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The Treaty of Waitangi, often referred to as the founding document of Aotearoa New Zealand. Signed on 4th February 1840, the treaty formalized the relationship between Maori and the Crown (Kingi 2007). The Treaty of Waitangi consisted of 5 parts namely: the preamble, 3 articles and the postscript and exists in Maori and in English. Issues arose due to poor translation of the treaty and as a result there were different interpretations of the treaty between the English and Maori versions. The English version states that Maori give up sovereignty to the crown whereas in the Maori version it states ‘kawanatanga’ which enables the crown to set up government in New Zealand (course reference).
Both versions have similar objectives emphasizing that Maori and non-Maori share equal health and well-being but the Maori version places emphasis on Maori control over all things Maori (Kingi 2007). A few years thereafter it was evident that the rights promised to the Maori were ignored, resulting in land confiscation, language displacement and a loss of political power and economic control. The loss of Mauri land, control and culture led to Mauri depopulation. In historic fashion Mauri recovered from near extinction with little help from the Treaty or the Crown and platforms for Mauri health development was established (Kingi 2007). The Waitangi tribunal was established in 1975 and served as a platform where treaty related issues could be discussed outside of a court setting. This eventually led to the restoration of the relationship between the Treaty and Mauri health through the establishment of the Treaty principles identified by the Royal Commission of Social Policy (1988).
The three principles namely: partnership, protection and participation were established to create a common ground based on both versions of the Treaty (Kingi 2007). The principle of partnership places an obligation on the Crown to incorporate Mauri in the design of health legislation, health policies and health strategies. This encompasses the involvement of all indigenous communities in the development of strategies for Mauri health gain, appropriate health and disability services (Kingi 2007).
The principle of participation encompasses the requirement for Mauri to participate in all levels of the health and disability sector ensuring that health strategies are in alignment with present-day Mauri realities (Kingi 2007). The final principle of protection serves to eradicate disparities amongst Mauri and non-Mauri ensuring equitable health outcomes as well as protection over Mauri cultural concepts and values. The aim of the Treaty principles lie within the principles, to eradicate any inequalities between Mauri and non- Mauri as well as to preserve Mauri culture and values.
Maori health and well-being are described by a concept called ‘ Te whare tapa wha’ which represents a holistic approach to health consisting of four cornerstones. This concept illustrates that each of the four cornerstones play an equal role in maintaining complete health and well-being. Therefore if one of the four cornerstones are weak, a person is considered as unwell (Pistacchi 2008). The four cornerstones consist of: physical health (Taha tinana), spiritual health (Taha wairua), family health (Taha whanau) and mental health (Taha hinengaro).
Physical health (Taha tinana) refers to the ability for physical development. According to Pistacchi (2008) Maori believe that body, mind and soul are closely related and has an effect on physical health. Spiritual health (Taha wairua) refers to the ability for faith and what makes a person uniquely Maori, by providing a link to their ancestors (Pistacchi 2008). Family health (Taha whanau) refers to the ability to belong. Maori believes that family gives them strength to be who they are, and it is what connects them to their ancestors. The final dimension is mental health (Taha hinengaro), which refers to the thoughts, feelings and emotions and how a person feels about their state of health (Pistacchi 2008).
The Treaty of Waitangi places an obligation on the health care system of New Zealand to provide equitable health care to all. New Zealand has a multicultural society consisting of many ethnic groups. Providing equitable healthcare to a multicultural society requires a certain level of cultural competency. The Health Practitioners Competency Assurance Act 2003 created a legislative framework whereby ensuring cultural competency of health practitioners (Ratima, Waetford et al. 2006). Its significance was to address long standing cultural inequalities and to provide a culture supportive environment through creating an understanding of the Treaty of Waitangi. (Ratima, Waetford et al. 2006). Other culturally relevant Acts include: NZ Health and Disability Commissioner Act 1994, NZ Health and Disability Act 2000 and the Treaty of Waitangi.
Cultural competency is a prevalent factor in addressing longstanding disparities faced by Mauri and the indigenous people of New Zealand and plays a pivotal role in achieving the best clinical outcomes (Ratima, Waetford et al. 2006).
A healthcare professional it is my responsibility to meet all competency requirements set out by HPCAA 2003, more so cultural competency. Equipped with knowledge of the Treaty of Waitangi and the history Aotearoa New Zealand, I have gained understanding about the longstanding disparities that exist within the healthcare sector between Mauri and non- Mauri. I have learned the significance of being a culturally competent health practitioner and how cultural competency is a pivotal factor to actively diffuse the longstanding cultural inequalities as well as how it can be beneficial in achieving the best clinical outcomes. Therefore I will ensure that my practice is in line with the defining characteristics of a culturally competent health practitioner according to Ratima, Waetford et al. (2006).
Ensure that assessments, treatment plans are culturally relevant to each client. Seek to create a trustworthy environment between health care provider and client through communication, actively seeking client preferences and feedback, educate clients about what to expect during physiotherapy and the active participation of their family. I would seek to create networks for informed referrals as well as creating client awareness of relevant services to ensure that each client receives holistic care. I will ensure the collection of quality ethnicity data as well as reflect on my practice in all aspects ensuring that I am actively working to reduce cultural inequalities (Ratima, Waetford et al. 2006).
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