Though they are the

largest indigenous minority group of

New Zealanders, the Maori population
share a rich culture and impeccable
heritage that leaves everyone in sheer
awe. Time has not always been a friend
of the Maori, and there is inequity on
various levels. Nevertheless , as a
famous local saying says,
Turn to the sun, and let the
shadows fall behind you !
the Maori have always been fearless
and faced the problems head on,
smiling.
In a world today, we have indeed
accepted our indigenous people into our
societies. But have we accepted them
into our hearts ? Despite legal
enforcements and numerous
government policies, hidden inequities
still persist. Mere granting of 4g in the
Maori neighbourhoods (McNeill, Canny
et al. 2016) and admiring their sporting
capabilities is furtive mockery. We need
embrace their culture and understand
the health dynamics in order to address
the causes of increasing morbidity, lower
life expectancy and higher incarceration
rates of the Maori population.

The Moari Greeting. Source: (Rebecca P 2013)

Historians believe that

the Maori people share their roots of
origin with Polynesia and the Americas.
They travelled via the South Pacific and
finally reached Aotearoa (New Zealand)
around 950 1130 AD. Their voyages
constituted the long canoes called The
Great Fleet. Although scholars do
believe it to be a myth that has been
passed from generation to generation,
there is not much historical evidence to
prove otherwise.
The name "Mori,
means the local people. It is also the
name of the language spoken by the
people and was officially recognized in
1987 by the Parliament of New Zealand.
The term Pakeha, refers to the
European settlers that arrived in 1815.

Maori Canoe
Source: (Engineering 2015)

According to the
National statistical data, as of 2013,
there were 682,200 Maori people which
roughly constitutes about 15.4 % of the
total New Zealand population. The
median age of the males is 22 and the
females is 24 years. Whereas it is 35.7
and 38.2 in respectively in the remaining
New Zealand population.
It is not just the median age that is
alarming. According to data from 201012, the Mori life expectancy at birth
was 72.8 years for males and 76.5 years
for females. This is comparable with 80.2
years for non-Mori males and 83.7
years for non-Mori females. One could
argue that the rates have steadily
improved over the past 10 years,
however there is no significant change in
the morbidity rates. Over the last 7-10
years, the Maori have significantly
urbanized and are wide spread along
Auckland, Waikato and Northland.

In the 1800s after the

arrival of the Europeans, trade was
widespread along the North Eastern coast of
the islands. Initially, most of the trade took
place between the Maori and the newly
established state of New South Wales. The
trading goods constituted natural resources
like timber and flax in return for pigs,
potatoes and seeds. However, as there was
no supervising body, disputes and violence
became more widespread. When major
voyages like the Venus and the Boyd were
destroyed, it was believed by the British that
the crew members were killed and eaten by
the Maori. This alleged barbaric reputation,
caused much dismay in the trading world.
The British tried to introduce spirituality into
the Maori by sending preachers with the
motto of peace and tranquility. However,
the Maori were more interested in the
commercial aspect of the deal.
The Maori learnt the art of farming and use
of blankets to substitute traditional clothing.
In the 1830s ,whaling began to gain
importance and the extracted oil and bones
were exported to Sydney & England. This
was a time when about a 1000 ships visited
New Zealand every year. Slowly, natural
resources, lands and fisheries were being
exploited by the settlers. Traders also
included sailors, escaped convicts and
adventurous. Violence was on the rise and
insecurities grew even more when a few
French ships were spotted at the Bay of
Islands.
Keeping these concerns in mind, on the 6th
of February 1840, a treaty was signed
between 35 Maori chiefs and a settled
British resident, Sir James Busby, who
promised them partnership and protection.
The translated form of the document is still
considered to be biased and unfair.
Primarily, because the chiefs gave up
sovereignty of the land to the British empire
in understanding that they received equal
rights in establishment of a directorate.

The Treaty of Waitangi .Source :(New Zealand Archives

2014)

The Maori have always

given special importance to literacy and
education since generations. From
sculptures to tattoos, the art always
defined teachings and traits.
According to Dr.Ngahuia Te Awekotuko,
a Professor of Psychology at Waikato
University, the Maori tattoos describe,
Who we are, where we come from,
and where we are going
Despite the high level of importance
given to literacy, the overall education
rates in the Maori population are
considerably low. A mere 12.3 percent
of Mori women and 7.4 percent of
Mori men have reported to hold a
Bachelors degree or a diploma
qualification, and a staggering 33
percent hold no qualification at all,
according to the 2013 census.
Furthermore, 52 percent of the men and
35 percent of the women over the age of
15 were employed. But, the
unemployment rate has risen from 11
percent in 2006 to 15.6 percent in 2013.
Is this a result of lack of opportunity or
lack of equity, requires more study.

Tattos describe the Maori

Source: (Joy 2014)

We need to acknowledge that education

is a key building block in determining the
socio-economic and environmental
situation of a person. These factors
further influence the health status of an
individual.

The problem does not

halt there. A fall in employment rates and
increased suicidal tendencies, denote an
unaddressed element of mental trauma.
The families being joint and larger, have
increased cases of domestic violence.
Alcohol and drug intoxication, rising crime
rates, and unease in society has been
observed. When compared to the rest of
the New Zealand population, the
incarceration rates of the Maori are
significantly high. A few theorists believe
this is due to a Warrior gene hypothesis,
a defective Monoamine Oxidase gene
expression. However, labeling groups as
genetically impaired is immoral, racist and
should be promptly disregarded.
Since the 1900s, the Pakeha, (European
settlers) have not been completely
legitimate in aspects of governance. Trade
did exist between the groups consisting
agriculture and tobacco products which
later on became a cause of depreciation
of health in the Maori.
Treaties were broken and remade
constantly. Most parts of the land were
confiscated by the Pakeha in this process.
One could argue that, had the Maori been
more educated and aware of the
consequences of trade at that time,
perhaps there would have been a better
today.

Depression. Source: (The Times 2009)

The algorithm begins with

the lack of education and unemployment.
With more stomachs to feed per family, a
depressed mind often seeks the transient
pleasure of intoxicants and drifts further
from the reality of depreciating health.
Consequent rage, crime and domestic
violence have contributed to the increased
levels of incarceration among the Maori.
One observes inequalities across high level
indicators ranging from life expectancy to
infant mortality. Cardiovascular disease,
cancer and asthma are ailments expressed
downstream as a result of these inequities.
The government has provided funding only
for oral health of the children and primary
health care. However, as per a study
(Jansen and Smith 2006), the fact that the
Maori are less likely to be involved in
treatment where partial or complete out of
pocket expense is required, denotes the
presence of a burden.
In order to address a burden and propose
reforms that induce recovery and augment
the health status of a population, we need
to focus at levels that need attention. This
article will take a look at the following
determinants of health in the Maori,
evaluate the current trends, and propose
reforms that augment their health status.
Areas of focus :

Maori women
Source: (Nelson 2012)

Early life influences

Socio-economic status
Housing
Gender
Racism

Danny brown grown uphttps://www.youtube.com/watch?v=NHf

WY0is3rE
Danny Brown, a quarter Filipino born to
teenage parents in Detroit, America
(Ahmed, 2012). The start of Remember
when my first meal was school lunch; All
we ate for dinner was Captain Crunch
this highlights struggles that are faced by
young children from low socio-economic
backgrounds in trying to obtain equitable
education, when they have no breakfast
and a nutritionally poor dinner.
Danny Brown also comments on the
teachers in Teacher always ask me, what
was I doing; Scribbled in my notebook and
never did homework; Low attention span.
Guess these Adderall work these lines
comment that while the school did
provide lunch, when he wasnt paying
attention, they resorted to tertiary
treatment in prescribing Adderall rather
than focus on the issues of nutrition.
Whilst Danny Brown should be
commended on his use of rap to increase
his socio-economic standing, the
accumulation of risks and looking at the
effects of childhood social class by
identifying specific aspects of the early
physical or psychosocial environment
(such as exposure to air pollution or
family conflict) or possible mechanisms
(such as nutrition, infection or stress) that
are associated with disease over an
individuals life course.

Child welcoming father home from jail.

Source: (Waititi 2010)

Children are largely dependent on others

and are sometimes vulnerable; they are
continually learning and developing the
skills to make responsible decisions in terms
of looking after themselves and their
community. These children are citizens in
their own rights and need to be given
proper unbiased representation.
It is becoming increasingly evident that
maternal health and wellbeing during
pregnancy and even before conception can
affect fetal health. Early life influences
later-life health through social trajectories,
such
as
educational
opportunities,
socioeconomic and health circumstances.
Adverse childhood circumstances are
shown through lower birth weights, poor
diet, infections and passive smoking.
New Zealand has one of the highest levels
of inequality in educational outcomes of all
OECD countries (OECD Publishing 2010).

Ana Rupene with child

Source: (Rupene 2014)

In 2012 the New Zealand government

announced its slogan for address this issue
as Every Child Thrives, Belongs, Achieves
in a paper for vulnerable children and
includes a 10 year plan (Childrens Action
Plan 2016). This report addresses this Mori
health inequality of that prevent children
from thriving and belonging by critically
analyzing health care access, food insecurity
and home/cultural environments. Mori are
overrepresented in New Zealands child
poverty statistics. It is evident that there is a
need to address this as a source of
inequality, with one in three Mori children
living in poverty. According the Sustainable
Development Goals (SDGs), early life
influences relates directly to goals 3
healthy lives and well-being for all at all
ages, 4 inclusive and equitable quality of
education and promote lifelong learning
(WHO 2015). 28% New Zealand kids are
living in poverty (Statistics New Zealand,
2015).

Figure C1 Life course history with early-life stages highlighted in (beige), middle life (green) and later life (blue)

Children in poverty are living in cold, damp, over-crowded houses, they do not have warm or
rain-proof clothing, their shoes are worn, and many days they go hungry. Poverty can also
cause lasting damage. It can mean doing badly at school, not getting a good job, having poor
health and falling into a life of crime. Short term impacts are lesser health outcomes, social
exclusion and live with life-time scars, with reduced employment prospects, lower earnings,
poorer health and higher rates of criminal offending.
Early life influences are defined as the time from conception to early childhood at 12 years old
when children complete primary school (Figure C1). There are many significant life events
during this time, ranging from essential literacy, numeracy and motor skill development to
general growth from a foetus to the start of puberty. In 2015, 1 in 3 Mori are under 15 years
of age and only 1 in 17 are over 65; comparatively 1 in 6 non-Mori are aged under 15 and 1
in 6 are over 65 (Statistics New Zealand, 2015). This highlights the disparity between Mori
and non-Mori populations and the potential impacts poor early-life experiences have on later
life. A critical development stage is when children are under 5 as it sets the basis for health
behaviors that children will carry throughout their life course.
At the individual level, education can make a huge difference. For example, an educated girl is
likely to increase her personal earnings potential, be more likely to delay marriage and
pregnancy and be more likely to access health support, leading to lower rates of maternal
mortality (DFID 2012). Additionally, this will increase outcomes for future generations with
approximately 50% worldwide reduction in child mortality is due to increased education of
women at reproductive age (Gakidou., Cowling, Lozano & Murray 2010).
This report will focus on solutions that take a whole-child approach to improve equality
between Mori and non-Mori populations. Three SDoH identified that can be improved to
reduce health inequalities are addressed, being the perinatal period (three weeks pre- and
post-birth), lack of immunization, and poor nutrition.

In New Zealand, neonatal mortality rates are

40 percent higher in Mori than the
European populations (Simpson, 2016). The
greatest cause of infant mortality in Mori
populations is Sudden Unexplained Death in
Infancy, with Mori populations having 5.74
times higher than Pkeha populations (Craig
E, 2012). The potential causes of this have
been identified as more than half of
pregnant Mori women smoking during
pregnancy, potentially unsafe objects in the
crib and bed sharing (Tipene-Leach,
Hutchison, Tangiora, et al. 2010).
Tobacco smoking during pregnancy has been
linked to the following adverse health effects
in child birth; miscarriages, low birthweights, placental abruption and birth
defects (Flenady, Koopmans, Middleton, et
al. 2011). The rates of pregnant women
smoking are declining but there is still a
significant disparity between Mori (43%)
and non-Mori (14%) populations (Flenady
et al. 2011). One positive is that most Mori
women will cease smoking after being
discharged from hospital, showing that they
are want to do what is best for their child.
However, these women return to homes and
social settings with smokers and often start
smoking again (Dixon, Aimer, Fletcher, et al.
2009). Having children in environments with
high levels of smoking also has been
estimated to contribute to 15, 000 episodes
of Asthma and over 27, 000 consultations for
respiratory problem annually (Woodward &
Laugesen 2001). As such this indicates that
involving the Whnau, Mori political
units/elders, in reducing rates of smoking
throughout the community.

Pregnant Maori woman. Source :(Shutter Stock Inc.

2016)

To show the importance of immunization the

Depart of health and Aging Australia
estimates that if in a childcare center,
including schools, of 500 children that had
not been immunized for the Measles,
Mumps, Rubella (MMR) Vaccine the
following would occur; (Department of
Health and Ageing Publications, 2012).

Almost every child would get measles

20 children with pneumonia
25% of at least 1 child developing
inflammation of the brain (Encephalitis)
Comparatively, if every child was vaccinated
with MMR the vaccine will cause 1 case
every 2000 years. This is great that
departments are being transparent but facts
like this are often changed by the anti-vaxer
movement to just Vaccines causes
encephalitis or the famous vaccines cause
autism and contain poisonous mercury.
Such statements as these are incredibly
damaging to population approach provided
in using vaccines and require further
education or upstream policies to enforce
immunization. This could be through access
to subsidized healthcare, children must be
vaccinated; this approach is often met with
comments of nanny-states interfering in
home life.

Traditional Maori Children

Source: (Navigate plus 2013)

Figure C2. Immunisation coverage by Milestone Age and Ethnicity. (source (Simpson, 2016))

Immunization rates between infant Mori and non-Mori populations are generally lower
particularly at the key age of 6 months (fig. C2). At six months the conferred mothers
immunity becomes less effective if breastfeeding is stopped. Breastfeeding in Mori culture is
socially important and is considered a treasure or taonga and family support is strong with
about 80% breastfeeding rates until 6 months (Unicef NZ 2015). New Zealand Health that
breastfeeding continues until at least one year when a followed immunization program will
provide protection for infants.
The increase in immunization rates after six months are likely due Health (Immunisation)
Regulations 1995 this requires early childhood services to keep a record and for them to
contact their doctor and inform them of free immunizations for under two year old. This free
immunization program should be extended for all ages for crucial immunizations such as
MMR. This regulation does not provide the power for exclusion of non-immunized children
and as such these children can harbor and allow the proliferation of mutant.

Doctor weighing Neonates. Source :

(New Zealand Archives 2014)

Food insecurity is a global issue and is identified as Goal 2 (Zero Hunger) of the Sustainable
development goals (UN 2015). As New Zealand is an affluent nation and welfare support is available,
food security is often considered to not be a significant problem (Else 2000). Behavioral and cognitive
research has shown the need for children to have adequate nutrition. The issue of whether this
responsibility is the governments or parents debated vehemently; often polarizing people.
Current policy aims to educate children on healthy food choices, reduce access to poor nutrition
foods in school tuck-shops, such as pies and soft drink, and ensuring children take all uneaten food
home so parents can see what is being eaten (Breakfast, 2016). Yet, the quality and type of food in
low socio-economic families are often nutritional poor, being high in salt and sugar with low amounts
of fresh produce. It is evident that there is a need to address this as a source of inequality, with one
in three Mori children living in poverty and only one-in-ten lunchboxes meeting nutritional
standards (Craig et al. 2013). As more onuses are on parents, the more likely the perpetuation of
inequality and intergenerational poverty. This section will analyze the potential changes that could be
adapted at the institutional level.
In combating the nutritional inequalities of Mori children will also address other races, which are
likely to have the same problems and attending the same low decile schools. Currently, the kick start
breakfast program exists that are sponsored by milk and cereal companies, Fonterra and Sanitarium,
in conjunction with the government to all schools (Kickstart Breakfast 2016). Whilst, it is great that all
schools are receiving funding for breakfast the usefulness of this in the schools above the 6th decile is
somewhat limited and it currently has a waiting list. With the limited funding that is available, a
greater result is likely to be achieved if the populations that are at risk are targeted.

Maori children. Source :(Navigate plus 2013)

This pragmatic approach does not adequately meet the needs of the lower decile schools and may
exasperate obesity problems associated with the developed world. Presently, 74% of lower decile
schools (1-4) are providing sandwiches or a light cooked meal for lunch at least sometimes (Carne
and Mancini 2012). This shows that the schools are willing and the demand is there for this project
but the current methods incorrectly address the issues by providing free breakfasts to all schools. A
population approach is ideal; however, it is important to define what the population is rather than
simply all schools as parents in higher socio-economic schools may choose not to provide a lunch
where they normally would. A more ideal approach is to assist 1-4 decile schools. Approaching this
problem on a whole-school basis prevents stigmatism from other students and those requiring
assistance are more likely to use the service if it does not highlight who are the haves and the
have nots. Parents will not feel shame that they are not able to provide for their children. If parents
feel embarrassed they may keep their child home to avoid scrutiny, further exasperating
intergenerational inequalities. Parents in low decile schools that are able to provide lunch for their
child(ren) will also benefit from this program as they are likely to be poorer and the program will
allow them to allocate funds elsewhere, resulting in reduced stress and improved well-being.

The health inequalities that arise in childhood

can cause life-long damage to the ability for
people to achieve their fullest potential. This
damage is largely financially driven and the
burden of this health inequality suggests
future widening in the gap as the capacity for
primary health care is not matching the needs
of Mori populations, particularly those from
a low socio-economic background. It is evident
that while the obvious answer to solving these
problems is to reduce out of pocket expenses
it does not fully acknowledge the Treaty of
Waitangi which requires consultation with
Mori Whnau.
The major challenges in implementing the
strategies outlined in this report are in dealing
with the ideological viewpoint that
governments should not be interfering in
home life. This could be the government
forcing people to help vaccinations,
controlling what will be eaten. However, the
government has an international obligation to
all New Zealand children through the Treaty of
Waitangi 1840. Governments should move
quickly to reprioritize investment towards
achieving best practice in the areas of:
reproductive
health;
prenatal,
natal,
postnatal, and whole-of-life nutrition;
maternity and postnatal care; and health,
early childhood education and social service
interventions for the first three years of life,
with a focus on the vulnerable, particularly
indigenous Mori and Pasifika children.
Incorporating Whnau into decision making
with likely increase the use of native Mori
language into the school curriculum and the
best methods of causing a cultural change in
how Mori individuals will assist those at risk,
particularly pregnant women and children in
achieving the best health outcomes. The result
would be more culturally specific shared
understandings of acceptable behavior, rather
than the universal program design by the
government.

Maori Children riding a horse

Source: (Voninski 2006)

How well and how long one lives one's life is

powerfully shaped by one's place in the
hierarchies built around occupation,
education and income. (Carroll, Casswell,
Huakau, Howden-Chapman, & Perry, 2011)
Living standards for Mori were significantly
lower on average than for the total
population (2004). The proportion of Mori
experiencing severe hardship was 17% and
40% of Mori families were living in hardship
(compared to 19% of European settlers)
measured by the Ministry of Social
Development (2004) with the Economic
Living Standard Index (ELSI). (Bridget
Robson, Cormack, & Cram, 2000)
Socio-economic factors can influence health
status either directly or indirectly (via midstream factors). They can also impact an
individuals use of health care services. Social
status in Mori is also determined to certain
extent by facial tattooing which signifies
ones position in social structure.

Traditional Maori clothing:

Source : (Ernest Chen 2010)

Education has several positive outcomes:

chances of greater employment, higher
productivity, higher income, economic growth
and better health and standard of living. It also
enhances ones sense of self-worth, security
and belonging. School leavers of Mori are less
likely to obtain any formal qualifications and
more likely to not have gained university
entrance qualifications than the general
schooling population. Less consequences for
their future employment and income, and
consequently health. (parliamentary library,
2000)
In 2005, Mori secondary school students (13%)
were more than twice as likely as non-Mori
students (5%) to be granted an early-leaving
exemption, three times more likely to be
suspended from school, and twice as likely to
quit school by age 16. (Robson, Cormack, &
Cram, 2000)

Employment, the prime source of income

has additional benefits such as it enhances
involvement within the
community,
furnishes chances for social contact and
provides a sense of self-worth. It has a huge
impact on an individuals entire health
status. More Mori are unemployed than
non-Mori and are more likely to endure
poor health. Statistics show 12.9% Mori
were unemployed as compared to 4.9%
European settlers in 2013.
Relatively younger Mori population with
lower educational achievements and lack of
skills have exposed them to poor economic
conditions. Mori who are unemployed have
the poorest health literacy of all groups.
(Statistics New Zealand, 2015)
Mori are more likely to be employed as
plant and machine operators and
assemblers, construction workers or
elementary service workers contrarily nonMori are more likely to be employed as
legislators,
administrators,
managers,
professionals, or agriculture and fishery
workers. (Population Health & Board, 2012)
Income has large scale influence on an
individuals ability to make healthy lifestyle
choices which in turn are crucial for
protection, maintenance and promotion of
good health. Using the measure of less than
60 per cent of the median income, 23
percent of Mori while 11 percent of
European/ people had household incomes
below this threshold (Perry, 2013b:124). The
median weekly income of Mori in 2013 was
$486 9.72 while European income was
$620 12.4. (Marriott & Sim, 2015)

Traditional Carving
Source :(Dreamstime 2010)

Mori are more likely to engross in smoking

(consequent to low socioeconomic status and
populations with greater levels of deprivation)
when compared to other groups. In 2008, 45%
of Mori (15 years and older) were regular
smokers compared to only 21% of New
Zealanders of European origin. (Glover, Nosa,
Watson, & Paynter, 2010)

Tobacco smoking is a principal cause of

preventable
death
for
Mori
with
approximately 800 Mori dying annually of
various smoking-related diseases and is
responsible for around 10 percent of the gap in
health disparities between Mori and nonMori. (ASH, 2013)
Young Mori (lower socio-economic class) with
negative social behaviors, smoking and drug
abuse tend to attempt for deliberate self-harm.
(C. Wilson, 1999) . Mori were more likely to be
hospitalized for intentional self-harm than nonMori. With the rates being twice for Mori
females as compared to Mori males. Young
Mori had the highest number of
hospitalizations. (Ministry of Health Manat
Hauora, 2015)
The socio-economic status influences psychosocial aspect of Mori which attributes to the
lack of good coping skills and problem-solving
behaviors, positive beliefs and values, feelings
of self-esteem and belonging, hostility,
attachments to family, networks at school and
at work, secure identity and family and social
support. (Council, 2004)

Teenage Somking
Source : (Devil 2005)

Diet is a key contributor to good health and wellbeing. Majority of Mori (low incomes and living in higher
levels of deprivation) often consume readily available low cost food with poor nutritional value at a greater
rate which places them at higher risk from poor nutrition. (Population Health & Board, 2012)
Obesity and obesity-related illnesses are associated with socio-economic position, with the highest rates
among the Mori (apart from the genetic issue). It includes the perception that healthy foods are more
expensive. Mori when compared to non-Mori (accounting gender and age groups) had higher mortality
rates for cardio-vascular disease. The prevalence of diabetes (as well as undiagnosed diabetes) is
significantly higher in Mori than the general population. The age standardized rate ratios in the NZHS
2007 showed were 1.74 and 1.61 for Mori men and women respectively, compared with just 0.76 and
0.82 in European men and women (1 equals the national average). (McIntosh & Mulholland, 2011)
Mori males exhibit a direct relationship between Body Mass Index and SEP (however measured) which
means that higher SEP Mori males tend to be heavier than their counterparts. However, Mori females
exhibit an inverse relationship in this context. The years of life lost due to a higher than optimal body mass
index are 21-24% in the Mori while 11% in the non- Mori people. (N. Wilson, Blakely, Foster, Hadorn, &
Vos, 2012)

Moari Feast
Source : (Loh 2013)

Table S2- Proportion of people who currently smoke tobacco 15 years and older, by ethnic group and sex,
2014/15. Adapted from Ministry of Health, Statistics New Zealand (Statistics New Zealand, 2016)

Table S3- proportion of population, 15 years and over, who are obese by ethnic group and sex, 2014/15.
Adapted from Ministry of Health, Statistics New Zealand (New Zealand Government, 2015)

Males
BMI
35

Mori
Non-Mori

30

25

20

150
Educ 1

Educ 2

Educ 3

Inc 1

Inc 2

Inc 3

Dep 1

Dep 2

Dep 3

Population group

Females
BMI
35

Mori
Non-Mori

30

25

20

150
Educ 1

Educ 2

Educ 3

Inc 1

Inc 2

Inc 3

Dep 1

Dep 2

Dep 3

Population group

Table S9- Median of BMI distributions by socioeconomic category, gender and ethnicity, New Zealand
2002/03. Rates are age standardized within the range 1574 years. Adapted from (Martin Tobias, 2006)

Socio-economic status has significant influence

on Mori mental health. Significant relationship
was evident between living in higher
deprivation areas and experiencing higher
levels of psychological distress in the research
by NZMHS 2004 and NZHS 2007. (Krynen,
Osborne, Duck, Houkamau, & Sibley, 2013)
Loss of land, separation from mother earth and
fast urbanization lead to loss of income and
livelihood and also has severe psychological
impact on the Mori. (Durie, 1997)
Mori have high exposure to psychological
distress and limited range of coping strategies
due to the lack of social and economic
resources.
The male Mori suicide rate is higher with a
rate of 23.9 suicides per 100,000 of population
compared to 15.4 suicides per 100,000 of
population in 2010 for non-Mori males.
Female Mori suicide rate being 8.8 suicides per
100,000 of population compared to 5.7 suicides
per 100,000 of population non-Mori females.
(Marriott & Sim, 2015)
Mori experience of high social disadvantage,
social alienation and loss of identity account to
the higher suicide rates. (Hirini & Collings, 2005)

Suicidal thoughts
Source: (Kobayashi 2011)

Table S4- Intentional self-harm indicators, by age group and gender, Mori and non-Mori, 201214.
Adapted from Ministry of Health- New Zealand Government

Table S5- proportions of people with high levels of psychological distress by ethnic group and sex
2013-14. Adapted from Ministry of Health, Statistics New Zealand (Statistics New Zealand, 2014)

Mori are more likely to consume alcohol

ascribing to their lower socio-economic
status and combine it with other risk
behaviors (such as driving, operating
machinery, or using tobacco or other drugs),
to experience harmful effects of drinking
(such as injuries, assault, poorer
relationships or financial situation). Evidence
that under similar socio-economic
conditions, Mori are no more likely to
engage in excessive alcohol use than nonMori. (Marie, Fergusson, & Boden, 2012)
Problem gambling is an important risk to
Mori health. Ethnicity, deprivation and
access contribute to gambling harm. Mori
are more likely to live in deprived areas and
nearly half of Non-Casino Gaming Machines
(NCGMs) are found in such areas, there is a
greater risk of exposure to NCGMs for
Mori. The 2006-07 NZ Health Survey found
that 7% of Mori had experienced problems
with gambling (compared with 2.2% of
Europeans). (Population Health & Board,
2012)

Easy access to gambling:

Source:(Martin Young 2013)

Mori life expectancy at birth is about 8.2

years lower than for non-Mori. Mori in
high socio-economic groups have worse life
expectancy than non-Mori in low socioeconomic groups. (Statistics New Zealand,
2008), (Don Matheson, 2008)
The age-sex-standardized all-cause mortality
rate for Mori was twice that of non-Mori
(434 per 100,000 and 213 per 100,000
respectively). Mori males had the highest
mortality rates overall and within each age
group. Mori females had higher rates of
death than non-Mori males overall and in
most age groups (apart from 1524 years).
Mortality rates increased in Mori with
increasing area of socioeconomic deprivation
(Mori living in most deprived areas) and,
therefore at higher risk of death overall
compared to non-Mori. (Bridget Robson,
2005)

Maori families
Source : (Shutter Stock Inc. 2016)

Percentage
35
M ori

Non-M ori

30

25

20

15

10

0
04

59

10 141519202425293034353940444549505455596064656970747579808485 and
over

Table S7- Age-distribution of Mori and non-Mori deaths during 20002004. Adapted from Hauora:
Mori Standards of Health 4th edition, page 36 (Bridget Robson, 2005)

Table S8- Life expectancy at birth, by aggregated NZDep96 deprivation decile, for the Mori, Pacific and
European ethnic groups. Population-weighted midpoints of aggregated NZDep96 deciles differ for each ethnic
group. Adapted from (Tobias & Cheung, 2003)

Data regarding vehicle ownership is limited.

However, Mori have lesser access to public
transport and more difficulty attending
health services for both treatment and
prevention. Access to safe, accessible and
affordable transport is critical to Mori
wellbeing and development. (Public Health
Association of New Zealand, 2015)
Financial barriers are more likely to impact
on Mori due to the lower socioeconomic of
many Mori compared with non-Mori. (P
Jansen, Bacal, & Crengle, 2008)
Mori are more likely to work in unsafe
working conditions and less likely to have job
control. Higher rates of workplace injury
associated with the manual work is seen
among Mori. Shift works, noise exposure,
job strain and employment in occupations
more susceptible to occupational disease
have increased the degree of work-related
disorders in Mori. The over-representation
of Mori in low skilled occupations and
having low educational qualifications are the
prime factors. (Pearce et al., 2004)

In 2005, approximately 90% of Mori

individuals earned less than $38,000 per
year and they had a statutory tax rate of
19.5%. The 19.5% appropriate proxy tax rate
has not altered since its introduction. With
the changes in individual tax rates (and
previous movements in the tax rates for
individuals), a rate of 19.5% is difficult to
justify from a policy perspective (current
rate being 17.5%). (Inland Revenue Te Tari
Taake, 2010)

Less access to transport in Rural Sectors

Source: (Steinmetz 2010)

Table S6- Potentially hazardous drinking, among all adults aged 15 years and over by ethnic group and
sex, 2014/15. Adapted from Ministry of Health, Statistics New Zealand (New Zealand Government,
2016)

The policies made at all levels have an impact on Mori health (access to health care at all layers, infant
and maternal health and so on). Regulation of Mori rights and bigotry against the use of Mori language
in schools and discrimination at all socio-economic levels have impacted the health of Mori. The treaty
was never included in social policy legislation. There was distinct gap between acceptance of the treaty
and conveyance of its aims into actual health gains for Mori. (Ellison-Loschmann & Pearce, 2006)

Initiatives such as smoking cessation programs, removing GST from healthy food (promotes increased
consumption of healthy food), reinforced measures to reduce hazardous consumption of alcohol, restrict
excessive gambling and a society free from illicit drugs. (New Zealand College of Public Health Medicine,
2015)
Resource deprivation in the Mori society be made as small as achievable, over-representing of Mori in
the most deprived and low social-economic areas be terminated and the effects of exposure to chronic
stress be tackled effectively. (Tawhai & Gray-Sharp, 2011)
With the involvement of stakeholders such as policy advisors and decision-makers, (especially the
Ministry of Health, the Minister of Health and Cabinet), funders and providers of health services, (District
Health Boards, hospitals, non-government organizations and primary health care organizations), local
government and especially communities

Table S11- Public Socio-environmental Policy Which Shapes Environments, Personal Behavior, and
Prospects for Health. Adapted from (Caroline Maskill, 1991)

Health equity is the absence of systematic

disparities in health (or in the determinants of
health) between different social groups who
have different levels of underlying social
advantage/disadvantage that is, different
positions in a social hierarchy. (Reid &
Robson, 2000)
The approach should be to obtain equity not
just equality. Effective steps by the
government (sectoral and inter-sectoral
approach) to surface the socio-economic
impact on Mori health outcomes. Active
involvement of people and communities in
resource allocation, decision-making and
governance of health services. Reforms in
policies (economic, welfare, health, transport
and taxation). Equity and emphasis to provide
better opportunities as well as advancements
in education, employment, occupation and
income. Awareness and initiatives to cultivate
health behaviors and also to deal with psychosocial issues. Review and strengthen present
initiatives aimed at reducing health
inequalities. (Mori Economic Development
Panel, 2012), (Ministry of Health, 2002)
Acknowledgement of the Treaty of Waitangi
and orderly enactment of the provisions as
stated through clear planning, policy and
delivery. Anti-discriminative legislation,
community development programs, settingsbased programs, workplace interventions (for
example, Occupational Health and Safety),
local authority policies, health protection,
health education and development of
personal skills. Health funding arrangements,
making use of health impact assessment tools
and frequent monitoring of service delivery.
Reducing barriers (cultural, language) and
improving access to proper high quality health
care and disability services (Mori specific
services). Development of skilled workforce.
Income support and provisions such as
disability allowances, compensation schemes.
(World Health Organization, 2005)

A meeting with the Pakeha

Source: (Massey University 2012)

Place effect The effects of place on

health
Airs, Waters, Places. - Hippocratic Medical
Corpus, 5th Century BCE.
Medical practitioners have been working on
the causes of disease and realized the
association between the health condition
and the places that patients live at. The
issues regarding the place effect arouse
during the 17th century urbanization
gradually become one of the most important
topics in the population heath field
(Macintyre & Ellaway, 2003).
The place effect has been studied
throughout the world, and researchers have
found some clear associations between
housing factors and health. However, argues
remains that whether the place effect is
merely a mark of result under multiple socioeconomic health determents factors, or it
has its own influence on the general
household health. Nowadays, there are
many studies confirmed the place effect is
one of the causation of household health
and the place effect can be both directly
influence the physical aspect of health
(Barker, 1990; Cubbin, Hadden, & Winkleby,
2000)
and
indirectly
on
the
psychological/social wellbeing(Evans, Wells,
& Moch, 2003).

Maori Symbols
Source: (Shutter Stock Inc. 2016)

The universal recognition on the place

effect offers some fundamental ground for
looking into a particular group of population.
However, rather than there being one
single, universal area effect on health there
appear to be some area effects on some
health outcomes, in some population
groups,
and
in
some
types
of
areas.(Macintyre, Ellaway, & Cummins,
2002) Macintyre described the place effect
in such a way to express its nature of
complication.

It is almost impossible to provide a universal

place effect rule and it requires highly
specific information on the group to explain
how the place effects have influence on the
groups health. Therefore, it demands great
focus on a particular group to have an
overview on the particular issue without
applying wrong experiences, and ultimately
produce a potential solution to the problem.
The huge gap of health between Maori
population and Caucasian population are
caused by varies factors including early
childhood influence, gender, instrumental
racism, housing issues, and in general Socioeconomic status. In this report, we are going
to have a close look at the place effect on
Maori population in New Zealand, examine
the causation of the huge gap of health
between Maori households and Caucasian
households caused by the different housing
issues, and trying to explore the potential
remedies to close the gap. The place effect
is an enormous topic and has its influence on
almost all aspects of life. It also interacts with
other health factors.
For example, the housing effects on parental
behaviors have deep influence on early
childhood mental and physical development.
Therefore, it is hard to cover all aspects of the
place effect in this report. As a result, only
few selected aspects, which with good
indication of the gap between Maori and
Caucasian households including overcrowding,
tenure type, home quality and neighborhood
deprivation, are presented in this work. The
place effect influence on health is also
discussed according to Turrells population
health model. (Turrell & Mathers, 2000)

The Kapa Haka Dance

Source :(New Zealand Tourism 2015)

Maori traditional house is called

Wharepuni, which is literally means
sleeping house. Maori families
gathered together and form a Kaniga
(village), with Wharepuni and other
structures like Pataka (storage house),
Kauta (kitchen house) and Wharenui
(meeting house). The old fashioned
Wharepuni is built with local materials
including timber, bark, ferns, earth and
etc. and does not have windows or
internal separation. Wharepunis dont
have windows or glasses until the
western settler introduced these building
elements/materials (Sissons, 2010).

A meeting to discuss about Wharepuni

Source :(Cathedral 1992)

The traditional Maori Wharepuni create

many health concerns which have been
raised back in 1800s, including the health
problems caused by drinking water
safety, lack of sewerage and hygiene
installations, overcrowded space without
separation and ultimately inadequate
house. The government tried to address
the Maori health problem (especially the
diseases introduced by westerners)
caused by housing through introducing
sanitation facilities including tap water
and sewers system in 1880s which
decreased the bacterial infectious
disease rate, and Whare Pakeha which
the order instructed the demolishment
of 1,256 Wharepuni. 2,103 new cottages
were constructed throughout New
Zealand(Lange, 1999). However, the vast
majority of Maori population was still
living in traditional Wharepuni without
ventilation and modern sanitation
installations.

The 1918 influenza epidemic is a

catastrophic event on local Maori population
that made New Zealand government realized
the tremendous gap of health, in which the
Maori death rate was 4.5 times that of
Europeans(Pool, 1973) and led to new
initiatives (e.g. Native Housing Act 1935 etc.)
to improve Maori housing and public health.

Wharepuni .Source :(Cathedral 1992)

The Maori population started migrating

towards city during the period, and by 1926
there were only less than 20% of entire
Maori population. The urban place effect
on Maori population including overcrowding
and home quality started to became an issue
for the Maori household. However, the
problems did not discourage the migration
due to the job opportunities in the cities. The
number tremendously increased during the
post-WWII period and reached 84% in 2013
and one fourth of the urban Maori
population live in Auckland.(P. Meredith,
2015).

Church and Medicine.Source: (Church Libraries 1994)

Overcrowding, Tenure type, Housing

quality, and Neighborhood deprivation
The disadvantaged position of Maori
household, including overcrowding, house
quality, house ownership/affordability, and
neighborhood, makes Maori population
more vulnerable towards, both mental and
physical, health problems through the place
effect on psychosocial factors and health
behaviors, or directly on the health of Maori
population.(Turrell & Mathers, 2000)
Note: The flowcharts only include the
factors discussed in the text.
Flu Clinic.Source :(New Zealand History 2004)

Overcrowding issues. Source : (Teara Govt. 2013)

In 2006, there were 13% of Maori households living in overcrowded accommodations with about
23% of Maori population. And 4% of Maori households are severely crowded. The overall trend of
crowding issue in Maori population indicates a decline; however, the disparity between Maori and
Europeans remains huge. There is almost 6 times more Maori population as Caucasian population
lived in overcrowded accommodations(Flynn, Carne, & Soa-Lafoa'i, 2010). Studies suggest that
both subjective and objective experiences on Household crowding(Gove, Hughes, & Galle, 1983)
has negative impact on life quality and furthermore on the both mental and physical aspect of
health(Gomez-Jacinto & Hombrados-Mendieta, 2002)
Overcrowding can be interpreted as a mental environmental stressors caused by the unsatisfied
need for space. A person living in an overcrowded environment experiences the lack of privacy and
over exposure to other individuals behaviors which together lead to chronic mental concerns,
including frustration, depression and aggression which sometimes leads to violence. Along with the
physiological influence, study also suggests that household crowding influence peoples behavior,
usually in a harmful way. For instance, people tends to adopt social withdraw as a coping strategy
as a respond to chronic crowding. And social withdraw comes with a high price breakdown of
socially supportive relationships and in turn elevate psychological stress.(Evans, Rhee, Forbes,
Allen, & Lepore, 2000) As a result, more health damaging behaviors, including smoking,
alcohol/drug abusing, domestic violence and etc., become more attempting for the people under
crowding stress, and ultimately lead to chronic health issues including high blood pressure, asthma,
arthritis etc.

Overcrowding is also one of the major

factors that influence the spread of
infectious diseases. Factors including lack of
space in the household and highly frequent
interpersonal contact provide ground for
infectious disease, especially airborne and
vector-borne ones. Tuberculosis is an
important bacterial infectious disease in
New Zealand. It spreads through air when
people cough (which is one of the major
symptoms), spit, speak, or sneeze. An
overcrowded house cannot provide enough
space for quarantine. Therefore, if one of
the family members caught TB, he/she will
most likely infect the whole family.
As a result, the CAU level of TB associate
with the crowding level in the household,
and research suggests that the TB incident
can be reduced by reducing the
overcrowding in the households. (Michael
Baker, Das, Venugopal, & Howden-Chapman,
2008).
Another example of bacterial meningitis
spreading among overcrowded households is
Meningococcal disease. It is not as
contagious as common cold but can be
transmitted through saliva and prolonged
general contact with infected person, and it
caused more severe health morbidity than
TB. Research suggests that overcrowding
issue is the major factor of Meningococcal
disease infection and it has highest incident
rate
in
Maori
children
living
Auckland(Michael Baker et al., 2000).

A Child playing with mud near her house

Source :(Maramartanga 2008)

In 2008, 75% of EZ European household owns

their accommodation meanwhile the number
for Maori household is 45%. The house
ownership is under the influences of varies
Social-Economic Status (SES) factors including
employment, income, education and etc. The
difference between two ethic groups on
housing ownership is a result of all the SES
factors. Furthermore, house ownership
influences other housing factors, e.g.
crowding, housing quality and etc., as well. For
example, the household with owner-occupied
housing usually can affords a higher-quality
residential environment than rental
housing(Megbolugbe & Linneman, 1993).
Tenure is a both a marker of household SES
and a factor that influence health. Though
tenure type is only responsible for 5.4% of
clinical health measure variance, it limits the
health agencies for the renters. Renters are
more likely to be exposed to health damage
factors including dump, noise, etc. (which is
linked to housing quality) and less likely to
have health promoting features like gardens
etc. (which is linked to neighborhood
quality)(Macintyre et al., 2003).
As a result, the place effect on the
downstream of population health caused by
different tenure types is hard to define
considering the variety of health
damaging/promoting factors and their
multitude impact on both physical and mental
aspect of health. Therefore, it is only fair to
explain the tenure type influence on clinical
level by general health measurements, e.g. life
expectancy, DAILY and etc.

Maori Dwelling. Source: (New Zealand Tourism 2015)

The housing problems cover cold, dampness, and

need for repair. There are 45% of Maori
household have housing problems mentioned
above, meanwhile the percentage of NZ European
household having problems is only 37%, though
the absolute number is higher. Maori households
are also most likely to have problems relevant to a
need for immediate or extensive repairs on
home.(NZ.Stat, 2016) The house quality is
identified as one of the major impact factors on
health(HowdenChapman, Isaacs, Crane, &
Chapman, 1996).
Home quality has direct link to the physical aspect
of health, as problematic houses can increase
both the chance and severity of home injuries.
The most common cause of home injuries result in
hospitalization is fall, which usually caused by
slips, trips, entrapments, collisions, poor lighting
and poor ergonomics.(Braubach, Jacobs, &
Ormandy, 2011). The home injury can result in
cuts, bruises, broken bones etc. and sometimes
with severe cases can result in paralysis, longterm physical constraints and death, which
contributes to both morbidity and mortality. Kool
identifies Maori population with a significantly
higher portion in hospitalization caused by home
injury in his study(Kool, Chelimo, Robinson, &
Ameratunga, 2011) and the result is largely due to
the poor home quality among the vast majority of
Maori households.

Maori carvings
Source : (Dreamstime 2010)

Lower house quality also provides ground for

respiratory morbidity including airborne
infections and bronchial asthma especially
the houses with dump and mould . Dump is a
significant health risk factor which causes
not only respiratory morbidity but also
tiredness, headache and airborne infections
(Bornehag et al., 2001). Mould is usually
considered as a mark of dump. However, it is
also, most of the time accompanied with
dump condition in the house, leads to both
allergic asthma caused by the fungus, and
non-allergic asthma caused by the mycotoxin
produced by fungus (Zock et al., 2002)

Mould in homes.
Source : (Wn.com 2015)

NZDep 2013 is a set of decile system to

evaluate the deprivation of a neighborhood.
The higher NZDep 2013 score refers to a
greater level of deprivation in the
neighborhood(Atkinson, Salmond, &
Crampton, 2014).
The data indicates a larger total of NonMaori ethnic group living in extreme
deprived neighborhood. However, the
percentage of Maori population living in
extreme deprived neighborhood is larger.
23% of Maori population lives in extreme
deprived neighborhood (NZDep2013: 10),
and 72% in deprived neighborhood
(NZDep2013: 6-10). Meanwhile, the
numbers for non-Maori population are 7%
(in extreme deprived neighborhood) and
44% (in deprived neighborhood).

Neighborhood influence population health

with
4
major
agencies,
including
Neighborhood institutions and resources,
physical
stress,
social
stress
and
neighborhood based interpersonal dynamics.
(Ellen, Mijanovich, & Dillman, 2001). The
four agencies, together, influence on health
related behaviors and mental health are
both long term, with the weathering effect
from accumulated stress, low environmental
quality, limited resources which make the
household in deprived community more
vulnerable, and short term with its influence
on health relevant behaviors, attitudes, and
healthcare utilization.

A problem at large.
Source: (Creating Communities NZ 2012)

Despite their smaller populations, Mori had more

hospital admissions per year attributable to
household crowding than European/Others. For
European/Others
exposure
to
household
crowding is estimated to cause 5% of the hospital
admissions a year for housing related
diseases/conditions/injury. For Mori the
contribution from exposure to housing issues is
higher, with an estimated 16.8% of the total
hospitalizations a year.
The contribution of exposure to household
problem is particularly large for some conditions
affecting Mori population (e.g. Tuberculosis,
asthma, home injury and etc. as suggested in the
previous text). And Mori children and elders are
even more vulnerable due to their exposure to
housing issues. For example, an estimated at least
23% of Maori children disease burden can be
attributed to this exposure to housing issues. By
comparison, the estimate is only 9% in
European/Other(M Baker, McDonald, Zhang, &
Howden-Chapman, 2013). And Maori male elders
is the group which has been identified as the most
vulnerable group against home injury (Kool,
2011).
There are few attempts to address the huge gap
health between Maori population and Caucasian
population caused by housing issues, including
Rural Housing Programme, Community Owned
Rural Rental Housing Loans, Special Housing
Action Zones and etc. which target on Maori
household and try to improve Maori housing
quality in general. However, it is such a problem
that is difficult, if not impossible, to solve due to
its high resistant to resolution and the complexity
to change the Maori health behaviors in general,
that it is can be identified as a Wicked Problem
(Commission, 2012) and therefore required
interdisciplinary solutions (Brown, Harris, &
Russell, 2010) more than policies only to reach a
sustainable result.

Maori carvings
Source : (Dreamstime 2010)

Most of the housing issues discussed above

are the result of poor economic stands or in
general the low socio-economic status of
Maori households, which is one of the most
persistent social issues. Therefore, it
demands solutions that focus on mid-stream
health determinants (e.g. behaviors and
physiological wellbeing) as well as in general
improving Maori
households
socioeconomic status. To tackling the Wicked
Problem of Maori health issues caused by
housing problems, the following approaches
are recommended:
1. Establishing targeted marketing
campaign on Maori household to
promote health promoting behaviors
(e.g. healthier diet and etc.);
2. Establishing targeted education
campaign on Maori household to reduce
health damaging behaviors (e.g.
smoking, drug/alcohol abusing and etc.);
3. Providing subsidies for house
repairing/maintaining services;
4. Supporting community level nongovernmental organizations to promote
Maori physiological wellbeing;
5. Advertising the available public services
to Maori household and encouraging
their public resource utilization;
6. Reduce the socio-economic status gap
between Maori and Caucasian
population through political tools
including tax and subsidies.

The Kapa Haka Dance

Source :(New Zealand Tourism 2015)

From modern sport to Human Rights

policies, racist behavior is condemned
worldwide. The last decade saw racism gain
importance as a social determinant of health
on an international scale, contributing to
significant disease burden across different
populations. (Pascoe & Smart Richman,
2009)

Background:
The caste system in India, apartheid in South
Africa and the slavery seen in early American
colonies are a few examples where people in
higher authorities, treated the minorities
with disgust and discrimination. However,
things were a bit different when it came to
the Maori population. Unlike indigenous
communities in different parts of the world
who were succumbed to have poorer health
outcomes, the Maori population were not
entirely crippled by the effects of
colonization. Largely due to the Treaty of
Waitangi which played a major role in
negotiating governmental policies between
the Maori and the Pakeha.
Nevertheless, (Robson & Harris, 2007) the
Maori people have lower life expectancy
rates and increasing rates of morbidity even
today. It is an understated notion, that racism
is felt only at a personal level. The history of
colonization suggests that racism had been
institutionalized and was expressed in
discreet forms of socio economic
configurations. It had negative impacts on
education, healthcare, employment and pay
grades. Land and various assets (Kokiri, 2000)
were confiscated under the dogma of rapid
urbanization rendering more than half of the
Maori (Kahukura, 2010) to live in more
destitute residential areas
Racism historic roots. Source : (Shutter Stock Inc. 2016)

Extent of the issue:

The percentage of political partnership gained
in the governance of New Zealand is debatable.
However, the Maori possessed strong rights to
protect their community, when compared to
other minorities across the globe. Yet,
according to a study conducted by (Bramley,
Hebert, Tuzzio, & Chassin, 2005) which
reported inequities in health of New Zealand
and the United States populations, there was a
larger gap between the life expectancies of the
Maori and the European settlers (8.9 years) in
comparison to the native Indians and American
settlers (7.4 years). This pattern repeated for all
other indicators included in the study.
Another survey based study (Harris et al.,
2006) that was conducted exclusively in New
Zealand, with 4108 people of Maori origin and
6269 settled Europeans, concluded that racism
is one of the key factors that is responsible for
socio economic deprivation and plays a vital
role in determining the inequalities in health.

Racism (Bhopal, 1998; Williams, 1997) refers to

a belief that a few races are superior to others.
From the discrimination of skin tone to ethnic
prejudices, racism has many colors in itself.
These practices trigger and reinforce a system
of oppression and inequality (Bhopal, 1998;
Krieger, 2001).
Two main types of racism have been described:
interpersonal and institutional
by (Karlsen & Nazroo, 2002)

Interpersonal racism pertains to the

discriminatory interactions that take place at
an individual level. These can be felt directly
either physically or verbally.

Protest against Rugby association

Source : (Citizens All Black Tour Association 1981)

Institutional racism on the other hand, is

invisible. It refers to discriminatory policies
which are ingrained within an organization
(Karlsen & Nazroo, 2002; Krieger & Berkman,
2000).
Micro-aggressions:
In public, there are often interactions and
glances which may go unnoticed when lacking
attention. These convey impugnable messages
to racial minority groups and are called as
micro-aggressions (Sue & Constantine, 2007).D
Sue and her colleagues have described these
micro-aggressions to occur in various formats
ranging from subtle derogatory looks and
gestures to verbal assaults. These occur often
unconsciously, hurting the colored individual.
She classified these into micro-assaults; which
are readily perceived by the victim, microinsults; unintentional, rude actions which lack
empathy and micro-invalidations; when the
people of the majority fail to accept the
presence of such a phenomenon and its
consequences on minorities.

Despite indifferences, the Maori accepted their

fate and continued to carry on with their lives.
It was not until 2003, that the hidden element
of racist behaviors was brought to light by the
New Zealand Health Survey which included
questions on personal experiences of racial
discrimination.
A number of studies across the world show the
poorer outcomes in health as a result of
interpersonal racism (Collins Jr, David, Handler,
Wall, & Andes, 2004; Karlsen & Nazroo, 2002)
and institutional racism (Collins, 1999; Jackson,
Anderson, Johnson, & Sorlie, 2000).
(Krieger, 2003) conducted a research and

A Maori Boy. Source :(Nelson 2014)

identified five pathways through which

racism affects the health of a population.
1. Social and Economic deprivation
2. Exposure to environmental hazards
3. Socially experienced trauma
4. Use of harmful products
5. Health care
For deeper understanding of how these
pathways determine health, it is important
to understand the upstream, mid-stream
and downstream social determinants of
health as proposed by (Turrell, 2006) in
relation to institutional and interpersonal
racism.(Table R1 and R2)
1.Institutional racism
a)Employment :
This is one of the several reasons for a vast
majority of Maori men and women to be
unemployed. Although the government
and various private companies encourage
graduates with an indigenous origin to
apply, and a significant number of people
are attaining jobs, data indicates that the
unemployment rates for both men and
women have increased steadily since last
year (Ministry of Business, 2016). An
average of 12.2% Maori men and women
population are unemployed. With larger
families to feed, and a racist notion, that
the Maori are physically fitter, they are
given occupations which have hazardous
effects on their health (Pearce et al.,
2004). (Table R3)
b)Education:
Schooling for children in the Maori has
improved in the last five decades.
However, there are reports of Maori being
looked upon in awe when they re-enter
University after a semester break.(Duff,
2015).This is due to a fact that only 25% of
Maori who finish school, go to college.
This is 50% lower than the Non- Maori
population (Marriott & Sim, 2015).
Newspaper article: Fighting racism
Sources: (Fightback Organization 2014)

Table R1 and R2 Influence of Racism on Social determinants of health.

Adapted on the principles proposed by Gavin Turell

Education and employment are keys areas

where the Maori have been termed as
underachieving (Lock & Gibson,
2008).Lesser the education, lesser the
number of jobs or lower is the pay scale.

c)Housing:
In aspects of housing, systematic racism has
pushed the Maori away from neighborhoods
with proper sanitation and hygiene. Policies
in the housing markets are constructed in a
way that most cannot afford the same
(Kahukura, 2010). Racial discrimination has
led to introduction of pepper potting
policies aimed at concentrating the Maori in
particular neighborhoods (Waldegrave, King,
Walker, & Fitzgerald). This causes much ill
health both physically and mentally.

Wellington Hospital Old Trauma room entrance

. Source : (ford 2011)

d)Healthcare :
Self-reported research on racism which was
conducted by (Harris et al., 2006)showed
that the area where the Maori most felt
racial discriminated was in a medical setting.
Identical discrepancies were found in a study
in Aotearoa, (Westbrooke, Baxter, & Hogan,
2001) which reported that less number of
Maori cardiac patients are likely to undergo
surgical procedures when compared to NonMaoris. Similar is the case in caesarian
section in pregnant Maori women (Harris et
al., 2007).Although people do acknowledge
presence of such attitudes in the outer
world, it is least expected from a physician
who has an ethical obligation towards his
patient. This area has less research in New
Zealand, but a better example was seen in
the hospitals of California, USA. Several
women of Arabic descent until 6 months
after the 9/11 attacks, had pre term labour
or gave birth to babies with Low Birth Weight
(LBW) whereas the outcomes of labour
remained the same for rest of the patients.
(Lauderdale, 2006).

e)Criminal Justice:
Around 150 people per 100,000 are
imprisoned in New Zealand every year. It
has the highest rate of incarceration per
capita, only second to the United States
(Department of Corrections, 2001).
Despite being only 15% of the total
population, they are over-represented in
the prison setting up to 6 times when
compared
to
the
European
settlers(Workman, 2011). Up to 43% of
those convicted are Maori, 47% of violent
offenders are Maori (Soboleva, Kazakova, &
Chong, 2006) and a total of 51% of the total
incarcerated are Maori (Doone & Unit,
2000; Workman, 2011). Whether the
criminal justice system is imparting longer
sentences or whether the Maori are the first
to be suspects in case of any crime and
hence convicted, requires further study.
However, these prisons often serve as a
prison pool for various infectious diseases.
Indulging in risky behaviors (Patten & Gray,
1991) like sharing of needles and
unprotected sexual intercourse transmit
infections like HIV, Hepatitis B and
Tuberculosis. Upon release from the
correctional facility, these diseases are
carried home. A more recent study
(Stewart, Henderson, Hobbs, Ridout, &
Knuiman, 2004) also showed that all
prisoners irrespective of their gender or
ethnicity, who were released from prison,
died sooner. More so, when they had
histories
of
risky
behaviors
.
f)Urbanization:
The Maori are spiritual people. They value
their land as Papatuanuku ; Mother Earth
(Durie, 1997). As a result of massive
urbanization, various parts of Maori land
were consfisicated. This not only led to loss
of occupations with respect to cultivation,
but also added to psychological grief.

Maori Over represented in prison

Source: (Guardian 2015)

2.Interpersonal Racism

a)Physical assault:
Interpersonal racism is more visible
when it occurs in the form of a physical
attack. Direct injuries to the victim may
result in disability and death. This fact
remains and understatement given the
associated mental factors during this
racist transition. Post assault instillation
of fear, misery and a feeling of
helplessness later convert into
depression and stress. A study (Paradies,
2007) showed that psychological stress,
is expressed by adolescent victims of
racism in forms of violence, smoking,
substance abuse or increased alcohol
consumption. Violence leads to jail while
others only increase the existing burden
of disease in the society.
b)Sexual Assault:
In New Zealand, (Fanslow, Robinson,
Crengle, & Perese, 2007) one in three
teenagers under the age of 16 are likely
to be victim to sexual assault with
approximately 70% of the cases involving
contact of genitals. Moreover, the
likelihood for a Maori female to be a
victim to sexual assault is twice as high
as a non-Maori (Mayhew & Reilly, 2007).
Literature suggests (Thomas, 1993) that
rates of sexual assault on Aboriginal
women by non-Aboriginal men were
higher in the past. However, evidence
regarding the current traits is lesser.
Abuse of this kind has devastating effects
on the mind, body and soul.

Luminato Festival spreading awareness

Source: (Steel 2014)

c)Verbal Assault:
Micro-aggressions in the form of
involuntary degrading gestures do exist,
however, it is when the verbal abuse has
targeted intent, the effects are mentally
traumatizing. Subsequent psychological
stress often impedes vital decisions in
their lives. A feeling of hostility warrants
unwantedness in social gatherings.
These emotions later convert to
depression which works in a negative
feedback mechanism, leading to isolation.
Rage, stress and depression are emotions
which direct young Maori adults to adopt
unhealthy behaviors like smoking and
substance abuse. History also suggests
that when parents try to protect their
children from being victim to racism, by
trying to impose restrictions, results have
been calamitous with children turning to
suicide (Goldberg & Hodes, 1992).

Thus, the lack of

appropriate education, increased poverty,
longer periods of incarceration,
psychosocial factors, risky behaviors and
decreased access to healthcare have
added effects on the health of the person.
Products of risky health behaviors
pathologically influence the human body
via inflammation or infection.
Hypertension and hyperlipidemia increase
the chances of cardiovascular disease
whereas immunosuppression leads to
systemic and bronchopulmonary
infections both of which add to the
morbidity and mortality of the population
(Harris et al., 2006).
Maori clothing
Source :(Shutter Stock Inc. 2016)

Given the fact that the element of racism

exists since the time of the prophets, it is
not easy to tackle the situation with mere
reforms and appeals to human right
commissions. In the 1980s an attempt
was made to dethrone institutional
racism, by introducing recommendations
from Puao te Ata Tu. (Table R4). These
recommendations were accepted by the
Minister of Social Welfare and are till date
the fundamental basis of antidiscrimination in all levels of public
services (Tennant, 2005). However, there
still exist loop holes in the system. A
targeted approach to bring reform to the
structure (institutional racism) and the
agency (interpersonal racism) is necessary.
1.Education :
Mass movements of intellectual resistance
indeed existed in the history of the Maori
which tried to rebalance inequities. One
such movement was the rejuvenation of
Te Reo me ona tikanga by developing
educational institutions and universities
for the Maori (Cram & Pipi, 2001).
Thus historically, it can be acknowledged
that a good place to start reform, is to
begin with education. Schooling begins to
inculcate cultural co-existence at grass
root level. The fondest of memories are
often with school friends. Education not
only eliminates racist attitudes, but also
teaches methodologies to recognize its
patterns and advocate against them.
Educational programs initiate cultural
familiarization and understanding upon
which relationships that thrive can be
constructed among societies.
Abolishing Racism from Childhood
Source: (Maoribank School 1975)

Table R3 The unemployment rates for both Maori men and women
increased from March 2015 to March 2016
Adapted from Statistics New Zealand, Household Labour Force Surve, March
2016; MBIE

Table R4 Summary of recommendations from Puao te Ata Tu

Adapted from Puao Te Ata Tu, Ministerial Advisory Committee. 1988,
p.9-14. Wellington, New Zealand; Department of Social Welfare

2.Law and the media:

Racial harassment laws do exist (Ministry
of Justice, 2002)for the benefit of the
minorities that prohibit all kinds of
mockery. Despite this, there are reports of
racial abuse which indicate the lack of
public awareness. Social media should
enlighten the society regarding the active
and passive effects of racism and
subsequent punishment against violators.
A dedicated telecommunication hotline
for reporting racial abuse of any form can
be incorporated.
3.Professional Training:
As the commonest place of social
interaction are the offices and commercial
centers, all the staff should be trained to
handle cultural incompetency with
extreme care and professionalism.
Caution should be practiced to not
illustrate involuntary signals of microaggression. Institutions play a vital role in
advocating such strategies (Grant et al.,
2009). Ethical guidelines ought to be
included in the terms and agreements
across all occupations, breach of which
would lead to prosecution.
4.Advocacy:
The National Rugby League and FIFA
soccer federation are examples of
organizations who have utilized media to
advocate against racism. They undertake
strict action against all forms of
derogatory racist actions in sport. Similar
anti-racism advocacy can be adopted by
politicians and television celebrities who
set trends and are role models in the
modern society.
The FIFA soccer federation says no to Racism
Source : (Fifa.com 2011)

5.Leadership and voice to the victims:

A study conducted by (Pack, Tuffin, & Lyons,
2015) in New Zealand reported the resistance
that is encountered in speaking up against racist
behaviors. Some subjects conveyed difficulty in
expressing the abstract assault, a few chose to
ignore and some vocalized. This indicates that
there is a lack of confidence in the Maori, who
have acclimatized to oppression. Leadership
development programs paired with telephone
hotlines can serve better in imparting a voice to
the community.
6.Monitoring:
Despite having well accomplished
recommendations from Puao te Ata Tu, the
system lacks vigilant monitoring protocols.
Frequent surveys ,awareness polls against racist
experiences and adaptation of evidence based
research in elimination racial discrepancies can
help in making the system full proof.

Adopting cultures, the New Zealand rugby team

performing Kapa Haka
Source : (Players Tribune 2008)

The element of Racism has been a foundation to

discrimination since beginning of the
colonization era. It may seem natural to find
more competency in the company of a like
minds, colors or tongues. When this notion
extends into governing bodies, it has invisible
influences on policies. Decades later, we now
stand at a point where racism has altered the
minds of the people. Targeted marketing of
substances, massive urbanization and the school
to prison pipeline are examples of ideologies
that have crept into society and changed its
dynamics with the minorities suffering in
silence. To remain in denial and focus only on
ways to combat resulting ailments is naive. A
well organized and vigilant system which
constantly monitors and balances structural
inequities is mandated.

Demolishing discrimination. Prince Harry visits the

Maori
Source: (The Mirror 2014)

Mori culture has developed around having

specific gender roles which became part of
their social norms and these gender roles are
still observed in their current culture. Many of
the gender roles which Mori culture
practiced were similar behaviors observed in
other cultures. Mori women were not
allowed to fight in wars (Stearms, 2013).
Women in Mori culture are considered to be
sacred as they have the ability to bear
children and so continue the tribe. Women
cared for the family, and were involved in
opening calls for meetings storytelling and
welcoming guests with songs and dances
(Stearms, 2013).
Many health and social issues affect Mori
women, such as inequalities in education,
employment, income, substance abuse,
violence and poor nutrition. The following
report is going to focus on the SES impacts
from breast cancer, gambling, and cultural
attitudes towards teenage pregnancy.
Demographics :
The number of people who identify as Mori
is increasing (refer to Figure G1) (Statistics
New Zealand, 2013b). The age structure for
Mori people is younger compared to nonMori NZ (refer to Figure G2 and Table G1).
Approximately 12% of New Zealanders
identify as Mori. The Mori population is
over represented in the lower socio-economic
groups. They have larger families, start
families at younger ages, and are more likely
to smoke and be obese (Lawrenson et al.,
2016).

When you educate a man;

you educate a man.
When you educate a woman;
you educate a generation.
Brigham Young

Maori Women. Source :(Shutter Stock Inc. 2016)

1.Health :
Heart disease and lung cancer are the largest
causes of death in NZ (see Table G2). Suicide
and motor vehicle accidents are common causes
of death for males, but not in the top five killers
of women. Diabetes was a common cause of
death for Mori but wasnt in the top five
causes of death for non-Mori (Kahukura,
2010b).
2.Life Expectancy :
Mori have lower life expectancy at birth than
non-Mori in NZ (refer to Figure G3 and Figure
G4) with women having higher life expectancy
than men. In 2013, the life expectance at birth
for Mori men was 73 years and for Mori
women 77.1 years. This was lower than the
expected life age for non- Mori (Kahukura,
2010b).

3.Suicide:
Suicide is the leading cause of death for Mori
males. Mori suicide rates were almost double
that of non-Mori people between 2010-2012
(refer to Figure G5). Mori women were more
than twice as likely to commit suicide than nonMori women. The highest suicide rates were
observed in people aged between 15-24 year
olds (Kahukura, 2010b).

Maori Women
Source :(iles 1901)

4.Education:
In 2013, 12.3% of Mori women and 7.4% of
Mori men had started a bachelor degree or
higher. The rates were 75% of Mori people had
a bachelor degree, 13.2% had postgraduate or
an honors degree, 10% had a master degree and
1.8% had a PhD (Statistics New Zealand, 2013a).
There is a decreasing rate of Mori with no
formal qualifications. Mori women (69.8%)
have more formal qualifications than Mori men
(63.2%). 16.6% of Mori were undertaking full
or part time studies with more Mori women
(59%) studying then Mori men (41%) (Statistics
New Zealand, 2013a).

5.Obesity and Nutrition:

Mori adults are more likely to be obese than
non-Mori adults (refer to Figure G6). Many
adults do not meet the daily recommended
nutrition indicators. Approximately 66% of
Mori people did not consume the
recommended intake of vegetables and fruit
serving daily. Mori women were more likely to
make better food choices than Mori males
(Kahukura, 2010b).Studies show that there was
little difference in the exercise rates between
Mori and non-Mori people. In 2013-2014 only
38.5% of Mori adults met the recommended
physical activities levels (refer to Figure G7)
(Kahukura, 2010b). By not following healthy
midstream behaviors this places the individual
at increased downstream health impacts.

6.Cancer:
Mori adults aged over 25 have higher cancer
rates than non-Mori adults (refer to Table G3).
Mori women have a lung cancer rate over 4
times that of non-Mori women (EllisonLoschmann et al., 2015). Upstream policies such
as public health actions and health impact
assessments must be incorporated in Mori
cancer control. Issues which need to be
addressed are the ethnic inequalities in
education, income, labour market, housing and
wealth along with the common midstream
behaviours observed in people of low
socioeconomic such as smoking, heavy drinking
and obesity if the cancer inequalities are to be
achieve to reduce intergenerational inequalities
(B Robson & EllisonLoschmann, 2016).

Maori Women against cancer

Source :(Shutter Stock Inc. 2016)

Mori women have one of the highest rates of

breast cancer in the world. They are more likely
than non-Mori women to have breast cancer
with larger tumors and at younger ages (I.
Meredith, Seneviratne, Gerred, Ramsaroop, &
Harman, 2015). Why Mori women have such
high breast cancer rates is unknown, but it is
believed to be linked to midstream health
behaviors (Lawrenson et al., 2016).

Even the survival rates of breast cancer are

lower in comparison to non-Mori women.
There is limited information on how ethnicity
plays a role in cancer survival but the
inequalities of cancer survival fall under
socioeconomics (Seneviratne et al., 2015).
These factors include income, housing, and
healthy environments. Any inequality in these
factors results in inequalities in health
(Seneviratne et al., 2015).
The New Zealand government has funded
health system which provides free specialist and
hospital care and subsidized primary healthcare
service. There are free breast cancer screening
services available to women aged 45-69 years.
Mori women in rural regions are less likely to
have regular mammographic screening than
non-Mori women in urban regions. Even the
death rate is twice as high. When cancers are
diagnosed at more advanced stages, the
possibility of successful treatment is reduced.
Women who seek screening are linked to a
combination of health literacy, cultural
appropriateness, socioeconomics and
geography (Seneviratne et al., 2015). The free
healthcare service is only a minor step towards
reducing the inequalities. It does not mitigate
the poverty, transport to medical services,
timely access to medical treatments, access to
pharmaceuticals and social welfare access.
Mori generally receive inferior cancer care
along with longer delays for treatment
(Seneviratne et al., 2015).
Maori women
Source: (Nelson 2012)

Genetics in Mori women does not appear to

be the reason for the high breast cancer
morbidity. Mori women generally have their
first child at a young age and breastfeed for
long periods. These midstream behaviors are
linked to lower breast cancer rates. Midstream
behaviors of high alcohol intake and obesity are
linked to increasing breast cancer rates
(Lawrenson et al., 2016).
Mori people have high obesity issues as
healthy food options are often unaffordable;
the NZ government has upstream strategies to
address this issue. Mori people often have
greater physical barriers to accessing health
care service. Approaches to encourage more
Mori women to access breast cancer screening
include GPs which Mori patients trust and feel
comfortable around, and having appointments
at times which suit the patient, especially if they
are required to travel (Lawrenson et al., 2016).
Education on the importance of testing and
support available is essential for combatting the
inequalities for Mori women on breast cancer
issues.

8. Employment and Economics:

The average weekly income in 2008 was less for

Mori people when compared to non-Mori of
the same gender. Women received a lower
average weekly income than males of their
same ethnic backgrounds. The average weekly
income for 2008 was: $998 non-Mori males;
$830 Mori males; $666 non-Mori women;
$601 Mori women (Statistics New Zealand,
2013a). Unfortunately, in 2013 Mori women
still earned less than Mori males. The medium
income for Mori over 15 was $22,500, with
men ($27,200) earning more on average than
women ($19,900) (Statistics New Zealand,
2013a).
Mori men (52.9%) are employed in more full
time positions compared to Mori women
(35.1%). Unfortunately, the Mori
unemployment rate has risen from 11% in 2006
to 15.6% in 2013 (Statistics New Zealand,
2013a).

Maori against gender inequality

Source: (Shutter Stock Inc. 2016)

Tobacco and alcohol were introduced into NZ by

European settlers and Mori started using these
substances. Many Mori are heavy smokers
which has major health impacts. Almost 40% of
Mori adults smoke, and more Mori women
smoke than Mori men. The highest smoking
rate is observed in Mori women aged between
20 to 24 years (refer to Figure G8). The average
age which Mori begin to start smoking is 11.5
years (The Encyclopedia of New Zealand, 2013).
Irresponsible drinking (refer to Figure G9) is also
observed in Mori culture and this can have
negative social impacts including risk-taking,
violence, poor relationships, and lower
productivity. Along with the negative impacts of
alcohol, Mori communities are also adversely
impacted by other intoxicants. The use of
cannabis, recreational drugs and inhaling of
aerosols is commonly practiced. Approximately
64% of Mori survey admitted to having used
recreational drugs (The Encyclopedia of New
Zealand, 2013).

To quit is not easy

Source: (National Library 1905)

Maori Gambling addictions. Source (Tattoo Art)

Gambling is a global social and health issue, and NZ is no exception. Gambling causes issues for gamblers
family, friends, work and entire community. Gambling was introduced into NZ by European settlers. Since the
introduction Mori people have engaged in gambling acts and are more likely to have gambling related issues
than other social groups (refer to Figure G10) (Grogan, 2012). The number of women gambling has increased
over the past few decades, with women choosing to play gambling machines. One of the negative effects of
women increasing gambling habits is the risk increases of childhood neglect. Mori have the highest problem
gambling rates with 16.6% aged between 20-34 year olds (Grogan, 2012). Many Mori battle poverty,
unemployment and dependency on welfare. The hope of winning a fortune is enticing and a ticket out of
their current struggling financial state.
The unfortunate aspect is that in the hope of winning money the family member spends. This results in
children skipping meals, causing further health and wellbeing effects and increased financial hardship. One in
16 Mori men and one in 24 Mori women are reported to have either a moderate or high risk gambling
addiction. Mori women are 3.5 times more likely to have a gambling problem than non-Mori women
(Grogan, 2012). Children who grow up in gambling households are more likely to engage in behaviors such as
smoking, drinking, drug use and gambling. Children whose parents gamble are more likely to have behavioral,
physical and physiological issues, grow up in broken homes, be unhappy teenagers, commit crime,
work/schooling issues, attempt suicide and have poor mental state. While parents are gambling they often
expose their children to poor role modelling, social and interpersonal skills with negative effects where they
are under achievers, engaging in high risk activities, being sexually promiscuous and physically abusive
(Grogan, 2012).

Traditionally Mori women used the poroporo

plant as a contraceptive. They boiled the leaves
and drank the water one week prior to
menstruation. Many Mori women are using
long acting reversible contraceptive methods
such as the implant (23%) and the intra uterine
device (11.5%). The upstream government
policies are allowing Mori access family
planning and sexual health centers to aid in
choosing suitable contraception methods (New
Zealnad Family Planning, 2015).
Issues of unexpected pregnancy and sexually
transmitted infections affect Mori culture and
this is due to the upstream issues in the
inequalities in the sexual and reproductive
health system. Health inequalities are the result
from income and gender and then affect the
midstream actions of the individual. Low
income people require more information and
comprehensive sexual and reproductive health
services but unfortunately are less likely to seek
sexual health care (New Zealnad Family
Planning, 2015).
There is limited information on Mori cultural
attitudes towards teen pregnancy. Teen
parenting has never been a historical issue
among the Mori culture. Mori teenagers who
fall pregnant are more likely than non-Mori
teens to carry their baby to full term and raise
their child (Pihama, 2011). The teen pregnancy
rate for Mori women is three times higher
than the rate for non-Mori. Mori culture is
different from western culture since they do
not have the concerns about what age is too
young to be a parent or bearing a child out of
wedlock. Western culture considers teen
pregnancy as a social, political and economic
issue, whereas Mori culture does not (Pihama,
2011). There is a common view in NZ from nonMori that teen pregnancy is a problem, but the
upstream way the society should approach the
issue is that they are parents regardless of their
age and these women should be valued and
supported. The upstream considerations should
focus on poverty reduction, childcare
requirements, health care availability, income
support and pay equality (Pihama, 2011).

Maori women
Source: (Wahine 1935)

Mori women start families at younger ages

than non-Mori women. Half of all Mori
women who gave birth were under the age of
26 as opposed to non-Mori women who had a
median age of 30.1 years. The highest birth
rates occur in mothers aged between 20-24
years old and this was 2.7 times higher than
non-Mori women (Marie & Fergusson, 2011).
Mori have different beliefs than non-Mori
about when to become parents. The Mori
culture places a premium on reproduction and
starting a family at a young age as it this is seen
as a contemporary marker of strength of Mori
cultural identity (Fergusson & Boden, 2011).

There are socioeconomic inequalities in Mori

health when compared to non-Mori. The
upstream determinants of health affect
individuals health behaviors which results in
negative health implications in the downstream
areas. Some of these issues are caused by
economic inequalities. Poor health is linked to
cancer and shortening Mori womens health,
life expectancy and overall wellbeing. Other
issues that western culture see as a problem
the Mori culture see as a norm such as starting
families at a young age. The policies should not
dictate to women of a certain culture when is an
appropriate time to start a family but instead
encourage women to be able to achieve highly
while balancing parenting duties.

Maori women
Source: (Nelson 2012)

Figure G1: Mori ethnic group by age and sex at 2013 census (Statistics New Zealand, 2013b)

Figure G2: Mori and non-Mori ethnic population at 30 June 2015 (Statistics New Zealand, 2013b)

Figure G3: Life expectancy at birth by sex and ethnic groups from 1995-97 to 2012-2014 (Statistics New
Zealand, 2013b).

Figure G4: Life expectancy at age 65 by sex and ethnic groups from 1995-97 to 2012-2014 (Statistics New
Zealand, 2013b).

Table G2: Major causes of death, ranked by age-standardized mortality, by gender, Mori and
non-Mori in 2010-2012. (Kahukura, 2010b).

Figure G5: Suicide deaths age-standardized rates by sex for Mori and non-Mori, between
1996- 2012 (Statistics New Zealand, 2013b).

Table G3: Cancer indicators by gender and ethnic background, 2010-2012. (Kahukura, 2010b).

Table G4: Socioeconomic indicators, by gender, Mori and non-Mori in 2013. (Kahukura,
2010b).

Figure G6: Proportion of population, 15 years and over, who are obese by ethnic group
and sex, 2014/2015 (Statistics New Zealand, 2013b)

Figure G7: Proportion of population who are physically active. 15 years and over, by
ethnic group and sex, 2014-2015 (Statistics New Zealand, 2013b).

Figure G8: Proportion of the population who currently smoke tobacco. 15 years and
older by ethnic group and sex in 2014-2015 (Statistics New Zealand, 2013b).

Figure G9: Potentially hazardous drinking, among all adults, aged 15 years and over by
ethnic group and sex in 2014-2015 (Statistics New Zealand, 2013b).

The Mori have been victim to political sabotage and continue to endure the subsequent effects of racial
discrimination till date. Deeply embedded within the structure of organizations, it has adversely altered
the thought process (agency) and existing dynamics of the Maori population. Poor health choices such as
smoking, drinking and lack of nutrition are linked to significant mortality and morbidity among them.
Addressing the socio-economic issues in Mori is significantly complex and requires a more holistic
approach. Socio-economic position alters Mori health chiefly through family income, work conditions and
unemployment (Chapple, 2000). It is health equity that the Mori strive for. With limited control over
upstream factors which determine the socio economic status of the people, risky behaviors and have been
adopted. These further influence the progeny.
New Zealands current motto is Every child thrives, belongs and achieves. This follows the Sustainable
Development of healthy lives and well-being for all at all ages. It is evident that policy, such as the
implementation of government programs for free lunches and immunization can reduce the gap between
Mori and non-Mori. This results in higher attendance rates and consequently increased educational and
socio-economic upliftment.
Targeted marketing has been responsible for altering the rationale of the family memebers. Teens adopt
smoking habits early on and gambling is another example of addiction where women hope they can break
the poverty cycle by winning a fortune. This attitude causes significant loss of income resulting in poor
allocation of resources towards nutrition and health. There is a difference in priorities between western
and Mori culture with regards to child bearing. Children are deemed as taonga (cultural treasure), and
women are encouraged to have more babies. On the contrary, Western culture considers ill-timed
pregnancy as a threat to the career of the female and a poor economic decision. This highlights the need
for a more dynamic and culturally appropriate solution to the problems of the Maori. Respecting the
difference of opinion of the Whhau (Mori political groups) whilst protecting the rights of the Maori
women should be the primary focus.

Housing is another social determinant which plays a major role in altering the health status of the
population. Mori have a long history of having poor housing conditions. In 1918 when influenza struck,
Maori suffered 4.5 times greater mortality when compared to European settlers. Overcrowding, tenure
type, housing quality and neighborhood deprivation are reasons for the easy spread of diseases. It is
important to focus on the upstream factors (housing policy and subsidies) and midstream factors (mental
wellbeing, community services and education) to further influence the downstream aspect of health.
The government should aim to transform policies (health, welfare, economic, housing, transport and
taxation) at the structural level which enhances education, employment, housing, individual and social
environments of Mori. These policies alongside effective healthcare delivery, can help reduce the disease
burden in society. (RUSSELL, SMILER, & STACE, 2013).

Currently, the focus is on a concept called Pae Ora which has interconnected elements and directions for
healthy individuals, their families and respective environments (Ministry of Health, 2014). These elements
and directions reinforce each other, contributing towards a strategic action plan for Mori health. The set
of directions are applicable to both individuals and government contributions. It is based on the pillars of
Rangatiratanga, focusing on the gains and equity. The Treaty of Waitangi and provide a basis for formation
of this concept.
The elements, directions, threads and pathways for action that make up He Korowai Oranga set the
direction for how to achieve Pae Ora. They focus on development of the Mori communities, their
increased participation and providing effective and appropriate services across all sectors. This
interdisciplinary approach requires participation of individuals, health professionals, politicians and
international cooperation to reduce the burden at large.
Mori populations have been more successful in lessening the gap compared to Australian Aboriginals,
who faced similar English invasions. The differences between these two populations stem from the unique
struggles they faced. Mori have been more largely accepted by their culture and this can be seen in The
Treaty of Waitangi and this is likely the cause of the reduced gap. They have built educational and medical
institutions which have been contributing towards better socio-economic status and health. However,
structural policies remain the primary factors that influence decisions and subsequently the health of the
people. With roots of discrimination buried deep within the structure of organizations, abolishing it may
not be entirely feasible. Nevertheless, a large scale multi-modal and vigilant system that can bring
substantial change in the structure, transform the agency; the perpetrators and develop bold leadership
qualities in the oppressed, is mandated.

Life does not grant us options to choose family, intellect or skin tone for that matter.
By introducing a strategic action plan and dismantling societal health gaps, we
would a step closer in redeeming ourselves.

New Zealand Landscapes

Source : (Engineering 2015)

Acknowledgement:
We would like to thank the wonderful teaching staff and the highly interactive classes of PUN106. All
the members of the group have put significant effort in the formation of this article. The images have
been taken from multiple sources including shutter stock, a pay per image service. They have been
included in the references. This article is for educational purposes only. We do not wish to use it for
commercial purposes in any manner.
Thanking you,
PUN 106 Internal Maori Group 11
Obaidulla Khalid, Cameron Woodruff, Jinghan Li, Neeli Devireddy , Sharyn Shephard

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