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Primary health is at the forefront of efforts to address health inequities. Effective primary health care keeps people well and improves longevity and quality of life. The persistence of health inequities, particularly between Indigenous peoples and non‐Indigenous peoples globally, suggests that there is a need to strengthen policy and practise. Unique to Aotearoa (New Zealand) is te Tiritio Waitangi, a treaty negotiated in 1840 between the British Crown and hapū (Māori [Indigenous] subtribes). This treaty is foundational to public policy in Aotearoa and requires the Crown (New Zealand government) to uphold a set of responsibilities around protecting and promoting Māori health. This paper examines to what extent Primary Health Organisations are upholding te Tiritio Waitangi. The study utilises data from a nationwide telephone survey of public health providers conducted in 2019–2020 recruited from a list on the Ministry of Health website. This paper focuses on data about te Tiriti application from 21 Primary Health Organisations from a sample size of thirty. Critical te Tiriti analysis, an emerging methodology, was used to assess to what extent the participating primary health organisations were te Tiriti compliant. The critical te Tiriti analysis found poor to fair compliance with most elements of te Tiriti but good engagement with equity. Suggestions for strengthening practise included examining relationships with Māori, utilising a planned approach, structural mechanisms, normalising Māori world views and consistency in application. The onus needs to be on non‐Māori to contribute to the cultural change and power‐sharing required to uphold te Tiriti. Critical te Tiriti analysis is a useful methodology to review te Tiriti compliance and could be used in other contexts to review alignment with Indigenous rights and aspirations. [ABSTRACT FROM AUTHOR]

Māori health providers emerged in Aotearoa/New Zealand in the 1980s as a mechanism to achieve self‐determination for Māori communities. However, the contracts funding Māori health providers limit expressions of self‐determination and fail to reflect Te Tiriti O Waitangi, the founding treaty of Aotearoa/New Zealand. Significant health reforms are proposed in Aotearoa/New Zealand, including the creation of a Māori Health Authority that will commission services from Māori health providers. This paper aims to critique the government contracts provided to Māori health providers in the light of the health reforms. A discourse analysis was undertaken on contracts held by a Māori health provider. The study was informed by a Kaupapa Māori congruent methodology that centralised Māori knowledge. The contractural language utilised a variety of discursive techniques that ultimately limit the power of Māori health providers. These discursive techniques included the redefinition of Māori concepts of self‐determination, the use of rhetoric that was not matched by action, reshaping Māori health priorities to reflect the funders' priorities and the application of a deficit lens to Māori health issues. The discursive techniques present in these contracts is consistent with previous work demonstrating a failure of funders to centralise Māori knowledge and ways of being. Success of the proposed health reforms and the Māori Health Authority should require dismantling of non‐Māori ways of commissioning and contracting, otherwise there is the continued risk of discriminatory contracting practices limiting the expression of self‐determination for Māori health providers. [ABSTRACT FROM AUTHOR]

The incidence of diabetes in people with an intellectual disability, although unknown, is indicated to be higher than the general population. Given the challenges individuals with intellectual disability may face, this population is often dependent upon key workers to manage their health and well-being. One aim of a wider study on the self-management of diabetes by people with intellectual disability was to explore how key workers supported their self-management. That aim was the focus of this paper. Between 2009 and 2010, 17 staff from five residential intellectual disability services and two supported independent living services within New Zealand, consented to a semi-structured interview. Transcripts of the interviews were analysed using Thomas' General Inductive Approach. Three overarching themes emerged; having knowledge and understanding, being lifestyle police and ensuring future well-being. While knowledge, skills and perspectives varied, all participants were committed to ensuring that the lifestyle of the person concerned was compatible with the management of their diabetes. A range of perspectives existed between the expectations they had of themselves, colleagues and the individual with diabetes. There was an identified need for initial and ongoing education of permanent and casual staff and the people themselves with diabetes in collaboration with health and disability services to build confidence and promote self-management practices. In so doing, the impacts of this long-term condition may be reduced and the health outcomes improved for people with intellectual disability. [ABSTRACT FROM AUTHOR]