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In April 2019, educators from around Aotearoa (New Zealand) and Australia came together to share their experiences of teaching Indigenous public health. The inaugural International Indigenous Public Health Education Leadership Symposium provided an opportunity to (i) discuss the range of challenges of this work, and (ii) to affirm a collective aspiration to strengthen the contribution of public health education to improved Indigenous outcomes. Talking across the borders of individual institutions, distinct cultures and nations enabled a rich conversation about the interface of health and Indigenous education. We explored the twin agendas of decolonisation and indigenisation, meeting the respective needs of Indigenous and non-Indigenous students, and how to best mobilise Indigenous public health leadership. This article will outline the discussion that unfolded and that led to the establishment of an inclusive Australia/Aotearoa/South Pacific Indigenous public health education entity and network.

Background: There are high rates of child dental caries in Aotearoa, New Zealand. Education focuses on sugary drink consumption, primarily soft drinks. However, fruit beverages are commonly provided to young children by parents. Frequency of consumption of fruit beverages is adversely associated with dental caries and tooth wear. Objectives: To investigate oral health awareness and practices around fruit beverages in parents and caregivers of young children in Auckland, New Zealand. Methods: 147 parent and primary caregivers of children aged between 1-10 years participated in a cross-sectional survey in 2015. Participants were recruited from early childhood health and education institutions throughout Auckland and completed a questionnaire on awareness of dental behaviours and activities around fruit beverages. Descriptive statistics described the data and associations were calculated using Chi-square. Results: Participants reported a higher consumption of fruit beverages by children over the weekend compared to weekdays (60% v 33% =1 time/day respectively). The parents and caregivers demonstrated awareness of both protective oral health practices, and harmful behaviours, around fruit beverage consumption. There was no association between parental awareness of harmful fruit beverage behaviours and protective dental practices. Two individual associations were found. Parents who rated "juice with meals is harmful" highly were likely to be higher in "milk and water only given" practices. Likewise, a high rating for "juice drunk every 20-30 min" was more likely to be higher in "I dilute the juice with water" practice. Dental practitioners were the primary source of oral health advice for their children. Conclusions: Parental awareness around protective and harmful behaviours of fruit beverage consumption varied. The focus of oral health promotion activities to parents of young children around sugary drinks should include the harmful effects, and protective oral health practices, of fruit beverages. [ABSTRACT FROM AUTHOR]

An integral part of colonisation is the suppression and marginalisation of indigenous knowledges. The indigenous health system within Aotearoa (New Zealand) was supplanted with a colonial infrastructure and praxis which has proven ineffective in addressing systemic health inequities created by the processes of colonisation. This novel study interrogates discursive representations of Māori (Indigenous peoples of Aotearoa) within colonial public health policy between 2006 and 2016. Colonial policy refers to generic or mainstream policy that are designed for 'all' New Zealanders. We utilised thematic analysis to examine 106 policies and, after excluding 13 ethnic specific policies, identified 68 policies containing no mention of Māori. The analysis highlights five themes relating to discursive representations of Māori. These were: i) silence about Māori health; ii) Māori as especially at risk; iii) Crown (lack of) responsiveness to te Tiriti o Waitangi obligations; iv) recognition of Māori philosophical approaches to service provision; and v) utilising mātauranga Māori (Māori knowledge). These findings suggest colonial policy presents a barrier to the pursuit of health equity and is poorly aligned to global Indigenous human rights declarations. Within the context of Aotearoa it echoes the sentiments of the key Waitangi Tribunal [WAI 2575] finding that health policy is contributing to health inequities and failing Māori. Health policy must be decolonised to better engage with human rights declarations and te Tiriti o Waitangi obligations in order to achieve health equity. [ABSTRACT FROM AUTHOR]

Racism and government policies of colonisation and assimilation contribute to the disproportionate burden of disease carried by indigenous people globally. In colonial contexts such as Aotearoa New Zealand, these inequities are routinely monitored but governments believe economic growth and better lifestyles will resolve the issues. Stop Institutional Racism (STIR), a group of health activists, is challenging this dominant discourse and building a boutique social movement to transform racism within the New Zealand public health sector. Central to the work of STIR is partnership between indigenous and non-indigenous practitioners underpinned by Te Tiriti o Waitangi – the founding document of the colonial state of New Zealand. This paper reflects on STIR organisational processes and political achievements to date. We have worked towards mobilising the public health sector, re-energising the conversation around racism and strengthening the capacity and evidence base of the sector around key sites of racism and anti-racism praxis. This paper will be of interest to others within the global public health community who are looking for new collective ways to organise and challenge entrenched inequities. [ABSTRACT FROM PUBLISHER]

Objectives.New Zealand has a unique tool, Te Tiriti o Waitangi, the Treaty of Waitangi, for addressing health disparities. Indigenous Māori have compromised health status compared to other groups. This paper investigates ways in which public health units (PHUs) and non-governmental organisations (NGOs) use Te Tiriti o Waitangi in service delivery to Māori. Design.A nationwide telephone survey of primary health providers (n=162) was conducted in 2014-15. Participants were asked about effectiveness and monitoring of their service delivery to Māori. Results.PHUs reported actively working with Māori, and Te Tiriti o Waitangi to reduce health disparities. Direct Māori engagement with development and delivery of programmes was viewed as essential. Strategies included designated PHU staff in positions of responsibility, formal partnerships with Māori, and providing operational and strategic guidance. Some PHUs supported development of cultural competencies. NGO responsiveness to Māori was variable. Some NGOs described prioritising service delivery and programmes for Māori. Others reported the focus of their service was European or other non-Māori ethnicities. Lack of resources or past difficulties engaging with Māori were barriers. Conclusion.Public health has an ethical commitment to reduce health disparities. Advancing Te Tiriti obligations in everyday practice has the potential to address inequalities. [ABSTRACT FROM AUTHOR]

The Waitangi Tribunal in their Wai 2575 Report recommended the establishment of Te Aka Whai Ora (the Māori Health Authority) to remedy some of the contemporary breaches of Te Tiriti o Waitangi (Te Tiriti). Te Aka Whai Ora was the culmination of decades of Māori advocacy for the establishment of independent Māori health leadership, policymaking and commissioning. Under urgency, the new National-led coalition Government passed the Pae Ora (Disestablishment of Māori Health Authority) Amendment Act 2024 in February. In this paper we use Critical Tiriti Analysis (CTA), a five-stage process, to review the extent to which the Act is compliant with the five elements of Te Tiriti (the authoritative Māori text), the preamble, the three written articles and the oral article. We found that the Act had very limited Tiriti compliance and the potential to do great harm. We offered practical suggestions how this could have been avoided., Competing Interests: HC has received payment for expert testimony for the Waitangi Tribunal evidence brief., (© PMA.)

The current health reforms in Aotearoa New Zealand are being described as "transformational". Political leaders and Crown officials maintain the reforms embed a commitment to Te Tiriti o Waitangi, address racism and promote health equity. These claims are familiar and have been used to socialise previous health sector reforms. This paper interrogates claims of engagement with Te Tiriti by undertaking a desktop critical Tiriti analysis (CTA) of Te Pae Tata: the Interim New Zealand Health Plan. CTA follows five stages from orientation, close reading, determination, strengthening practice, to the Māori final word. The determination was done individually and a consensus was negotiated from the indicators; silent, poor, fair, good, or excellent. Te Pae Tata proactively engaged with Te Tiriti across the entirety of the plan. The authors assessed Te Tiriti elements of the preamble, kāwanatanga and tino rangatiratanga as "fair", ōritetanga as "good" and wairuatanga as "poor". Engaging more substantively with Te Tiriti requires the Crown to recognise that Māori never ceded sovereignty and treaty principles are not equivalent to the authoritative Māori text. Recommendations of the Waitangi Tribunal WAI 2575 and Haumaru reports need to be explicitly addressed to allow monitoring of progress., Competing Interests: Nil, (© PMA.)

There is renewed international effort to improve the health and well-being of migrants. For African migrants, theoretical frameworks designed to account for and guide interventions to address the underlying mechanisms that interact to influence health and well-being remain largely underdeveloped. The aim of this study was to address this gap by providing a unique socio-ecological framework with specific entry points for targeted health promotion action aimed at improving the health and well-being of African migrants living in Aotearoa New Zealand. The African Hut model of health was developed through an inductive iterative approach informed by a review of the evidence and semi-structured interviews with key informants. The interviews were conducted in person using one-on-one format and employed to refine initial themes from the literature. A hybrid thematic analysis, involving both inductive and deductive approaches was used to analyse the interview data. The health and well-being of African migrant communities are the outcome of complex interplay of individual, economic, social and structural factors. To protect and promote the health of African communities in Aotearoa requires tailored interventions that centre culture and deliver holistically., (© The Author(s) 2023. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

The Muslim community is a vibrant part of New Zealand society. As this community grows, researchers will need to strengthen engagement and collaboration to tailor the delivery of services. Given the paucity of the literature, this conceptual paper drawing on a study on health and Ramadan presents an exemplar for doing research with Muslim communities. This paper proposes several key elements (i) the importance of relationships, (ii) engagement with imams (mosque leaders), (iii) cultural and religious safety, (iv) a gendered approach and (v) utilizing religious festivals. These findings will be of interest to policy makers, practitioners and scholars wishing to engage with this community., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

The second wave feminist dream of smashing the patriarchy remains a task yet to be completed on a complex to do list. Women, particularly able-bodied cis-gendered white women however do enjoy the privilege of living longer than men. But our longer lives take place within patriarchal-capitalist systems where many women's social and cultural rights continue to be compromised. How do we ensure that all women can exercise our right to health and wellbeing? In this paper, the authors examine, critique, review and re-vision the dynamics of power and patriarchy over three distinct time periods - 1999, 2019 and 2039. We look to the past to track progress; we look to the present to see what we have achieved and look to the future for what might be. This conceptual paper is informed by the authors' expert knowledge, a review of the literature and the novel use of speculative ethnography. The authors conclude that patriarchy remains not only a negative determinant of women's health that needs to be smashed, but is also a threat to all people and to planetary health.

Introduction: Across Aotearoa (New Zealand), there are chronic shortages of qualified Māori (Indigenous peoples of Aotearoa) health practitioners and systemic ethnic health inequities. This study, focussing on the discipline of occupational therapy, explores Māori graduates' recollections of the institutional barriers that impacted on their study in this field over a 25-year period., Methods: This qualitative study interviewed seven Māori occupational therapy graduates using pūrākau-an innovative Māori narrative inquiry method. Pūrākau (stories) were collected in 2018 via kanohi ki te kanohi (face to face) semi-structured interviews. They were analysed using the kaupapa Māori (Māori philosophical) framework of Pū-Rā-Ka-Ū which draws on traditional Māori mātauranga (knowledge)., Findings: The institutional barriers identified were (1) cultural dissonance, (2) cultural (in)competency and (3) the limitations of (Western) pastoral care., Conclusion: This study highlighted how racism is embedded within the Western tertiary education system. To create a safe learning environment for Māori students, tertiary education institutions require a planned approach to address racism within policy, procedures, the curriculum, teaching and professional staff., (© 2022 The Authors. Australian Occupational Therapy Journal published by John Wiley & Sons Australia, Ltd on behalf of Occupational Therapy Australia.)

From a public health perspective, there is strong evidence that income is a major modifiable determinant of health. District health boards (DHBs), who were responsible for providing and/or funding regional health services across Aotearoa, are major employers. International literature suggests implementing a living wage strategy can improve health outcomes, contribute until July 2022 to the reduction of ethnic health inequities, and is ethical and socially responsible business practice. In February 2021, official information requests were sent to all DHBs to determine engagement with the living wage movement. This was augmented through a content analysis of publicly available collective employment contracts to benchmark practice. The review found no DHBs were registered living wage employers, nor is it a requirement of those whom they sub-contract. Two out of twenty DHBs are planning to become living wage employers, and several confirmed they were working collectively to improve working conditions of lower paid workers. This paper makes a scholarly argument for DHBs to commit to becoming living wage employers. As significant regional employers this is an opportunity for DHBs to positively contribute to the alleviation of entrenched poverty a modifiable determinant of ethnic health inequities., Competing Interests: Nil.

Ethnic health inequities between Māori and other New Zealanders continue to manifest systemically across the health sector. They are unjust, unfair, and are a breach of Te Tiriti o Waitangi. Institutional racism is a key modifiable driver of these disparities. Historically, health sector responses to racism could be characterised as ad hoc or in-action. Efforts have included investment in Māori health providers, Māori representation in governance, equity initiatives, kawa whakaruruhau-cultural safety and Te Tiriti training. Most anti-racist interventions have been educational and focused on individual change-especially for operational staff and students, rather than decision-makers. These historic contributions have been insufficient to address entrenched problems of systemic and societal racism.This paper examines three anti-racism initiatives currently occurring across Aotearoa; i) the Matike Mai Constitutional Transformation report/movement, ii) the development of the National Action Plan Against Racism, and iii) Ao Mai Te Rā currently being developed within the health sector.Drawing on long-time involvement in anti-racism praxis and scholarship, the Māori and non-Māori authors of this paper are making the case to re-imagine anti-racism theory. Such re-imagining needs to centre engagement with Te Tiriti. In addition, we argue it needs to involve both tangata whenua and Tauiwi., Competing Interests: Nil.

Aim: The Pae Ora (Healthy Futures) Bill is the framework for a reformed health system intended to embed Te Tiriti o Waitangi and centre equity. The Bill is informed by the Wai 2575 Health Kaupapa Waitangi Tribunal Inquiry and the Health and Disability System Review, both of which established an urgent mandate to transform the health sector. This desktop review explores to what extent the proposed Bill is likely to uphold Te Tiriti., Methods: This paper uses Critical Tiriti Analysis to review the Pae Ora Bill. The analysis involves five phases: (i) orientation; (ii) close reading; (iii) determination; (iv) strengthening practice and (v) Māori final word. As part of that, a determination is made whether the Bill is silent, poor, fair, good or excellent in relation to the Preamble and the four articles (three written, one verbal) of te Tiriti o Waitangi (Māori text)., Results: The desktop analysis showed fair engagement with most of the Te Tiriti elements; but with good commitment to address equity issues. The Bill was silent in relation to wairuatanga (spirituality) and there is no evidence of Māori values informing it., Conclusion: The dominant Crown narrative that interprets kāwanatanga as the right to govern over all peoples pervades this legislation. There are significant power sharing shifts within this Bill and these are welcomed, but whilst the Crown maintains ultimate power and authority only a partial fulfilment of Te Tiriti will be evident within the health system., Competing Interests: Nil.

Objective: Breaches of Te Tiriti o Waitangi (Te Tiriti) and evidence of institutional racism have been consistently documented within the public sector for decades. Chief executives across the sector have a critical responsibility to lead the implementation of the Crown's Te Tiriti o Waitangi responsibilities. This paper examines the recruitment and performance review processes of public sector chief executives from 2000 to 2020 to ascertain Te Tiriti compliance., Methods: Recruitment and performance review templates were obtained via official information requests to Te Kawa Mataaho Public Service Commission. The data were analysed using a five-stage Critical Tiriti Analysis to determine compliance based on indicators developed around the five elements of Te Tiriti., Results: Our study found no explicit evidence of engagement with te Tiriti in any aspect of the recruitment and or performance review processes in the documents released., Conclusions: This appears to be another contemporary breach of Te Tiriti that urgently needs to be addressed prior to the new round of appointments in the health sector. Implications for public health: With significant senior appointments about to be made within the health sector, this paper is a timely contribution to the wider debate about the implications of the WAI 2575 Waitangi Tribunal report on the health sector., (© 2021 The Authors.)

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 Tiriti o 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 Tiriti o 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., (© 2021 John Wiley & Sons Ltd.)

Within Aotearoa (New Zealand) there are systemic health inequities between Māori (the Indigenous people of Aotearoa) and other New Zealanders. These inequities are enabled in part by the failure of the health providers, policy and practitioners to fulfil treaty obligations to Māori as outlined in our foundational document, te Tiriti o Waitangi (te Tiriti). Regulated health professionals have the potential to play a central role in upholding te Tiriti and addressing inequities. Competency documents define health professionals' scope of practice and inform curriculum in health faculties. In this novel study, we critically examine 18 regulated health practitioners' competency documents, which were sourced from the websites of their respective professional bodies. The competencies were reviewed using an adapted criterion from Critical te Tiriti Analysis, a five-phase analysis process, to determine their compliance with te Tiriti. There was considerable variation in the quality of the competency documents reviewed. Most were not te Tiriti compliant. We identified a range of alternative competencies that could strengthen te Tiriti engagement. They focussed on (i) the importance of whanaungatanga (the active making of relationships with Māori), (ii) non-Māori consciously becoming an ally with Māori in the pursuit of racial justice and (iii) actively engaging in decolonisation or power-sharing. In the context of Aotearoa, competency documents need to be te Tiriti compliant to fulfil treaty obligations and policy expectations about health equity. An adapted version of Critical te Tiriti Analysis might be useful for those interested in racial justice who want to review health competencies in other colonial settings., Competing Interests: Nil.

This Special Issue is entitled "Women, patriarchy, and health inequalities: an unresolved issue" [...].

The Health and Disability System Review (the 'Simpson Review') was an opportunity for health sector transformation, particularly in light of the recent damning WAI 2575 Waitangi Tribunal report released during the review process. There appears to have been a concerted effort to engage with the sector, an impressive Māori Expert Advisory Group and an extensive body of available scholarship documenting where improvements could be made. In this viewpoint, the authors, tangata whenua (Indigenous people of the land) and tangata Tiriti (people of te Tiriti) and health scholars and leaders undertook a high-level review of the Simpson Review report and analysed it against key elements of te Tiriti o Waitangi. The Simpson Review was an opportunity to share power, commit to Māori health and embed structural mechanisms, such as the proposed Māori health authority, to uphold te Tiriti o Waitangi. It was also an opportunity to recommit to health equity and eliminate institutional racism. We conclude that the Simpson Review did not take up these opportunities, but instead perpetuated further breaches of te Tiriti., Competing Interests: Dr Came reports being co-chair of STIR: Stop Institutional Racism.

In colonial states and settings, constitutional arrangements are often forged within contexts that serve to maintain structural racism against Indigenous people. In 2013 the New Zealand government initiated national conversations about the constitutional arrangements in Aotearoa. Māori (Indigenous) leadership preceded this, initiating a comprehensive engagement process among Māori in 2010, which resulted in a report by Matike Mai Aotearoa which articulated a collective Māori vision of a written constitution congruent with te Tiriti o Waitangi (the founding document of the colonial state of New Zealand) by 2040.This conceptual article explores the Matike Mai Aotearoa report on constitutional transformation as a novel means to address structural racism within the health system as a key domain within the constitutional sphere. Matike Mai suggests alternative conceptual structural formations through its focus on the kāwanatanga (governance), the relational and the tino rangatiratanga (sovereignty) sphere. This framework is informed by a range of Indigenous ethical values such as tikanga (protocol), belonging, and balance that can usefully inform the redesign of the health sector.We assert that constitutional transformation and decolonization are potentially powerful ethical sources of disruption to whiteness and structural racism. We argue that, to eliminate entrenched health disparities, change processes need to be informed by the Indigenous inspirations expressed in the Matike Mai report.

Prior to colonisation, Māori had a well-developed holistic health system based on maintaining balance between people, place and spirit. The colonial imposition of British economic, religious, educational, legal, health and governance, through warfare, immigration, legislation and social coercion had a devastating effect on Māori health outcomes. With the release of the WAI 2575 Waitangi Tribunal report exposing the failings of our health system in relation to Māori health, the need to decolonise our health system becomes more pressing. A key difficulty in this work is the poverty of transformative language, concepts and frameworks in our workforce. This paper is the product of an anti-racism think tank that occurred in April 2019. While working through a system change analysis on our colonial health system, Māori and Tauiwi activists and scholars created an allegory-from gorse to ngahere. The allegory depicts the ongoing impact of the colonial health system as represented by gorse, and the possibilities of a decolonised health system represented by ngahere-a self-sustaining and flourishing native forest. Racism has a geographic specificity. The allegory we developed is a mechanism for conceptualising decolonisation for the context of Aotearoa. It serves to reinforce the different roles and responsibilities of the descendants of the colonisers and the colonised in the pursuit of decolonisation., Competing Interests: Nil.

Te Tiriti o Waitangi , a treaty negotiated between Māori (the Indigenous peoples of Aotearoa) and the British Crown, affirmed Māori sovereignty and guaranteed the protection of hauora (health). The Waitangi Tribunal, established in 1975 to investigate alleged breaches of the agreement, released a major report in 2019 (registered as WAI 2575) about breaches of te Tiriti within the health sector in relation to primary care, legislation, and health policy. This article explores the implications of this report for the New Zealand health sector and the decolonial transformation of health systems. The tribunal found that the Crown has systematically contravened obligations under te Tiriti across the health sector. We complement the tribunal's findings, through critical analysis, to make five substantive recommendations: (1) the adoption of Tiriti -compliant legislation and policy; (2) recognition of extant Māori political authority ( tino rangatiratanga ); (3) strengthening of accountability mechanisms; (4) investment in Māori health; and (5) embedding equity and anti-racism within the health sector. These recommendations are critical for upholding te Tiriti obligations. We see these requirements as making significant contributions to decolonizing health systems and policy in Aotearoa and thereby contributing to aspirations for health equity as a transformative concept., Competing Interests: Competing interests: None declared., (Copyright © 2020 Came, O’Sullivan, Kidd, and McCreanor.)

Māori women with advanced breast cancer are less than half as likely as their Pākehā counterparts to reach the five-year survival mark. We argue that this inequity is unacceptable. We trace the inequity back to i) inadequate screening and risk assessment, ii) lack of support for patient navigation, iii) failure to offer accessible state-of-the-art treatments, and iv) delays in receiving life-prolonging care. We posit that each of these factors is a site of institutional racism and privilege as they cause Māori women to experience significantly worse outcomes than non-Māori. In the active pursuit of justice, cancer survivors, women living with cancer and their supporters across the country have been engaging in passionate advocacy to address inequities. As the Ministry of Health develops a new cancer control plan, in this viewpoint opinion piece, we seek to amplify these distressing inequities and offer evidence-based recommendations to improve the quality of care and ultimately survival rates. Breast cancer inequities are modifiable. We recommend prioritising breast cancer screening and risk assessments for Māori women, reducing treatment delays, providing Māori-centered patient navigation, increasing funding for treatments and drugs to align with the OECD standard of care, and holding health providers accountable for ethnic inequities. We call on policy makers drafting the new cancer control strategy, and those working across the cancer continuum, to take action to improve breast cancer outcomes so Māori women will gain valuable life-years., Competing Interests: Dr Came is co-chair of STIR:Stop Institutional Racism—this is a nationwide network of activist scholars and public health practitioners committed to eliminating institutional racism in the health sector.

Objective: To critically examine, within the New Zealand context, the regulated-health practitioners' cultural competencies, their readiness to deliver culturally responsive health services to Māori (Indigenous peoples) and identify areas for development., Design: A mixed methods critical analysis of the regulatory bodies' cultural competency standards for health practitioners from their websites., Setting: The New Zealand regulated-health workforce, legislated by the Health Practitioners' Competency Assurance Act 2003 and the Medical Practitioners Act 2007, requires practitioners to regularly demonstrate cultural competence., Participants: The information provided on the websites of the 16 professional bodies for regulated-health practitioners., Main Outcome Measure(s): These standards were analysed against indicators of the knowledge-action-integration (KAI) framework for culturally responsive practice, and scored according to these being explicit, not explicit, or not evident., Results: Competency standards aligned to the 'knowledge' component were more likely to be explicit requirements. This included indicators related to understanding personal cultural values, beliefs, practices, assumptions, stereotypes and biases and the influence these have on practice. However, the 'action' and 'integration' components were less likely to be explicit. Five regulatory bodies provided no definitions of cultural competence. There was mixed engagement with te Tiriti o Waitangi or the Treaty of Waitangi., Conclusions: Variation in clarity surrounding requirements for cultural competence/responsiveness exists across most health regulatory bodies. Notably, the measurability of many standards tended to lack precision. Universal cultural competence standards could support health practitioners to deliver an improved healthcare experience for Māori, emphasizing cultural competence as a quality and safety issue., (© The Author(s) 2019. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Upholding te Tiriti o Waitangi should eliminate institutional racism against Māori and contribute to the achievement of health equity. Given the Waitangi Tribunal is investigating health-related breaches of te Tiriti o Waitangi, we argue institutional racism, a key determinant of health inequalities, needs to be acknowledged and addressed within the health sector. Historically the Crown response can be characterised by denial and inaction. The Crown has the power and resources to take action through mechanisms such as those they are currently applying to child poverty and gender pay inequity. Anti-racism literature recommends planned, systems-based approaches to eradicate the problem. We need the government to uphold our Tiriti responsibilities and we require a plan to end racism in the New Zealand health system., Competing Interests: Dr Came is co-chair of STIR: Stop Institutional Racism—this is a nationwide network of activist scholars and public health practitioners committed to eliminating institutional racism in the health sector.

Aim: This study examines how public health policy in New Zealand has represented the Treaty of Waitangi (the English version) and te Tiriti o Waitangi (the Māori text) between 2006 to 2016., Method: A dataset of 49 public health strategies and plans, published between 2006 and 2016, were secured from the New Zealand Ministry of Health database. A thematic analysis using Braun and Clarke's process was undertaken and then the findings were reviewed against the Māori text of te Tiriti., Results: Twelve documents referred to either te Tiriti or the Treaty. Crown discourses were characterised as i) rhetorical, ii aspirational, iii) practical and/or iv) substantive. We present a matrix of Crown health strategy and plan discourses and analyse their relationship to te Tiriti., Discussion: Public health strategies and plans rarely address Treaty of Waitangi or te Tiriti o Waitangi obligations. This silence is inconsistent with legislative requirements to engage with the Treaty and health equity and is likely to inform health-related Waitangi Tribunal claims [WAI 2575]. Further work needs to be done to strengthen alignment of health policy to fulfil Crown obligations under te Tiriti., Competing Interests: Dr Came reports being co-chair of STIR: Stop Institutional Racism—this is a nationwide network of activist scholars and public health practitioners committed to eliminating institutional racism in the health sector.

Racism is a "wicked" public health problem that fuels systemic health inequities between population groups in New Zealand, the United States and elsewhere. While literature has examined racism and its effects on health, the work describing how to intervene to address racism in public health is less developed. While the notion of raising awareness of racism through socio-political education is not new, given the way racism has morphed into new narratives in health institutional settings, it has become critical to support allies to make informing efforts to address racism as a fundamental cause of health inequities. In this paper, we make the case for anti-racism praxis as a tool to address inequities in public health, and focus on describing an anti-racism praxis framework to inform the training and support of allies. The limited work on anti-racism rarely articulates the unique challenges or needs of allies or targets of racism, but we seek to help fill that gap. Our anti-racism praxis for allies includes five core elements: reflexive relational praxis, structural power analysis, socio-political education, monitoring and evaluation and systems change approaches. We recognize that racism is a modifiable determinant of health and racial inequities can be eliminated with the necessary political will and a planned system change approach. Anti-racism praxis provides the tools to examine the interconnection and interdependence of cultural and institutional factors as a foundation for examining where and how to intervene to address racism., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

New Zealand's central government, and more specifically the Ministry of Health, consistently acknowledges their special relationship with Māori and the strategic importance of Māori health, and certainly, strengthening Māori health is critical to addressing systemic health inequities. This paper, framed in terms of the Crown principles attributed to the Treaty of Waitangi, ie, participation, protection and partnership, examines three structural decisions that threaten to unravel the whāriki (foundational mat) of Crown Māori health policy infrastructure. These include the disestablishment of the Ministry of Health's policy team, Te Kete Hauora, revoking mandatory district health boards' (DHB) Māori health plans and reporting, and downscaling the requirements of DHBs to consult. These actions appear to breach the Articles of te Tiriti o Waitangi and may be cited as such in the forthcoming WAI 2575 kaupapa health hearing before the Waitangi Tribunal. The authors call for the Ministry of Health to embrace its Treaty obligations, and to protect and reinstate the whāriki of Māori health infrastructure., Competing Interests: Dr Came is co-chair of STIR: Stop Institutional Racism—this is a nationwide network of activist scholars and public health practitioners committed to eliminating institutional racism in the health sector.

New Zealand's core health policy document-the New Zealand Health Strategy (NZHS)-was released in its final form in April 2016. This paper provides a critique of the strategy in particular, as it relates to health equity particularly for Māori. We introduce the five NZHS themes of-people powered, closer to home, value and high performance, one team and smart system-to focus on the aspirational goal of eliminating health inequities. Our critical framework is informed by Te Tiriti o Waitangi. We identified that the NZHS relies on the isolated efforts of committed individuals and organisations to achieve health equity and Te Tiriti engagement, rather than through a planned systems viewpoint. Evidence on health equity and Te Tiriti application suggests efforts need to be sustained, systematic and multi-levelled to be successful, rather than ad hoc and piecemeal.

Although New Zealanders have historically prided ourselves on being a country where everyone has a 'fair go', the systemic and longstanding existence of health inequities between Māori and non-Māori suggests something isn't working. This paper informed by critical race theory, asks the reader to consider the counter narrative viewpoints of Māori health leaders; that suggest institutional racism has permeated public health policy making in New Zealand and is a contributor to health inequities alongside colonisation and uneven access to the determinants of health. Using a mixed methods approach and critical anti-racism scholarship this paper identifies five specific sites of institutional racism. These sites are: majoritarian decision making, the misuse of evidence, deficiencies in both cultural competencies and consultation processes and the impact of Crown filters. These findings suggest the failure of quality assurance systems, existing anti-racism initiatives and health sector leadership to detect and eliminate racism. The author calls for institutional racism to be urgently addressed within New Zealand and this paper serves as a reminder to policy makers operating within other colonial contexts to be vigilant for such racism., (Copyright © 2014 Elsevier Ltd. All rights reserved.)