A critical analysis of te Tiriti o Waitangi application in primary health organisations in Aotearoa New Zealand: Findings from a nationwide survey.

Primary health is at the forefront of efforts to address health inequities. Effective primary health care keeps people well and improves longevity and quality of life. The persistence of health inequities, particularly between Indigenous peoples and non-Indigenous peoples globally, suggests that there is a need to strengthen policy and practise. Unique to Aotearoa (New Zealand) is te Tiriti o Waitangi, a treaty negotiated in 1840 between the British Crown and hapū (Māori [Indigenous] subtribes). This treaty is foundational to public policy in Aotearoa and requires the Crown (New Zealand government) to uphold a set of responsibilities around protecting and promoting Māori health. This paper examines to what extent Primary Health Organisations are upholding te Tiriti o Waitangi. The study utilises data from a nationwide telephone survey of public health providers conducted in 2019-2020 recruited from a list on the Ministry of Health website. This paper focuses on data about te Tiriti application from 21 Primary Health Organisations from a sample size of thirty. Critical te Tiriti analysis, an emerging methodology, was used to assess to what extent the participating primary health organisations were te Tiriti compliant. The critical te Tiriti analysis found poor to fair compliance with most elements of te Tiriti but good engagement with equity. Suggestions for strengthening practise included examining relationships with Māori, utilising a planned approach, structural mechanisms, normalising Māori world views and consistency in application. The onus needs to be on non-Māori to contribute to the cultural change and power-sharing required to uphold te Tiriti. Critical te Tiriti analysis is a useful methodology to review te Tiriti compliance and could be used in other contexts to review alignment with Indigenous rights and aspirations.