Abstract
The goal of this study was to review Māori oral health services utilising a kaupapa Māori framework.
The aims of the study were to identify the issues in the development, implementation and operation of Māori dental health services within each of the three types of Māori health providers (mainstream, iwi-based, partnership). The three Māori oral health services are:
(i) Te Whare Kaitiaki, University of Otago Dental School, Dunedin.
(ii) Te atiawa Dental Service, New Plymouth.
(iii) Tipu Ora Dental Service, in partnership with the School Dental Service, Lakeland Health, Rotorua.
Method:
A literature review of kaupapa Māori research was undertaken to provide the Māori framework under which this study was conducted. The kaupapa Māori methodology utilised the following criteria:
(i) Rangatiratanga: The assertion of Māori leadership;
(ii) Whakakotahitanga: A holistic approach incorporating Te Whare Tapa Wha;
(iii) Whakapapa: The origins and development of oranga niho;
(iv) Whakawhanuitanga: Recognising and catering for the diverse needs of Māori;
(iv) Whanaungatanga: Culturally appropriate forms of relationship management;
(v) Maramatanga: Raising Māori awareness, health promotion and education; and
(vi) Whakapakiri: Recognising the need to the build capacity of Māori health providers.
Ethical approval was granted by the Otago, Bay of Plenty and Taranaki Ethics Committees to undertake interviews and focus groups with Māori oral health providers in Dunedin, Rotorua and New Plymouth. Information was also sought from advisors and policy analysts within the Ministry of Health. A valuable source of information was hui korero (speeches and/or discussion at Māori conferences). An extensive literature was undertaken including an historical search of material from private archives and the now defunct Māori Health Commission.
Results: An appropriate kaupapa Māori methodology was developed which provided a Māori framework to collate, describe, organise and present the information on Māori oral health.
In te ao tawhito (the pre-European world of the Māori) there was very little if any dental decay. In te ao hou (the contemporary world of the Māori) Māori do not enjoy the same oral health status as non-Māori across all age groups. The reasons for this health disparity are multifactorial but include the social determinants of health, life style factors and the under-utilisation of health services. In order to address the disparities in Māori oral health, Māori providers have been very eager to establish kaupapa Māori oral health services. The barriers to the development, implementation, and operation of a kaupapa Māori oral health service are many and varied and include access to funding, and racism. Māori health providers have overcome the barriers through two strategies: firstly, the establishment of relationships within both the health sector and the Māori community; and secondly, through their passion and commitment to oranga niho mo te iwi Māori (oral health for all Māori). The outcome of this review will contribute to Māori health gain through the recognition of appropriate models and strategies which can be utilised for the future advancement of Māori oral health services, and hence to an improvement in Māori oral health status.
Conclusion:
This review of Māori oral health services has found that there are oral health disparities between Māori and non-Māori New Zealanders. In an effort to overcome these disparities Māori have sought to provide kaupapa Māori oral health services. Whilst there is a diversity in the provision of Māori oral health services, kaupapa Māori services have been developed that are appropriate, effective, accessible and affordable. They must have the opportunity to flourish.