3.2 Te Tiriti o Waitangi
There are a wide range of practices in Aotearoa, New Zealand, all differing in size, location and demographics. The College recognises that practices require different levels of Te Tiriti o Waitangi training and continuous professional development (CPD).
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The practice educates all team members in Te Tiriti o Waitangi and its application to improve health equity for patients, family or whānau, including Māori as tangata whenua. |
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Training
There are a wide range of practices in Aotearoa, New Zealand, all differing in size, location and demographics. The College recognises that practices require different levels of Te Tiriti o Waitangi training and continuous professional development (CPD). The nature of the practice will determine the type of training or CPD the team requires. For example, general practices with high Māori patient and practice team demographics should demonstrate how they apply Te Tiriti o Waitangi principles in their practice. This may be captured in meeting notes and can be used as evidence.
Another practice may need to learn the basics of Te Tiriti o Waitangi before putting the principles in action, in this case, team members need to undergo specific Te Tiriti training which may be done in-house or through a training provider.
Sometimes a mixed approach may suit the practice, for example, most of the team are demonstrating momentum in applying Te Tiriti o Waitangi principles while a few team members may require training in order to get them up to speed. In this situation the evidence presented may be a mixture of formal or in-house Te Tiriti o Waitangi training, alongside other documented evidence.
Te Tiriti o Waitangi
The College acknowledges Te Tiriti o Waitangi / the Treaty of Waitangi (Te Tiriti) as a founding document of our nation, and the rights and obligations that it contains. We recognise Māori as Tangata Whenua under Te Tiriti and that they are guaranteed certain rights in their relationship with the Crown under Article Two. We recognise non-Māori as Tangata Tiriti under Te Tiriti, who together with Māori as Tangata Whenua, are guaranteed equity rights under Article Three.
Both Tangata Whenua and Tangata Tiriti share a joint citizenship under Te Tiriti, and under other elements of the constitutional framework for Aotearoa New Zealand.
The College recognises and accepts the impacts of colonisation on Māori, and the impacts of systemic, institutional, interpersonal, and internalised discrimination on Māori and on other groups in the population.
Hauora report
HAUORA – the Report on Stage One of the Health Services and Outcomes Kaupapa Inquiry by the Waitangi Tribunal, published in September 2019, recommends that a re-defined set of principles of Te Tiriti o Waitangi be applied to the primary health care system. The Ministry of Health has utilised these principles in the recent re-development of its Māori Health Action Plan, Whakamaua, noting that they are applicable to the wider health and disability system and not just to primary care.
The College recognises these principles as articulated in HAUORA and Whakamaua and applies them to its work in all areas:
- Tino rangatiratanga: Providing for Māori self-determination and mana motuhake in the design, delivery and monitoring of health and disability services.
- Partnership: Working in partnership with Māori in the governance, design, delivery and monitoring of health and disability services – Māori must be co-designers, with the Crown, of the primary health system for Māori.
- Equity: Being committed to achieving equitable health outcomes for Māori.
- Active protection: Acting to the fullest extent practicable to achieve equitable health outcomes for Māori. This includes ensuring that the Crown, its agents, and its Treaty partner under Te Tiriti are well informed on the extent, and nature, of both Māori health outcomes and efforts to achieve Māori health equity.
- Options: Providing for and properly resourcing Kaupapa Māori health and disability services. Furthermore, the Crown is obliged to ensure that all health and disability services are provided in a culturally appropriate way that recognises and supports the expression of Hauora Māori models of care.
The College realises that understanding Te Tiriti is an evolving process, and that relevant work will from time to time need to be revised, based on these evolutions.
Health equity in the context of our history
Understanding our history can help inform our future. The impacts of colonisation upon Māori are well documented, and include systemic, institutional, interpersonal, and internalised discrimination towards Māori and on other groups in the population.
Some resources that will help practices to better understand the development of responses to this over time include:
He Ara Hauora Māori: A Pathway to Māori Health Equity from the MCNZ gives practices a clear outline of the rights-based and needs-based arguments for prioritising health for Māori.
As part of The Health Services and Outcomes Kaupapa Inquiry, the Waitangi Tribunal is conducting an ongoing inquiry into the ways the Crown has responded to health inequities experienced by Māori. The Stage One report examines how, despite the promise of the reforms, the Crown has failed to properly fund the primary health care sector to pursue equitable health outcomes for Māori, by failing to target funding where it is needed most and failing to ensure money earmarked for Māori health issues is used for that purpose.
Many of the effects of colonisation on hauora, health, and wellbeing are detailed in an associated data report WAI 2575 Māori Health Trends Report (2019).
The Ministry of Health website also carries useful data for better understanding the long-term effects of colonisation on Māori health.
The government’s Māori Health Action Plan 2020-2025, Whakamaua, sets the government’s direction for Māori health advancement over the next five years.
This is a sample of the information that practices can access to better understand the frameworks that the health sector is now working in. The College encourages practices to become familiar with key health issues relevant to each practice’s population groups, including Māori.