Editorial overview on Maori health


Dr Leo Buchanan, 342 The Terrace, Te Aro, Wellington 6011, New Zealand. Email: leobuchanan@xtra.co.nz

Is there a Maori culture? An affirmative answer is surely crucial to running with this blockbuster issue on Indigenous child health. But first, who is Maori and where are they found? Until the 1980s, the official New Zealand census definition was based on the person having ‘half or more’ Maori origin – which half and its whereabouts were not specified. Now, however, census data and common usage define Maori as a person of Maori ancestry who chooses to identify as Maori. In the 2006 census, 15% of the New Zealand population reported Maori ethnicity, with just over half of these 565 329 people only identifying Maori as their ethnic group.1 Thirty-five percent of the Maori population was identified as less than 15 years of age.

At the time of significant European settlement, Maori overwhelmingly lived within their own traditional tribal areas. As recently as the 1950s, Maori predominantly lived in rural and semi-rural settings, but major urban relocation commenced from then on. Today, 84% of Maori live in urban areas, defined as areas with more than 30 000 inhabitants.1*

The Polynesians' love for travel combined with opportunities saw significant trans-Tasman shifts in the Maori population. From 1795 onwards, there were regular visitations to Sydney by Maori chiefs seeking trading opportunities. The current Maori population in Australia is approximately 93 000,2 while the Indigenous population is estimated to be 517 000.3

The second question to be asked is whether there is a specific Maori culture, and if so, where is it to be found and in what measure? One difficulty with this is that the meaning of the word culture has been changed from the 1950s, when it meant refinement, or tillage of the soil, or probably a blood agar plate for propagating bacteria if you were a medical student. While the New Zealand Oxford Dictionary 2005 may help by offering one definition of cultures as ‘The Customs, institutions and achievements of a particular time or people’, the Medical Council of New Zealand's ‘Statement on Cultural Competence’4 asserts that there are, among others, rugby, army, police, gay, religious and rural cultures that need to be considered. Buchanan and Malcolm attempt to clarify this question within this issue in their article on ‘Challenges of Providing Child Health Care in the Indigenous Population of New Zealand’.

In the famous 1930s correspondence between Te Rangi Hiroa (Sir Peter Buck), the first Maori medical graduate within New Zealand, and Sir Apirana Ngata, the first Maori graduate from a New Zealand university, Te Rangi Hiroa answered Sir Apirana Ngata's question as to what constituted Maori culture by stating that ‘Maori is a culture that puts other before self’. Some of the material in this issue such as that on physical abuse may severely shake that assertion. Other contributions will identify adverse morbidity and mortality outcomes for Maori compared with non-Maori, which should raise questions of social justice and equity in the minds of thoughtful readers. The issue of economics and its interplay with health outcomes can not be ignored when examining the health status of Maori.5 Proportionally, a greater number of Maori are found living in the areas of the greatest socio-economic deprivation. For Maori children, this is particularly pertinent, with 25% of Maori children living in poverty compared with 15% of European New Zealand children.6

From a New Zealand perspective, Maori would appear to be in a much more favourable position than their Australian Aboriginal cousins in terms of their health, education and social situation. It would appear that the Australian Government's ‘Closing the Gaps’ programme has general acceptance as a marker of the Australian conscience on Aboriginal alienations. In New Zealand, a programme of the same name was introduced in 19997 to address social inequalities, including discrepancies in health outcomes, between Maori and non-Maori. The shelving of that programme from political pressure indicates an important difference between the attitudes towards Indigenous populations. The sheer size of the Maori population in New Zealand attracts vocal advocates to enhance its special status and needs – but also belligerent critics who believe we should all be paddling the same canoe. Certainly, there is no shortage of health challenges for Maori. What can sometimes be overlooked is that Maori skills and expertise are not just confined to the sporting and entertainment areas, but cover all areas of human endeavour.

It could be that the way forward for Maori is back to the future in the sense of more Maori rediscovering what it is to be Maori. In the meantime, there is much work to be done to rectify the challenges identified in this issue. Part of that work involves informed advocacy at the political level in partnership with Maori. Part of it, however, rests on the shoulders of each and every paediatrician to have the heart and mind to respond sensitively to the special circumstances and belief of Maori. This surely is what is meant by cultural competency.

Arohanui ki a Koutou

Ko Te Ati Awa me Taranaki, me Ngati Ruanui nga iwi.


  1. *In 1956, two-thirds of Maori lived in rural areas.