Filipo Katavake-McGrath is a planning advisor in the Population Health Strategy & Investments unit at Counties Manukau Health. He is a strong communicator, planner and performance strategist, analyst and researcher. He has a passion for social cohesion and is always looking for innovative opportunities to bring community, government and business together with the educational, commercial, ecological and spatial environments to chart paths to successes.
Health equity is a priority for Counties Manukau Health (CM Health). Our community is diverse, with high Māori, Pacific and youth populations compared with the rest of New Zealand. These populations continue to face health inequalities despite decades of government policies, programmes and projects aimed at reducing the disparities.
Why don’t the efforts to reduce inequality work?
Political agenda are set in a standardised way. They begin with the manifesto of a political party, which structures the government’s policy platform after an election. At the next level down, the minister agrees on services to be delivered with a provider agency, such as a district health board (DHB), according to legislation determined by policy and the will of the government. Ministry of Health contracts and agreements with DHBs segregate funding for specific services and determine metrics to be reported on. These factors influence strategy, how human resources are organised, and protocols for how clinical services are delivered within DHBs. All of this results in a very structured way of delivering healthcare.
To attempt to overcome the shortcomings of this process, programmes such as the Pacific Analysis Framework of the 1990s applied an ‘equity lens’ by trying to incorporate the views of Pacific people. There were two problems with this approach:
1. The manifesto and policy agenda were set without consultation; the Pacific voice was sought only on the content of the policy. A fundamental layer in the process was therefore missing, which prevented the policy from truly reflecting the views of Pacific people.
2. Political analysts attempting to consult with Pacific communities often did not have a network of contacts in those communities, which made consultation difficult.
How can we do things differently?
Applying an ‘equity lens’ is not enough. The continuing dismal statistics prove that. To achieve equity, project teams must work from the ‘ground up’.
First, understand the target audience. Define the community the project needs to reach. What are their values, characteristics, experiences and customs? What distinguishes them from other groups? Avoid assuming that Māori and Pacific peoples are a homogenous group. They aren’t: Māori tribes, for example, vary considerably. So do Pacific cultures, age groups, and so on.
The best way to refine this knowledge is by talking to people from the target community. Project teams which start out without a network of contacts in their target community may need to leverage connections with colleagues to help them reach out. CM Health, for example, has specialist Māori, Pacific and Asian health teams which are well-connected in their communities.
Once project teams understand the target community, they can use a culturally appropriate research or project delivery approach to structure their work. There are many such approaches available.
For example, the Māori health model Te Whare Tapa Whā, developed by Māori health expert Mason Durie, is a holistic health and wellness philosophy that considers four dimensions of wellbeing: taha hinengaro (mental health), taha whānau (family health), taha tinana (physical health), and taha wairua (spiritual health). There are also iwi-specific Māori approaches to research and project delivery.
The Kakala methodology is an example of a Tongan research approach. The methodology was developed by a Tongan teacher who likened the educational process to the traditional Tongan process of weaving a ceremonial kakala, or garland. It is based on the ideas of reciprocity, relationships and purpose that are central to Tongan culture.
There are resources available to support project teams that lack experience in indigenous or ethnic methodologies. Specialists in Māori and Pacific research units, such as those at the University of Auckland, Auckland University of Technology and the University of Waikato, are often willing to advise novices on appropriate methodologies for addressing specific problems in identified populations.
We know traditional approaches will never close the equity gap. It’s time for a new idea. My challenge to project teams is to reframe the way you plan and deliver your project to better reflect the lives of the communities you work with. If you’re running a project in a Māori or Pacific community, why not consider a Māori or Pacific way of solving the problem?