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Introduction
Due to the ongoing effects of colonisation, Māori (Indigenous to New Zealand), like many Indigenous peoples, disproportionately suffer from more ill-health and at an earlier age in almost every health and social indicator than their non-Indigenous peers (1). As a result, Indigenous peoples are often targeted as key groups in health initiatives. Indigenous peoples are commonly treated as dependent consumers of a service as opposed to designers and drivers of their own wellbeing. Indigenous worldview, language and preferences are therefore often not integrated into such initiatives. With this consumer approach, Indigenous health has not significantly improved, suggesting there is opportunity for transformation.
Most analyses of ‘Māori health’ have focused on relatively contemporary Māori ill-health and disparities as measured by a comparison with Pākehā (non-Māori) health standards (2). While such an equity approach that focuses on grouping populations by ethnicity has helped to expose Māori health inequalities, it still emphasises majority non-Indigenous standards and compares Māori against these standards, often resulting in deficit approaches, and ‘whitestream’ measurements and solutions (3). This also contributes to the stigmatisation and problematisation of Māori who are deemed ‘less than’, ‘at-risk’ or ‘vulnerable’ to worse health outcomes (4).
To effectively engage Māori and transform Māori health outcomes and experiences requires more than a focus on inequalities and addressing social determinants of health. The broader social determinants of health are essentially controlled by colonisers, with Indigenous peoples often required to work within non-Indigenous systems. The extent to which Indigenous peoples can achieve their own aspirations of optimum health and wellbeing within such frameworks is limited.
Rights-based approaches to wellbeing for Indigenous peoples, such as those confirmed in the United Nations Declaration of the Rights of Indigenous Peoples and in Aotearoa New Zealand’s Te Tiriti o Waitangi, ensure the prioritisation of improving outcomes specifically for Māori. Rather than being viewed as consumers, this rights-based approach promotes Māori as the drivers of wellbeing enabling Māori to be involved in every component of the funding, planning, implementation and evaluation of health and wellbeing initiatives. It also prioritises Indigenous notions of wellbeing. Indigenous people’s notions of health and wellbeing are embedded in their worldview, culture and language, pursuit of self-determination, diverse identities, aspirations and colonised realities. A strong cultural identity and self-determination have both been...