership for equitable Māori health, ensuring meaningful representation and support. The vision of comprehensive health equity for Māori communities depends on collaborative efforts, open dialogue, and a commitment to dismantling systemic barriers. Ultimately, It underscores the crucial role of genuine self-determination and anti-racist efforts in achieving health and well-being for Māori in New Zealand.

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