# A Policy and Ethical Framework to Improve Maori Health 

> **Through Maori Traditional Healing**[^1]

Aroha Te Pareake Mead

Manager, Cultural Heritage & Indigenous Issues Unit, Te Puni Kokiri:
Ministry of Maori Development & Senior Lecturer, Maori Business, School
of Business & Public Management, Victoria University of Wellington, New
Zealand

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\[Presented to the 5^th^ World Congress of Bioethics, Imperial College
of Medicine, London, UK, September 2000\]

# 1. Introduction

## The day before I left New Zealand to travel here to this Congress, it was 

> announced that the New Zealand Health Funding Authority (HFA) had
>
> granted for the first time ever to five Maori health providers, funds
> to deliver

Maori holistic healing services. This development has not occurred in a
vacuum or by chance. As with other indigenous peoples, it comes after a
long history of Maori endeavoring to re-assert their rights and
expertise in taking care of their own and others, after emerging from
the traumatic experience of colonization and active suppression of their
knowledge, cultural values and sciences.

Researching and developing traditional healing is not just about finding
ways to offer to the wider world what indigenous peoples have known and
practiced for centuries. In the year 2000, traditional healing is about
using traditional knowledge systems, sciences and practices that for the
large part still remain outside of contemporary science, in the first
instance to redress the poor health status that indigenous peoples
worldwide have experienced post-colonization. Secondly, to promote
traditional knowledge for future generations of indigenous peoples; and
thirdly to share with the world their traditional knowledge in an
environment of consent, participation, access protocols, and sharing of
benefits.

> This paper looks specifically at the situation of Maori, the
> indigenous peoples
>
> of New Zealand, and the efforts made by both Maori and government to
> improve Maori health and Maori development.

2.  **The Context**

    1.  **Historical Context**

The historical experience of Maori is similar to that of indigenous
peoples worldwide. We inhabited the land now known as New Zealand for
over 2000 years before European settlers arrived. In 1840 a Treaty was
signed with the British government, the Treaty of Waitangi and thus
began a journey that is still in progress today -- a journey of two
Treaty partners acting honourably towards each other and in good faith.
In 1840 when the Treaty was signed, the estimated Maori population was
410,000. 56 years later, the Maori population had been reduced to 42,000
-- casualties of the diseases that settlers brought with them,
casualties of wars with settlers, and casualties of war amongst Maori
tribes after the introduction of the musket to Maori communities.

> As with other colonized peoples, Maori culture was forced into the
> underground, as pressure to become civilized and assimilated bore down
> on the country like a plague. Tohunga (traditional healers) were
> forbidden to practice traditional healing in a Tohunga Suppression Act
> (1907)[^2]. Maori were forbidden to speak the Maori language, in fact,
> even my parents generation was caned at school for speaking Maori. The
> rate of land alienation and destruction of native forests and fauna
> was alarming. Forests were destroyed not because the wood was needed,
> or even the land for that matter -- but because many of the British
> immigrants who settled in New Zealand were, amongst other things,
> superstitious and considered forests as places of evil. \[Today less
> than 20% of our native forests still remain. The majority of these are
> found on Maori land and in the Conservation estate.\] The Maori
> population experienced rapid urbanization in the post-war years.
> According to Pool, it was the most accelerated move experienced by any
> population in the world.[^3]

At various points in history, different ideologies have been used to
describe the situation of Maori and the relationship with their Treaty
of Waitangi partner, the New Zealand government. As a country we have
gone through complete denial that Maori had/have special rights as the
indigenous peoples of the land, or, that the Treaty of Waitangi created
not just historical but also contemporary and future responsibilities
for government to Maori people, over and above governance and
citizenship.

> I won't go into further detail of the past -- suffice it say, the past
> exists and its effects are still felt today. The phrase
> '*post-colonization trauma syndrome'* has recently found its way into
> our policy makers' vocabulary. I would like to use the time available
> to look more at the situation today and the efforts both Maori and
> government are currently engaged in.
>
> **2.2 Who are Maori? Maori Demographics**

Maori are the indigenous peoples of Aotearoa Te Wai Pounamu, the country
you know as New Zealand. Maori are a Polynesian Pacific peoples who
share with other Polynesian peoples' a linguistic tradition, fundamental
elements of cosmology and spiritual values and the knowledge,
generational experience, and custom of utilizing culture and those
natural resources that were available in the places they lived.

> O/Head #1 - Maori/NZ population 1996 (last census)

Maori comprise 16% of the total New Zealand population. We are a
youthful population and our birth rate is almost double that of
non-Maori. Maori are also the third largest indigenous population in the
South Pacific.

> O/Head #2 - Maori/NZ population 2051 (projection)
>
> ***Within 51 years the Maori population is predicted to reach almost 1
> million people***.
>
> There are just over 60 distinct Maori tribes, but all speak the same
> language, te reo Maori, are subject to the one Treaty and live
> alongside other New Zealanders in urban as well rural communities.
> Even though the majority of the Maori population lives in urban areas,
> we still remain tribal peoples with very strong tribal traditions. In
> fact the term 'Maori' was only created after the Europeans arrived.

3.  **A Policy Framework: Socio-Economic Disparities between Maori and
    all other New Zealanders**

It is my contention that a government should not develop a framework for
traditional health that stands alone or sits apart from a more
comprehensive indigenous development strategy to redress past historical
grievances, respond to the current situation and plan for the future. To
do so would be to render traditional healing services vulnerable to
exploitation and misappropriation, as there would not be sufficient
additional legal and non-legal mechanisms to protect the relevant
traditional knowledge and practices.

It is the policy of the current government to recognize that there are
gross socio-economic disparities between Maori and non-Maori and that
these disparities are worsening over time. Government has developed a
framework, called 'Closing the Gaps' which represents the first
significant and high-level effort to halt the socio-economic decline of
Maori and to take more proactive steps to assist Maori to achieve
self-determination of their whanau (families), hapu (sub-tribes) and Iwi
(tribes).

In order to ascertain how best to 'close the gaps', it was first
necessary to identify precisely where the gaps exist. The Ministry of
Maori Development undertook a comprehensive statistical analysis and
published their findings in a document called 'Closing the Gaps'. These
finding have set the *disparity indicators* that are now being used to
gauge improvement.

Overhead #3 -- Closing the Gaps

***This figure provides a representation of the differences between
Maori and non-Maori on a scale of 1 to 100. Parity is achieved when both
Maori and non-Maori meet at the outer circle.***

Overhead #4 -- Causes of death

***Maori live less than other New Zealanders living in the same
communities as they do. They have disproportionately higher mortality
rates than their non-Maori neighbors in conditions that for all intents
and purposes are preventable or curable***. ***What is causing and
widening these disparities?***

In all sectors -- education, labour, criminal justice, housing, income
and health, it was clear that the status quo was simply not delivering
outcomes for Maori. It had to be acknowledged that the notion that one
policy for all is fair and just and effective was simply not backed up
by the statistics. Perhaps, the recommendations that Maori had made to
various governments over the years, was in fact the answer, *"Maori
leading Maori development."*

In the case of addressing poor Maori health, there are ways in which the
general delivery of health services must be improved -- but there is
also wisdom in widening the accessibility of traditional healing
practices for Maori, as the outcomes are not solely limited to improved
health. Durie refers *to medical pluralism* \[recognizing that multiple
approaches to healing\][^4] . There are also benefits in terms of
language promotion, cultural preservation, replenishment of the natural
environment as well as self-esteem, which can positively, impact on all
the other areas. [^5] The policy framework for government therefore is
at one level 'closing the socio-economic disparities between Maori and
non-Maori' and at another level, addressing and settling Treaty of
Waitangi grievances (which I'll discuss soon).

4.  **Maori Traditional Healing**

I was asked to give a brief descriptive on the nature of Maori
traditional health services. It should be made clear that the primary
focus for traditional healers is that of the overall well being,
physical, spiritual and emotional of a person. It is considered
important to remedy all of these areas simultaneously or in close
proximity, as neglecting one area, can cause ineffectiveness in the
others. Often, it is also necessary to heal not only the person, but
their family and immediate home and work surroundings.

Traditional healing comprises a number of components, each one of them
requiring specialist knowledge, these being:

> *Mirimiri* massage, physiotherapist, chiropractor
>
> *Rongoa* ethnobotany - medicines derived from native flora and fauna
>
> *Karakia* spiritual well-being of the person, their family
>
> and immediate environment, protection

It can often take several specialist healers to deal with a situation.
Note that I am using the term 'situation' rather than 'condition' to
reinforce the concept of healing the person and their surroundings, and
not just a tangible condition. There are also specialists for women,
childbirth and children. Maori traditional healing can be and is applied
to any situation and any condition known by medical practitioners, but
it also plays a very important and unique role in healing a condition we
call *Mate Maori* (Maori sickness) which afflicts some Maori and is
untreatable by medical practitioners.

There is a national body of traditional Maori healers.[^6] Traditional
healing has recently re-emerged as either the preferred choice for many
Maori seeking care or as a complimentary service to medical care. There
are a number of reasons for this. One of them is that Maori have very
different perceptions of illness and wellness. For instance in a recent
study that examined Maori concepts of disability, one informant
commented:

Overhead \# 5 - Maori concepts of disability[^7]

In other words, policies that prioritize installing ramps for disabled
people into buildings might go some way towards making places more
accessible, but it won't even touch this particular perception.

Redressing land alienation is the most important issue for Maori. When
the Treaty of Waitangi was signed in 1840, Maori 'owned' all of the
land.

Overhead #6 - Land alienation[^8]

Now, Maori own only 6% of the total New Zealand land mass. 12.5% in the
North Island and 0.5% in the South Island. There are over 800
outstanding Treaty claims against government. In all honesty, I would
not be able to stand before you today and talk to you about Traditional
Healing, if there was no progress being made on Treaty grievances and
settlements. Over the next 50 years, this map will change significantly
as more Treaty settlements are achieved and land and natural resources
returned to Maori tribes. Traditional healing also offers to Maori one
of the few spaces available to them to grieve for their loss of heritage
at a very personal individual level.

5.  **An Ethical Framework: The Mataatua Declaration on the Cultural &
    Intellectual Property Rights of Indigenous Peoples**

### The Mataatua Declaration was developed in 1993 by indigenous peoples from 14 countries. It has since been signed by over 500 indigenous nations indicating a widespread agreement with the principles and recommendations for action that it contains. The Declaration articulates indigenous concerns about the inadequate protection of their traditional knowledge and cultural and intellectual property at local national and international levels. It also outlines many ethical principles which are highly relevant to the issue of traditional healing, including the necessity to protect biological diversity and to prioritize the establishment of indigenous education and research institutions.

### 

### The Mataatua Declaration is routinely quoted by Maori tribes, and over time, government has come to accept many of its ethical principles. 

> O/Head \# 7 Mataatua Declaration: Traditional Knowledge Is:
>
> ***Traditional knowledge is*** a) local, site-specific, b) an
> essential aspect of self-determination of whanau, hapu, Iwi and
> indigenous peoples worldwide,
>
> c\) there for indigenous descendants ***first***, d) collective but
> can be held by individuals in trust, e) is collective and
> intergenerational but, individuals can innovate and individuals can be
> guardians.
>
> The essential point is that acknowledgement of the local and site
> specific nature of traditional knowledge, guides policy makers to
> develop mechanisms and capacity building at the local level rather
> than solely at the national level.
>
> O/Head \# 8 Mataatua Declaration: TK can be shared:
>
> ***Traditional knowledge can be shared*** a) alongside and/or after
> its promotion amongst indigenous descendants, which is to say, not
> BEFORE its promotion amongst indigenous descendants,
>
> b\) requires access protocols, informed consent, cultural and
> intellectual property rights, contracts at a local level, regulation
> of the observance of contracts at a national levels,
>
> c\) requires agreements on any sharing of benefits which is not only
> about financial benefits, but reciprocity, ensuring that the local
> community derives some benefit, capacity building, equipment,
> training, and when appropriate financial benefits.

6.  **A Framework for Implementation of Traditional Healing Services**

With a historical context acknowledged, a comprehensive and strategic
government policy framework established, and an agreement on basic
ethical principles for both Maori and government to observe, the issue
of implementation becomes more achievable. Given that the Mataatua
Declaration prioritizes indigenous people asserting greater control over
the research impacting on their lives, then, it is clear that a
framework for implementation of traditional healing services requires
Maori in the first instance to define for themselves an appropriate
implementation framework and to use it to negotiate with government.

In 1996, a Maori research unit identified ten criteria representing
minimal conditions that might be expected from a traditional healing
service taking into account the realities of the contemporary health
system:[^9]

-   **Traditional** basis for healing activity - there should be
    evidence that a healing activity does in fact have a traditional
    basis.

-   **R**elevant for today -- not all traditional practices were sound
    or desirable

-   **Accessible** -- few healers have fixed fees, in economic terms
    they are therefore more accessible than mainstream services.

-   **D**emand -- the value of any service is that it responds to a
    clear need

-   **I**ntegrated body of knowledge to rationalize treatments

-   **T**raining for practitioners -- knowledge of healing is not
    static, it require ongoing training

-   **I**nternal arrangements for maintaining excellence -- excellence
    is something highly valued in Maori society

-   **O**pen to other approaches -- medical pluralism, reciprocal
    respect for other systems of healing

-   **N**ot harmful

-   **A**ccountability -- traditional healing providers have to be
    accountable to the people they care for, to their funders

-   **L**iaison -- no longer acceptable for workers to work in isolation
    of each other

7.  **Conclusion**

In conclusion, returning to the point I started this presentation with
-- my observation that the announcement of the first Maori traditional
healing service being funded by the NZ Health Funding Authority, has
occurred **after**;

-   the country as a whole has learned to acknowledge the historical
    context and continuing impact upon Maori of colonization;

-   developing a policy framework for government to redress historical
    grievances as well as deal with contemporary inequities including
    but not limited to Maori health;

-   developing an ethical framework for government and Maori;

-   Maori themselves have developed an appropriate framework for the
    offering and purchasing of traditional healing services;

-   **and after** government has made corresponding commitments to
    protect traditional healing from misappropriation and to assist
    Maori to promote the on going learning of traditional knowledge in
    their own institutions**,** kohanga reo (Maori language pre-school
    nests), kura kaupapa (Maori primary schools), and Whare Wananga
    (tribal universities).

> **BIBLIOGRAPHY**

[Maori Concepts of Disability]{.underline}, Jo Kingi & Anne Bray, Donald
Beasley Institute Incorporated, Dunedin, 2000

[Closing the Gaps, Second Progress Report]{.underline}, Ministry of
Maori Development, Wellington, 2000

[Maori Statistics: Fact Sheets]{.underline}, Monitoring & Evaluation
Branch, Ministry of Maori Development, Wellington

Fact Sheet 1, [Maori Self Employm]{.underline}ent, March 1999

Fact Sheet 2, [Maori Women]{.underline}

Fact Sheet 3, [Maori Unemployment]{.underline}, June 1999

Fact Sheet 4, [Maori Living in Urban and Rural New Zealand]{.underline},
June 1999

Fact Sheet 5, [Maori Smoking Patterns]{.underline}, July 1999

Fact Sheet 6, [Maori Youth]{.underline}, September 1999

Fact Sheet 7, [Maori Personal Income]{.underline}, January 2000

Fact Sheet 8, [The Maori Language and Education]{.underline}, February
2000

Fact Sheet 9, [Maori and Unpaid Work]{.underline}, March 2000

Fact Sheet 10, [Maori Men]{.underline}, July 2000

Fact Sheet 11, [Maori Graduates]{.underline}, July 2000

[Building a Better Future: The Treaty Settlement Process]{.underline},
Office of Treaty Settlements, Wellington, 2000

[Standards for Maori Traditional Maori Healing]{.underline}, Ministry of
Health, Wellington,

June 1999

[A Framework for Purchasing Traditional Healing Services]{.underline}: A
Report prepared for the Ministry of Health by Te Pumanawa Hauora,
Research Report TPH 96/1, Massey University, Palmerston North, New
Zealand, June 1996

[Maori Statistics]{.underline}, New Zealand Census Statistics,
Wellington, 1996

[The Mataatua Declaration on the Cultural and Intellectual Property
Rights of Indigenous Peoples]{.underline}, June 1993

[Te Iwi Maori: NZ Population - Past, Present and
Projected]{.underline}*,* Pool, I. Auckland University Press, Auckland
1991

Unpublished paper, [Te Puni Kokiri]{.underline} [Report on the
Acceleration of the Purchasing of Traditional Maori Healing
Services]{.underline}, Lyn Harrison, 2000

#### Criteria for A Framework of Implementation

**Of Traditional Healing Services**

-   **T**raditional basis for healing activity

-   **R**elevant for today

-   **A**ccessible

-   **D**emand

-   **I**ntegrated body of knowledge to rationalize treatments

-   **T**raining for practitioners

-   **I**nternal arrangements for maintaining excellence

-   **O**pen to other approaches

-   **N**ot harmful

-   **A**ccountability

-   **L**iaison

[^1]: Paper presented at the 5^th^ World Congress on Bioethics: Ethics,
    Law and Public Policy, Imperial College, London (UK), 20-24
    September 2000.

[^2]: The Tohunga Suppression Act was subsequently repealed in 1964 but
    even before this date, Maori traditional healers had re-emerged and
    had significant numbers of followers.

[^3]: Pool I. Te Iwi Maori: NZ population, past, present and
    projected*,* Auckland University Press, Auckland 1991

[^4]: , MH Durie, A Framework for Purchasing Traditional Healing
    Services, 1996, page 2

[^5]: Closing the Gaps is the language of the government of the day, but
    the aspirations of Maori extend

    beyond this ideology. They do not wish to be exactly like non-Maori,
    but as citizens they are entitled to good health, proper housing, a
    job, and to be tribally and culturally distinct.

[^6]: Nga Ringa Whakahaere o te Iwi Maori: The National Body of
    Traditional Maori Healers was established in 1992. The Board
    advocates on behalf of healers and has participated in a number of
    government policy initiatives relevant to the preservation and
    promotion of traditional healing (e.g. the review of the Patents
    Act, consultations on a framework for purchasing traditional healing
    practices.)

[^7]: Maori Concepts of Disability, Donald Beasley Institute, Dunedin,
    pages 8 & 9

[^8]: Maori Land Today, Part 2 -- Settlement Framework, Building a
    Better Future, Office of Treaty Settlements, Figure2.1 and 2.2,
    pages 13 & 14.

[^9]: A Framework for Purchasing Traditional Healing Services, Te
    Pumanawa Hauora Research Report TPH 96/1, June 1996, 24-29.