Haumanu Hauora: Refining public health institution policy to include Māori and climate change

doi:10.21203/rs.3.rs-1966481/v1

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Haumanu Hauora: Refining public health institution policy to include Māori and climate change

https://doi.org/10.21203/rs.3.rs-1966481/v1

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published 05 May, 2023

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The deepening climate crisis generates specific impacts that will exacerbate the already disproportionately negative health outcomes experienced by Indigenous. These disparate health outcomes have not spontaneously emerged, but rather have been foreshadowed by existing inequities. This article summarises a sample of the work undertaken as part of a two-year research project inNew Zealand to understand existing policy processes and ascertain the extent to which health institutions give serious consideration to climate change impacts on health vulnerabilities of Māori (Indigenous people). Speaking to tāngata whenua (Indigenous Māori), rangatahi (Indigenous Māori youth) and District Health Board (DHB) employees it was clear that processes were ad hoc and problematically silenced consistent Māori input. Research participants expressed their experiences of, and aspirations for, dealing with climate change. Their voices were not evident in DHB policy processes. The deficit in existing policy process shows a lack of preparedness in the face of climate change. Despite clear resilience and adaptation strategies, structural change is needed to address identified disadvantages. Through a co-designed a policy framework (“Haumanu Hauora”) we guide policy formation to mitigate climate change risk to Māori (and others). Central to the revised policy framework is the introduction of a commissioning, refining and monitoring stage. Alongside the policy framework intervention points provide guidance to the newly developed health institutions. Five intervention points reflect the substantial work needed to develop Māori responsive policy in anticipation of climate change impacts. Above all, we believe that strengthening health institution responsiveness to Māori health needs is essential.

Māori health

climate change

health institution policy

The New Zealand Public Health and Disability Act (NZPHD, 2000) enabled the creation of 20 District health boards (DHBs). Established in 2001, DHBs have overseen and been responsible for providing, or funding provision of most health services throughout New Zealand (Dwyer et al, 2014). Public Health Organisations (PHOs) were introduced to improve access to services and coordination of providers (Barnett & Barnett, 2004). In 2018, the government commissioned an independent review into New Zealand’s health system that was conducted over an 18-month period. The review noted a fragmented health system that struggles to deliver equity and consistency for all New Zealanders (Health New Zealand - Taranaki, n.d).

On 1 July 2022, all 20 DHBs were disestablished to become part of Te Whatu Ora (Health New Zealand). Te Whatu Ora is expected to work in partnership with Te Aka Whai Ora (Māori Health Authority) and Manatū Hauora (Ministry of Health). Te Aka Whai Ora is a newly established entity responsible for ensuring the health system works well for Māori. Iwi-Māori partnership Boards will have decision-making roles at a local level, and jointly determine local priorities and delivery with Te Whatu Ora. Iwi-Māori Partnership Boards will also be the primary whānau voice within the new public health system (Future of Health, n.d.).The latest health reform, with the creation of the partnership arrangement, heralds the promise of a new public health system that will better address the persistent health inequities Māori experience.

Existing health disparities (Ministry of Health, 2019), political marginalisation, discriminatory systems and racist practices (Lewis, Williams & Jones, 2020) that maintain inequitable health access compound risks of the known biophysical impacts of climate change (Holder, 2020; O’Niell, Green & Liu, 2012). As climate change continues, adverse health impacts are expected to be more severe and borne disproportionately by indigenous people and groups already suffering health inequities (Jones et al. 2014; Royal Society of New Zealand/Te Apārangi 2017). While there is a limited pool of public health-related climate change research in New Zealand, there is emerging evidence about the threat of changing climatic conditions on Māori well-being and health, as well as examples of Māori-led initiatives to address these risks (Jones et al. 2014).

A range of factors, with roots in historic and ongoing forms of marginalisation, manifest as disproportionate risks to Māori health in the context of climate change. These factors include existing Māori health disparities (Ministry of Health 2019); poorer access to and quality of health care (Graham & Masters‐Awatere 2020); socio-economic deprivation (Jones et al. 2014; Jones 2019); and political marginalisation (Lewis et al. 2020).

Māori views of health are holistic and recognise the relational and kin-centric connection between people, the land and ecosystems (Harmsworth & Awatere 2013; Panelli & Tipa 2007). However, Eurocentric views, based on universalistic approaches, have been prioritised in public health and climate change policy while the values fundamental to Māori views of health remain underappreciated and marginalised (Harmsworth & Awatere, 2013; Harris & Tipene, 2006; Lewis et al. 2020).

On a global scale, climate change is the biggest threat to humanity through compounding ecological disasters such as extreme weather events, rising sea levels, ocean acidification, increases in non-communicable diseases, along with the spread of vector-borne diseases (Bolton et al., 2019; IPCC, 2019, 2021; Jones et al., 2014, Royal Society of New Zealand/Te Apārangi, 2017). When it comes to examining climate change impacts, a focus on global averages has tended to mask disparities. Indigenous people are disproportionately impacted by climate change (Abate & Kronk, 2013; Nursery-Bray et al, 2020). As a consequence, the need to give greater consideration of indigenous people in climate change conversations is essential (Begay & Gursoz, 2018). Jones et al. (2020) had recently observed that few studies have examined climate change health impacts on Indigenous or Māori people, despite the clear need for these assessments. Other socially and politically marginalised groups within society (such as young, disabled, unwell and the impoverished) tend to be overlooked in climate change assessments. The presence of large numbers of Māori within these marginalised groups highlights the levels of intersection with climate change risk.

Those most at risk of exposure to floods, droughts, extreme heat, and the spread of vector-borne diseases, Māori, Pacific, and low-income groups in New Zealand, are also vulnerable to adverse health impacts from climate change (New Zealand College of Public Health Medicine, 2013; Howden-Chapman et al., 2010). Vulnerability to risk from climate change impacts food security, infrastructure and housing means that important determinants of health (such as healthy nutrition, safe drinking water and healthy homes) are undermined (Bennett et al., 2014).

The Sendai Framework for Disaster Risk Reduction (United Nations, 2015) identifies that public and private investment in disaster risk prevention and reduction is required through structural and non-structural measures in order to enhance the multifaceted nature of community and environment resilience. Pae Ora – Healthy Futures, the overarching aim for He Korowai Oranga, the national strategy for Māori health, calls for the impact of climate change on health to be addressed as part of Wai Ora – healthy environments (Ministry of Health, 2014).

The complex vulnerabilities experienced by Māori intersect to create a multifaceted and enduring health crisis that will be exacerbated by climate change. The vulnerability of Māori is not experienced simplistically, thus policy planning and response should also not be simplistic, insular or linear. To improve the health system, radical, meaningful and multiscalar change is required (Masters-Awatere, 2017). This is especially so with regard to institutional responses to climate adaptation. Multilevel consideration via national health strategies, annual plans, health practitioner competencies and Iwi-Māori representation will need to be responsive to climate adaptation with respect to vulnerable urban Māori populations.

Between 2018 and 2038, the Māori population is predicted to increase significantly in the urban centres of Auckland, Waikato and Canterbury. Vulnerable urban Māori are identified as being at risk in terms of unemployment (Stubbs et al., 2017), living in overcrowded housing or experiencing homelessness (Groot et al., 2011), the added constraint of climate change on those with fewer resources requires urgent attention. Hallegate and Rozenberg (2017) highlight that the vulnerable population of urban Māori have fewer resources, such as whenua and access to clean waterways, to fall back on and therefore have a lower adaptive capacity in the face of climate change.

This paper presents a sample of the work undertaken as part of a two-year research project that worked with three DHBs in the midland region (Te Manawa Taki) of New Zealand’s North Island. These DHBs contained a large proportion of Māori that captured both urban and rural Māori groups. Guided by the researchers, a climate change policy framework that considered whānau-centred healthcare knowledge, needs, resources and aspirations, to contribute to a transformed and responsive health system was designed.

The aim of this project was to facilitate consideration of the social impacts of climate change in the context of health. By assisting these health institutions (DHBs) to better prepare to deal with the scale and pace of climate change, the flow on impacts for other contracted service providers (whether iwi, mainstream or government agencies) will be highly beneficial. Through a collaborative partnership, we co-designed a policy framework (“Haumanu Hauora”) to guide policy formation to mitigate risk to Māori (and others) in the context of climate change.

Guided by Kaupapa Māori epistemology, theory and practice (Pihama, 2010; Smith, 2012), this research was committed to transformative action for positive Māori health outcomes. This project prioritises Māori health perspectives, aspirations and autonomy. Primarily qualitative in orientation, data was collected via interviews with key informants from participating DHBs and supplemented by interviews with subject matter experts. A review of contextual factors was undertaken to inform the interpretation of results and to develop a strategic review of key intervention points for implementation of the policy framework.

2.1 Interviews

The information obtained from the interviews was used to enable the researchers to identify the activity planning, strategic direction and potential interventions that contribute to and determine how Māori perspectives are considered in policy development. The key contributions were from tāngata whenua (Indigenous people – Māori adults) and DHB staff. A small group of rangatahi (Māori youth) were recruited to participate based on their interest in climate change.

Interviews with tāngata whenua provided our team with an opportunity to explore their experiences, views, and aspirations for their communities when considering experiences of climate change. Our discussions also covered the participants’ expectations for health policy in relation to climate change. Together we planned ways in which improvements could happen; such as through planning, strategies, and interventions that could inform our policy framework.

Interviews with DHB staff were principally intended for those who were involved in, or aware of, policy development and implementation processes. Our connections with key people and our partnership with project community collaborators at each of the DHBs helped us navigate the DHB research procedures and facilitated our recruitment at each site. The knowledge of DHB staff was intended to provide the researchers with information about the policy systems and processes across DHB health institutions. We also wanted to understand the existing process for incorporating Māori health considerations in any climate change relevant policies.

2.2 Participants

Five rangatahi Māori were interviewed. Each of the rangatahi Māori were wāhine (female), between the ages of 18-25 years with a passion and interest for, or had a role related to, climate change. Two interviews were held kanohi ki te kanohi (in-person), while three were held via zoom because of COVID restrictions.

Over a six-month period between June and December 2021 interviews were conducted within the three DHB regions. Two participants were subject matter experts (SMEs) from outside the relevant DHB regions. Twenty-five other people were recruited through their locality (Waikato, Lakes and Bay of Plenty). Nearly three quarters of the participants were Māori (n=23). A total of thirty-two interviews (n=32) were conducted.

After interviewing health institution staff, tāngata whenua and rangatahi it became clear that the aspirations and experiences of tāngata whenua and rangatahi were absent in climate change policy processes. The following section describes observed weaknesses of the current policy process.

Tāngata whenua and rangatahi felt that DHBs need to work with Māori before a crisis occurs in order to develop appropriate plans and policies that will help communities to be proactive in their preparations. Responding to health needs during a crisis contributed unnecessary additional stress for Māori DHB staff and Māori community health service providers. People agreed that Māori groups and providers working together added strength to their efforts.

Participants wanted to see a cross-agency approach used within the health sector to better address health issues. Descriptions of a regular forum held to facilitate sharing information across the region highlighted a potential opportunity for cross agency conversations to occur.

The ways in which indigenous voices are ignored or silenced were presented as a weakness of the current health system. Examples of both tāngata whenua and rangatahi speaking up as a voice for Māori on environment and climate change issues had been viewed negatively by people in decision-making positions. However, the value of having youth participate in decision-making environments, with their willingness to challenge and advocate strongly without fear of retribution, was presented as an untapped resource.

Participants had various perspectives on the use of mātauranga Māori (Indigenous, Māori knowledge) to help address climate change issues. Some felt that te ao Māori (a Māori worldview) had the solutions for addressing climate change; referring to iwi climate change strategic plans, grounded in their own cultural context, knowledge, and history. This type of strategic thinking was considered as mana motuhake (autonomy) in action;

… nobody would know [the hapū rohe and land], significant places, waters, better than the home people. So, there would be a huge expectation that anything to do with that area, that the iwi/hapū not only be a part of, but even lead with their own particular knowledge as well, and intergenerationally. So that kaitiaki role [is] restored and activated. (TW2A)

Members of each hapū or iwi can tailor climate change responses to the needs of te taiao (the environment), their land, their rivers or water bodies, the significant sites, and cultural spaces. Others felt that because climate change was not the fault of Māori, those who created the problem should have to fix it. Rangatahi were particularly passionate in this space, carrying the expectation that those who caused harm or damage should right their wrongs immediately.

When it came to connecting to māturanga Māori, the most passionate, and least forgiving, arguments were shared by rangatahi. For example, in response to a query about government documents they had read one rangatahi said;

The Emissions Reduction Plan is pathetic as it stands... It was all individual action, white privilege, money… And there's no sense of community, no sense of honouring tāngata whenua. It was sad... (RV2)

The seasoned perspective of tāngata whenua is balanced with and complemented by the passion of rangatahi.

3.1 Current policy process

Through key informant interviews with health institution staff and subject matter experts alongside documentation we were provided, our team were able to obtain a general sense of the policy formulation process at DHBs. This process was conceptualised as six phases of policy development: Internal design, specialist input, Māori input, committee oversight, approval and delivery. Each of these phases is described below.

Internal design - is when the need for a policy is determined. Decision-making processes were not clearly distinguishable, which frustrated staff. Nevertheless, there was general agreement amongst DHB participants that the flexibility of policies to be developed as and when needed within the different departments, units, or work areas was useful. Those generally charged with writing policies were staff who did not have experience with writing policy. There appeared to be no clear process or recommendation guiding staff about the knowledge or skills needed to write policy.

Specialist input - highlights how different departments, units and work teams can develop policy with input sought from others. While technical and specialist knowledge and expertise is vital for policy, consideration of equity is essential. The inclusion of Māori equity or Treaty relevant information was not consistent, and Māori policy staff often had to add this retrospectively at later phases.

Māori input - responds to the calls for more commitment to equity and Te Tiriti o Waitangi (Māori language version of the Treaty of Waitangi). In order for health institutions to meet their obligations of partnership under Te Tiriti o Waitangi, input from Māori is required. The creation of Iwi-Māori governance boards has enabled a pathway for Māori input to health institution operations. However, existing policy development did not have consistent processes to ensure Māori input.

Committee oversight – recognises the role of the Policy Committee to oversee the development of a policy, to support the policy development process through providing feedback and guidance, and to improve the quality of policy. Any changes, improvements, and additions were made at this point (before proceeding to the Approval phase). Once policy documentation is submitted, Policy Committee members determine the robustness of evidence and research supporting the draft policy, the measures and/or tools for monitoring and relevance, and consider the policy’s appropriateness for improving Māori health outcomes.

Approval - policies, or revised policies are (re)submitted to the Policy Committee as part of its formal approval. Once finalised and approved policies are disseminated through internal systems for implementation.

Delivery - organisational policy guidelines encourage staff to take responsibility for acquainting themselves with policies once the policies are available through the organisational intranet and utilise them as needed. However, relying upon staff, their availability, motivation and desire to learn about policies leaves implementation vulnerable. Participants suggested that the implementation of policy could be more effective.

A visual representation of the six phases of the policy process is presented in Fig 1.

Health institution staff describe policy development by employees with little or no prior knowledge and experience of policy. A lack of clarity regarding the relevance and importance of policy contributes to feelings of frustration when policies are prepared only to be turned away as unnecessary. Tāngata whenua and rangatahi offered relevant insights to the development of health policy that is embedded in mātauranga Māori.

Failures observed in the current process with regards to incorporating Māori health considerations into climate change policy are considered and a revised policy framework and possible intervention points are proposed. The latter would likely result in a clearer process, but also an improved engagement with, by and for Māori. Centrally we introduce a commissioning, refining and monitoring stage to guide the six existing policy phases. Within the monitoring stage we propose the addition of an evaluation phase as the seventh policy phase. Above all, we emphasise the need for internal and external Māori input into the entire policy development process. Although Māori input is considered in the existing policy process, it is often excluded, with specialist input progressing to the committee oversight phase immediately. Sometimes there is a retrospective addition of Māori input. However, such inconsistencies within health policy are not conducive to equitable and effective health outcomes for Māori.

The Policy Project (Department of the Prime Minister and Cabinet, 2021) identified commissioning conversations as essential. The importance of commissioning conversations at the outset of policy development ensures the following can be considered: context and purpose; resource and funding requirements; any benefits, disadvantages or risks; and the potential impacts (both intended and unintended). These commissioning conversations enable risk management planning. An appropriate commissioning stage at the outset will support policy development as well as clarify any financial and resourcing factors relevant for policy implementation (Department of the Prime Minister and Cabinet, 2021). Introducing Māori responsive climate health adaptation to the health institution policy process will involve consideration of decision-making factors, climate adaptation, Māori health delivery and outcomes, as well as the social determinants of health.

The challenge of incorporating cultural values and concepts into policy will take time and continuous effort to achieve. Recognising that success will not be obtained in the first or possibly fourth attempt, means recognising that refinements will need to be part of the ongoing implementation of a policy cycle. While the first step in policy formation is the commissioning stage, in alignment with the need to modify, adapt and edit policies before ‘approval’, we acknowledge the need for a refining stage that occurs after commissioning and before monitoring.

Within the refining stage efforts to ensure processes are responsive to contemporary agenda while being cognisant of both historical influences and future context are essential. In reflecting upon research, Smith (2012) argued that decolonising methodology encourages researchers to reflect and question the knowledge they learn.

Monitoring and evaluation are critical to achieving better outcomes. The monitoring stage provides the opportunity to reflect on decisions in a timely manner and to target evaluations specifically to areas in need of attention. Thorough monitoring may result in further policy refinement. For Indigenous communities the inputs need to be grounded in an Indigenous worldview to ensure that the outputs and outcomes achieved reflect the particular health and wellbeing of that community. The need for policy processes to move away from a linear model is imperative. We demonstrate the cyclical nature of a reflective, interactive policy process in Figure 2 below.

Achieving Pae Ora (healthy futures for Māori), includes Mauri Ora (healthy individuals), Whānau Ora (healthy families) and Wai Ora (healthy environments). However, there is no “one-size fits all” approach to working with Māori whānau. It is likely that Māori community health climate adaptation needs will vary as the situation for each community reflects their history, circumstance, location, and economic base. This diversity needs to be considered in climate policy responses. A key way to achieve this intervention in the policy process is to introduce the input of tāngata whenua (Māori external to the organisation), and vulnerable groups at all stages of the policy process. We outline both the familiar, and newly introduced, positions needed in a refined policy process in Figure 3.

In light of our observations of the current policy process and the need to incorporate stages that enable inclusion of evaluation and Māori voices throughout, we have conceptualised a refined policy process. An expectation for Māori involvement throughout the entire process is demonstrated in Figure 3 above. Within health institutions there are teams and roles where Māori staff can nominate the appropriate representatives to review policies. Having different people involved throughout the policy process means that the workload can be shared. While a high level of input is required at the commissioning phase, from the internal design as well as specialist and Māori input, the expected inclusion of Māori throughout is clear. Having Māori (and vulnerable group) voices during the commissioning phase will ensure that diverse experiences and goals will have been considered before policies arrive on the desk of the Policy Committee. By only having one exit point between the three phases (commissioning, refining and monitoring) Māori inclusion is secured (Figure 4).

With an ideal policy framework established we identify five key intervention points that should strengthen health institutions’ responsiveness to climate change by developing Māori responsive policy. Our intervention points were to ensure foundation alignment, enhance access to care, engage with vulnerable communities, build capacity and capability and demonstrate institution obligations. Some of these intervention points are tightly linked to the policy framework we developed. For example, ensuring foundation alignment necessitates a thorough commissioning phase that includes appropriate Māori input.

4.1 Implications for the new health system

Our suggested policy framework should be regarded as an amenable and living framework that can be readily applied to a shifting Health context in Aotearoa. That is, the essence of a robust commissioning, refining and monitoring stage of policy development that ensures substantive Māori input at all stages can be applied to a changing governance structure; as seen with the introduction of Te Whatu Ora (Health New Zealand) and Te Aka Whai Ora (the Māori Health Authority).

In order to deliver on the potential of the refined policy framework, there is a need to increase the awareness of and knowledge about climate change and the impacts on Māori health within health institutions. Health institution staff had limited understanding about the impacts of climate change on health and wellbeing for Māori. This similarly was reflected in their level of climate change knowledge. Participants acknowledged that climate change was an important area of knowledge to grasp but also described experiences where members of staff were resistant to change within their jobs. Introducing climate change was seen to be an area of new learning that would likely be resisted or ignored which could negate any steps to include climate mitigation and adaptation into policies and/or procedures. Ensuring there is a foundation alignment (intervention point #1) of Māori responsive climate health adaptation will strengthen any policy that emerges.

Public health institutions are part of the larger health system that have responsibility for maintaining health delivery, funding and service provision in New Zealand. A recent finding of the Waitangi Tribunal (2021) that health services had not met the health needs of Māori means that work needs to be done to improve equity in health outcomes for Māori. Enhancing access to care (intervention point #2) involves improving the health system to reduce unmet health needs; ideally through better planning to prepare for the impacts of climate change.

Legislative attention on climate change such as the Climate Change Response Act 2002, and the Climate Change Response (Zero Carbon) Amendment Act 2019 has started encouraging the public sector to work towards reducing carbon emissions. Both the national climate change framework (Ministry for the Environment, 2019) and risk assessment (Ministry for the Environment, 2020) highlight a need to understand present and future impacts of climate change to be able to plan for the changes that will continue to occur. While the public health system adapts to incorporate climate change as core business across health services, emphasis will need to be placed on building the capacity and capability of health institution staff (intervention point #3).

For the last 21 years, the nature of relationships with Māori communities has been facilitated through the Iwi-Māori Governance Boards within the DHBs with little to no direct relationship between the health institutions and iwi-Māori communities. Māori are overrepresented as patients and underrepresented as professionals in the health system (Ratima et al, 2007; Reid, Cormack & Crowe, 2016). Despite being a universal and publicly funded health care system, Māori continue to experience disadvantage (Graham & Masters‐Awatere, 2020). Intervention point #4 highlights engaging with vulnerable communities through authentic relationships with Māori and other vulnerable communities. New opportunities within the latest health reforms serve to support the revised policy framework that hinges on building relationships to facilitate health institution responses while giving greater voice to Māori, and vulnerable, communities to address climate adaptation health needs.

Despite a universal understanding that everyone has a right to health, there are profound disparities between Māori and non-Māori health access, experiences and outcomes in New Zealand. The substantial shift in the structure of the health system has implications upon the delivery of health services. Part of the solution to improving health outcomes can arguably be found in building “more socially cohesive institutions and more communitarian [and] less individualistic societies” (Mooney, 2012, p. 385). These wider structural considerations emphasise the need for responsive policy that is robust and involves partnered input from Māori at all stages. Intervention point #5 encourages health institutions to demonstrate commitment to a strategic direction that considers the climate change wellbeing needs of people in several areas (eg. social, legislative, psychosocial, environmental, cultural, mental and physical).

Weaknesses in the existing policy process of DHBs means that these types of health institutions will fail to prepare for the intersecting health crises that vulnerable Māori will experience in the face of climate change. Recognition of an ad hoc approach to policy development and disregard for Māori input despite obligations under Te Tiriti o Waitangi contributed to frustrations by all interviewed. Tāngata whenua and rangatahi expressed their experiences of, and aspirations about, dealing with climate change. However, their voices were excluded from policy. Within the research we heard a noteable desire for health system structural change, and the recent health reform has provided that. While the newly formed partnership of the three main health institutions (Te Whatu Ora, Te Aka Whai Ora and Manatū Hauora) has only just begun, expectations that they will address identified inequity and disadvantage are high. A refined policy framework and the intervention points noted within this paper provide guidance to the newly developed health institutions. These interventions - ensure foundation alignment, enhance access to care, build capacity and capability, engage vulnerable communities and demonstrate institution commitment - reflect the substantial work that is needed to develop Māori responsive policy in anticipation of climate change impacts on Māori health. Strengthening health institution responsiveness to Māori health needs is essential.

To the best of our knowledge, the authors have no relevant financial or non-financial interests to disclose.

Author contributions: All authors listed have contributed sufficiently to the project to be included as authors, and all those who are qualified to be authors are listed as authors. Material preparation, data collection and analysis were performed by Bridgette Masters-Awatere, Darelle Howard and Patricia Young. The first draft of the manuscript was written by Bridgette Masters-Awatere and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Ethical Approval: Appropriate ethical approvals for the research were obtained from the University of Waikato Human Research Ethics Committee (Health) (Ref: 2020#61 and 2021#52). Locality approvals were obtained from the appropriate health institutions between September and October 2020 (prior to commencement of interviews).

Data availability: The datasets generated during and/or analysed during the current study are not publicly available due to confidentiality clauses with the research funder but are available from the corresponding author on reasonable request.

Acknowledgements: The authors would like to acknowledge the following people who assisted with the Haumanu Hauora research project: Renae Dixon, Rhys Jones, Alex Macmillan, Nina Scott, Phyllis Tangitu, Megan Tunks, Rebekah Graham, Elisha Powell, Areta Ranginui Charlton, Kendon Bell and Bill Cochrane. We would also like to thank our research participants who willingly gave their time to attend the interviews and then joined us a second time to review and provide feedback on the policy framework and intervention points.

Funding Source: This project was funded by the Vision Mātauranga programme within the Deep South National Science Challenge. We thank them for their funding and administrative support. In particular we acknowledge the support of Sandy Morrison (Vision Mātauranga Lead) and Shaun Awatere (Kāhui member) throughout and more recently Naomi Simmonds (Partnerships Director, Māori).

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published 05 May, 2023

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Haumanu Hauora: Refining public health institution policy to include Māori and climate change

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Abstract

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1.0 Introduction

2.0 Methods

2.1 Interviews

2.2 Participants

3.0 Results

3.1 Current policy process

4.0 Discussion

4.1 Implications for the new health system

5.0 Conclusion

Declarations

References

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Journal Publication

Version 1