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BackgroundTe Tiriti o Waitangi was negotiated between the British Crown and Indigenous Māori leaders of Aotearoa New Zealand in 1840. Māori understood the agreement as an affirmation of political authority and a guarantee of British protection of their lands and resources. The Crown understood it as a cession of sovereignty. The tension remains, though legal and political developments in the last 35 years, have established that the agreement places a mandatory obligation on the Crown to protect and promote Māori health. It also requires that Māori may exercise rangatiratanga, or responsibility and authority, in relation to health policy development and implementation.MethodsTe Tiriti is, then, an instrument against which health policy is justly and efficaciously evaluated. This paper introduces critical Tiriti analysis as such an evaluative method. Critical Tiriti analysis involves reviewing policy documents against the Preamble and the Articles of te Tiriti o Waitangi. The review process has five defined phases: (i) orientation; (ii) close reading; (iii) determination; (iv) strengthening practice and (v) Māori final word.ResultsWe present a working example of critical Tiriti analysis using the New Zealand Government’s Primary Health Care Strategy published in 2001. This policy analysis found poor alignment with te Tiriti overall and the indicators of its implementation that we propose.ConclusionThis paper provides direction to policy makers wanting to improve Māori health outcomes and ensure Māori engagement, leadership and substantive authority in the policy process. It offers an approach to analysing policy that is simple to use and, inherently, a tool for advancing social justice.

Te Tiriti o Waitangi, a treaty negotiated between Māori (the Indigenous peoples of Aotearoa) and the British Crown, affirmed Māori sovereignty and guaranteed the protection of hauora (health). The Waitangi Tribunal, established in 1975 to investigate alleged breaches of the agreement, released a major report in 2019 (registered as WAI 2575) about breaches of te Tiriti within the health sector in relation to primary care, legislation, and health policy. This article explores the implications of this report for the New Zealand health sector and the decolonial transformation of health systems. The tribunal found that the Crown has systematically contravened obligations under te Tiriti across the health sector. We complement the tribunal’s findings, through critical analysis, to make five substantive recommendations: (1) the adoption of Tiriti-compliant legislation and policy; (2) recognition of extant Māori political authority (tino rangatiratanga); (3) strengthening of accountability mechanisms; (4) investment in Māori health; and (5) embedding equity and anti-racism within the health sector. These recommendations are critical for upholding te Tiriti obligations. We see these requirements as making significant contributions to decolonizing health systems and policy in Aotearoa and thereby contributing to aspirations for health equity as a transformative concept.

Many studies have documented the effect that colonisation has had on takatāpui, that is, Māori (the Indigenous peoples of New Zealand) with diverse gender identities, sex characteristics and sexualities. In this paper, we explore whether current Aotearoa New Zealand (hereafter Aotearoa) mental health policies meet the needs of takatāpui. We identified five mental health policy needs, informed by the literature. We then explored policy documents from government ministries, district health boards and non-government organisations to see the extent to which policy met these needs. Four themes were present in the literature analysed: an overall lack of acknowledgment of takatāpui and intersectionality; promising engagement with the needs of takatāpui by NGOs; symbolic commitment to Te Tiriti o Waitangi; and some limited engagement with Māori health models. The findings show promise in some areas but demonstrate a lack of engagement by policy to meet the needs of takatāpui.

M?ori in Aotearoa have higher incidence, prevalence and mortality from chronic disease. The dominant narrative in Aotearoa about the reasons for M?ori ill health neglects to acknowledge the history of colonisation and failures of the health system, alongside the holistic view of health taken by M?ori focusing on collective, wh?nau-based outcomes. In this article, we review health interventions for chronic disease that have a kaupapa M?ori philosophical basis. Our findings demonstrate that there is no clear process in health service design, delivery, research and funding that values and understands m?tauranga M?ori. Western knowledge systems are inadequate for collecting and presenting M?ori knowledge. Overall, we highlight that the tension between acknowledging that a ?by M?ori, for M?ori? 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 M?ori health outcomes.

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.

Lana Simmons-Donaldson speaks to University of Auckland Associate Professor Donna Cormack about the dire state of Maori health inequity and her thoughts on the government's health sector reforms.

Global disease trackers quantifying the size, spread, and distribution of COVID-19 illustrate the power of data during the pandemic. Data are required for decision-making, planning, mitigation, surveillance, and monitoring the equity of responses. There are dual concerns about the availability and suppression of COVID-19 data; due to historic and ongoing racism and exclusion, publicly available data can be both beneficial and harmful. Systemic policies related to genocide and racism, and historic and ongoing marginalization, have led to limitations in quality, quantity, access, and use of Indigenous Peoples' COVID-19 data. Governments, non-profits, researchers, and other institutions must collaborate with Indigenous Peoples on their own terms to improve access to and use of data for effective public health responses to COVID-19.