Having reviewed an example of environmental degradation (the effect of gold mining related activities on the acquatic ecosystems in Te Tai Poutini) from varying Maori and Pakeha perspectives I have developed a framework to find combine these perspectives into a working analytical tool kit. The tool kit is intended to better define the problems to ensure that they take into account the widely differing views of Maori and Pakeha and is able to promote solutions that will be appropriate and safe for both Maori and Pakeha. I have sought to collect and present a comprehensive analysis of both perspectives. I have focussed more heavily however on the Maori paradigms as they are less well reported in the literature on environmental health and less influence on the way we seek to protect people from the negative effects of environmental degradation. This is despite the fact that as Maori are more likely to be exposed to environmental damage in that they are on average poorer and therefore have less choice about where they may live and are more likely to eat foods taken directly from the environment. I will also show that the damage to the Arahura is far more than physical and will show the concern of kaumatua and their psychological anguish they have felt over the damage to this most tapu river. For this reason I have chosen to present this thesis, in the form of a powhiri model. This model allows me to present different aspects of the problem from a Maori perspective including the views of kaumatua as well as recorded traditions. I have then followed these sections with a response from a Pakeha perspective. This includes reviewing the different underlying world, view as well as some attempt to review the damage in Pakeha terms by reviewing the literature and undertaking some tests to establish procedures for a more comprehensive testing of the enviroment that surrounds the Arahura. The thesis will conclude with a section summarising both strands of information and attempt to develop a framework for a health tool kit - he kete hauora. This kete will utilise Whare Tapa Wha as a way of placing the information in a context that can be presented in a reasonably coherent form. Finally I will make a number of recommendations that I called a place mat - he whariki. These recommendations are presented in a framework from Te Tiriti o Waitangi. This reflects the primacy of the Treaty when considering the ways in which Maori are to be protected by the Crown. These recommendations seek to respond to the principle barriers that are currently preventing local Maori from achieving a full sense of well being but, if implemented, these recommendations will ensure the protection of the health of all peoples of Te Tai Poutini.

Since the introduction of tobacco into New Zealand, smoking and smoking related illnesses have become more prevalent in the Maori population than New Zealand's general population. The aim of the present research was to investigate smoking from a Maori perspective. It was hoped this information would provide a better understanding of how Maori can become smokefree. The present research also investigated a number of possible benefits that could be obtained by Maori through becoming smokefree. These benefits were analysed through Mason Durie's Whare Tapa Wha model, a Maori holistic health model. Semi-structured in-depth interviews were conducted with four Maori people, two of whom were current smokers and two who were ex-smokers. Common themes emerged from these interviews including the social aspect of smoking for Maori and the influence of the enviroment on smoking behaviour. Suggestions were given to illustrate how the social aspect of smoking and the cycle that subsequently develops can be broken. Using the Whare Tapa Wha model and the personal accounts given, the benefits of breaking such a cycle were discussed. Lastly, the importance of nurturing smokefree environments, especially Maori environments, was outlined. The notion of being positive about becoming smokefree and the need to celebrate giving up smoking were highlighted throughout this research.

Health is determined by the past as well as the present; the health status of indigenous peoples has been strongly influnced by the experience of colonisation and their subsequent efforts to participate as minorities in contemporary society while retaining their own ethnic and cultural identities. Colonial journays may have led to innovation and adaptation for Maori, but they have also created pain and suffering from which full recovery has yet to be felt (Durie, 2001). The oral health area can be described as having considerable and unacceptable disparities between Maori and non-Maori (Broughton 1995; Thomson, Ayers and Broughton 2003). Few reports have been conducted concerning Maori and patterns of oral health service utilisation, however a lower service utilisation among Maori than non-Maori has been noted (TPK 1996; Broughton and Koopu 1996). Overall, Maori oral health is largely unknown due to a paucity of appropriate research. This research aims to provide new information by describing Maori oral health outcomes over the life course, within a Kaupapa Maori Research (KMR) methodology. In general, the basic tenets presented for KMR are: (1) to prioritise Maori - from the margin to the centre; (2) to be Maori controlled - by Maori, for Maori; (3) to reject �victim-blame� theories; and (4) to be a step towards action and change in order to improve Maori oral health outcomes. The aims of this research are to: 1. Describe the occurrence of caris at ages 5, 15, 18 and 26 and periodontal disease at age 26 years for Maori. 2. Describe self-reported oral health, self-reported dental aesthetics and oral health service utilisation among Maori at ages 5, 15, 18 and 26. 3. Compare the above oral health characteristics between Maori and non-Maori . 4. Investigate the determinants of any differences in oral health outcomes between Māori and non-Maori using a KMR methodology. The investigation involves a secondary analysis of data from the Dunedin multidisciplinary Health and Development study (DMHDS). The existing data-set was statistically analysed using SPSS (SPSS Inc, Chicago, USA). Descriptive statistics were generated. The levels of statistical significance were set at P< 0.05. Chi-square tests were used to compare proportions and independent sample t-tests or ANOVA were used for comparing means. A summary of the Maori/non-Maori analysis shows that, for a cohort of New Zealanders followed over their life-course, the oral health features of caries prevalence, caries severity, and periodonal disease prevalence are higher among Maori compared to non-Maori. In particular, it appears that while Maori females did not always have the highest prevalence of dental caries, this group most often had a higher dmfs/DMFS for dental caries, compared to non-Maori. As adolescents and adults, self-reported results of oral health and dental appearance indicate that Maori males were more likely to report below average oral health and below average dental appearance, when compared to non-Maori. However, at age 26, non-Maori males made up the highest proportion of episodic users of oral health services. This study has a number of health implications: these relate specifically to the management of dental caries, the access to oral health services, and Maori oral health and the elimination of disparities. These are multi-levelled and have implications for health services across the continuum of care from child to adult services; they also have public health implications that involve preventive measures and the broader determinants of health; and involve KMR principles than can be applied to oral health interventions and dental health research in general. Dental diseases and oral health outcomes, such as dental anxiety and episodic use of services, are a common problem in a cohort of New Zealanders with results demonstrating ethnic disparities between Maori and on-Maori. As an area of dentistry that has had very little research in New Zealand, the findings of this study provide important information with which to help plan for population needs. The KMR approach prioritises Maori and specifically seeks to address Maori oral health needs and the elimination of disparities in oral health outcomes. While the issues that are raised may be seen as the more difficult to address, they are also more likely to achieve oral health gains for Maori and contribute to the elimination of disparities.

Although considered a substanially preventable disease, Type 2 diabetes is reaching epidemic status within the Maori population. This study sought to investigate factors that positively and negatively influenced levels of physical activity for Maori within Otepoti/Dunedin, and to discuss ideas and potential initiatives that could increase levels of physical activity and aid in the prevention of Type 2 diabetes. Eighteen Maori (9 males; 9 females) from this rohe (area) participated in a four hour focus group interview (groups of three) and were also invited to attend an evaluation hui. A Maori-centered research orientation was used throughout the research process. Individual transcripts from focus groups, debriefing discussion and content from the evaluation hui were inductively analysed to identify the main themes. The 'active' participants were physically active because of the benefits they attained for health and longevity, and to undertake task-oriented activity such as gathering kai. Barriers to physical activity (i.e., family, work), a contemporary societal shift towards inactivity, and negative personal attitudes and perceptions towards physical activity detrimentally affected levels of physical activity. Initiatives to increase levels of physical activity included community, educational and work-based initiatives. A key element of each proposed initiative was a 'by Maori for Maori' approach, with a focus on strengthening whānau and iwi networks, a comfortable environment and social support. While education was believed to be a key component for Type 2 diabetes prevention, an avoidance barrier and fatalistic attitudes could negatively affect any attempt to prevent Type 2 diabetes and increase levels of physical activity. The results indicated that to strengthen Maori identity, increase levels of physical activity and prevent Type 2 diabetes, positive changes (taking responsibility for health), cultural changes (a shift towards a stronger identity and belief in the taonga [treasure] of being Maori), societal changes ( a more positive view of Maori, better role models and education), and social economic changes (better access to exercise facilities, healthy food and education for those in the lower deprivation indices) were needed.

Maori health development advanced with the Hui Taumata (1984) and with the emergence of by Maori for Maori health service delivery. Rapua te ora, by Maori for Maori health service delivery. Rapua te ora, by Maori for Maori health service delivery is an expression of tino rangatiratanga. The case study of budget holding presents a Maori analysis of contemporary health services delivery to meet the needs of Maori. Maori engage in research as dynamic participants who define their roles. Maori provide new analyses of health whilst adding to the diversity of views within health research, health services administration, and health services management. Nested case study method is used to prepare this thesis. Methods nested within the case study are a literature review; empowerment evaluation, information systems strategy, provider profile method, and structural analysis. Kaupapa Maori theory, which underpins the Maori centered research approach, is used to ensure the research objectives are relevant and meet needs of Maori. Budget holding is a mechanism for provider development, systematically linking national public health oblectives to local and regional needs. At different levels of development Maori providers, new to public health, require careful anf thoughtful administration, where necessary, thoughtful management. The benefits for administrating the provision of public health services for Maori are clear vertical accountability to the purchaser, clear local accountabilities, and provider development consistent with local Maori health needs. Conclusions drawn from this case study are that Maori provider development is a response to health reforms characterised by multiple transformations of health service funding. Provider development and meeting disparate accountabilities are important issues for sustainability and the development of Maori providers for public health, and are applicable to the wider community, both national and international.

The concept of cultural safety arose in Aotearoa me Te Waipounamu/New Zealand in the late 1980�s in response to the differential health experience and negative health outcomes of the first nation people of Aotearoa me Te Waipounamu/New Zealand, the New Zealand Maori. It was introduced and developed by Maori nurses initially, as they recognised the effect culture had on health and understood safety as a common nursing concept. The concept of cultural safety has developed into a disipline which is taught as part of all nursing and midwifery curricula in Aotearoa me Te Waipounamu/New Zealand. As cultural safety has developed the concept of culture has been extended to include people who differ from the nurse by reason of: age, migrant status, sexual preference, socioeconomic status, religious persuasion, gender, ethnicity, and in Aotearoa me Te Waipounamu/New Zealand, the Treaty of Waitangi status of the nurse and recipient/s of her/his care. Nationally and internationally, health experience and health outcomes are poorer for people of minority group status than for people who are part of the dominant group. Public-health research is therefore generally conducted on, or with, people with minority group status. Public-health researchers, by education, are members of the dominant culture and may be unaware that their own and their clients; responses may relate to one/other or both cultures being diminished do not always ensure the safety of their own culture or the culture being researched. This study�s objective was to develop a flexible, culturally safe public health research framework for researches to use when researching people who are culturally different from themselves. The study will argue that the use of such a framework will contribute significantly to improved health outcomes for people with minority status and will assist the movement towards emancipatory social change. The methods undertaken included: gaining permission from Irihapeti Ramsden, the architect of cultural safety to undertake the research, conducting a literature review, consideration of primary sources and their key concepts, consulting widely with people in the field of public health and cultural safety, self reflecting on the writers own personal and professional experience and finally designing the culturally safe public health research framework.

Health is determined by the past as well as the present; the health status of indigenous peoples has been strongly influnced by the experience of colonisation and their subsequent efforts to participate as minorities in contemporary society while retaining their own ethnic and cultural identities. Colonial journays may have led to innovation and adaptation for Maori, but they have also created pain and suffering from which full recovery has yet to be felt (Durie, 2001). The oral health area can be described as having considerable and unacceptable disparities between Maori and non-Maori (Broughton 1995; Thomson, Ayers and Broughton 2003). Few reports have been conducted concerning Maori and patterns of oral health service utilisation, however a lower service utilisation among Maori than non-Maori has been noted (TPK 1996; Broughton and Koopu 1996). Overall, Maori oral health is largely unknown due to a paucity of appropriate research. This research aims to provide new information by describing Maori oral health outcomes over the life course, within a Kaupapa Maori Research (KMR) methodology. In general, the basic tenets presented for KMR are: (1) to prioritise Maori - from the margin to the centre; (2) to be Maori controlled - by Maori, for Maori; (3) to reject �victim-blame� theories; and (4) to be a step towards action and change in order to improve Maori oral health outcomes. The aims of this research are to: 1. Describe the occurrence of caris at ages 5, 15, 18 and 26 and periodontal disease at age 26 years for Maori. 2. Describe self-reported oral health, self-reported dental aesthetics and oral health service utilisation among Maori at ages 5, 15, 18 and 26. 3. Compare the above oral health characteristics between Maori and non-Maori . 4. Investigate the determinants of any differences in oral health outcomes between Māori and non-Maori using a KMR methodology. The investigation involves a secondary analysis of data from the Dunedin multidisciplinary Health and Development study (DMHDS). The existing data-set was statistically analysed using SPSS (SPSS Inc, Chicago, USA). Descriptive statistics were generated. The levels of statistical significance were set at P< 0.05. Chi-square tests were used to compare proportions and independent sample t-tests or ANOVA were used for comparing means. A summary of the Maori/non-Maori analysis shows that, for a cohort of New Zealanders followed over their life-course, the oral health features of caries prevalence, caries severity, and periodonal disease prevalence are higher among Maori compared to non-Maori. In particular, it appears that while Maori females did not always have the highest prevalence of dental caries, this group most often had a higher dmfs/DMFS for dental caries, compared to non-Maori. As adolescents and adults, self-reported results of oral health and dental appearance indicate that Maori males were more likely to report below average oral health and below average dental appearance, when compared to non-Maori. However, at age 26, non-Maori males made up the highest proportion of episodic users of oral health services. This study has a number of health implications: these relate specifically to the management of dental caries, the access to oral health services, and Maori oral health and the elimination of disparities. These are multi-levelled and have implications for health services across the continuum of care from child to adult services; they also have public health implications that involve preventive measures and the broader determinants of health; and involve KMR principles than can be applied to oral health interventions and dental health research in general. Dental diseases and oral health outcomes, such as dental anxiety and episodic use of services, are a common problem in a cohort of New Zealanders with results demonstrating ethnic disparities between Maori and on-Maori. As an area of dentistry that has had very little research in New Zealand, the findings of this study provide important information with which to help plan for population needs. The KMR approach prioritises Maori and specifically seeks to address Maori oral health needs and the elimination of disparities in oral health outcomes. While the issues that are raised may be seen as the more difficult to address, they are also more likely to achieve oral health gains for Maori and contribute to the elimination of disparities.

The concept of cultural safety arose in Aotearoa me Te Waipounamu/New Zealand in the late 1980�s in response to the differential health experience and negative health outcomes of the first nation people of Aotearoa me Te Waipounamu/New Zealand, the New Zealand Maori. It was introduced and developed by Maori nurses initially, as they recognised the effect culture had on health and understood safety as a common nursing concept. The concept of cultural safety has developed into a disipline which is taught as part of all nursing and midwifery curricula in Aotearoa me Te Waipounamu/New Zealand. As cultural safety has developed the concept of culture has been extended to include people who differ from the nurse by reason of: age, migrant status, sexual preference, socioeconomic status, religious persuasion, gender, ethnicity, and in Aotearoa me Te Waipounamu/New Zealand, the Treaty of Waitangi status of the nurse and recipient/s of her/his care. Nationally and internationally, health experience and health outcomes are poorer for people of minority group status than for people who are part of the dominant group. Public-health research is therefore generally conducted on, or with, people with minority group status. Public-health researchers, by education, are members of the dominant culture and may be unaware that their own and their clients; responses may relate to one/other or both cultures being diminished do not always ensure the safety of their own culture or the culture being researched. This study�s objective was to develop a flexible, culturally safe public health research framework for researches to use when researching people who are culturally different from themselves. The study will argue that the use of such a framework will contribute significantly to improved health outcomes for people with minority status and will assist the movement towards emancipatory social change. The methods undertaken included: gaining permission from Irihapeti Ramsden, the architect of cultural safety to undertake the research, conducting a literature review, consideration of primary sources and their key concepts, consulting widely with people in the field of public health and cultural safety, self reflecting on the writers own personal and professional experience and finally designing the culturally safe public health research framework.

Thesis (MHSc--Health Science) -- Auckland University of Technology, 2004. / Also held in print (165 leaves, 30 cm) in Akoranga Theses Collection (T 362.108999442 HUD)

Thesis (M.M.P.D.)--University of Waikato, 2007. / Title from PDF cover (viewed April 30, 2008). Includes bibliographical references (p. 89-99)