Maori Health Research Priority Setting

• Disclaimer
• Introduction / Abstract
• Rationale
• Maori Health Needs and Maori Health Inequalities
• Background
• The Role of the Crown
• Resourcing Maori Health Research
• Conclusion
• Acknowledgement
• References

Disclaimer

The views expressed are not necessarily the views of Te Pumanawa Hauora or the Department of Maori Studies, Massey University.

Introduction / Abstract

In order to be consistent with the principles of the Treaty of Waitangi, health research priorities should address Maori health needs (protection).

Besides addressing ethical issues related to the dissemination of researched information to the participants, Maori health research priorities should reflect the needs of Maori and involve Maori (participation).

Health for Maori is also dependent on the quality and timeliness of the health research. Quality and timeliness of the delivery of health research by health researchers may not be relevant for some Maori because the research may not reflect Maori health priorities. This paper aims to discuss how Maori health research priorities may be further explored by recommending strategies that match Maori health priority setting with Crown policy (partnership).

Rationale

The role of the researcher in developing and carrying out effective health research is critical in ensuring the high quality of Maori health research and its relevance to the health needs of Maori. The health researcher must ensure the principles used are relevant to Maori. The researcher is also responsible for ensuring research undertaken has clear aims and objectives, is well planned, and clearly meets accepted standards of research and ethical rigour.

Establishing a framework for describing the process for identifying and prioritising Maori health research priorities will enable critical review and evaluation. The framework developed would share the same principles used to describe Maori and Crown health priorities.

Maori Health Needs and Maori Health Inequalities

Determining Maori health priorities is critical to meeting Maori health needs and protecting Maori health. Many factors, environmental and historical, are related to the health inequalities experienced by Maori. The strong association between some measures of socio-economic status, ie poor housing, and health inequalities (eg hospital admissions for respiratory disease) indicate solutions may be beyond the health sector to address.

Maori health needs have been defined by the statistical information collected which describes Maori experience with the health sector. Additional information from socio-economic descriptors has enriched this statistical information, but the interpretation has not proven causality or defined Maori health needs in culturally relevant terms. Health inequalities experienced by Maori are best described as a subset of Maori health need. Maori perceptions of health are holistic, encompassing whanau, physical, mental and spiritual well-being. Maori health need, as defined by Maori perceptions of health, encompasses the physical and mental inequalities described by the health statistics.

Maori health needs, therefore, may not equate to health inequalities experienced by Maori in the delivery of personal health services and public health programmes. Population-based health services (public health) offers a wider scope in addressing health need. Public health encourages the formulation and application of population-based interventions outside Vote Health (fiscal resources dedicated to the provision of publicly funded health services).

Maori health is a health gain priority area, and the research sector is charged with assisting in the identification of the most productive research for achieving health gains for Maori. Research priorities would enable all health researchers to identify possible benefits for Maori within their own research.

Determining Maori health priorities is a critical element in planning Maori health research. Without clear and relevant health research priorities, Maori health research cannot begin to meet Maori health needs. Setting Maori health research priorities would require a methodology based on clear and accepted principles, led by Maori health priorities. The principles would be developed from researched information, both scientific and cultural.

Establishing research priorities would assist with maximising health outcomes because the Maori health research workforce in New Zealand is a finite resource of which many members are in training. A framework for establishing Maori health research priorities would take into account all resources including the development of a sustainable skilled and competent Maori health research workforce.

Background

The aims in developing a framework for determining Maori health research priorities are strategic and therefore must describe Maori health needs which would in turn describe and rank priorities for Maori health research. The objectives may be to investigate current and past settings used to determine Maori health priorities and match them to the Maori health research knowledge base over a realistic time frame.

Maori health research priorities are not explicit, and are funded by a number of agencies to meet a wide variety of differing research needs. Maori health research priorities, therefore, are not clear and there is no framework which describes how Maori health priority setting takes into account the divergent needs of the diversity of Maori health research stakeholders.

In order to remain relevant and durable, health research priorities must include utilisation-focussed studies together with research that simply extends our knowledge base. This process therefore would not be just about reaching a consensus on priorities, but about covering the health and Maori development sectors to identify research that will contribute increasing gains in Maori health and well-being.

The Role of the Crown

The Crown’s objective is “To seek to improve Maori health status so in the future Maori will have the opportunity to enjoy the same level of health as non-Maori.”

This objective is designed to enable providers and funders of health services to address health inequalities experienced by Maori. Health inequalities have been assessed as the excess morbidity and mortality experienced by Maori in relation to non-Maori. Health inequalities describe health outcomes, but do not necessarily describe priority without consideration of health values and principles, which are culturally based (eg Te Whare Tapa Wha).

Without relevant and accurate researched information to meet the information needs of providers, the inequalities that exist today may continue for some time yet. Therefore specific Maori health priority research is essential to ensure the Crown can deliver on personal and public health goals as described in “Whaia Te Ora mo Te Iwi” and “He Matariki: A Strategic Plan For Maori Public Health”.  ^{1     2}  

The Crown’s Maori health objectives, outlined in sections 7 and 10 of the Health and Disability Services Act, recognise the special needs of Maori and other particular populations. “Whaia Te Ora mo Te Iwi” described the Health and Disability Services Act as forming the framework for the implementation of the Health reforms. The Crown goes further. “Any discussion about Maori issues in the health sector, must begin with an acknowledgment of the relationship between the Crown, this legislation (The Health and Disability Services Act) and the Treaty of Waitangi.”  ³  

The Government acknowledged the potential for the health reforms to address Maori health concerns, as well as the active contribution Maori have made to the health systems over the years.  ⁴   The Minister described the expectation that health gains would be built on the response by Maori to increase their participation in the (health) sector, and said Maori have responded to changes in the health sector with enthusiasm, and have contributed to the development of more culturally effective health service delivery.

Maori have identified health priorities in areas that have affected Maori ability to determine Maori cultural norms. This is exemplified by the Waitangi Tribunal claim regarding the water outfall at Motonui (Te Ati Awa). The Motonui claim arose because the discharge of waste water grossly affected Maori values of health and the environment, and affected the ability of Maori to access their resources including the collection of kaimoana (seafood).

The Crown’s public health objectives for Maori were identified within the Public Health Commissionís (PHC) public health goals which formed the basis for the development of “He Matariki”. Cumming (1995) outlined the issues that have arisen from the extensive consultation the PHC carried out to produce He Matariki. Cumming also noted that the consultation highlighted Maori health priorities based on service provision, but did not identify Maori health research priorities. He Matariki enables Maori needs to be implemented into policy and programmes as funding permits.

He Matariki provides a strategic plan for Maori public health based upon six Maori public health goals:

• to promote a social and physical environment which improves and protects whanau public health
• to improve and protect the health of Tamariki
• to improve and protect the health of Rangatahi
• to improve and protect the health of Pakeke
• to improve and protect the health of Kaumatua
• to improve Maori health status so in the future Maori will have the opportunity to enjoy at least the same level of health as non-Maori.

The life cycle approach adopted by He Matariki enables Maori to plan for the delivery of health services in a manner consistent with Crown health objectives, but also allows Maori needs to be recognised, and Maori processes undertaken. The development of Maori health research priorities may also be guided by this same approach.

Resourcing Maori Health Research

High priority is attributed to Maori health research themes. The ability to undertake Maori health research to meet this need is limited by the relatively small number of appropriately qualified Maori health researchers.

Setting Maori health research priorities therefore is essential to the efficient use of the limited Maori health research workforce. The relatively small Maori health research workforce was, until recently, focussed on two Health Research Council (HRC) funded Maori health research units in Palmerston North (Te Pumanawa Hauora: TPH) and Wellington (Te Roopu Rangahau Hauora-a-Eru Pomare: TRRHEP). HRC Training Fellows are also located in Auckland, Wellington, and Dunedin. Maori health researchers are employed in a number of other research units such as the Injury Prevention Units in Auckland. Ngai Tahu have established a Maori health research centre at Otago University, Dunedin.

The Maori Health Committee of the HRC is currently revisiting its funding policy and its Maori Health priorities. Clear Maori health research priorities for guiding the research programmes are yet to be published, and without clear priorities the performance of Maori health researchers is difficult to assess.

Conclusion

The development of Maori health research priorities requires a significant investment of time and funding in an extensive and rigorous collaboration between the wider New Zealand community, policy makers and health practitioners (including health researchers). The role of the health researcher will be one of facilitation. The durability of the priorities identified will in part be determined on the rigour of the research undertaken and also on the sensitivity of the priorities to political change at local and national government levels.

Acknowledgement

This paper was prepared with the assistance of funding from the Health Research Council of New Zealand (HRC Grants 93/ 290 and 96/105). Te Pumanawa Hauora was established with HRC grant 93/290 and the assistance of Massey University and Te Puni Kokiri (The Ministry of Maori Development).

References