Introduction
According to Durie (2004) Maoris are indigenous people of New Zealand their population consists 14% of the total New Zealand population. Maoris managed to retain their high regard on the elderly, of which fulfills roles of the whānau and the tribe. On the 1996 census, the Statistics New Zealand (1997) found out that the Maori population is very young having a rate of more than 56% under the age of 25 years old. And because of the low fertility of Maoris decades from now the number of Maori elderly will have a great increase. There would be a significant amount of change regarding the health policies, delivery and services given to the Maori elderly. And because of the high regard of Maoris on their elderly there are Westernized policies that the whānau perceives as barriers such as cultural barriers. A whānau-focused approach is a strategy in which it addresses the health services that must be given to Maoris especially elders with a great respect on the cultural belief of Maoris.
Objectives of the Study
The aims of this study are to identify the health status of Maori elders and then identify the policies and approaches given and its implications.
Literature Review
Definition of Terms
Whānau. It has been defined that whanau is a scattered group that is based on a mutual whakapapa or a descent from a shared ancestor, and in which particular commitments and duties are maintained. The word whanau has been extended in recent times which include non-traditional conditions like Maoris having similar interests but do not have a direct blood relationship starts to form a cohesive group. (Durrie, 1994a)
Family. Families are described according to the composition, if it’s single-parent family, nuclear or extended. The socioeconomic status, if the family is earning a high, middle or low income. The age distribution, if the family is child dependent or young. The ethnicity, if the family is Maori or Pakeha. And by the way the family communicates with the society. (Ministry of Health, 1998, p. 2)
Oranga. Oranga is defined as well being in He Matariki. It is a subjective concept and it can be categorized as a result that is influenced by different factors. Such factors include; (a) sense of identity (b) self-esteem, confidence and pride (c) control over his or her destiny (d) a voice that is heard (e) intellectual alertness, spiritual awareness and physical fitness (f) personal responsibility and co-operative action (g) respect for others (h) knowledge of te reo Maori and tikanga Maori (i) economic security and (j) whānau support. (Ministry of Health, 1998, p. 3)
Kaumätua. It refers to Maori that are over 55 years old. Traditionally it pertains to the position and role of kuia or older woman and koroua/koro or older man achieve as appreciation given to their contribution and being knowledgeable in tikanga Maori. (Ministry of Health, 1997, p. 4)
Over the past years, even though New Zealand has been heavily influenced by the western society, the Maori society was able to retain the positive regard on the elderly and ageing people, having a status on the Maori society and expecting them to exercise certain responsibilities and obligations on behalf of the whānau and hapu or tribe. On the next fifty years there is a great change in the demographic pattern of Maori elderly having a very youthful Maori population which is 56% under the age of 25 years old; there is a great implication on the service planning on Maori development and elderly. The future Maori elderly will or may have fewer chances in developing a secure cultural individualism. (Durie, 1999b, p. 102)
In addition the population of Maori has a median age of 10 years younger than the whole of New Zealand population. Even though it is youthful the population of Maoris is also growing old because of the increasing life expectancy and low birth rates. Hence, the magnitude and the numbers of ageing Maoris will rise notably on the next 20 to 30 years. By this time, the older Maori population will be challenged with a lot of alterations in whanau structures, conditions of health care and the manner the agencies in the government delivers the services to the older citizens. The postulation regarding the established role of Maori elderly in Maori society in general will not fit all Maoris. However, older Maoris will be relied increasingly as soon as it is required to use the traditional Maori resources. Precise information regarding the scope of existent situations about Maori elderly is important for the future health planning. (Waldon, 2004, p. 169)
There are four pre-requisites of Maori health which are; (a) whanaungatanga- kinship relationships (b) taonga tuku iho- cultural heritage (c) tea o tũroa- environment and (d) tũrangawaewae- land base. These factors are defined as key to a secre identity and wellbeing of Maori. The most widely cited Maori model of health is Whare Tapa Whā it describes good health as the equilibrium among the four interacting measures; (a) te taha wairu- spirituality, (b) te taha hinengaro – thoughts and feelings (c) te taha tinana- the physical side and (d) te taha whānau – the extended family. Each of the measures is necessary in assuring the stability of health. The common quality of the Maoris health model is that it is describes as holistic in nature, locating individual within the family context, identifying the determinants of health whether it is spiritual, cultural, social and biological, highlighting the continuity between past and present and accounting good health as an equilibrium between interacting variables. The Maori concept of health incorporates spiritual dimension and cultural integrity. However, there are criticisms on the Maori model of health and one of them is that there are a number of Maoris who are disconnected from the tribal society, and the model connotes that Maoris that do not have access in resources such as tribal land, kinship networks and Maori language, cannot anticipate in achieving good health. (Ratima et al, 2006, pp. 3-4)
In a study conducted by Durie (2004c, p. 1142) older Maoris are considered as the carriers of the Maori culture and are expected to perform a broad scope of responsibilities and obligations in the relationship of tribal affairs and also the cultural life of the family and community. A trademark of well being in older Maori is the ability to deliver leadership and direction in spite of advancing years with no heed to the socio-economic status. Furthermore, wellbeing is conceptualized as an interaction between personal health outlook and the involvement in central elements of Maori society like land and language. In the research on older Maoris, participants having the lowest score in the cultural indication scale were most likely having the worst health. Older people having low scores in cultural index conveyed lower level in wellbeing, even though there is the presence of identical health standards.
Furthermore, together with the membership of a Maori to a whānau comes an array of roles, duties and commitments, and a considerable amount of functions. The five primary needs identified by Durie (1994e) that are satidfies by the family and whānau are: (a) manaakitanga – the role of protection and nurturing (b) tohatohatia – the ability of the whānau and the family in sharing resources (c) pupuri taonga – the role of custody in relation to family / whānau physical human resources and knowledge (d) whakamana – the ability of the family / whānau to empower members and (d) whakatakato tikanga – the capacity of whānau to plan for future needs. (Ministry of Health, 1998, p. 3)
The Ottawa Charter (WHO 1986) is the action strategy that delivers a useful model in which it contemplates the wellbeing of older people and kaumätua. Health promotion is a procedure thet enables the individuals and communities to raise authority over and improve health. Health promotion is conformable with the aspirations of Maoris to be responsible in delivering programs on public health and provide services that meet their needs and necessities. Additionally discussions on the health of Maori must start with regard to the Treaty of Waitangi which is the founding document of the nation of New Zealand; it identifies the connection between Maori as tängata whenua and the Crown. (Ministry of Health, 1997, p. 6)
There are diverse ways in the improvement of the health status of Maoris. On health and disability support services the following are emphasized; information regarding health needs which is the basis for the decisions on the allocations of resources, assessment of needs, planning and the evidence of effectiveness, primary and preventive health, clarity of roles and focus on organization and accountability on performances, unfairness of access on population groups, participation of Maori in the delivery of services and the purchasing decisions, new arrangements regarding primary care funding and new providers and creative deliver of services. There are barriers in accessing services to Maoris and these are the cost barriers, location barriers, cultural barriers, and structural barriers. Reducing the barriers to obtain the services is likely to be attained via a whānau-focused approach in which it addresses the modern and historical factors that bring about various realities for whānau. The realities vary differently from iwi to iwi, hapu to hapu and whānau to whānau. The most efficient strategies for modifying whānau health practices and behaviors occurs best in the context of aspirations on Maori development. Maori development is equivalent to whānau development. Programs that are whānau focused allows the inclusion and involvement of both Maori associated with hapu and iwi and those who are not. The approach which is whānau-focused acknowledges different realities in the development and delivery of programs regarding public health that will be efficient in addressing the barriers on culture to whānau accessing the services on health. Whānau are the excellent conductors through the Maori society, and whānau are essential in promoting health messages and accessing the full cope of Maori networks, alliances, communities and social structures. Programs that are recognizably Maori, and that authenticates whānau values and beliefs are most likely to reduce the structural barriers in which some whānau undergo in conveying the programs and services. In delivering the services the provider must take account the beliefs of whānau. This strategies allows progress in the direction of quality of life outcomes for members of whānau namely the Te Ara Ahu Whakamua Hui, it includes having a powerful sense of identity, high self-esteem, confidence, independence, pride, a powerful voice, alertness on the intellect, physically fit, awareness of the spirituality, responsibility on oneself, cooperation, respect, know-how on te reo Maori and tikanga Maori, financial security and a healthy whānau support. (Ministry of Health, 1998, pp. 31-36)
Methodology
Different literatures were acquired via different electronic databases such as Google and Yahoo. By using the keywords whānau and community led initiative and Maori Elderly. This electronic search obtained different articles. The articles were read. After reading the articles it is then sorted to those who are relevant to the study and those that are not. The articles that were chosen uses surveys in their study, sample sizes, age groups, health policies and duration of the study, of which are important factors in the development of vital knowledge in carrying out this research.
A literature review is an important part in producing a research because there numerous literature reviews that gives evidence and support for a point of view and argument. Some related literatures were created to provide a background for different researches. Others persuade the readers to accept the alterations and some just states a concept in order for readers to fully understand the topic.
The main objective of a literature review is to share to the readers the ideas, and pieces of information that has been already approved. It must be guided by a common knowledge and includes the strengths and weaknesses of the study. It is a broad, scholarly, comprehensive, in-depth, systematic and critical review of scholarly publications, unpublished scholarly print material, audiovisual material and personal communication. (Beanland et al, 1999).
The literature reviews support the content and significance of the study. It is written at the first part of the paper. The related literatures put the study in a specific context by relating it to other studies, confirming and challenging the results and presenting new knowledge and ideas. (Richardson, 2000)
The reviewer of the literatures must be knowledgeable enough to choose the studies that were accepted and credible. All studies give and provide literatures, although the purpose for the accreditation of the related literatures changes depending on the methodology of the study. Having important and relevant related literatures gives the author or authors the chance and possibility to make the readers believe that the objective, process and outcomes of the study have great bases of knowledge.
Critique the Articles
Eight articles were chosen from different articles yielded using electronic database. The articles chosen were related to the chosen topic. Using the eight articles pieces of information were gathered and rendered to cause equilibrium on the examination regarding the past literatures. The Critiquing Framework by Bray and Ree (1995) was used in the ten articles. It uses twelve questions in scrutinizing the article. It is a simple and very convenient that enables the authors in identifying the right direction of the articles.
Search Strategy
The main objective of the search strategy is to look for different citations identified as consensus development, clinical trial reviews, citations from articles and journals and etc. the initial step is to look for a research topic, a researcher usually poses a question. Once the topic has been identified search it up using the keywords on articles in the university library, encyclopedias and medical journals. The researchers must outline the topic and must take note the significant references and bibliographies.
Electronic database searches
With the rapid pace of technology nowadays, Internet is the new source of related literature apart from the usual like the libraries. Internet provides various online libraries such as the Medical Literature Online (MEDLINE), which gives the latest researches, studies and medical breakthroughs that is very useful in creating a thesis proposal. An electronic library in Universities which provides CD-ROMS that can be easily accessed by the students is also another way of getting pieces of information regarding the topic of your study. CD-ROMS is a very effective tool in looking and scanning for different bibliographies and references. The use of different search engines like google and yahoo is another manner in which a researcher can find different online journals and articles for free.
Ethical Considerations
The main principle in the ethical context is it must include beneficence, respect in human dignity and justice. The respondents on the research must not be harmed if they participated in the study. The conductor of the research must ask consent to the participants and its immediate family. The patients must be guarded from physical and psychological harm during the conduction of the research. If the participants were physically and psychologically harmed and damaged, the study and the samples would be automatically removed from the study. (Polit et al, 1999)
Ethical considerations give information on every step on the international research procedure. If the authors or researchers develop questions without thinking carefully the ethics involved, the researcher cannot conduct his/her study abroad. (a) Institutional Protection of Your Informants- if the study requires the participation of human beings like interviewing using questionnaires, the research proposal must be first reviewed and approved by the Institutional Review Board before starting the study. It may require the researchers to ask for informants to sign consent forms to ensure anonymity of the participants. (b) Personal Responsibility – the primary responsibility of the researcher is to do no harm. Researchers have the personal ethical responsibility on the decisions and actions regarding on the research. When working with others especially if it involves the participation of human, the researchers must: represent oneself honestly, ask permission in conducting an interview, don’t make promises you cannot keep, be prompt and respectful, be grateful for the time and effort the participants have given, present your credentials and give contact information so that your participants can reach you.
Conclusions
There are a lot of changes nowadays in the Maori society and one of those is the change in the demographic pattern in which the fertility rates of Maoris are low and the population is generally youthful. On the next decades there would be a considerable increase in Maori elderly. Maori culture follows the whānau and in which the elderly are regarded as high persons in the society.
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