Reading: Durie, 1985 - A Māori Perspective of Health Flashcards
Is health a universal concept? Does a Māori perspective of health differ from that of WHO’s (1948) definition?
-Durie (1985) argues no
-The assumption that it is underlies inequities in health care
-Māori have a definition of health distinct from WHO’s 1948 ‘western’ definition.
Who are deemed the ‘experts’ of health in Māori health and how do their views compare to health professionals?
- For Māori people concepts of health emerge during marae discussions in which elders share their wisdom.
-The opinions of elder’s are sometimes at odds with the advice and views of health professionals trained using a westernized health ‘framework’.
-In fact, when you ask professionals and elders what prominent health issues Māori individuals are faced with today they provide vastly different answers (diabetes, cardiovascular disease etc. versus food pollution and the health of children).
Four cornerstones of Māori health perspective
-Te Taha Wairau (a spiritual dimension)
-Te Taha Hinengaro (a psychic dimension)
-Te Taha Tinana (a bodily dimension)
-Te Taha Whanau (a family dimension)
These elements create a holistic approach to health i.e. if any one of them falls down then poor health will result.
Te Taha Wairau (a spiritual dimension)
-Not usually considered an important element in western health definitions whereas for Māori it is often deemed the most essential.
-It encompasses religious beliefs and practises but it not confined to a particular adherence to a denomination or regular church going. Instead emphasis is placed on prayer (informal or formal) and acknowledgement of the land’s power
-A spiritual connection to one’s environment underlies the importance placed by many Māori to retrieve the body of a relative from hospital soon after death. In their eyes, for a finite period of time the spirit of the deceased individual ‘floats’ between the visible world and spiritual dimension. Without access to the body mourner’s cannot guide the spirit to go on and their own sense of continuity with their ancestors/ history is not reinforced. This is just one example of how a practice enforced in our health system (post mortem regulations) undermines a Māori approach to health.
-Additionally, Te Taha Wairua contributes to Mana (“a state of spiritual authority and power conferred by the gods”) which is labelled as a hallmark of optimum health.
Te Taha Hinengaro (psychic side)
-Takes the stance that emotions and cognitions are interlinked vital components of health whereas traditional western views have downplayed these elements instead focusing on the physical sciences.
- Differences in thinking style are seen between Māori and non-Māori. Māori tend to be more holistic with emphasis placed on the context. In contrast, a western approach is often more analytical and involves breaking down a target into its constituent parts.
-For Māori thinking with a focus on the self + personal ambitions would be viewed as unhealthy.
-Further, emotional awareness and expression is linked with cognition for Māori while a typical western approach separates these into two distinct streams.
Te Taha Tinana (the bodily side)
-A consideration in both Māori and non-Māori approaches to health.
-However, there are a few practises in Māori culture that differ such as the separation of food and utensils associated with it from other aspects of bodily care, the view of the head as sacred, and the idea that stepping over a person instead of going around is unhealthy.
- These beliefs explain why New Zealand Hospitals may seem unhygienic to Māori; a bed side table has many different purposes instead of a discrete function. Lacking awareness of these cultural differences in health care can therefore alienate a population of New Zealanders (Māori) as they lose confidence in a system that by all accounts violates their core beliefs.
Te Taha Whanau (the family side)
- For Māori family is identified as their primary support system and so of the upmost relevance in determining health outcomes.
-Shifts of a western approach to encompass this have begun however, there is still a lack of consideration for the non-nuclear nature of Māori families. Traditionality, Māori children are raised in equal parts by the elders and parents which utilises the wisdom of the elders and frees up time for the young to work. Western health professions argue a stable environment is only created from a nuclear set up which understandably generates friction with Māori perspectives
-Another conflict raised is in the establishment of identity. For, non-Māori a strong sense of independence from the family unit and being able to stand as your own ‘whole’ person is deemed healthy. On the other hand, for Māori tribal affiliation/ family is essential in creating what is known as a group identity. Rejection of this or an insistence on independence is labelled immature and a sign of ill health.
According to Durrie (1985) does socioeconomic status fully explain differing Māori health outcomes? What is instead the likely cause?
- According to Durie (1985) socioeconomic status although often cited in modern literature as a cause of differing Māori health outcomes (e.g. morality) does not fully explain them.
- Instead, a likely cause is a health system designed to favour attitudes differing from that of Māori.
Broad implications of Durrie (1985)
-There is a need for greater acceptance of Māori ideas and practice’s when it comes to health care.
-For successful health campaigns targeted at Māori this thinking as well as the input of elders needs to be at the forefront.
-This paper is therefore important in the field of health psychology because it raises awareness of the ideas that Māori hold towards health and therefore, could inform culturally sensitive revisions to the way which be approach healthcare in this country.
What changes have already been shown in NZ hospitals demonstrating greater culture sensitivity to Māori health perspectives?
- The appointment of Māori liaison officers
-The creation of a Marae space for Māori families to explore culturally relevant therapy programs
-The admission of the family alongside the Māori patient within psychiatric wards
-The return of the placenta after child birth by obstetric units to allow for traditional burial.
-Although these are good first steps a lot still needs to be done to fully accommodate Māori health attitudes into patient care.
- Māori experts and elders should be consulted to successfully inform these procedures and generate a more comprehensive approach to health care in New Zealand.
