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The historical context of colonial legacies and capitalist policies are shaping responses to climate change but so too are non-capitalist and alternative-capitalist practices. Indigenous peoples’ world-views are commonly argued to align with non-capitalist approaches and often said to be the answer to climate change. However, Indigenous peoples are never only ‘ecological natives’ ‘living at one with nature’ but have multiple roles and identities in the political economy. Indigenous world-views could be used in ways to support capitalist practices and policies (which many argue have caused climate change) or to support alternative-capitalist practices (which others argue promote harmonious relationships between humans and the planet).
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Māori in Aotearoa have higher incidence, prevalence and mortality from chronic disease. The dominant narrative in Aotearoa about the reasons for Māori ill health neglects to acknowledge the history of colonisation and failures of the health system, alongside the holistic view of health taken by Māori focusing on collective, whānau-based outcomes. In this article, we review health interventions for chronic disease that have a kaupapa Māori philosophical basis. Our findings demonstrate that there is no clear process in health service design, delivery, research and funding that values and understands mātauranga Māori. Western knowledge systems are inadequate for collecting and presenting Māori knowledge. Overall, we highlight that the tension between acknowledging that a by Māori, for Māori approach is best, and the difficulty in defining appropriate evidence collection methodology and outcome measures when funders and policy makers continue to require Western-centric interventions is an obstacle to improving Māori health outcomes.
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Co-designed research is gaining prominence within the health care space. Community engagement is a key premise of co-design and is also particularly vital when carrying out kaupapa Māori research. Kaupapa Māori describes a “by Māori, for Māori” approach to research in Aotearoa/New Zealand. This article discusses the research process of Hā Ora: a co-design project underpinned by a kaupapa Māori approach. The objective was to explore the barriers to early presentation and diagnosis of lung cancer, barriers identified by Māori. The team worked with four rural Māori communities, with whom we aimed to co-design local interventions that would promote earlier diagnosis of lung cancer. This article highlights and unpacks the complexities of carrying out community- engaged co-design with Māori who live in rural communities. In particular, we draw attention to the importance of flexibility and adaptability in the research process. We highlight issues pertaining to timelines and budgets, and also the intricacies of involving co-governance and advisory groups. Overall, through this article, we argue that health researchers need to prioritise working with and for participants, rather than on them, especially when working with Māori communities.
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The majority of Indigenous health models do not directly acknowledge that health is a contested political space. Providing a Foucauldian analysis, this article suggests a function of biopower is to naturalise discourses such as the poor Māori health statistic to appear based on factual evidence and thus are apolitical. Employing Foucault's triad of power 'sovereign, disciplinary and biopower' to understand the genealogy of Māori health, this article proffers mana motuhake (Māori political self-governance) as an appropriate health analytic because it, first, identifies Indigenous health as political and, second, because it recognises the disempowering role that colonialism has played in relation to Māori biopolitical self-governance. Hence, we suggest Māori health will be enhanced by mana motuhake and that research underpinned by Indigenous agency and self-governance resists biopower. The article references two Ageing Well National Science Challenge funded research projects because they innovatively fundamentalise mana motuhake and politics to Indigenous health.
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Health inequities experienced by kaumātua (older Māori) in Aotearoa, New Zealand, are well documented. Examples of translating and adapting research into practice that identifies ways to help address such inequities are less evident. The study used the He Pikinga Waiora (HPW) implementation framework and the Consolidated Framework for Implementation Research (CFIR) to explore promising co-design and implementation practices in translating an evidence-based peer-education programme for older Māori to new communities.
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