Abstract
Understanding Indigenous health inequities requires an equity lens to recognise the impact that colonisation and loss of cultural identity have on health and well-being. An equity lens enables a critical examination and understanding of systems and processes that entrench racism and embed inequity. The United Nations Declaration of the Rights of Indigenous Peoples and Te Tiriti ō Waitangi clearly states that health equity is a basic right of Indigenous Peoples and should form the basis of action in health services and research.
This thesis focuses on chronic kidney disease as a case study to explore and investigate inequities in health outcomes. This thesis includes a critical appraisal of the role of research as a colonisation tool that has maintained health inequity. The thesis explores and enacts Indigenous research praxis, such as Indigenous Data Governance and Sovereignty to assert Indigenous rights, and utilises Indigenous methodology as a tool of decolonisation to explore inequities.
The findings of this thesis led to the design and development of the CONSIDER statement; the Consolidated criteria for strengthening reporting of health research involving Indigenous Peoples. The CONSIDER statement is a consolidation and synthesis of ethics and research guidelines for working alongside Indigenous Peoples, it provides a 17 point checklist for research institutions and researchers by which to record completeness of reporting.
The findings of this thesis present how the use of Indigenous quantitative methodologies has identified significant differences in clinical practice patterns related to Māori experiences of dialysis and transplantation.
This thesis demonstrates that if research and health systems continue along the status quo, without any consideration for roles and responsibilities in relation to health equity, Indigenous Peoples will continue to experience the worst health outcomes in their own nations. Equity in outcomes is not the end goal, elimination of the impacts of colonisation and racism on the health and the long-term well-being of Indigenous Peoples is the end goal. Health research and health systems must continue to strive to address inequities by monitoring the provision of best practice, as well as identifying the provision of future treatment and management practices to ensure equity. Mauri Ora.