Māori health centres ‗on the personal and the collective…the relationships between the [people] and the environment both physical and spiritual‘ (Cunningham, 1998, p. 396)
Māori health has gone from one of the best in the world to one of the worst (Mikaere & Milroy, 1998). To a large degree this has been the result of colonisation and the implementation of hegemonic legislation and policies (Awatere, 1984; Bishop, 1994; Tuhiwai-Smith, 1999). Early colonial legislation and policies sought to acquire land and in the process assimilate Māori into the cultural norms of the Pākehā and in the process Māori tino rangatiratanga was marginalised. A consequence of the
marginalisation of Māori tino rangatiratanga is the poor health status for Māori (Dow, 1999; Durie, 1994c).
Chapter Five reviews Māori health practises in an endeavour to frame Māori health for the purposes of this study. Following this, discursive interactions between colonial health legislation and policies and Māori health are discussed showing the effect of colonial health legislation and policies in the colonisation process.
Contemporary relationships between health legislation and policies and Māori health revitalisation are discussed, and the development of health services as they relate to Māori is highlighted.
Māori health
Traditional Māori health discourses were about maintaining a holistic balance between the spiritual and psychic worlds, the political world, the environment (the land, the sea, the bush, the birds, the fishes), the people (whānau, hāpu and iwi), the person‘s position in Māori society (ariki rangatira, rangatira), tuakana/teina
77 living (Cunningham, 1998; Davis & Ashton, 2001; Dow, 1999; Durie, 1994c; Durie, 1999; Durie, 2001; Durie, 1997c). As mentioned earlier Māori believed we came from the gods and would return to the gods. Therefore, our mental, emotional, and physical health were intricately linked to the spiritual world (Durie, 1998b; Hiroa, 1958; Pere, 1991). Spiritual practises were integrated into the very existence of Māori well-being. Included in the spiritual practises of the Māori were our connections to our ancestors (Pere, 1991). Closely associated with the spiritual aspect of Māori health was mauri. Mauri is difficult to define but it is often referred to as the breath of life or life force. All living things had mauri. Without this they would die.
Another aspect of Māori health discourses was politics, Māori politics which were as important in the past as they are today. Traditional Māori politics were determined by the tikanga of the iwi. Decisions concerning whānau, hapū and iwi were made at hui, and kanohi ki te kanohi (Durie, 1998a; Pere, 1991). Included in the politics of Māori health were Māori economic and domestic affairs (Durie, 1998a; 1998b; 1999; Pool, 1991). The land, sea and human resources provided an economic base, which enabled Māori to barter for goods inter-iwi and internationally.
Environmental issues have always been important to Māori as a healthy environment meant a healthy whānau, hapū and iwi. Māori had whakapāpa connections to the land. Papatūānuku was considered the earth mother and represented a source of food and income. Within traditional Māori society whakapāpa linkages to particular iwi boundaries determined land ownership. Being able to establish whakapāpa linkages to a particular piece of land determined a person‘s tūrangawaewae (place to stand), which in turn related to issues of identity and hinengaro (mental health) (Durie, 1998a; 1998b; Hiroa, 1958; Lange, 1999; Pere, 1991; Pool, 1991). Links to iwi land gave Māori particular kaitiaki responsibilities. It was the responsibility of iwi to make sure the land was looked after for future generations (Durie, 1998a; 1998b; Hiroa, 1958; Pere, 1991). Māori links to the land on a more personal level were about rejoicing and enjoying working with and on the land (Pere, 1991). Māori had similar beliefs and responsibilities with regard to the moana in that the moana was to be respected as a source of food and cared for. Customary rituals were practised to
78 ensure the seabed was not over-exploited and would provide food for generations to come.
Another traditional health discourse was mana tangata or the importance of Māori people (Durie, 1994c; Durie, 1997c; Pere, 1991). Mana tangata was about people‘s position in the whānau, hapū and iwi, their roles and responsibilities as whānau, hapū and iwi members, their relationship to themselves and to the world. It was also about their spiritual, mental, emotional, and physical health.
A key cultural practise was taonga tuku iho which, refers to the ‗highly prized practises and beliefs of our forbears, our ancestors‘ (Pere, 1991:28). One such practise was te reo which was important because it is through te reo that cultural nuances are passed down and that cultural norms learnt. Cultural norms and nuances are critical to the self-esteem of Māori and therefore their hinengaro. Māori society was an oral society. Hence, customary practises and whakapāpa linkages were passed on through te reo. Māori spiritual practises were integral to healing. Karakia was used in treating illness, particularly with respect to illnesses that had no known causes (Hiroa, 1952). Māori societal structures provided social support and created order in people‘s lives. Other healing practises included rongoā, and mirimiri.
Integral to the maintenance of the balance between mana wairua, the political, the environment and mana tangata were the cultural beliefs of tapu and noa. Within the health context tapu ensured whānau, hapū and iwi remained healthy. For example, within the pa, certain areas were kept for toileting purposes and other areas for food scraps (Durie, 1998b; Lange, 1999; Newell, 1954; Pere, 1991; Pool, 1991). Another example was during childbirth and for a time following, women and children were kept separate from others. This was partly to ensure mother and child were protected from disease during a vulnerable time but also to provide a time for mothering and without other demands being expected.
79 Existing alongside tapu was noa. In the health context, when the rules and regulations of tapu were removed the thing or behaviour became noa. This meant whānau, hapū and iwi were able to access things or practise behaviours which had previously been prevented. For example, in some cases when food was scarce a tapu was put on it to prevent people from gathering it until it was bountiful again. When it was in
abundance the tapu was removed and people were again allowed to access it (Durie, 1998b; Hiroa, 1958; Lange, 1999; Newell, 1954; Pere, 1991; Pool, 1991). With the arrival of the Pākehā, the ability to practise Māori healing began to change.