Evaluating traditional models

In writing this section I wanted to come across something quite simple but seemingly ellusive: information assessing the effectiveness of any of these models of Māori health

I wanted a definitive answer as to whether they work or not i.e. do they improve outcomes for Māori.

Aue, this was not to be.

Although te whare tapa whā has been applied extensively, from smoking cessation to whanau violence there doesn't seem to be a great deal of specific information into the effectiveness of any of these models of health.

The focus seems to be on another angle all together- the PHO.

The Ministry of Health describes a PHO as:

Primary health organisations (PHOs) are funded by district health boards (DHBs) to ensure the provision of essential primary health care services, mostly through general practices, to those people who are enrolled with the PHO.

In simpler terms, a PHO is an organisation which takes responsibility for an individuals primary health care and is funded by the local DHB.

There is a movement towards self-determinism in health promotion, with the development of specifically Māori PHOs which include frameworks such as te whare tapa wha.

So it's about independence but also about what models are used.

It's about Māori 'doing' health for Māori using Māori models of what that means.

An evaluation of specifically Māori PHOs  largely focused on cost and showed them to be effective.

Next time: Activism

Te wheke

Te wheke is the Māori word for "octopus" and its meanings are quite complex.

The head of the octopus represents the whānau while the eyes represent waiora, what could be translated as wellbeing.









The legs of the octopus represent eight other aspects of health:

Wairuatanga – spirituality
Hinengaro – the mind
Taha tinana – physical wellbeing
Whanaungatanga - extended family
Mauri – life force in people and objects
Mana ake – unique identity of individuals and family
Hā a koro ma, a kui ma – breath of life from forbearers
Whatumanawa – the open and healthy expression of emotion

It is important to remember that there are no clear distinctions between these aspects of health.

I took this almost verbatim from the Ministry of Health website as I couldn't put it better myself.

Te wheke was developed as a concept by Dr. Rangimarie Turuki Rose Pere, a Māori elder who has been involved in education, community development and language revitalization for the past 40 years.

Te whare tapa whā

Te whare tapa whā means the house with four cornerstones and is a Māori model of health developed by psychiatrist Dr Mason Durie in 1982.

It can be applied to any health issue, whether it involves physical or psychological well-being.

If one of the four cornerstones is missing this can cause an imbalance and poor health outcomes.

These four aspects can also mean the four walls of a house. If any wall is missing, the house will fall down.

According to the Ministry of Health the four cornerstones are:

Taha tinana or physical health: this represents the capacity for physical growth and development.

Taha wairua or spiritual health: this represents wider communication and faith. It is often one of the least recognised of the four.

Taha whānau or family health: this represents the capacity to belong and the wider social setting.

Taha hinengaro or mental health: this represents the capacity to communicate, to think and to feel.

Taken together these four elements represent the necessary aspects for positive health outcomes.

Next: Te wheke.

What is health?

Health might seem like a simple concept.

It's something that we engage with constantly but may have trouble quite defining.

When it comes down to it, our understanding of health of health is probably dominated by a western model which is quite particular in what it encompasses and how it is meant to work.

Sofie Ehrlich explains this brilliantly in an article from 2015.

She says that three things in particular have shaped the way medicine is practiced in the western world.

Firstly, the best way of understanding health is to break it down to its constituent parts. This is called reductionism.

Secondly, in order for something to have importance and be taken seriously it needs to have statistical significance, in other words, be important in a mathematical sense.

Thirdly, the mind and the body need to be considered separately in order to be understand properly.

The western model is traditionally very reliant on prescription drugs and surgery: if something doesn't work, medicate it or cut it out.

There are alternatives to this view of health.

Specifically, a number of different models of how we can look at health have been suggested that are informed by Māori rather than Pakeha culture.

In the next blog: Te whare tapa wha

Real People

Thus far it's might be difficult to see health as something that affects real Māori people.

From what's been said it's possible to come up with some ridiculous hypothetical Māori with cancer, diabetes and a conduct disorder who typifies the research.

That's a bit ridiculous but I think it's the case that health statistics are difficult to personalise.

Here are three case studies of people who in some way or another personalise what the statistics say:

I hope that brings all this back to something a bit more human and a bit more real.

(Thanks to the Health Navigator website, a charitable trust that brings free accessible online health information to people)

Next: What is health?

Hauora hinengaro

I think hauora hinengaro, mental health, deserves to be talked about seperately.

It's often assumed to be included in general health but doesn't really get the attention that it deserves.

In the Māori Health Chart Book 2015 referred to in the previous post there's a single table (38):



The key thing here is that Māori adults were one-and-a-half times as likely as non-Māori adults to report a high or very high probability of having an anxiety or depressive disorder.

Still, that doesn't exactly paint a picture. Mental health is often simply prefaced to physical health and barely rates a mention.


Maori Mental Health Needs Profile: A review of the evidence published by the Department of Health
gets more specific and concludes that:

Disorder prevalence and difference between Māori and non-Māori varied between disorders. Māori were 1.2 times more likely to have a major depressive disorder, 1.6 times more likely to have an anxiety disorder, 2.8 times more likely to have a conduct disorder, and 1.5 times more likely to have a substance disorder than nonMāori.

Although there's variability between kinds of disorders there's definitely marked inequality.

Next post: Real people