Kidd et al.
Health care in Aotearoa New Zealand privileges the Western worldview. Consequently, institutional racism is a health system attribute demonstrated by prolonged health inequities, including life expectancy, between Māori and non-Māori. The Crown has breached Te Tiriti o Waitangi, an enduring agreement between Māori and the Crown, by failing to design and deliver health services adequately for Māori, and failing to provide opportunities for Māori sovereignty. Māori experts have articulated the need to surpass equity and achieve Māori aspirations. This qualitative kaupapa Māori research explored Indigenous aspirations for health system transformation, specifically in an environment free of racism. Three online wānanga with Māori health practitioners highlighted the difficulty of describing aspirations when mamae (hurt) continues to be felt in the existing system. By capturing these experiences, we mapped differences between the current system and Māori aspirations for Hauora Māori – a construct where whānau health care and support for wellbeing is indistinguishable from everyday life. The biggest barriers identified in moving towards this approach are Crown resistance to prioritising Māori aspirations for hauora, and the expectation that aspirations should fit within current structures. To achieve hauora Māori, we need changes to funding allocations, prioritising hapū-based commissioning, and improved monitoring and accountability.
