The Decade of Maori Development (1984-1994) stimulated the re-emergence of distinctly Maori approaches to progressing their own advancement. Maori health promotion is one such approach that has a central concern for improving Maori health outcomes. A range of Maori collectives are providing what they claim to be distinctly Maori health promotion initiatives. However, Maori health promotion has a pragmatic orientation, and this has, at least in part, led to conceptual and theoretical under-development. There is an almost complete lack of empirically and theoretically sound work to conceptualise Maori health promotion. This research programme has focused on identifying the defining characteristics of Maori health promotion. The primary data source for this research programme was three case studies of Maori health promotion interventions. Tipu Ora - a Maori community-based well-child programme; the Plunket Kaiawhina Service - a national Maori focussed initiative located within a mainstream service; and, the Wairarapa Maori Asthma Project - a tribally-based asthma management initiative. The main source of data in each of the case studies was in-depth open-ended interviews with programme participants and stakeholders. Data was also drawn from document review and archival records. The findings of this research indicate that Maori health promotion is based on a broad concept of health, which can be expanded as the basis for a more general argument for Maori advancement. Maori health promotion is the process of enabling Maori to increase control over the determinants of health and strengthen their identity as Maori, and thereby improve their health and position in society. Its defining characteristics have been identified in this research programme, and presented in �Kia uruuru mai a hauora�, a framework for Maori health promotion. The Framework has the potential to provide the basis for a more consistent and rigorous approach to Maori health promotion practice, policy, purchasing, and research. Aspects of the Framework may also have wider application to generic health promotion and other indigenous peoples� approaches to health promotion. This study concludes that Maori health promotion draws primarily on the heritage and new knowledge that arises from Maori and Western experiences. However, it remains grounded in the distinctive concepts and values of Maori worldviews. Maori health promotion is a distinctly Maori process, in step with and indigenous health promotion, but primarily on the determination of Maori to be Maori.

The Decade of Maori Development (1984-1994) stimulated the re-emergence of distinctly Maori approaches to progressing their own advancement. Maori health promotion is one such approach that has a central concern for improving Maori health outcomes. A range of Maori collectives are providing what they claim to be distinctly Maori health promotion initiatives. However, Maori health promotion has a pragmatic orientation, and this has, at least in part, led to conceptual and theoretical under-development. There is an almost complete lack of empirically and theoretically sound work to conceptualise Maori health promotion. This research programme has focused on identifying the defining characteristics of Maori health promotion. The primary data source for this research programme was three case studies of Maori health promotion interventions. Tipu Ora - a Maori community-based well-child programme; the Plunket Kaiawhina Service - a national Maori focussed initiative located within a mainstream service; and, the Wairarapa Maori Asthma Project - a tribally-based asthma management initiative. The main source of data in each of the case studies was in-depth open-ended interviews with programme participants and stakeholders. Data was also drawn from document review and archival records. The findings of this research indicate that Maori health promotion is based on a broad concept of health, which can be expanded as the basis for a more general argument for Maori advancement. Maori health promotion is the process of enabling Maori to increase control over the determinants of health and strengthen their identity as Maori, and thereby improve their health and position in society. Its defining characteristics have been identified in this research programme, and presented in �Kia uruuru mai a hauora�, a framework for Maori health promotion. The Framework has the potential to provide the basis for a more consistent and rigorous approach to Maori health promotion practice, policy, purchasing, and research. Aspects of the Framework may also have wider application to generic health promotion and other indigenous peoples� approaches to health promotion. This study concludes that Maori health promotion draws primarily on the heritage and new knowledge that arises from Maori and Western experiences. However, it remains grounded in the distinctive concepts and values of Maori worldviews. Maori health promotion is a distinctly Maori process, in step with and indigenous health promotion, but primarily on the determination of Maori to be Maori.

This thesis explores the variety of ways in which scientific views of genetic testing are portrayed in the realm of popular culture. As a case study, I have used the identification of the gene for hereditary stomach cancer which occurred in New Zealand in 1998, and was the result of a partnership between the affected whanau and scientists from the University of Otago. Both the empirical and theoretical findings of this project have shown how such accounts are not neutral or transparent. Rather, they are positioned to represent certain values and ideas, and this is even more evident when those affected are Maori. However, considering textual representations of the gene and cancer has revealed the importance of taking into account the fact that these 'things' are also physical and material. I consider the implications of this and consider the ways in which the whanau health workers negotiate the fetishism apparent in biomedicine. Despite its misgivings, biomedicine has immense benefits, some of which the whanau have manipulated and appropriated for their own good, although they do so on their own terms. Despite the many complexities involved in this case study, this is a positive and hopeful story where those involved in the stomach cancer gene project have emerged with improved solutions.

In the past, Maori experiences of research have been described by Jahnke and Taiapa (1999) as follows: "Contemporary Maori society has become increasingly focused on issues of self-sufficiency, self-determination and whanau, hapu and iwi development. Attempts to address these issues have highlighted a lack of satisfactory research in respect of these and other Maori concerns. Much of the research done on Maori in the past has proven to be of little benefit to Maori themselves, tending to emphasise negative statistics without attempting to provide the information necessary to effect positive change. As a consequence, many Maori treat research with a degree of suspicion, questioning both the motives of researches and the methodologies employed" (p.37). A number of tools have been used to define the public health of Maori, including Maori women. This dissertation aims to describe some of the methodologies and methods used in relation to analytical frameworks developed by leading Maori research academics such as Linda Tuhiwai Smith, in critiquing research undertaken defining the key public health issues for Maori women. Maori Health Researchers experiences of research, methodologies and methods used have also been determined based on qualitative interview techniques. There are currently significant gaps in both the information in determining the methodologies and methods used, particularly in research contributing to gains for Maori women.

This study examines the �Kai o te Hauora� Maori Community nutrition training delivered by Maori Provider, Te Hotu Manawa Maori as a means of bringing about nutritional change in a Maori community. The aim of the Kai o te Hauora Training is to empower iwi and Maori communities with the skills, knowledge and resources to enable them to make informed decisions about their nutritional health. The research methods were grounded in Kaupapa Maori research methodology. Three community members who have taken part in the Kai o te Hauora training were interviewed as well as those people with whom they have networked within the wider community. Formal unstructured interviews were carried out with a total of twenty-three people over a twenty month period from November 1998 to June 2000. The interviews were each transcribed and analysed for key themes. The results of the interviews documented the changes in behaviour and attitudes toward nutrition for the Maori community in the Whakatane region, through the stories of the three community members who had taken part in the training. Their successes and difficulties in attempting to influence change were also recorded. The success of the Kai o te Hauora training in relation to the literature is discussed. The importance of working from a Kaupapa Maori framework in both nutrition interventions and research relating to Maori is emphasised. This framework inherently acknowledges the importance of Maori networks, values and concepts. The importance of the Kai o te Hauora training principle of empowerment is also acknowledged as being fundamental to the programmes success. The need for further research to measure the impact of the Kai o te Hauora programme, and Maori women�s contributions to their communities is noted, as is the need for this research to have been carried out within a Kaupapa Maori framework.

More is becoming known about the importance of sleep to health, with inadequate sleep recognised as a significant public health issue. Sleep clinics have reported disproportionate numbers of Māori and Pacific peoples with more severe obstructive sleep apnoea syndrome (OSAS), raising concerns about accessibility of services and possible differences in prevalence between ethnic groups. Prevalence information on sleep disorders in Aotearoa is needed to assess its public health impact and plan for population health care needs. This thesis presents a national study examining the prevalence of OSAS symptoms and risk factors among Maori and non-Maori adults in Aotearoa. This project is also situated within the wider scope of ethnic inequalities in health between Maori and non-Maori and is concerned with making a positive contribution to Maori health and the elimination of disparities. Kaupapa Maori Research (KMR) is the underlying methodology that drives this study. As such, it assumes a Maori norm, and prioritises Maori needs. A Maori/non-Maori analytical framework is used that distinguishes Maori as tangata whenua, addresses Maori health needs as well as non-Maori, and enables the monitoring of guarantees as outlined by the Treaty of Waitangi. The goals of this thesis were to estimate the prevalence of OSAS symptoms and risk factors among Maori and non-Maori adults in New Zealand, and to examine independent predictive variables for specific OSAS symptoms. An objective was also to contribute to KMR through designing and undertaking a KMR project using a quantitative method, with the development of concepts for use in other areas of research. In April 1999, a short questionnaire was sent to a sample of 10000 New Zealands (5500 of Maori descent and 4500 non-Maori participants to enable research questions to be examined with equal statistical power for both groups. The results demonstrate that the prevalence of OSAS symptoms and risk factors, particularly among non-Maori, are comparable to other international studies, indicating that OSAS is likely to be a common problem among adults in Aotearoa. Furthermore, the results suggest that Maori are significantly more likely to suffer from OSAS than non-Maori, with higher rates of symptoms and risk factors of OSAS among both men and women. As an area of medicine that is under-serviced in Aotearoa, the results provide important information with which to plan for population needs. There are a number of health implications from this study, relating specifically to the diagnosis and management of OSAS in Aotearoa, and to Maori health and the elimination of disparities. These are multi-levelled and include health service implications across the continuum of care, from specialist sleep services to primary care; public health implications that involve preventive measures and broader determinants of health; and KMR principles that can be applied to interventions and health research in general. As a KMR project the implications and recommendations focus on Maori health research in general. As a KMR project the implications and recommendations focus on Maori health gain and addressing disparities in health. This is consistent with Maori health rights, and a population approach that considers health inequalities and the role of wider determinants of health and health services.

This research was designed to see whether the clinical method espoused by Moira Stewart et al in the book "Patient-Centered: Transforming The Clinical Method" is appropriate for Pakeha general practitioners to use in clinical consultations with Maori patients. This thesis uses qualitative methodology. One of my supervisors and I selected from the kuia (old women) and kaumatua (old men) of Hauraki those whom I would approach to be involved. Nearly all responded in the affirmative. The kuia and kaumatua talked about their tikanga, about the basis of tikanga, about the spirituality of their Maori worldview. They talked about the need to maintain their tikanga, about qualities that they respect. They described different roles within Maoridom, especially those of the kuia, whaea (mothers) and Tohunga (experts). They refer to a GP as a Tohunga because of the GP�s special expertise. The GP is able to use his or her special expertise to heal Maori patients, but needs to be able to get through barriers to do so. They are also clear that Maori and Pakeha live in two different worlds which can merge in some circumstances. I came to two conclusions. The first is that the elements of Patient-Centered Medicine are relevant to the consultation of a Pakeha GP and Maori patient, and provides a framework that is productive. The second conclusion is that there is a better framework for working with Maori patients, within which Patient-Centered Medicine can be practiced more effectively. Maori already have a framework (tikanga) in which they function, and if in their settings, especially the marae, he or she is welcomed and has a place in their world; tikanga accommodates the GP as a Tohunga and Maori respond to him or her as such. In summary, a Pakeha GP who has some knowledge of tikanga or Maori culture and who has a basic knowledge of the Maori language of tikanga of Maori culture and who has a basic knowledge of the Maori language can work very well for his or her Maori patients by working within the framework of Tikanga Maori and by being patient-centered in consultation.

This thesis is concerned with cervical cancer amongst New Zealand women, particularly Maori women. Maori women have an alarmingly high incidence of cervical cancer, approximately three times higher than non-Maori women. Maori women experience one of the highest rates of cervical cancer in the world. Chapter one, two and three form the introductory section of the thesis, Section A. Chapter one provides an overview of cervical cancer incidence in the world, followed by a more detailed analysis of the occurrence of cervical cancer in New Zealand and a discussion of the aetiological factors of cervical cancer. Cervical screening is discussed in Chapter two. The ethnic differences in incidence and mortality of cervical cancer between Maori and non-Maori and possible reasons for these differences are studied in Chapter three. Section B consists of the original work undertaken. A pilot study (Chapter four) was conducted to trial the methods for the national study (Chapter five). The national study was a retrospective review of the cervical smear histories of Maori women first diagnosed with invasive cervical cancer over a recent two year period in order to investigate why Maori women have not had their disease detected by screening and treated at the intraepithelial stage. Maori women�s knowledge of and attitudes towards cervical screening were obtained in a survey in Ruatoria (Chapter six). Section C concludes with a chapter (Chapter seven) on the conclusions and recommendations based on the material reviewed and the work undertaken.

Throughout the twentieth century, Maori life expectancy for both men and women has increased significantly. For most health conditions however, medical statistics show that the Maori mortality rate remains significantly higher than the rate for the NZ non-Maori population. The results of epidemiological studies show that some of these health conditions may be environmentally induced. There appears to be a high incidence of obesity in the Maori population which has been related to dietary intake, with an associated high incidence of diabetes, heart disease and hypertension. These conditions appear to be particularly prevalent among Maori women. It is thought that the Maori population are gentically susceptible to obesity; a trait which manifests itself when there is a plentiful food supply in the population. At present, there is very little information available about the dietary intake of the Maori population, or the effect of diet upon obesity and associated health disorders in this group. The aim of this survey was to obtain information about the dietary intake of a sample of Dunedin Maori women using the diet history method of assessment. Also to determine the incidence of obesity and other dietry related health conditions in this group. Chapter 2 reviews the change in food habits and health status of the Maori population over the last two centuries, as well as reviewing the different methods by which information for dietary surveys is obtained. After setting out the methods and findings of the survey, Chapter 5 discusses the results in light of information obtained from similar dietary studies of NZ women. The samples intake is compared to recommended nutrient allowances for NZ women and the incidence of dietary related health disorders is also discussed. Overall, Dunedin Maori women�s diet was not deficient in any of the recorded nutrients. Dunedin Maori women, in their middle years, exhibited substantially higher energy intakes than middle years non-Maori women in the 1977 National Dietary Survey. The level of Dunedin Maori women�s carbohydrate intake was the main contributing factor for this higher energy intake. Dunedin Maori women over 50 years of age exhibited substantially higher energy intakes than NZ women aged 50-54 years in the 1985 Timaru Health District Survey, with an overall higher consumption of carbohydrate, protein and fat. Over half of Dunedin Maori were classified as overweight or very overweight. Hypertension and diabetes were reported, and obesity was commonly found among women with these health conditions. Over half of Dunedin Maori women used cigarettes, the majority using between ten and thirty cigarettes per day. Dunedin Maori women are relatively isolated from the more densely populated areas of North Island Maori. As a result, the survey results cannot be interpreted as characteristic of NZ Maori women in general. The significance of these findings is rather the elucidation of a regional situation. Further studies of Maori women in both rural and urban areas of the North and South Island are necessary to determine if an overall pattern of high intake exists with a deleterious impact upon the health of Maori women.

During a 12-months period from 1 April 1966 to 31 March 1967 all infants born of Maori and Polynesian Pacific islander parentage domiciled within the Auckland Health District were included in a longitudinal infant health survey, and those that came under the supervision of the public health nurses in the district were followed up wherever practicable for a period of 12 months. The survey was primarily concerned with the social, biological, and operational (personal health services) factors likely to affect the health status and growth progress of infants of these migrant families undergoing the social processes of urbanisation--Part 1 - Introduction.