The "standard story" of anti-Maori talk in Pae Ora (Healthy Futures) Bill submissions.

AIM: To review some common patterns of race talk in a sample of submissions made to the Pae Ora (Healthy Futures) Bill. This bill proposed a structural reform of the health system in Aotearoa New Zealand to address long-standing health inequities experienced by Maori, the Indigenous peoples, and other priority populations. METHOD: In a sample of 3,000 individual submissions made in late 2021, we found 2,536 explicit references to race. Utilising the "standard story" frame of Pakeha/non-Maori race talk, five longer submissions that inferred that the Pae Ora bill was "racist" were analysed in detail. RESULTS: Many "standard story" race discourses were identified in the Pae Ora submissions. Three derived discourses included in this paper are: Pakeha as norm (monoculturalism or not seeing Pakeha as a culture), equality and the "Treaty" (equality for all to access healthcare), and one people (we are all New Zealanders). Sources such as the Waitangi Tribunal Wai 2575 Hauora report were drawn on to provide alternative discourses. CONCLUSION: Identifying Pakeha standard story discourses enables learning about language patterns systems draw on, and the development of tools and procedures to improve equity for Maori and eliminate institutional racism.

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

The current health reforms in Aotearoa New Zealand are being described as "transformational". Political leaders and Crown officials maintain the reforms embed a commitment to Te Tiriti o Waitangi, address racism and promote health equity. These claims are familiar and have been used to socialise previous health sector reforms. This paper interrogates claims of engagement with Te Tiriti by undertaking a desktop critical Tiriti analysis (CTA) of Te Pae Tata: the Interim New Zealand Health Plan. CTA follows five stages from orientation, close reading, determination, strengthening practice, to the Maori final word. The determination was done individually and a consensus was negotiated from the indicators; silent, poor, fair, good, or excellent. Te Pae Tata proactively engaged with Te Tiriti across the entirety of the plan. The authors assessed Te Tiriti elements of the preamble, kawanatanga and tino rangatiratanga as "fair", oritetanga as "good" and wairuatanga as "poor". Engaging more substantively with Te Tiriti requires the Crown to recognise that Maori never ceded sovereignty and treaty principles are not equivalent to the authoritative Maori text. Recommendations of the Waitangi Tribunal WAI 2575 and Haumaru reports need to be explicitly addressed to allow monitoring of progress.

A Critical Tiriti Analysis of the Pae Ora (Healthy Futures) Bill.

AIM: The Pae Ora (Healthy Futures) Bill is the framework for a reformed health system intended to embed Te Tiriti o Waitangi and centre equity. The Bill is informed by the Wai 2575 Health Kaupapa Waitangi Tribunal Inquiry and the Health and Disability System Review, both of which established an urgent mandate to transform the health sector. This desktop review explores to what extent the proposed Bill is likely to uphold Te Tiriti. METHODS: This paper uses Critical Tiriti Analysis to review the Pae Ora Bill. The analysis involves five phases: (i) orientation; (ii) close reading; (iii) determination; (iv) strengthening practice and (v) Maori final word. As part of that, a determination is made whether the Bill is silent, poor, fair, good or excellent in relation to the Preamble and the four articles (three written, one verbal) of te Tiriti o Waitangi (Maori text). RESULTS: The desktop analysis showed fair engagement with most of the Te Tiriti elements; but with good commitment to address equity issues. The Bill was silent in relation to wairuatanga (spirituality) and there is no evidence of Maori values informing it. CONCLUSION: The dominant Crown narrative that interprets kawanatanga as the right to govern over all peoples pervades this legislation. There are significant power sharing shifts within this Bill and these are welcomed, but whilst the Crown maintains ultimate power and authority only a partial fulfilment of Te Tiriti will be evident within the health system.

A critical analysis of te Tiriti o Waitangi application in primary health organisations in Aotearoa New Zealand: Findings from a nationwide survey.

Primary health is at the forefront of efforts to address health inequities. Effective primary health care keeps people well and improves longevity and quality of life. The persistence of health inequities, particularly between Indigenous peoples and non-Indigenous peoples globally, suggests that there is a need to strengthen policy and practise. Unique to Aotearoa (New Zealand) is te Tiriti o Waitangi, a treaty negotiated in 1840 between the British Crown and hapu (Maori [Indigenous] subtribes). This treaty is foundational to public policy in Aotearoa and requires the Crown (New Zealand government) to uphold a set of responsibilities around protecting and promoting Maori health. This paper examines to what extent Primary Health Organisations are upholding te Tiriti o Waitangi. The study utilises data from a nationwide telephone survey of public health providers conducted in 2019-2020 recruited from a list on the Ministry of Health website. This paper focuses on data about te Tiriti application from 21 Primary Health Organisations from a sample size of thirty. Critical te Tiriti analysis, an emerging methodology, was used to assess to what extent the participating primary health organisations were te Tiriti compliant. The critical te Tiriti analysis found poor to fair compliance with most elements of te Tiriti but good engagement with equity. Suggestions for strengthening practise included examining relationships with Maori, utilising a planned approach, structural mechanisms, normalising Maori world views and consistency in application. The onus needs to be on non-Maori to contribute to the cultural change and power-sharing required to uphold te Tiriti. Critical te Tiriti analysis is a useful methodology to review te Tiriti compliance and could be used in other contexts to review alignment with Indigenous rights and aspirations.

Primary healthcare response to family violence: a Delphi evaluation tool.

BACKGROUND: Family violence is identified as a significant yet preventable public health problem internationally and in Aotearoa, New Zealand. Despite this, responses to family violence within New Zealand primary healthcare settings are generally limited and ad hoc. Along with guidelines and resources, a systems approach is indicated to support a safe and effective response to those who experience violence in the home. AIM: To modify an existing United States evaluation tool to guide implementation of family violence intervention programmes within New Zealand primary healthcare. METHODS: Twenty-nine expert panelists, representing diverse family violence prevention and intervention organisations across New Zealand, participated in three rounds of a modified Delphi method to identify ideal primary healthcare family violence response programme indicators. In Round One, tool scope and context issues for New Zealand were identified; in Round Two, expert panelists identified ideal indicators and rated indicator importance, and in Round Three, expert panelists attended a one-day workshop to achieve consensus on tool categories, indicators, scoring and measurement notes. The developed tool was subsequently piloted at six volunteer primary healthcare sites for performance, clarity and usefulness. RESULTS: The final tool encompasses 143 indicators organised within 10 categories. Pilot sites found the tool and evaluation experience useful in guiding programme development. CONCLUSION: The evaluation tool represents a best practice standard enabling focused family violence intervention programme development and quality improvement within primary healthcare settings. A standardised evaluation tool may be useful in guiding programme development. Future evaluations will enable individual and national benchmarking activities, using category, overall and target scores to measure progress across settings and over time.