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Māori health research advancement

This page provides background and resources to assist health sciences researchers to implement Māori-responsive research practices.

Māori Health Advancement online workshops open for registrations now (no cost), postgraduates, staff, and allied health professionals most welcome.

The basis for Māori-responsive research

Three reasons why researchers need to create Māori-responsive research are:

  1. We have the Treaty of Waitangi in Aotearoa
  2. We have a mandate from Government funders
  3. We need to improve health equity for Māori
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Treaty of Waitangi

All researchers must must consider the Treaty of Waitangi articles and principles in their research.

Articles

  • Kawangatanga- Governance
  • Tino rangatiratanga - Autonomy
  • Oritetanga - Equity

Principles

Partnership — recognition of Māori groups as partners in research and respect for their cultural knowledge and traditions, including Māori individual and collective rights, Māori data, Māori culture, cultural concepts values, norms, practices and language.

Participation — control over involvement in research processes by Māori, and Māori participation in design, governance, management, implementation and analysis especially for research involving Māori.

Protection — actively protecting Māori rights and ensuring there are tangible benefits that can be realised within Māori groups in an equitable manner.

The National Ethics Committee states, “All health research carried out in Aotearoa is of relevance to Māori. How relevant, is a decision to be made by Māori.”

Partnerships to support aspirations

Within the Division of Health Sciences and the wider University our primary Treaty relationship with Ngāi Tahu has served as the foundation for our partnerships with many iwi throughout the country as an increasing number of which, like Ngāi Tahu, are moving into their post-settlement development phase. There are now greater opportunities and increased expectations for institutions such as ours to tangibly support development aspirations.

The Treaty of Waitangi and Research Ethics in Aotearoa: Maui Hudson and Khyla Russell (PDF)

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Government mandate for research funding

Health Research Council of New Zealand (HRC)

The Health Research Council of New Zealand has recently announced, that in 2020 it will start scoring each health research application for the quality of its approach to addressing Māori Advancement in research. Careful consideration of the issues in doing this, has highlighted that many health researchers (in particular biomedical and clinical) are yet to fully understand the background to this or the best approach to take in order to ensure their research is aligned with the requirements of the HRC’s Māori Advancement requirements.

Māori Health Advancement Guidelines (PDF)

Guidelines for Researchers on Health Research Involving Māori (PDF)

NZ Māori Health Advancement (HRC website)

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Ministry of Business, Innovation and Employment (MBIE)

MBIE has recently created A Guide to Vision Mātauranga, that describes principles of good practice for Vision Mātauranga in the National Science Challenges and across the science sector. The recommendations are proposed to help the sector to leap to the next level of science excellence, impact and success. These can be summarised as movement from poor to excellent practice, as follows.

  • Empower knowledge
  • Empower people
  • Empower Māori resources
  • Empower the future

Related resources:

Vision Mātauranga (PDF)

Rauika Māngai – A Guide to Vision Mātauranga (PDF)

Vision Mātauranga Guidelines for Applicants (PDF)

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Division of Health Sciences relationship with Ngāi Tahu

Within the Division of Health Sciences and the wider University our primary Treaty relationship with Ngāi Tahu has served as the foundation for our partnerships with many iwi throughout the country as an increasing number of which, like Ngāi Tahu, are moving into their post-settlement development phase. There are now greater opportunities and increased expectations for institutions such as ours to tangibly support development aspirations.

We recommend in the first instance that all Division of Health Sciences researchers read the page 7 of the Māori Strategic Framework to undertake research that is transformative and beneficial for Māori communities, including research that increases understanding of te ao Māori and mātauranga Māori, and supports the University’s commitment to excellence in research.

Related resources:

University of Otago – Māori Strategic Framework 2022 (PDF)

A Strategic Approach to Māori Advancement (University of Otago website)

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Health equity for Māori

Defining inequity

Concepts of inequalities and inequities have been used interchangeably within literature however these concepts differ in meaning. Health inequities are defined as, “differences which are unnecessary and avoidable, but in addition are considered unfair and unjust” (Robson, Cormack, & Purdie, 2006; Whitehead, 1992).

Equity is based on the ethical concept that everyone is entitled to achieve the same level of positive outcome within society. This does not mean that everyone receives equal resources; it instead ensures that those with most poor outcomes receive support to attain the same level of outcomes as those with the best outcomes and most resources; ensuring resources are fair and just. Inequalities are differences.

Hauora Māori IV (PDF)

Health inequity in Aotearoa

In Aotearoa health disparities are highlighted in health data relating to Māori, Pacific peoples and lower socioeconomic groups, who experience worse health and higher rates of morbidity and mortality than other New Zealanders. Over recent decades a number of important goals for the health sector has signalled changes in both secondary and primary health care delivery, and priorities for the health sector.

He Korowai Oranga, The New Zealand Māori Health Strategy is one such example. He Korowai Oranga sets the overarching framework that guides the Government and the health and disability sector to achieve the best health outcomes for Māori:

He Korowai Oranga ( Ministry of Health website)

Related resources:

The Guide to He Korowai Oranga Māori Health Strategy (PDF)

Whakamaua Māori Health Action Plan 2020–2025 (PDF)

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Key considerations for researchers

Te Ara Tika Guidelines

We recommend using the Te Ara Tika framework to guide you through thinking about Māori Health Advancement while developing your research. This framework was developed by Pūtaiora (Māori members of ethics committees) and the National Ethics Advisory Committee (NEAC):

Te Ara Tika Guidelines for Māori research ethics: A framework for researchers and ethics committee members (PDF)

A Brief Introduction to Te Ara Tika (PDF)

Ethnic specific analysis

The definition of ethnicity used by Statistics New Zealand is as follows: ‘Ethnicity is the ethnic group or groups that people identify with or feel they belong to.’

Using this definition, ethnicity is seen as self-perceived and people can belong to more than one ethnic group.

Undertaking ethnic specific analyses can be a useful way of highlighting differences in morbidity and mortality between population groups as well as highlighting differences in effectiveness of services or other interventions. All of these analyses can be useful in informing improvements in health policies and practices for Māori.

Related resources:
University of Otago – Ethnicity Data project (Department of Public Health, UOW)

Invited Commentary: “Race,” Racism, and the Practice of Epidemiology" (PDF)

Ethnicity Matters: Māori Perspectives (Department of Statistics, PDF)

The politics and practice of counting: ethnicity in official statistics in Aotearoa/New Zealand (Ministry of Health website)

Issues in monitoring Māori health and ethnic disparities: an update (PDF)

Classification and output of multiple ethnicities: Considerations for monitoring Māori health (Ministry of Health website)

Ethnicity, national identity and ‘New Zealanders’: Considerations for monitoring Māori health and ethnic inequalities (Ministry of Health website)

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Informed consent

The nature and specificity of consent obtained in the informed consent process can sometimes be difficult. Consents should be sought for:

  • Ongoing storage in tissue banks
  • The establishment of cell lines
  • Tissue being sent overseas
  • Use within genetic studies
  • Future use

Often Māori favour the acknowledgement of both individual and collective consents as some ethical issues can be usefully considered and consented to by an individual and other ethical issues require whānau or community engagement. A collective is useful in the early decision making process about the appropriateness of the study while an individual can decide once the study has begun whether or not they will participate. This means that two forms of consent are required for research involving human tissue and/or genetic samples. Firstly, that of an appropriate whānau / community / collective for the study to take place (via consultation) and secondly, those of individual Māori participating in the study.

On-going communication with donors or participants

Beyond the initial consent process, it is also important to provide a communication channel so that donors and their whānau are able to find out what has happened to their tissue and for which research projects it has been included. This provides a way for donors/participants to vary or withdraw their consent both for the actual study and future studies (if so consented).

Think globally, act locally: collective consent and the ethics of knowledge production: Maui Hudson (wiley.com website)

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Confidentiality

Participation in research usually involves confidentiality of participant identity. Maintaining this confidentiality can be difficult for Māori, especially with smaller or regional studies. The combination of extensive Māori social networks and (possibly) small numbers of eligible Māori participants requires researchers to minimise the inclusion of identifiable information in any research reports or publications—to avoid the unintentional identification or incorrect identification of an individual, community, or organisation.

Conversely, Māori participants may ask that their research information is made available beyond themselves (in line with collective accountability, or to ensure wider benefit from the research process for their communities). The research application should specifically indicate if either of these situations could apply to the intended project, and (if so) they should include a strategy to address the issue.

Related resources:

Data confidentiality principles and methods report (data.govt.nz website)

Degrees of identification in data (PDF)

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Human tissue and genetics

Māori view all tissue and body fluids as taonga (to be treated as a treasure). However, body fluids and tissues are also regarded as tapu (and therefore need to be treated with caution) rather than noa (neutral). This distinction is important, since biological specimens must be treated with great care and kept away from food and cooking utensils.

The process of consent to the taking of tissue and body fluids (as part of a research protocol) amounts to entrusting the researcher with this taonga. Consent for tissue or body fluid collection is not given lightly, and consequently all tissues should be handled with respect. Many universities and hospitals already have protocols for the sampling, storage, and disposal of tissue from Māori. These can include Māori supervision of the process, and rituals for the cleansing of the storage site or samples. Where samples are required, it is important that the researcher seek and follow the advice of the local Māori advisory or management team and document this in their application.

It is expected that where tissues and body fluids will be transported (particularly outside of Aotearoa), there will be evidence of specific processes in place to ensure that samples are used only for the purposes for which consent has been provided and then disposed of in a suitable manner. The application form should outline what protocols are being followed for handling human tissue and what, if any, specific processes are being followed for any Māori specimens.

Genetic research

The use of genetic material from Māori, as well as from indigenous flora and fauna, is highly contentious and there is a general reluctance among Māori to be involved in genetic research. Many of these contentious issues have been discussed by Baird et al,12 or are outlined in the submissions to the Royal Commission on Genetic Modification.

However, several Māori-specific genetic projects have proceeded, including at least two researcher-initiated projects. In all cases, extensive consultation was required with whanau, hapu, and iwi. Involving Māori in mainstream projects is less straightforward. Possible strategies include excluding Māori from such a study or not collecting ethnicity data, making Māori samples non-identifiable. Again, researchers should familiarise themselves with the issues, then follow local protocols in determining how to address this issue and refer to these in their applications:

Guidelines on the Use of Human Tissue for Future Unspecified Research Purposes Submissions summary (PDF)

Te Mata Ira Guidelines for Genomic Research with Māori (PDF)

He Tangata Kei Tua Guidelines for Biobanking with Māori (PDF)

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Intellectual property

Mātauranga Māori (most commonly translated as Māori knowledge) encompasses the body of knowledge originating from Māori ancestors. It includes the Māori world view and perspectives, as well as Māori creativity and cultural practices including Te Reo Māori, the Māori language. These are important considerations for researchers, particularly those involved in the development of patentable knowledge or new services.

New Zealand Intellectual Property Office (iponz) resources:

Protecting intellectual property with a Māori cultural element: User Guide (PDF)

Concepts to understand (iponz website)

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Koha

It may be appropriate to provide participants with a small gift in recognition for their time, mātauranga and contribution, however financial incentives could contradict the basis of informed consent as well as create a source of bias in recruiting a research sample.

Some examples of koha could be:

  • Letter or card of thanks
  • Certificate of participation
  • Book, petrol or food vouchers

One way to ensure that a koha is not regarded as an incentive is to wait until the research is complete before offering it. Koha is not the same as payment for research involvement or participation.

University of Otago Koha Payments Policy and Procedure

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