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Economists view land taxes as having beneficial efficiency properties relative to other forms of taxation. Furthermore, land taxes in New Zealand are administratively easy to implement since all properties are already valued on a regular basis. However, questions remain about the distributional properties of a land tax. Five questions are addressed in this paper: First, what are its vertical equity properties (in relation to household income/wealth)? Second, what are its horizontal equity properties (for people with similar incomes/wealth but with different landholdings)? Third, what are the impacts of the tax on landowners involved in land-extensive primary industries? Fourth, what are the impacts on owners of Māori land? Fifth, what inter-generational equity distributional considerations arise? After addressing these questions, the paper considers broader changes to the tax system accompanied by a central government land tax that incorporates the following features: (1) Māori freehold land that is currently non-rateable under the Local Government (Rating) Act 2002 is exempt from the tax; (2) a tax-free threshold is set based on the per hectare value of the land parcel; (3) a proportionate tax is levied on all land value above the threshold; and (4) an option is provided to accrue the tax liability (with interest) until property sale to alleviate cashflow constraints. The paper concludes that the strong efficiency and administrative properties of a land tax, structured as above to alleviate certain distributional concerns, make land tax a valid option for central and local governments to consider. [ABSTRACT FROM AUTHOR]

Background: Health, illness, and the body are conceptualized within the cultural context of a society. The values and belief systems of a society, including media portrayals, shape how health and illness present. Traditionally, Western portrayals of eating disorders have been prioritized over and above Indigenous realities. This paper explores the lived experiences of Māori with eating disorders and their whānau (family/support system) to identify the enablers and barriers to accessing specialist services for eating disorders in New Zealand. Method: Kaupapa Māori research methodology was used to ensure the research supported Māori health advancement. Fifteen semi-structured interviews were completed with Māori participants including; those with an eating disorder diagnosis (anorexia nervosa, bulimia nervosa, and binge eating disorder), and/or their whānau. Structural, descriptive, and pattern coding was undertaken within the thematic analysis. Low's spatializing culture framework was used to interpret the findings. Results: Two overarching themes identified systemic and social barriers to accessing treatment for Māori with eating disorders. The first theme, was space, that described the material culture within eating disorder settings. This theme critiqued eating disorder services, including idiosyncratic use of assessment methods, inaccessible service locations, and the limited number of beds available in specialist mental health services. The second theme, place, referred to the meaning given to social interactions created within space. Participants critiqued the privileging of non-Māori experiences, and how this makes a place and space of exclusion for Māori and their whānau in eating disorder services in New Zealand. Other barriers included shame and stigma, while enablers included family support and self-advocacy. Conclusion: More education is needed for those working in the space of primary health settings about the diversity of those with eating disorders to enable them to look beyond the stereotype of what an eating disorder looks like, and to take seriously the concerns of whaiora and whānau who present with disordered eating concerns. There is also a need for thorough assessment and early referral for eating disorder treatment to ensure the benefits of early intervention are enabled for Māori. Attention given to these findings will ensure a place for Māori in specialist eating disorder services in New Zealand. Plain English summary: Eating disorders are at least as common in Māori (Indigenous people of New Zealand) when compared to their non-Māori counterparts, however, a recent study investigating specialist service use data identified lower-than-expected service use for Māori. This paper explores the lived experiences of Māori with eating disorders and their whānau (family/support network) to understand the barriers and enablers to accessing treatment. Participants in this study identified both systemic and social barriers to accessing treatment for eating disorders; Systemic barriers included the idiosyncratic use of assessment methods by health practitioners, and inaccessible service locations, including the number of available inpatient beds. While social barriers included the stereotype of what an eating disorder looks like, shame, stigma, and discrimination; support networks were described as both an enabler and barrier to accessing specialist treatment for eating disorders. The findings from this study suggest thorough assessment and early referrals are needed for Māori presenting with disordered eating concerns. Moreover, more education is needed for those working in primary healthcare settings about the diversity of eating disorders to ensure they move beyond the stereotype of what an eating disorder looks like. [ABSTRACT FROM AUTHOR]

Background: Disparities in cardiovascular outcomes between Māori and non-Māori persist despite technological advances in the treatment of cardiovascular disease and improved service provision. Little is known about how social determinants of health, such as income [in]security affect Māori men's access, treatment, and recovery from cardiovascular disease. This paper explores the contexts within which cardiovascular disease is experienced and healthcare becomes embedded. Methods: This study utilized a case-comparative narrative approach to document and make sense of the patient experiences of four male Māori patients who, in the previous 6 months, had come through cardiac investigation and treatment at Waikato Hospital, a large tertiary cardiac center in New Zealand. Participant accounts were elicited using a culturally patterned narrative approach to case development, informed by Kaupapa Māori Research practices. It involved three repeat 1–3-hour interviews recorded with participants (12 interviews); the first interviews took place 5–16 weeks after surgery/discharge. Results: Each of the four case studies firstly details a serious cardiac event(s) before describing the varying levels of financial worry they experienced. Major financial disruptions to their lives were at the forefront of the concerns of those facing financial insecurity—as opposed to their medical problems. Financial hardship within the context of an unresponsive welfare system impacted the access to care and access to funding contributed to psychological distress for several participants. Economic security and reciprocal relationships between employers and employees facilitated positive treatment experiences and recovery. Conclusion: Findings suggest that although multiple factors influence participant experiences and treatment outcomes, financial [in]security, and personal income is a key determinant. The heterogeneity in participant narratives suggests that although general inequities in health may exist for Māori as a population group, these inequities do not appear to be uniform. We postulate diverse mechanisms, by which financial insecurity may adversely affect outcomes from treatment and demonstrate financial security as a significant determinant in allowing patients to respond to and recover from cardiovascular disease more effectively. [ABSTRACT FROM AUTHOR]

This article presents a description of a specific Indigenous research methodology, Kaupapa Māori Research (KMR), followed by a discussion of the potential contribution that KMR and other Indigenous frameworks make toward understanding and addressing widespread mental health inequities affecting the world's Indigenous peoples. The contribution of existing qualitative KMR to the fields of health and mental health in New Zealand is discussed, and innovative approaches employed within these studies will be outlined. This paper describes the utility of KMR methodology which informed the development of qualitative interviews and the adaptation of an analytic framework used to explore the impact of systems on the experiences of Māori (the Indigenous peoples of New Zealand) with bipolar disorder (BD). This paper adds to others published in this journal that describe the value, inherent innovation, and transformative potential of KMR methodologies to inform future qualitative research with Indigenous peoples and to enact systemic change. Transformation is achieved by privileging the voices of Māori describing their experiences of mental health systems; presenting their expert critique to those responsible for the design and delivery of mental health services; and ensuring equal weight is given to exploring the clinical, structural and organizational changes required to achieve health equity. It is proposed that this approach to research praxis is required to ensure that studies do not perpetuate institutional racism, which requires close adherence to Indigenous research priorities and partnership with Indigenous peoples in all steps of the research process. [ABSTRACT FROM AUTHOR]

Worldwide, large amounts of administrative data are collected within official statistics systems on Indigenous Peoples. These data are primarily used for government and state policy purposes as opposed to by Indigenous Peoples to support Indigenous agendas (Taylor & Kukutai, 2017). In Aotearoa me Te Waipounamu New Zealand, Māori need high quality data to develop evidence-based policies and programs and to monitor government policies that impact on Māori. In this methodological paper, we describe uses of administrative data for Māori and current barriers to its use. We outline the development of a novel administrative data infrastructure and future longitudinal study. By explicating our Indigenous initiated, designed and controlled data project, we make a methodological contribution to Indigenous Data Sovereignty and Kaupapa Māori (Māori worldview) epidemiology. [ABSTRACT FROM AUTHOR]

Globally, there is growing recognition of the benefits that indigenous peoples can bring to ecology and conservation, drawing on deep spiritual and cultural ties to the environment. The contribution of indigenous peoples and their knowledges is now widely acknowledged as critical to successful efforts to mitigate anthropogenic impacts. In New Zealand, matauranga spans all aspects of indigenous Maori knowledge and is conceptualised, developed and maintained through practice and connection. We searched all issues of the Proceedings of the New Zealand Ecological Society and the New Zealand Journal of Ecology from 1953 to 2018 to identify and highlight papers that feature research partnerships with Maori and/or acknowledge and explore matauranga Maori in a meaningful way. There were only three, republished here in this virtual issue. Although there has been a recent increase in studies that incorporate matauranga Maori published in other journals, we argue that substantive commitment to community partnerships and bicultural research has not been realized in ecological research. Working with interdisciplinary knowledge including matauranga will be critical to halt further biodiversity loss and improve outcomes for the environment and people, in New Zealand and worldwide. Matauranga Maori has much to contribute to positive biodiversity and ecological outcomes, but it will require institutional and systemic support of scientific researchers to develop authentic partnerships with Maori communities to transform research practices. [ABSTRACT FROM AUTHOR]

Background: Māori have been found to experience marked health inequities compared to non-Māori, including for injury. Accessing healthcare services post-injury can improve outcomes; however, longer-term experiences of healthcare access for injured Māori are unknown. This paper reports on data from the longitudinal Prospective Outcomes of Injury Study – 10 year follow up (POIS-10) Māori study in Aotearoa/New Zealand (NZ), to qualitatively understand Māori experiences of accessing injury-related healthcare services long-term. Methods: Follow-up telephone interviews were conducted with 305 POIS-10 Māori participants, who were injured and recruited 12-years earlier, experiencing a range of injury types and severities. Free text responses about trouble accessing injury-related health services were thematically analysed. Results: Sixty-one participants (20%) reported trouble accessing injury-related health services and provided free text responses. Three related themes describing participants' experiences were connected by the overarching concept that participants were engaging with a system that was not operating in a way it was intended to work: 1) Competing responsibilities and commitments encapsulates practical barriers to accessing services, such as a lack of time and having to prioritise other responsibilities such as work or whānau (family); 2) Disrupted mana refers to the feelings of personal disempowerment through, for example, receiving limited support, care or information tailored to participants' circumstances and is a consequence of patients contending with the practical barriers to accessing services; and 3) Systemic abdication highlights systemic barriers including conflicting information regarding diagnoses and treatment plans, and healthcare provider distrust of participants. Conclusions: Twelve years post-injury, a considerable proportion of Māori reported experiencing barriers to accessing healthcare services. To restore a sense of manaakitanga and improve Māori access to healthcare, Māori-specific supports are required and systemic barriers must be addressed and removed. [ABSTRACT FROM AUTHOR]

The Ngāi Tahu indigenous Māori community of Aotearoa/New Zealand successfully maintained 150 years of legal grievance against the British Crown following the signing of the Treaty of Waitangi and colonization. The importance of women leaders, the guiding role of elders, the long-term commitment to intergenerational health for all tribal members, the democratic processes in the current context for Ngāi Tahu iwi within Aotearoa and engagement with the legal system was crucial in building towards a post-conflict society. Alongside this there were and are creative empowerment processes that nourished cultural vitality. This paper shares a 'conversational exchange' about the processes that occurred after Treaty of Waitangi settlement was reached, as the tribe stepped into the challenge of navigating the complicated additional corporate, bureaucratic, governance, and legal structures. The eldest Māori woman from Ōtākou Marae, Te Waipounamu (South Island), describes her experience of listening to the old people, going to tribal hui (meetings) and creating support and services in the Māori community. Her words, presented in full, modelling innovative methodology that prioritises the role of transparent Southern Māori and Pākehā conversation in a post-settlement environment. The relationship of trust between the authors, representing two cultures with a history of colonization, grew over several decades of shared discussion, cultural supervision and listening. Our kōrero (conversation) begins with one question: What are the effects of democracy on sustainable culture and community? [ABSTRACT FROM AUTHOR]

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Since few decades ago, the use of traditional insignias on commercial products has been increasing, across the globe. In particular, the use of indigenous insignias on commercial products of non-indigenous origin is often in countries such as USA, Canada, Australia or New Zealand where there are larger indigenous communities. Either as offensive or exploitative the respective practice is unacceptable for indigenous people. Appropriation of traditional insignias by non-indigenous people - i.e. registering indigenous names and symbols as trademarks for commercial products of non-indigenous origin has been considered as particularly unacceptable practice. The aim of the paper is to assess whether the conventional trademark law system contains mechanisms that can combat inappropriate use of traditional insignias. In order to achieve respective goal, international and European sources in the field of trademark law, as well as specific national solutions, are analyzed. Research has revealed that conventional trademark law systems provide protection against misuse of traditional insignias only in exceptional occasions. Therefore, certain countries, where there are larger indigenous communities and public policies are focused on the prevention of offensive use of indigenous insignias, have introduced minor or larger intervention in their conventional trademark law systems to increase effectiveness when it comes to combating offensive uses of indigenous insignias. It is shown how in New Zealand the concept of cultural offense as an absolute ground for trademark refusal is introduced while in Canada official insignia as a special type of trademark is introduced. The impact of those interventions is considered and whether these could be relevant for the European union. Similar interventions applicable in the conventional European trademark law for the protection against inappropriate use of European indigenous and traditional indications are analyzed. [ABSTRACT FROM AUTHOR]

The appointment of the University of Waikato's first Assistant Vice-Chancellor Pacific in February 2019 was an important milestone, not only recognising years of work and dedication by numerous Pacific and Māori staff, but triggering a new strategic direction for 'Pacific at Waikato'. This paper explains that journey, one that is underpinned by Pacific cultural legacies, strengths, values and identity; built on talanoa-vā; informed by research, data analytics, student and community voice; combined with strategic thought and planning; and outworked in the pan-Pacific epithet, 'imua'. This is a story of resilience, determination, negotiating a pandemic, problem-solving and innovation in an environment that seeks a 'culture of belonging' and where Pacific learners are encouraged to be themselves in the pursuit of educational achievement. This paper will be of interest to education providers, stakeholders and policy makers. [ABSTRACT FROM AUTHOR]

This paper presents an analysis of the qualitative data collected for a study investigating the effect of the Working for Families policy on Māori families’ self-reported whānau ora (family wellbeing). Data are drawn from a discrete set of 30 qualitative interviews undertaken with Māori whānau involved in the Te Hoe Nuku Roa Longitudinal Study. Whānau perceptions about how the Working for Families policy has impacted on their lives and the contribution the policy has made towards their family's wellbeing is presented. The paper discusses how the Working for Families policy appears to have become an integral component of household income for many low-to-middle-income whānau and reflects on how this policy, conceived and designed (amongst other things) to alleviate and redress child poverty, is contributing towards supporting family wellbeing or ‘whānau ora’. [ABSTRACT FROM PUBLISHER]

The limited impact of traditional extension techniques has resulted in the increasing use of participatory approaches to support interaction between Māori communities and scientists. This paper draws on the experience of a 5 year case study of such an approach among scientists and Māori on the East Cape. While supporting the value of a participatory approach, the paper argues that the adoption and use of such an approach must be viewed as an iterative process and one that challenges all participants, not only on operational detail, but on the ethical issues posed by such work. This paper highlights the value of a collaborative approach but questions the appropriateness of branding all such approaches as participatory research when used to support national policy initiatives. It concludes that participatory approaches challenge the scientists involved as much as the communities concerned and questions the validity of conventional measures of success in any evaluation of such work. [ABSTRACT FROM AUTHOR]

Comprehensive exploration of Māori experiences of discrimination in Aotearoa New Zealand remains limited, particularly in relation to exposure to multiple and interlocking forms of discrimination. This paper presents findings from a secondary analysis of Te Kupenga 2013, the first Māori Social Survey, examining patterning and prevalence of different forms of discrimination for Māori (n = 5,549). Māori report experiencing multiple forms of discrimination, both over their lifetimes and within the last year. Although racial discrimination was the most commonly reported form, Māori also experience discrimination on the basis of other grounds including age, gender, and income. Māori also report exposure to multiple forms of discrimination. Discrimination occurred in a range of settings, with schools and workplaces common sites. The findings support the lived reality of Māori that racial and other forms of discrimination are pervasive, and experienced in multiple domains across the life course, representing a persistent breach of rights. It is critical that other forms of discrimination are measured alongside racism in order to understand and address the realities of multiple discrimination for Māori in Aotearoa New Zealand. [ABSTRACT FROM AUTHOR]

Neuropsychological tests are routinely used to assess Māori, the indigenous people of New Zealand, yet very few investigations of the psychometric properties of these tests with this population have been conducted. This paper focuses on factors that may impact performance of Māori adults on neuropsychological testing. The Wechsler Adult Intelligence Scale-IV (WAIS-IV) was administered to a sample of 284 Māori stratified for age (between 16 years and 90 years) and gender in order to establish a Māori normative data set. The sample who primarily spoke English as their first language were recruited from a range of urban, regional and rural areas in New Zealand to obtain representation of the main Māori Iwi (tribes). Analysis of test results suggests acculturation, education, income, and, "a culturally positive experience" may have accounted for some of the variance in test performance. [ABSTRACT FROM AUTHOR]

Evidence-based practice is an approach to professional practice that involves a structured process of collecting, interpreting and applying valid and reliable research and evidence to support decision-making and continuous service improvement in professional practice. This paper reports on emerging initiatives in evidence-based practice at the University of Southern Queensland (USQ) Library, a regional multi-campus university in Australia. It demonstrates how evidence-based practice forms part of our organisational strategy to engage with our community and society. The case study describes a new model of embedding evidence-based practice through a role explicitly dedicated to developing the library's evidence base. While other libraries may have a person responsible for assessment, performance metrics or data analysis, the Coordinator (Evidence-Based Practice) has a broader mandate - to work with library staff to develop tools, skills and expertise in evidence-based practice. The paper will describe why this role was created and how the Coordinator is working to engage with library staff to understand their business and the evidence needed to support service improvement for the Library. By doing this, USQ Library is building the capacity to demonstrate value to stakeholders, gain a deeper understanding of clients' needs and experiences, promote robust decisionmaking and improve service delivery. The paper also outlines a research project led by the Coordinator (Evidence-Based Practice) to develop a conceptual model of evidence-based practice within academic libraries at the organisational, rather than individual level. Current models of evidence-based library and information practice apply predominantly to individuals. Informed by relevant literature and 16 semi-structured interviews with library professionals from Australian and New Zealand university libraries, three themes emerged to describe how evidence-based practice might be experienced at the organisational level. The lived experience at USQ Library and our research investigations suggest that being evidence-based provides benefits to an academic library's culture, practice and impact. [ABSTRACT FROM AUTHOR]

Background A critical first step toward incorporating equity into cost-effectiveness analyses is to appropriately model interventions by population subgroups. In this paper we use a standardized treatment intervention to examine the impact of using ethnic-specific (Māori and non-Māori) data in cost-utility analyses for three cancers. Methods We estimate gains in health-adjusted life years (HALYs) for a simple intervention (20% reduction in excess cancer mortality) for lung, female breast, and colon cancers, using Markov modeling. Base models include ethnic-specific cancer incidence with other parameters either turned off or set to non-Māori levels for both groups. Subsequent models add ethnic-specific cancer survival, morbidity, and life expectancy. Costs include intervention and downstream health system costs. Results For the three cancers, including existing inequalities in background parameters (population mortality and comorbidities) for Māori attributes less value to a year of life saved compared to non-Māori and lowers the relative health gains for Māori. In contrast, ethnic inequalities in cancer parameters have less predictable effects. Despite Māori having higher excess mortality from all three cancers, modeled health gains for Māori were less from the lung cancer intervention than for non-Māori but higher for the breast and colon interventions. Conclusions Cost-effectiveness modeling is a useful tool in the prioritization of health services. But there are important (and sometimes counterintuitive) implications of including ethnic-specific background and disease parameters. In order to avoid perpetuating existing ethnic inequalities in health, such analyses should be undertaken with care. [ABSTRACT FROM AUTHOR]

This paper aims to consider the various parts of what is required to achieve the best possible health outcomes from medicines in partnership with the person for whom they are prescribed. Specifically, it looks to highlight the process from an Indigenous view with respect to Māori in Aotearoa New Zealand, and claims a multi-dimensional approach is imperative. Attaining optimal use of medicines is necessary to help achieve health equity. There is an urgent need to understand and investigate models of care that achieve this optimal state. [ABSTRACT FROM AUTHOR]

Objectives This paper aims to examine ethnic differences in financial barriers to access to prescriptionmedication in New Zealand. Methods Data from SoFIE-Health (wave 3), which is an add-on to the Statistics New Zealand-led longitudinal Survey of Family, Income and Employment (SoFIE) (N¼18 320), were analysed using logistic regression, adjusting for demographic, socioeconomic, health behaviour and health variables. Financial barriers to access to prescription items were measured by the following question: 'In the past 12 months, have there been any times when a doctor gave you a prescription, but you didn't collect one or more of these items because you could not afford the cost?'. Results The odds of deferring buying a prescription at least once during the preceding 12 months because they could not afford the cost of the prescription were greater for Maori and Pacific people than for NZ Europeans (OR 2.98, 95% CI 2.56 to 3.47 vs OR 3.52, 95% CI 2.85 to 4.35). Adjusting for potential confounders attenuated the ORs to 1.31 (95% CI 1.08 to 1.58) for Maori people and to 2.17 (95% CI 1.68 to 2.81) for Pacific people. Deferring buying medications because of cost was also associated with increased odds of poor self-reported health status, high/very high psychological stress and the presence of two or more comorbid conditions. Conclusion Ethnicity plays a critical role in facilitating or impeding access to primary health care. This suggests that policy measures to further reduce financial barriers to buying medication may improve access to care for everyone including Maori and Pacific people and may have positive health implications. [ABSTRACT FROM AUTHOR]

This paper explores how participatory video – a methodology increasingly used in community development and anthropological research – may enable a feminist practice of looking which does not perpetuate hierarchical power relations and create voyeuristic, distanced and disembodied claims to knowledge. I reflect on experiences from a participatory video project with members of a Maaori tribe in Aotearoa New Zealand in light of geographers’ uses of video to date. I argue that participatory video, if used within carefully negotiated relationships, has potential to destabilize hierarchical power relations and create spaces for transformation by providing a practice of looking ‘alongside’ rather than ‘at’ research subjects. [ABSTRACT FROM AUTHOR]

In the late 1960s, New Zealand and the United States collaborated to establish a southern hemispheric carbon dioxide (CO2) monitoring station on New Zealand's coastal cliffs. The New Zealand CO2 Project, as it came to be known, is an underappreciated landmark in the history of environmental monitoring. The archival record of its early years reveals the extent to which efforts to measure atmospheric carbon dioxide concentrations interacted closely with one of the most hotly debated political issues of the mid-twentieth century: urban air pollution. The designation of CO2 as air pollution on a planetary scale had profound legal implications in an era in which clean air legislation increasingly brought air pollution within the scope of governmental regulation, and administrative agencies began to jostle for control of the monitoring enterprise. The precise nature of CO2 as an air pollutant, however, was difficult to pin down. In these initial years of concerted carbon dioxide monitoring, when the lines between climate science and air pollution research were still blurred, CO2 developed its many pollutant identities. The nature of these identities - and the ways in which scientists and science administrators negotiated their boundaries - retain their relevance today, as nations continue to link air pollution and climate legislation in the twenty-first century. [ABSTRACT FROM AUTHOR]

Background: Despite a low rate of infant mortality, Aotearoa New Zealand has a high rate of Sudden Unexpected Death in Infants (SUDI), with disproportionate impact for Pacific infants. This study explored the infant care practices, factors and relationships associated with increased risk of SUDI amongst Tongan, Samoan, Cook Islands Māori, and Niuean mothers in New Zealand, to inform evidence-based interventions for reducing the incidence of SUDI for Pacific families and their children. Methods: Analysis comprised of data collected in 2009–2010 from 1089 Samoan, Tongan, Cook Islands Māori and Niuean mothers enrolled in the Growing Up in New Zealand longitudinal cohort study. The sleeping environment (bed-sharing and sleep position) of the infants was assessed at 6 weeks. Multivariable logistic regression analysis were conducted, controlling for sociodemographic factors to explore the association between selected maternal and pregnancy support and environment factors and the sleeping environment for infants. Results: Mothers who converse in languages other than English at home, and mothers who consulted alternative practitioners were less likely to follow guidelines for infant sleeping position. Similarly language, smoking, alcohol, household dwelling, crowding and access to a family doctor or GP were associated with mothers following guidelines for bed-sharing. Conclusion: The impact of SUDI on Pacific infants may be lessened or prevented if communication about risk factors is more inclusive of diverse ethnic, cultural worldviews, and languages. Societal structural issues such as access to affordable housing is also important. This research suggests a need for more targeted or tailored interventions which promote safe sleeping and reduce rates of SUDI in a culturally respectful and meaningful way for Pasifika communities in Aotearoa, New Zealand. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Indigenous peoples' rights include the right to self-determine one's identity. For Māori, this includes self-assignment of ethnicity, and traditional identities such as Iwi (tribe). New Zealand's Ministry of Health requires health services to collect ethnicity data using standard protocols. Iwi data are also collected by some health services; however, with no health-specific protocols, little is known about Iwi data collection and quality. The National Hauora Coalition (NHC) Primary Healthcare Organisation (PHO) sought to understand Iwi data collection across its network of primary care providers. AIM: To understand Iwi data collection at the NHC PHO; specifically, is it being routinely collected, how is it being collected and what are the results? METHODS: In 2017, NHC's general practice clinics were invited to submit their enrolment forms, which capture ethnicity and potentially Iwi information, by e-mail to the audit team. Forms were reviewed to determine whether Iwi information was being collected and if so, what question was being used. Iwi numbers were collated from the annual data extract. RESULTS: Thirty-three of a total of 35 clinics (94%) submitted their enrolment forms to the audit team. Nine of the 33 clinics (27%) sought Iwi name/s with a specific question on their enrolment form. Six different 'Iwi' questions were used by the nine clinics. The data extract revealed that the NHC had Iwi data for 13% (2672/20,814) of its Māori enrolments. Ngāpuhi were the largest Iwi group at the NHC. DISCUSSION: This is the first study to describe the quantity and quality of Iwi data collection in NZ primary care. Standard procedures for collecting, recording and using Iwi data are being developed by the NHC PHO. These could inform national protocols to optimise the quality of Iwi data. [ABSTRACT FROM AUTHOR]

This article argues that the cultural assimilation of Māori family forms, originating in colonial private family laws, continues under the Care of Children Act 2004 (COCA). It finds that the opportunity to draft a law that was respectful of tikanga Māori and te Tiriti o Waitangi was lost when legislators ignored all the critiques of the operating principles and processes of the Pākehā legal system, provided by Māori during the 1980s and 1990s. The article argues that cultural assimilation continues through court decisions, since COCA principles require priority to be given to parents, with a corresponding marginalisation of whānau, hapū and iwi. The article concludes that incremental reform would be unlikely to achieve legislation that is fit for a bicultural Aotearoa New Zealand. It advocates for a transformational Māori-led family law reform process, guided by te Tiriti o Waitangi/the Treaty of Waitangi and by tikanga Māori. [ABSTRACT FROM AUTHOR]

Homelessness has re-emerged as a significant issue in Aotearoa, New Zealand (Aotearoa/NZ) in recent decades, with Māori (Indigenous peoples of New Zealand) being impacted disproportionately due to ongoing processes of colonisation and impoverishment. Whether living on the streets of an urban centre, small city, or rural district, the lifeworlds of homeless people are frequently textured by social, material, and spatial exclusions, uncertainties, insecurities, and stigma. This article explores how the Open Arms Day Centre (OADC), a drop-in day centre for homeless people in Whangārei (a small city in Northland), functions as a dependable Pou Whirinaki (pillar of strength and support) in the everyday lives of Māori experiencing homelessness. Employing a Māori-centred, case-based approach, we explored the experiences of a small group of local service users, volunteers, and staff through interviews, photographic exercises, and regular casual conversations. This culturally informed mode of inquiry resulted in a deeper understanding of the OADC’s operation as what health geographers have also referred to as a space of care. Such spaces offer those frequenting them opportunities for respite, inclusion, belonging, and routine. They become Pou Whirinaki through enactments of Māori relational values and practices that foster a sense of ontological security, cultural continuity, and shared humanity. [ABSTRACT FROM AUTHOR]

The article informs about addresses the high obesity rates in New Zealand, emphasizing the need for safe and patient-centered weight loss interventions in general practice. Topic include discusses the health risks associated with obesity, the challenges in implementation, and advocates for resources and funding to support effective interventions in healthcare.

In 2011, New Zealanders decided by referendum to retain the mixed member proportional representation voting system. This article investigates the benefits of including a deliberative, participatory process in electoral reform to encourage collective debate and an informed choice by voters. In the last decade, Canada and the Netherlands have used citizens' assemblies, a form of participatory democracy, for electoral reform. This paper argues that a similar process would have been appropriate and valuable for New Zealand. Moreover, the discussion highlights the value of citizens' assemblies for minorities who can be outvoted in a referendum. This is considered with specific reference to voters in the Māori seats who had much at stake in the electoral reform. In addition to the general benefit of citizens' assemblies for electoral reform, a New Zealand assembly would have allowed for collective deliberation that ensured the inclusion of the perspectives of voters in the Māori seats. [ABSTRACT FROM PUBLISHER]

Despite career satisfaction models being well established, little is understood about the career satisfaction of indigenous employees. Using a sample of 172 Maori employees, the indigenous people of New Zealand, we tested a career satisfaction model with a cultural wellbeing factor over and above established factors of human capital, sociodemographic, individual differences and organizational sponsorship. This new measure workplace cultural wellbeing was found to significantly relate to career satisfaction, accounting for twenty-three percent of the variance over and above the established factors which highlights its importance for indigenous workers. Furthermore, due to collectivistic orientations amongst Maori, collectivism was tested as a potential moderator and found to significantly interact with workplace cultural wellbeing, showing that Maori respondents reported the greatest career satisfaction when workplace cultural wellbeing was high, irrespective of collectivism orientation. This paper offers an extended model for exploring career satisfaction of indigenous workers. [ABSTRACT FROM AUTHOR]

Background: Discrepancies have been reported between what is being researched, and what patients/families deem important to be investigated. Our aim was to understand research priorities for those who live with cancer in Aotearoa/New Zealand, with emphasis on Māori. Methods: Adult outpatients with cancer and their whānau/family completed a survey (demographics, selecting keywords, free-text comments) at Christchurch hospital. Quantitative and qualitative data were evaluated using standard statistical and thematic analyses, respectively. Results: We recruited 205 participants, including both tūroro/patients (n = 129) and their whānau/family/carer (n = 76). Partnership with Māori health workers enabled greater recruitment of Māori participants (19%), compared to the proportion of Māori in Canterbury (9%). Cancer research was seen as a priority by 96% of participants. Priorities were similar between Māori and non-Māori participants, with the keywords 'Cancer screening', 'Quality of Life' and 'Development of new drugs' chosen most often. Free-text analysis identified three themes; 'Genetics and Prevention', 'Early Detection and Treatment', and 'Service Delivery', with some differences by ethnicity. Conclusions: Cancer research is a high priority for those living with cancer. In addition, participants want researchers to listen to their immediate and practical needs. These findings may inform future cancer research in Aotearoa. Māori terms and translation: Aotearoa (New Zealand) he aha ō whakaaro (what are your thoughts) hui (gathering) mate pukupuku (cancer) mokopuna (descendent) Ōtautahi (Christchurch) rongoā (traditional healing) tāne (male) te reo (Māori language) Te Whatu Ora (weaving of wellness, Health New Zealand) tikanga (methods, customary practices) tūroro (patients) (alternative terms used: whānau affected by cancer or tangata whaiora (person seeking health)) wahine (female) Waitaha (Canterbury) whakapapa (genealogy) whānau ((extended) family, based on whakapapa, here also carer) [ABSTRACT FROM AUTHOR]

Lung cancer screening can significantly reduce mortality from lung cancer. Further evidence about how to optimize lung cancer screening for specific populations, including Aotearoa New Zealand (NZ)'s Indigenous Māori (who experience disproportionately higher rates of lung cancer), is needed to ensure it is equitable. This community-based, pragmatic cluster randomized trial aims to determine whether a lung cancer screening invitation from a patient's primary care physician, compared to from a centralized screening service, will optimize screening uptake for Māori. Participating primary care practices (clinics) in Auckland, Aotearoa NZ will be randomized to either the primary care-led or centralized service for delivery of the screening invitation. Clinic patients who meet the following criteria will be eligible: Māori; aged 55–74 years; enrolled in participating clinics in the region; ever-smokers; and have at least a 2% risk of developing lung cancer within six years (determined using the PLCOM2012 risk prediction model). Eligible patients who respond positively to the invitation will undertake shared decision-making with a nurse about undergoing a low dose CT scan (LDCT) and an assessment for Chronic Obstructive Pulmonary Disease (COPD). The primary outcomes are: 1) the proportion of eligible population who complete a risk assessment and 2) the proportion of people eligible for a CT scan who complete the CT scan. Secondary outcomes include evaluating the contextual factors needed to inform the screening process, such as including assessment for Chronic Obstructive Pulmonary Disease (COPD). We will also use the RE-AIM framework to evaluate specific implementation factors. This study is a world-first, Indigenous-led lung cancer screening trial for Māori participants. The study will provide policy-relevant information on a key policy parameter, invitation method. In addition, the trial includes a nested analysis of COPD in the screened Indigenous population, and it provides baseline (T0 screen round) data using RE-AIM implementation outcomes. [ABSTRACT FROM AUTHOR]

This study investigates Māori taxation or tax-like practices to explore the relationship between taxation and Indigenous self-determination in Aotearoa New Zealand. We find historical examples of customary distribution practices, harbour dues, tollways, stock grazing fees and fines and joint stock subscriptions, all practiced by Māori leadership to raise revenues and assert authority. These findings contribute to tax research by advancing an argument for tax justice that takes Indigenous sovereignty seriously. [ABSTRACT FROM AUTHOR]

Purpose – The indigenous Māori culture of New Zealand offers valuable insights for the development of ideas about the concept of asset. To highlight such insights, and to encourage a rethinking, this paper aims to explore the meaning of the closest Māori term to asset, taonga. Design/methodology/approach – The critical review the authors conduct fuses Western literature-based scholarship with an indigenous scholarly method that utilises oral information and the written literature of Māori scholars who have recognised traditional and scholarly credentials. Findings – Taonga includes a sacred regard for the whole of nature and a belief that resources are gifts from the gods and ancestors for which current generations of Māori are responsible stewards. Taonga emphasises guardianship over ownership, collective and co-operative rights over individualism, obligations towards future generations, and the need to manage resources sustainably. Originality/value – The insights offered by Māori culture are beneficial in addressing a range of vexing environmental and social issues in ways that embrace a broader set of principles than those based on individual property rights and economic values. [ABSTRACT FROM AUTHOR]

BACKGROUND AND CONTEXT: New Zealand's primary mental health initiatives (PMHIs) have successfully filled a health service gap and shown good outcomes for many presenting with mild to moderate anxiety/depression in primary health care settings. Maori have higher rates of mental health disorders and complexity of social and mental health needs not matched by access to PMHIs. ASSESSMENT OF PROBLEM: The Wairua Tangata Programme (WTP), a Hawkes Bay PMHI, aimed to provide an integrated, flexible, holistic, tikanga Maori-based therapeutic service targeting underserved Maori, Pacific and Quintile 5 populations. External evaluation of the programme provided formative and outcome feedback. RESULTS: The WTP reported high engagement of Maori (particularly women), low non-attendance rates, good improvements in mental health assessment exit scores, strong stakeholder support and service user gratitude. GPs reported willingness to explore mental health issues in this high needs population. Challenges included engaging Pacific peoples and males and recruiting from scarce Maori, Pacific and male therapist workforces. STRATEGIES FOR IMPROVEMENT: Effectively meeting the target population's complex social and therapeutic needs required considerable programme flexibility, referral back into the programme and assistance with transitioning to other therapeutic or social support services. Referral criteria required adaptation to accommodate some sectors, especially youth. A group programme was developed specifically for males. LESSONS: A holistic PMHI programme delivered with considerable flexibility and a skilled, culturally fluent team working closely with primary care providers can successfully engage and benefit underserved Maori communities with complex social and mental health needs. Successful targeted programmes are integral to reducing mental health disparities. [ABSTRACT FROM AUTHOR]

This paper provides a brief overview of the history of early childhood care and education (ECCE) in Aotearoa New Zealand, before proceeding to discuss the range of documents produced by the New Zealand Ministry of Education in relation to the sector, from the inception of the national early childhood curriculum, Te Whāriki. He whāriki mātauranga mō ngā mokopuna o Aotearoa: (Ministry of Education, 1996a) up to the present day. From the point of its promulgation in 1996, Te Whāriki set in place the expectation of a radically different notion of curriculum, in its non-prescriptive philosophical, sociocultural, holistic and 'bicultural' nature (Nuttall, 2003). Not the least of these challenges was the delivery of a curriculum inclusive of the Māori culture, values and language by a predominately non-Māori teacher workforce. This is followed by discussion of ways in which the promulgation of Te Whāriki formed part of a groundswell of change and led to an enhancement of pedagogies in support of its 'bicultural' expectations. The paper concludes with examples from recent research of modes of pedagogical practice that reflect such programme delivery. [ABSTRACT FROM AUTHOR]

ABSTRACT This paper provides part of an analysis of the use of the Maori term whakapapa in a study designed to test the compatibility and commensurability of views of members of the indigenous culture of New Zealand with other views of genetic technologies extant in the country. It is concerned with the narrow sense of whakapapa as denoting biological ancestry, leaving the wider sense of whakapapa as denoting cultural identity for discussion elsewhere. The phenomenon of genetic curiosity is employed to facilitate this comparison. Four levels of curiosity are identified, in the Maori data, which penetrate more or less deeply into the psyche of individuals, affecting their health and wellbeing. These phenomena are compared with non-Maori experiences and considerable commonalities are discovered together with a point of marked difference. The results raise important questions for the ethical application of genetic technologies. [ABSTRACT FROM AUTHOR]

In New Zealand, Māori (indigenous New Zealanders) and Pacific students tend not to attain the same levels of educational success as Pākehā (New Zealanders of European descent). Addressing this problem is a particular challenge in the sciences. The kaupapa (values-base) of Te Rōpū Āwhina (Āwhina) is to produce Māori and Pacific professionals to contribute to Māori and Pacific development and leadership through the creation of an inclusive off- and on-campus whānau (extended family) environment where high expectations, aspirations and achievement, collective success, and reciprocity are normalised. This paper reviews theories and practices of recruitment and retention relevant to Māori and Pacific students at tertiary level, presents the rationale for Āwhina in the Faculties of Science and Architecture and Design at Victoria University of Wellington, and assesses the impact of the whānau. Based on analyses of quantitative measures of student achievement, and biennial surveys of student responses from the first 6 years of Āwhina, it is suggested that the results are consistent with improving Māori and Pacific graduate and postgraduate achievement and retention. Potential implications for efforts to reduce disparities in tertiary education in New Zealand and elsewhere are summarised. [ABSTRACT FROM AUTHOR]

A large number of studies have demonstrated that Māori students are not performing well in education. The literature in the general area of Māori education paints a very grim picture that demonstrates a clear preoccupation with failure and underachievement. These studies often overlook the experiences of Māori adult students who return to study long after leaving school and experience considerable success. This paper focuses on the academic success of 16 indigenous students at a New Zealand university. It is based on the findings of a qualitative investigation that explored the experiences of Māori adult students who entered university with very few formal school qualifications and then went on to attain undergraduate degrees. This paper pays particular attention to the role of the whānau in facilitating Māori educational success at university. [ABSTRACT FROM AUTHOR]

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This paper fleshes out the rather sparse empirical literature on citizenship with data collected from seven focus groups involving a wide range of New Zealanders. Results indicate that the term "citizenship" is relatively unimportant to identity and belonging compared to "family" and "community". Yet there is considerable agreement about the key elements of citizenship and what makes a "good citizen". Knowledge about citizenship, however, is not evenly distributed or experienced in the same way by different groups of New Zealanders, with Māori participants offering notably more negative perspectives on citizenship, and benefit recipients most likely to feel like "second-class citizens". Against predictions, the findings further suggest that neo-liberal reforms have not eliminated a belief in community spirit and collective solutions to social problems. although New Zealanders do believe that individuals should be responsible for themselves, they also expect government to ensure the social and economic conditions that make this possible. [ABSTRACT FROM AUTHOR]

This paper presents estimates of yield for effort of the cultivar, ‘Taputini,’ which is a sweet potato that was eaten by the Māori of New Zealand before European contact in the 18th century. The two experimental archaeology gardens were planted at sites on either side of Cook Strait: the one with clay soils is on the South Island at Robin Hood Bay; the one with sandy soils is at Whatarangi on the North Island. The records of labor input required to cultivate these gardens over seven years for Robin Hood Bay and six years for Whatarangi compared with crop yields provide data on the economics of pre—European kūmara gardening. Also reported are some of the properties of the soil. These gardens produced an average of 12 metric tons (1,000 kilograms=1 metric ton) per hectare (ha), which is not much less than contemporary yields for modern cultivars and 3 to 4 times most previous estimates of pre-European production. [ABSTRACT FROM AUTHOR]

Abstract This paper reports on a study designed to bring the voices of young people directly into the social science literature regarding environmental influences on well-being. we analyse accounts from young Maori about their families and the roles families play in order to focus on strengths and positive resources for the promotion of youth wellbeing. Interview data were gathered from 12 females and 15 males, aged between 12 and 25 years, resident in the counties/Manukau region. Participants who were managing satisfactorily in their lives were purposively selected for diversity of background and circumstances. our "life story" approach sought narrative accounts of both everyday experiences and the highs and lows of life; data were transcribed verbatim and analysed using discursive methods. Clusters of themes relating to family environments including relationships with parents, siblings and extended kin groups emerged. Participants provided detailed and nuanced accounts of family cultures; reporting on conflict, caring, gender issues, sensitivity, discipline, levels of guidance and forms of support. [ABSTRACT FROM AUTHOR]

Among Maori families, the loss of an infant to SIDS is a terrible burden that reverberates through social networks for years after the event. The statutory services that investigate the death have a huge impact on such processes. This qualitative investigation studied the experiences of whanau following a SIDS death by reporting narrative data, gathered from families, police officers, coroners, and pathologists. Thematic analyses revealed multiple domains of high significance--police actions, post-mortem, and coronial process--to bereaved whanau, and this paper considers their implications for grieving, service provision, and social justice. [ABSTRACT FROM AUTHOR]

This paper has two main objectives. First, it examines the ways in which the Waitangi Tribunal considers the notion of "time" (and its corollary "timelessness") in relation to the Treaty of Waitangi. The Tribunal has increasingly emphasised the timelessness of the Treaty, its ability to transcend temporal notions of time, and the implications of this for the relationship between the Treaty partners, Maori and the Crown. Second, it compares these tendencies with contemporary Maori ideas of time, as they are presented in the modern Treaty claims process. It is argued that the Tribunal, especially in its more recent reports, has signalled a marked shift in its acknowledgment of Maori concepts of time. Its published reports from 1999 onwards show more appreciation not for only for Maori understandings of the Treaty relationship, but for Maori values and concepts which, by their articulation and inclusion in the hearing process, test orthodox and dominant assumptions regarding the nature of change over time. Some broader trends may also be observed. Since the 1980s, there have been numerous references to the Treaty and its principles in statutory law, Waitangi Tribunal reports, and Deeds of Settlement ratified by successive New Zealand governments. Furthermore, there has been increasing (but by no means universal) recognition of the Treaty as a "developing social contract", rather than a static historical document, with much of the impetus for such an interpretation coming from findings and recommendations of the Waitangi Tribunal. [ABSTRACT FROM AUTHOR]

In early nineteenth century New Zealand the arrival of missionaries and whalers initiated two different kinds of European relationships with indigenous Maori, which impacted on the indigenous landscape. This paper examines the details of Maori and European interaction at Te Puna, in the Bay of Islands, northern New Zealand. At Te Puna there is evidence for Maori agricultural intensification and fortification, and early European missionary villages, deserted by the mid-nineteenth century. My methods combine historical archaeology and an anthropological approach to history to re-examine the landscape, inhabitants, and events of early nineteenth century cultural interaction through an analysis of the archaeological record and historic accounts and images. Cultural landscapes are examined in regard to key themes: Maori concepts of mana and tapu, evidence for cultivation, and European and Maori perceptions of the colonial era at this place. [ABSTRACT FROM AUTHOR]

During the last twenty years Māori have endeavoured to re-establish control over their material culture and spiritual relationship to the landscape working through new associations with local bodies, museums and researchers. One of their concerns is with cultural wetlands. Wetlands contain Māori, archaeological and ecological values. Despite this, current legislation offers little or no protection for these fragile ecosystems or for the spiritual concerns of Māori. The previously extensive wetlands of Taranaki have been partly drained to produce farmland, and many waterlogged wooden artefacts have been recovered. On-going drainage continues to place these sites at risk. This paper outlines our efforts to strengthen the relationship between Ngāti Mutunga of north Taranaki and their wetlands through a research programme in which Ngāti Mutunga play an active role. Our joint venture has required effort and understanding from both parties, and the research programme's aims and procedures have been altered to accommodate Māori concerns. [ABSTRACT FROM AUTHOR]

Aims: Monogenic diabetes accounts for 1-2% of diabetes cases yet is often misdiagnosed as type 2 diabetes. The aim of this study was to examine in Māori and Pacific adults clinically diagnosed with type 2 diabetes within 40 years of age, (a) the prevalence of monogenic diabetes in this population (b) the prevalence of beta-cell autoantibodies and (c) the pre-test probability of monogenic diabetes. Methods: Targeted sequencing data of 38 known monogenic diabetes genes was analyzed in 199 Māori and Pacific peoples with BMI of 37.9 ± 8.6 kg/m² who had been diagnosed with type 2 diabetes between 3 and 40 years of age. A triplescreen combined autoantibody assay was used to test for GAD, IA-2, and ZnT8. MODY probability calculator score was generated in those with sufficient clinical information (55/199). Results: No genetic variants curated as likely pathogenic or pathogenic were found. One individual (1/199) tested positive for GAD/IA-2/ZnT8 antibodies. The pre-test probability of monogenic diabetes was calculated in 55 individuals with 17/55 (31%) scoring above the 20% threshold considered for diagnostic testing referral. Discussion: Our findings suggest that monogenic diabetes is rare in Māori and Pacific people with clinical age, and the MODY probability calculator likely overestimates the likelihood of a monogenic cause for diabetes in this population. [ABSTRACT FROM AUTHOR]

This research explores international tourists' engagement with Māori indigenous tourist attractions in New Zealand. In-depth interviews with 18 international tourists were conducted after their visits to the Waitangi Treaty Grounds in Northland, New Zealand. The findings revealed clear evidence of some general engagement behaviours such as spending time and enjoyment which led visitors into deeper levels of behavioural and psychological engagement. The behavioural engagement occurred in two primary forms which are taking photos for a range of personal and impersonal purposes as well as conversation with staff. Also, three forms of psychological engagement were found, including engagement with cultural aspects, imagination, and learning. The perception of the authenticity and uniqueness of the attraction were important precursors to tourist behavioural and psychological engagement. [ABSTRACT FROM AUTHOR]

Asthma is a complex respiratory condition that has a high prevalence and significant health burden in New Zealand (NZ). Proximal determinants of asthma development and severity are well established; however there exists an underappreciation of more upstream determinants that are guided by political, environmental and social elements. In particular, NZ's housing policy, climate change challenges and unaffordability of nutritious foods are significant root drivers of asthma development in the present and into the future. Importantly, upstream social determinants have an inequitable impact on asthma burden for Māori and Pacific peoples in NZ. Such disparities are perpetuated by broader elements of colonisation, institutional racism and inequitable policy development. An analysis of the distal drivers of asthma in NZ reveals a necessity for health professionals to question our nation's priorities and advocate for the targeting of upstream population level health determinants that promote equitable asthma outcomes. [ABSTRACT FROM AUTHOR]

Recent levels and trends of mortality and fertility of the minority Maori population of New Zealand are analysed. On this basis two projections for the year 1976 are presented, the first assuming a further rise in life expectation, which has already increased rapidly over the last two decades and the other that both mortality and the consistently high fertility levels will be reduced. Last century the decrease of the Maori population appeared to prove that culture contact led to the "racial suicide" of "inferior races." Their plight was widely recognized both in New Zealand and abroad, and gave rise to a series of speculative, even bizarre, essays dealing with the "Passing of the Maori." The sole concern of this paper is with the components of the rapid Maori growth rate-- mortality and fertility. Once these variables have been analysed it will be possible to speculate about future short-term trends of growth. At each census date some age group of males showed higher survival rates than did the same section of the female population. At the earlier period, survivorship levels were lower among females than among males over a wider span of ages, but mainly at childbearing and post-childbearing ages.

INTRODUCTION: Unmet needs are a key indicator of the success of a health system. Clinicians and funders in Christchurch, Canterbury, New Zealand were concerned that unmet health need was hidden. AIM: The aim of this survey was to estimate the proportion of patients attending general practice who were unable to access clinically indicated referred services. METHODS: The survey used a novel method to estimate unserviced health needs. General practitioners (GPs, n = 54) asked their patients (n = 2135) during a consultation about any health needs requiring a referred service. If both agreed that a service was potentially beneficial and not available, this was documented on an e-referral system for review. The outcomes of actual referrals were also reviewed. RESULTS: The patient group was broadly representative of the Canterbury population, but over-sampled female and middle-aged people and under-sampled Māori. Data adjusted to regional demographics showed that 3.6% of patients had a GP-confirmed unserviced health need. Elective orthopaedic surgery, general surgery and mental health were areas of greatest need. Unserviced health needs were significantly (P = 0.05) associated with greater deprivation, middle-age, and receiving high health-use subsidies. DISCUSSION: To our knowledge, this is the first survey of GP and patient agreement on unserviced referred health needs. Measuring unserviced health needs in this way is directly relevant to service planning because the gaps identified reflect clinically indicated services that patients want and need. The survey method is an improvement on declined referral rates as a measure of need. Key factors in the method were using a patient-initiated GP consultation and an e-referral system to collect data. [ABSTRACT FROM AUTHOR]