The well·being of the Maori

The well·being of the Maori A Maori doctor explains how social and cultural factors may explain statistical differences between Maori and non-Maori figures for health and education A otearoa (New Zealand) has a population of 3.3 million, of whom 12.2 per cent are Maori. It was over a thousand years ago that the Maori came to this land from Hawaiki in Eastern Polynesia bringing with them the "Polynesian culture." The temperate climate and diverse natural resources enabled the Maori to adapt to their new environment. Nine hundred years later, in the 19th century, these islands saw the arrival of the Pakeha (Europeans) who were soon to establish a British colony there. Although the initial contact with the Maori met with suspicion, the Pakeha were presently able to establish a rapport which eventually led to the signing of the Treaty of Waitangi. Under the Treaty a partnership was made between the Maori Chiefs (Nga Rangatira) on behalf of their people and Queen Victoria as Chief of Great Britain, who extended to the "Native of New Zealand her Royal Protection and imparts to them all the Rights and Privileges of British subjects." It is unclear to what extent Nga Rangatira understood the full impli- cations of the Treaty they had signed, since there had been a number of instances where a conflict of trust had been perpetrated by the representa- tives of the British government, especi- ally on matters of land tenure. Indeed the Treaty itself has been the focus of much discussion, particularly in recent times, by both Pakeha and Maori. For instance, since the recognition of Maori as an official language in 1987, it is now unclear whether English is an official language in law. It can be said that there have been some benefits for Maori health and well-being, and some good has been gained from British culture over this time. But there are many aspects of British culture which the Maori has learned to his or her disadvantage - such aspects as material wealth, the system of government and social behaviour. There is no doubt that, over the 20 Henare R. Broughton years, the Maori has had to struggle in order to survive within "a foreign cultural environment" at the expense of his own culture. From this context there has resulted much psychological distress and anger directed at the "institutions" of material wealth. Both British culture and the English language had a marked influence on the lifestyle of the Maori to the extent that a cultural transformation became inevitable. Through this culture the Maori was introduced to the concept Body callipers measure a sturdy Maori in Aotearoa (New Zealand). Photo WHO/P. Almasy of money, the use of the gun as a weapon , woollen garments for clothing, processed food in the form of flour, government, a system of law and politics. At the same time many foreign diseases arrived, such as gonorrhoea, syphilis, tuberculosis, alcohol abuse and other forms of social degradation. In the early part of this century, efforts to improve the public health of the villages were undertaken by two promi- nent Maori doctors trained in "western" medicine. They relied on the Maori language as the means by which they could "educate" their own people on matters pertaining to health. The Maori understanding of health highlights "the spiritual welfare which interacts with the physical, mental, social and cultural well-being of man and his environment." Language is an essential feature of culture for it pro- vides the means of sustaining tradi- tions, beliefs, customs and values (taonga); hence for the Maori his health and well-being depended on this valuable asset. The Pa (village) sites were located in a way that allowed village life to be well protected from invading forces but at the same time to be well serviced with basic needs in the way of potable water, food (fish, fowl, kumara, plant roots and so on), and a safe waste disposal system. Although people were living in a temperate climate, the often harsh weather conditions dictated the need to store food safely. Health customs Many Maori customs still have a relevance as health practices. For instance, it is not permitted to sit on a table, or to place a hat on the table where food is. prepared or eaten; washing clothing where dishes are washed is frowned upon, and so forth. Today the whole population is undergoing changes to its public health system. The changes are organi- zational in nature and entail an amal- gamation of district offices of the Department of Health (a central government agency) with hospital boards (local authority) to form area health boards. The responsibilities of the area health boards, however, do not include environmental health, an aspect covered by the territorial local authorities. A further feature of the area health boards is the significant omission of Maori health. The Maori population is particularly youthful, 39 per cent being under 15 years of age compared with 24.4 per cent among the total population. Only 3.9 per cent are in the over-60 age WORLD HEALTH, June 1989 group, compared with 14.7 per cent among the total population. These differences reflect both the higher historical fertility (in terms of birth numbers) and mortality levels of the Maori population relative to the total population. The fertility rate in recent years has declined, but the median age at childbearing is 23.3 years for the Maori women and 26.9 years for non-Maori women. Life expectancy at birth for the Maori man is 67.4 years and 71.3 years for the Maori woman. Over the past 35 years the Maori has made greater gains in life expectancy than the Pakeha. Excess of deaths Examination of the mortality data, on the other hand, shows that there is an excess of deaths among the Maori compared with the non-Maori, especi- ally with respect to heart disease. The infant mortality rate is still high, with 15.5 deaths per 1000 live births for the Maori, compared with 10.9 for the total population (1986 census). In 1976 the rates were 22.0 for the Maori and 13.0 for the non-Maori; since the rate for the total population was 14.0, some improvement has been made. It has been suggested that these differences may be due to social and cultural factors influenced by the economic well-being of the whole nation. Some observers believed that accessibility to the health services and the use made of it may explain these differences. Still others feel that they result from the nature of the service and the different ways in which Maori and non-Maori perceive its function. Had a bilingual education system been in existence since 1840, a different set of circumstances would be faced today in terms of the health and well-being of the Maori. Historically Maori was an unwritten language until the Pakeha arrived. The introduction of British culture brought with it the English language, and also the Christian faith whose missionaries developed Maori as a written language. Almost 150 years have passed and, despite the rapid adaptation the Maori has made to Western values, it has been at the expense of his language. Many observers believe that statistical differences between the Maori and Pakeha figures for health, educational attainment, social welfare and crime are due to social and cultural factors. «Language nest» It is of interest to note that some years before Maori became an official language in 1987 an enterprising pro- gramme to teach it to children at the pre-school level was introduced. The programme has become known as Te WORLD HEALTH, June 1989 Maori housewives have used natural hot-water springs for cooking food since time immemorial. Photo WHO/P. Almasy Kohanga Reo (language nest). Today there some 500 nests catering for over 8,000 children. Maori is taught in a cultural setting to infants in the pre- school age group (under five years), using much verbal interaction. In some areas bilingual schools have been for- med, which children from T e Kohanga Reo attend, but in other areas such schools do not exist nor are there any provisions for the continuing learning of the language. The value of learning Maori means a development of culti- vated learning experience through the formation of ideas, thought patterns, symbols, feelings, social interaction and an understanding of the environment. Sensitive issues have been created between the Maori and Pakeha which have become symbols of racial conflict, more especially in the last 25 years. The medium of the English language has been used in these circumstances. The Maori believe that it is essential for the social well-being of both Maori and Pakeha that Aotearoa should over the next ten years develop a bilingual approach to education. • 21