Mäori & Public Health: Ethics
A discussion paper
Preamble
Being asked to write a paper on Mäori perspectives on Public Health ethics
raises issues for me. Some years ago my research colleagues and I invited
Moana Jackson to participate in a project on genetic engineering. Our first
question for him was along the lines of whether Mäori had a ‘unique
perspective’ on genetic engineering. It was then that we received our lesson
about the use of the word ‘perspective’ (Cram, Pihama & Philip-Barbara,
2000:66-67). Moana said that,
‘The word perspective to me is interesting. It assumes that there is
something that is a given upon which Mäori can be expected to have a
valid point of view. The moment you do that you situate the Päkehä
model as the truth; and you ask Mäori to give a view on it. I think there
are Mäori truths and they exist independently of whatever Päkehä view
as reality or truth and to seek a Mäori perspective is to legitimate the
Päkehä perspective on the issue. So to ask for a Mäori perspective on
say the use of land is to validate the Päkehä concepts of property and
seek to fit a Mäori view of that within it. Whereas what we should begin
with is: what is the Mäori truth on land and how does that sit alongside,
rather then fit within, the Päkehä view?’
Perhaps even more scary than asking whether there is a Mäori ‘perspective’
on Public Health ethics is the thought of asking what the Mäori ‘truth’ about
Public Health ethics is. Once again, Moana is able to come to my rescue. A
few years ago I was experiencing difficulty writing a paper on Mäori research
ethics in the social sciences (Cram (2001). My problem was the ‘truth’; I was
only one Mäori researcher and the ‘truth’ seemed something much larger than
could be contained in just me. And then my whanaunga, Moana, said that I
should write about what I know is right. So this has been my approach to this
paper; I have written about what I know based on how I was raised, what I
have read, and the wisdom of those who I have talked with, worked with, and
eaten with. My disclaimer then, as now, lies in the words of Eber Hampton1
(1988) who says of his own work, ‘My hope is that the reader will think along
with me and will take what is useful and leave the rest’.
1
Eber Hampton is a Member of the Chickasaw Nation and president of Saskatchewan Indian
Federated College.
Mäori & Public Health: Ethics
Fiona Cram
August 2007
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Mäori & Public Health: Ethics
Background
The complicity of researchers and the policies and practices that research
findings have justified in the colonisation of Aotearoa has been welldocumented in many theses, articles and books on Mäori, research,
colonisation and ethics (for example, Linda Smith, 1999; Ngahuia Te
Awekotuku, 1991). This situation is not unique to Aotearoa and to Mäori;
across the globe indigenous peoples have protested about being overresearched by people who are alien to them and their communities, with the
outcomes of this research too often being ‘misguided and harmful’ (Marlene
Brant Castellano, 2004). Indigenous peoples are now justifiably both weary
and wary of research and its outcomes (McNeill, Macklin, Wasunna &
Komesaroff, 2005).
Marlene Brant Castellano (2004:98), for example, describes the howls of
protest and the scepticism from indigenous peoples in Canada during the
1992 Royal Commission on Aboriginal Peoples’ workshop to establish a
research agenda. Like many workshops and hui in Aotearoa throughout the
1980s and 1990s2, and often even into the present day, people’s experiences
of research gave them no reason to believe that it could serve their
communities well. In Canada in 1992, the cry that they had been ‘researched
to death’ was met by the quietly spoken words of an Elder;
‘If we have been researched to death, maybe it’s time we started
researching ourselves back to life’.
On this pathway ‘back to life’ indigenous peoples now ask and expect more of
those who come to find out about, and possibly ‘do good’, for their
communities. Some of the first responses to these expectations were made
by non-indigenous researchers who embedded notions such as respect and
cultural competence into their disciplinary codes of ethics (Te Awekotuku,
1991). Codes of good practice for indigenous research were also produced by
agencies such as the Health Research Council of New Zealand and the World
Health Organisation (HRC, 1998; WHO, 2003).
Indigenous communities also produced their own codes of conduct for those
wanting to work alongside them on research (e.g., Akwesasne Good Mind
Research Protocol; Mi’kmaw Research Principals and Protocols). These
codes speak of indigenous people’s rights to protect their culture and
knowledge with these rights, in turn, underpinning the insistence of indigenous
peoples that they are the arbiters of how they are researched and
2
Here I am speaking of my personal experience and those with longer memories may be able
to extend this timeline further into our past.
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Mäori & Public Health: Ethics
represented. Only then can their cultural maintenance and revitalisation be
assured (Brant Castellano, 2004).
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Mäori & Public Health: Ethics
Public Health
Public health carries dual accountabilities of finding out and taking action. As
Steven Coughlin (2006) notes,
‘Ethical concerns in Public Health often relate to the dual obligations of
Public Health professionals to acquire and apply scientific knowledge
aimed at restoring and protecting the public’s health while respecting
individual autonomy’.
Public health therefore begins with the acquisition and application of, in
Coughlin’s view, ‘scientific knowledge’. If this knowledge does not represent
the ‘truth’ about indigenous peoples then the restoration and protection of the
Public Health of indigenous peoples is in jeopardy. Debates about the nature
of knowledge and the search for truth so as to improve our conditions have
raged since time immemorial and indigenous peoples are no strangers to the
imposition of newcomers’ worldviews and knowledge validation claims
(Caroline Kenny, Emily Faries, Jo-Anne Fiske & Cora Voyageur, 2004).
For Mäori, the knowledge that has been built up around us by others is often
about how we fall short of a norm that belongs to a worldview other than our
own (Cram, 1997). We are seen for our deficits rather than our strengths; the
things we need to change, rather than the things we need to build on. In 1968
Koro Dewes challenged this approach:
I am sick and tired of hearing my people blamed for their educational
and social shortcomings, their limitations highlighted and their obvious
strengths of being privileged New Zealanders in being bilingual and
bicultural ignored.
The collision of worldviews highlighted in this quote needs to be confronted if
the ‘acquisition and application’ of knowledge for the sake of the public’s
health is going to be inclusive, rather than marginalising, of Mäori. We have
our own knowledge systems that link us to this land; our own ways of
acquiring knowledge and testing knowledge claims (Linda Smith, 1999).
Sometimes these ways are sourced within tradition and other times we use
‘modern’ tools to explore issues that are important to us. Sometimes we
choose to work alone and other times we choose to work collaboratively with
non-Mäori. What is important here is that the choice is ours.
The remainder of this paper explores Kaupapa Mäori theory and Kaupapa
Mäori principles as they apply to Public Health. Over the past 10-15 Kaupapa
Mäori theory has emerged as a guide for both Mäori and non-Mäori
researchers who are committed to supporting Mäori struggles for control over
our own cultural well-being and survival (cf. Graham Smith, 1997). It is
therefore compatible with a Public Health agenda.
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Mäori & Public Health: Ethics
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Mäori & Public Health: Ethics
Kaupapa Mäori Theory
The term ‘Kaupapa Mäori’ emerged as part of our discourse in the late 1980s
and 1990s in the theorising of a ‘by Mäori, for Mäori’ educational intervention;
namely, Kura Kaupapa Mäori (Tuakana Nepe, 1991). Kaupapa Mäori is
literally ‘a Mäori way’. Taki (1996:17) expands on this further in her
consideration of the word ‘kaupapa’; namely that ‘kaupapa
encapsulates…ground rules, customs, the right way of doing things’.
‘The term ‘theory’ has been deliberately co-opted by Smith and linked to
‘Kaupapa Mäori’ in order to develop a counter-hegemonic practice and
to understand the cultural constraints exemplified within critical
questions such as ‘what counts as theory?’ Smith challenges the narrow,
eurocentric interpretation of ‘theory’…’ (Pihama, Cram & Walker, 2002).
Graham Smith (1997) writes that Kaupapa Mäori theory is founded on three
themes: taking for granted our right to be Mäori; ensuring the survival of the
Mäori language and culture; and the central place occupied by our struggle to
control our own cultural well-being.
The challenge of Kaupapa Mäori theory is to reclaim New Zealand as
Aotearoa, for Mäori and for whomever else wants to share this place on our
terms. These terms are not difficult to locate as they are in the Mäori text of
the Treaty of Waitangi. The guarantee of tino rangatiratanga is the affirmation
of our sovereignty and our right to determine our own destiny. It is the
guarantee of our right to be Mäori on our own terms.
Graham Smith highlights six principles that are an integral part of Kaupapa
Mäori theory:

Tino Rangatiratanga (the ‘self-determination’ principle)

taonga tuku iho (the ‘cultural aspirations’ principle)

ako Mäori (the ‘culturally preferred pedagogy’ principle)

kia piki ake i nga raruraru o te kainga (the ‘socio-economic’ mediation
principle)

whänau (the extended family structure principle)

kaupapa (the ‘collective philosophy’ principle)
Each of these is examined further with a view approaching Public Health
ethics from a Mäori rights standpoint.
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Mäori & Public Health: Ethics
Tino Rangatiratanga (the ‘self-determination’ principle)
The right of Mäori to sovereignty, or tino rangatiratanga, was affirmed in the
Mäori language version of the Treaty of Waitangi, signed between Mäori
chiefs and the colonial newcomers in 1840. Orange (1989:30) defines tino
rangatiratanga within the context of the Treaty as ‘the unqualified exercise of
their chieftainship over their lands, villages, and all their treasures’. In the
English version, however, Mäori sovereignty is ceded (Kelsey, 1986). The
1975 Treaty of Waitangi Act established the Waitangi Tribunal to hear claims
about breaches of the Treaty, and also required the Tribunal to give equal
weights to both versions of the Treaty (Jackson, 2001). Thus Maori rights
came to be seen with the context of the concerns of all New Zealanders.
The right to self-determination is the most common theme in indigenous (and
related) codes of ethics and declarations that affirm the rights of indigenous
peoples. For example, the Indigenous Research Protection Act drafted by the
Indigenous People’s Council on Biocolonialism begins with a statement about
sovereignty:
1.1 The natural and cultural landscapes, including wildlife, flora, fauna,
waters, and biogenetics, among others, located on aboriginal and
present day Tribal lands are owned by the Tribe and the disposition,
development, and utilization thereof are under the Tribe’s full control
and supervision.
In the Mataatua Declaration on Cultural and Intellectual Property Rights of
Indigenous Peoples the following recommendations are made to States,
National and International Agencies:
2.1 Recognise that indigenous peoples are the guardians of their
customary knowledge and have the right to protect and control
dissemination of that knowledge.
2.2 Recognise that indigenous peoples also have the right to create new
knowledge based on cultural traditions.
Self-determination is also one of the 45 principles of the United Nations’ Draft
Declaration on the Rights of Indigenous Peoples.
Any Public Health ethic must embody the Mäori right to self-determination.
Taonga tuku iho (the ‘cultural aspirations’ principle)
Kaupapa Mäori theory asserts the position that to be Mäori is valid, legitimate
and normal. This requires a strengths-based approach to research and to
interventions, rather than an approach that is deficit-based and victim-blaming
as the latter is invariably based on research by ‘aliens’ to the Mäori world.
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Mäori & Public Health: Ethics
In her discussion of research projects that can decolonise indigenous
peoples, Linda Smith (1999) pays tribute to indigenous calls for research
methods that are more able to tell indigenous stories as a means of
knowledge creation, healing and transformation. In Smith’s account, these
methods are qualitative and range from testimony to envisioning. Kaupapa
Mäori theory also creates space for the exploration and use of quantitative
research tools. These tools include the use of epidemiology to monitor the
Crown’s responsibilities to ensure good citizenship for Mäori (Robson, Purdie,
Cram & Simmonds, 2007).
In ethics guidelines this principle can be related to the principles of respect. At
the same time, however, it should be noted that ‘respect’ itself is a culturallyembedded term such that respect might be offered from within one worldview
but not received from within another worldview. An awareness of one’s own
cultural standpoint/worldview and the acquisition of some cultural skills to
negotiate the other’s world are therefore important if the collision of worlds is
to be avoided.
Ako Mäori (the ‘culturally preferred pedagogy’ principle)
This principle promotes teaching and learning practices that are unique to
Mäori culture. There is also an acknowledgment of ‘borrowed’ pedagogies
and an emphasis on Mäori being able to choose our own preferred
pedagogies.
The development of ‘by Mäori, for Mäori’ health services and programmes is
an expression of Ako Mäori. Such programmes and interventions are an
expression of the need for providers to be culturally ‘in tune’ with Mäori. Ricks
et al. (1999:xiii), for example, argue that in a system where the ‘dominant,
professional, and ‘expert’ driven service delivery model and system’
predominates a service will contribute to compartmentalisation, firm
attachment to the status quo, and a focus on deficit and pathology. On the
other hand, a system underpinned by values of inclusion, collaboration,
empowerment and integration will create personal and community capacity,
trusting relationships, and be community driven. The latter scenario is akin to
a Kaupapa Mäori approach whereas the former resonates of the criticisms of
mainstream (lack of) responsiveness to Mäori.
Kia piki ake i nga raruraru o te kainga (the ‘socio-economic’
mediation principle)
This principle addresses the issue of Mäori socio-economic disadvantage and
the negative pressures this brings to bear on whänau. While the cultural
aspirations principle is about looking from the inside and exploring what it is to
be Mäori, the socio-economic mediation principle is about an awareness of
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Mäori & Public Health: Ethics
structural issues that maintain Mäori marginalisation through the unequal
distribution of resources. As Leonie Pihama (1993) argues, ‘…intrinsic to
Kaupapa Mäori theory is an analysis of existing power structures and societal
inequalities… exposing underlying assumptions that serve to conceal the
power relations that exist within society’.
The concept of 'cultural safety' also embodies reflexivity with respect to our
own values, history, culture, etc. (Irihapeti Ramsden, 1988). Similarly, the
broad concept of cultural competency proposed by Hazel Symonette (2004)
encompasses the need to understand the ‘inside’ as normal while also having
an analysis of the ‘outside’. According to Symonette, the first component of
cultural competency, ‘Inside/Out’, requires people to develop an
understanding of power and privilege hierarchies, including how they and
those they are working with are located within these hierarchies. The second
component, ‘Outside/In’, encompasses the development of ‘diversity-relevant
knowledge and skills’.
This principle also acknowledges that intervening successfully for the
wellbeing of individuals and whänau must be sourced from Mäori realities.
Whänau (the extended family structure principle)
The whänau and the practice of whänaungatanga is an integral part of Mäori
identity and culture. The cultural values, customs and practices which
organise around the whänau and ‘collective responsibility’ are a necessary
part of Mäori survival. This importance of whänau as a building block to Mäori
well-being is emphasised in Ministry of Health strategic planning for Mäori
health (Ministry of Health, 2002) and within Mäori models of health (Durie,
1994; Murchie, 1984; Pere, 1983).
According to Mäori, te whänau-hapu is the heart of life for a person. It is
the ground in which kinship and social relationship obligations and duties
are learned, and enabled to flourish and flower (Henare, 1995 p.16).
Issues of informed consent and privacy and confidentiality are often located
within whänau and hapü. Decision-making about involvement in initiatives and
the adoption of new ideas also occur at this collective level. This has
implications for Public Health programmes and for health promotion activities.
Kaupapa (the ‘collective philosophy’ principle)
Kaupapa Mäori initiatives are held together by a collective commitment and a
vision. This vision connects Mäori aspirations to political, social, economic
and cultural wellbeing.
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Mäori & Public Health: Ethics
One element of this principle is the commitment to building the capacity of
Mäori. Kaplan (1999:31) describes the goal of capacity building as the
‘…building of robust and sustainable organisations which are capable of
sovereign focus and direction, of strategizing and innovation, of responding
with flexibility and adaptability to changing circumstances, and of acting
decisively to impact on, and change, their circumstances and social context’.
The seventh principle of the Arctic Council Capacity Building Strategy (Arctic
Council Capacity Building Strategy and Pilot Project, 2002:4) adds to this
mainstream definition by stating that,
‘Capacity building should facilitate the evolution of indigenous culture in
a way that enhances cultural integrity and identity. Cultural innovation
and adaptability must be founded on cultural robustness and resilience’.
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Mäori & Public Health: Ethics
Concluding Remarks
Kaupapa Mäori theory embodies the legitimation and validation of being
Mäori; of being able to stand and to live within Aotearoa. In the words of
Marlene Brant Castellano (2004:100), we are ‘talking about restoring order to
daily living in conformity with ancient and enduring values that affirm life’.
Within this Mäori–non-Mäori deficits are about the unequal distribution of
social privilege and power. These, in turn, are sourced within broken Treaty
promises and the denial of tino rangatiratanga. Kaupapa Mäori theory is
therefore political merely by virtue of the challenge it poses to the status quo.
If we are to fully regain our lives then this challenge is essential.
Mason Durie (1998:214) describes Mäori health development as ‘a story of
struggle, challenge, threat, adaptation, and adjustment’. The ‘good news’ is
that Public Health’s commitment to equity and social justice means that it is
well-placed to support and help facilitate Mäori aspirations for health and wellbeing. Public Health is no stranger to advocating for the marginalised and for
social change. Kaupapa Mäori theory provides a set of rights-based principles
that can ensure that this journey of support for Mäori is safe for all concerned.
Mäori are also familiar with Public Health tensions between the upholding of
individual rights and the need to protect public welfare. More discussion of
how these decisions are made based on tikanga (Mäori cultural practices)
may well add to the knowledge base and resources of Public Health.
Finally, there are other values and practices that could have been discussed
under the title of Mäori & Public Health: Ethics; for example, manaaki
(respect, kindness), awhi (foster), and aroha (compassion), to name but a
few. The interesting thing about the principles explored from Kaupapa Mäori
theory is that they provide the space and the opportunity for those working on
a Public Health initiative to come together to discuss the values that they want
to bring to their work. When these discussions take place between insiders
and outsiders (on whatever level), they are a means of crossing borders as
people come together to define what it means to value and respect one
another’s worldviews.
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Mäori & Public Health: Ethics
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