Mauri Ora: the Dynamics of Maori Health
Oxford University Press, $44.95,
Recently I attended an international conference in Auckland, focusing on gambling. This was an important conference, for it was planned to link with the review of legislation that governs gambling or gaming in New Zealand, and to showcase New Zealand in an international setting.
Like many conferences held in New Zealand, it was opened with a brief mihi or Maori welcome. The stage was then left for distinguished speakers, both local and international, to present their views. Through experience, Maori are aware that whoever defines the problem controls the range of solutions. This conference was no different from many organised in New Zealand. Although it looked like there was a Maori presence and the needs of Maori had been catered for by including a Maori stream, conference organisers had not considered that any Maori leaders had something to offer as keynote speakers.
Once again, Maori were made to feel like outsiders in their own country. Maori were allowed to attend the conference to listen and to share views with Maori in the Maori stream, but were given no real opportunity to define the problem of gambling from a Maori perspective. To redress the situation, Maori were forced to complain and to negotiate with conference organisers so that they could present a Maori view on gambling.
Constant advocacy for Maori is hard work. This is not often evident when you read Durie’s two publications, the earlier Whaiora: Maori Health Development and now Mauri Ora: the Dynamics of Maori Health. Social and political changes have occurred in New Zealand society because of constant advocacy and the interactions Maori have with people and institutions. Interactions create reactions, which places a burden on Maori and affects the health and well-being of Maori today. Durie alludes to this dynamic but does not discuss it explicitly, yet those with whom Maori interact will often define Maori advocates as “radical” or “troublemakers”.
If the gambling conference organisers had really wanted to raise the profile of gambling and its effects on New Zealanders’ health, especially amongst Maori, they should have invited Professor Durie. He could have shared his views on the effects of gambling as a lifestyle risk or on Te Ao Hou. It would also have enabled him to discuss the constant themes that are woven through Mauri Ora: the Dynamics of Maori Health. He could have discussed his many thoughts about the impact gambling has had on Maori, and what lessons we can learn from tackling other health issues, such as alcohol misuse (discussed in chapter five “Toko Mauri: Use and Misuse”).
If invited to speak, Durie would probably have suggested that to reduce the risk and harm that gambling create for Maori, new gaming legislation should empower them. It should include provisions for Maori participation in all levels of decision-making on licensing and regulating gambling in New Zealand. It should also recognise the Treaty of Waitangi and its principles.
Durie would also probably have suggested that interventions need to be developed and implemented on at least three different levels: a population-based approach, an individual therapeutic approach, and an approach that supports the development of whanau or family-like structures. These three approaches recognise the different interactions people have with each other and the social, political and cultural environment they live in.
Further, he would have highlighted the fact that everybody has their own genetic and cultural heritage and endowment, which is shaped and passed from one generation to the next. To change health behaviours, relationships and interactions need to be empowering, and undertaken in a spirit of partnership.
Durie would also probably have advised policy makers and health workers that they need to be aware that Maori have diverse realities. It is important to understand that each Maori individual is unique. Each person has arrived where they are today through their own personal journey, which has been influenced by the past and present interactions.
People are special, all individuals have their own mauri or life force, which needs to be nurtured by building and affirming their cultural values and beliefs. This is a consistent theme of Mauri Ora: the Dynamics of Maori Health. It views the strength of a person’s cultural and self-identity as a key indicator of good health, or recovery from an illness or life event, and it can also be used as a measure for evaluating the success of a policy. A strong cultural and social identity suggests that acculturation has been limited.
Mauri Ora: the Dynamics of Maori Health is an important publication in the development of New Zealand as a nation. It includes key statistics that remind us all that the future of New Zealand depends upon the development of Maori and in particular Maori youth. It is the youthful Maori population of today that will provide the workforce for tomorrow and carry with other New Zealanders the responsibility for supporting an aging, predominantly non-Maori population.
Durie emphasises that Maori health is dynamic and complex. It is “the product of the combined forces acting on the past and present experiences that serve to define Maori realities”. He warns that a mechanistic approach to solving a health issue will not work. Instead, we must consider the interactions that have taken and will take place between people, institutions, and different policies.
Mauri Ora builds upon Whaiora: Maori Health Development, and shows again Durie’s unique skills in bringing together complex information in a way that can be read and understood by a wide audience. It is based on Durie’s experience of working with Maori in a therapeutic way, especially in matters relating to mental health and well-being. It also compares the situation of Maori to other indigenous peoples, demonstrating that the effects of colonising indigenous populations are consistent across different countries. The book will be a useful resource to support undergraduate or postgraduate courses related to Maori health, mental health, psychology and other social science areas.
Lorna Dyall teaches in the Department of Community Health at Auckland University School of Medicine and Health Science.