From the world of darkness to the world of light

Abstract

For Māori, health research serves as a site of resistance, conveying the reality and experiences of being Māori. The current political landscape in Aotearoa New Zealand (AoNZ) is a source of grave concern for both Māori and non-Māori New Zealanders. Under discussion are proposed amendments, driven by a minority political coalition partner to Te Tiriti o Waitangi regarding Māori (Indigenous) rights of mana whenua (authority over traditional lands and resources) and tino rangatiratanga (self-determination), as reaffirmed by Te Tiriti o Waitangi when signed by Māori and British colonists in 1840.¹ Te Tiriti o Waitangi has been part of all government legislation since the mid-1990s and is the legal basis upon which Māori as tangata whenua (people of the land) and the Crown are meant to work together in an equitable partnership to advance AoNZ. Its principles are particularly important in healthcare to ensure that the existing health inequities affecting Māori, many of which are consequent to colonization,² are recognized, prioritized and addressed. Dilution or dissipation of Te Tiriti o Waitangi guiding principles will inevitably impact adversely on the health and healthcare of Māori.

The landscape of Māori health research in AoNZ has undergone a profound and transformative journey over several decades. Historically and contemporarily, research involving Māori has been undertaken using colonial research paradigms that are inherently extractive, problematising Māori, and operating outside Māori worldviews and cultural frameworks.² Researchers predominantly approach health studies through a Western biomedical lens that prioritizes a Western research agenda, often treating Māori participants as research subjects rather than active contributors to knowledge production. This approach has not only marginalized Māori perspectives and research priorities based on community needs but also ensured that many important research outcomes are not communicated to or enacted with Māori communities. This has perpetuated systemic inequities in health research, healthcare delivery, and health outcomes.

Increasingly, Kaupapa Māori research (KMR) methodology is being applied to how health research for and about Māori is conceptualized, conducted, and interpreted. Pioneered by Indigenous scholars like Graham Hingangaroa Smith and Linda Tuhiwai Smith, KMR is a comprehensive philosophical and political framework that asserts Māori cultural sovereignty in knowledge production.^{3, 4} Kaupapa Māori Research prioritizes Māori cultural values, practices, and worldviews as legitimate and essential forms of knowledge. Health cannot be understood through a purely Western biomedical lens but must incorporate comprehensive, holistic perspectives that include spiritual, social, and cultural dimensions of well-being, as well as acknowledging the ways in which systems contribute to the enabling and disabling of access to power, resources, and the social determinants of health.

Kaupapa Māori Research also shifts power dynamics in research processes. Instead of external researchers determining research agendas, KMR ensures that Māori communities are active agents in defining research questions, designing methods, collecting and interpreting data, and determining the dissemination of research findings. This participatory approach ensures that research is relevant and directly beneficial to Māori communities. This methodological transformation has yielded significant advancements in understanding and bettering Māori health experiences. Research using KMR approaches has illuminated complex health disparities, revealing how colonization, systemic racism, and structural inequities manifest in contemporary health outcomes. Research of this kind moves beyond deficit-based narratives to highlight Māori resilience and resistance, cultural strengths, and Indigenous healing practices. Importantly, KMR has been instrumental in developing healthcare interventions and policies that have changed practice. Some powerful examples of this include Professor Bev Lawton's research on human papillomavirus (HPV) testing, which has led to AoNZ adopting HPV self-testing as the primary method for cervical screening.⁵ This shift in practice makes AoNZ the first high-income country to implement this approach, which addresses the inaccessibility Māori experience within the health system, enabling agency-centred healthcare. To improve rates of sudden unexpected death in infancy (SUDI), KMR centred on wahakura, a woven flax bassinet for infants up to 5–6 months of age, led to the AoNZ Ministry of Health affirming wahakura as an evidence-based, safe sleeping device for babies.⁶ These examples are exemplary, but it is crucial to understand that not all Māori health research needs to be KMR to be responsive and transformational for Māori. In studies that are not KMR but are Māori-led or partnered, researchers have created more nuanced and effective health promotion strategies that respect Māori cultural practices and community dynamics. This aligned and partnership approach has been particularly transformative in enhancing the understanding of health for aging Māori, as evidenced by work in this collection from Dr. Joanna Hikaka and colleagues.^{7, 8}

While we have observed the enactment of KMR in health, the challenge remains to ensure the ongoing development of an equitable and responsive research evidence base for Māori. This current collection of research focussing on Māori, often led by Māori, published by Wiley in the last 12 months, has examples of KMR research and also non-KMR research methodologies, as well as editorial commentaries highlighting the transitionary phase in which research involving Māori finds itself. There are 47 publications (of which 9 are editorial commentary) in journals focussing on surgery, aging, family therapy, allied health, emergency, internal medicine and nursing practice. The number of articles included in this collection reaffirms the importance of the field and the urgency with which we must find solutions to the ongoing challenges facing our Māori communities.

The profound repudiation of the proposed changes to Te Tiriti o Waitangi confirms its importance to all New Zealanders.⁹ Te Tiriti will always be the foundation for Māori thought and practice in healthcare and health research – ensuring we ask the right questions in the right way and prioritizing the needs of our communities. Therefore, Māori (health) research is a profound assertion of Māori cultural dignity, self-determination, and the fundamental right to define and understand health and healthcare in Māori terms – an expression of mana whenua and tino rangatiratanga.

This Editorial was commissioned to introduce the Wiley Maori Research Collection on Health and Wellbeing which was published online in recognition of Waitangi Day on 6 February 2025. The link to the Collection is: https://onlinelibrary.wiley.com/doi/toc/10.1002/(ISSN)9999-0009.maori-health-wellbeing