By Laura Goodall 29/04/2016 11


What has the Māori word for ‘chieftainship’ got to do with a team of scientists looking at obesity in Northland? Answer: the researchers broke the scientific mould by putting the Māori communities — not scientists — in the leading role. Researcher Ricky Bell tells us how they did it.

Portrait of Ricky BellRangatiratanga is a powerful word.  It’s loosely translated to mean chieftainship, authority, leadership.  But it is so much more than that, especially with its history.

In 1840, Māori chiefs from across Aotearoa signed the British Crown’s Treaty of Waitangi in good faith.   However the chiefs didn’t know that the Māori version had the word rangatiratanga in place of the word ‘possession’ in the English version. This meant that Māori understood they had full sovereignty over their lands, living spaces and treasures, not merely possession.*  Unsurprisingly, this ‘mistranslation’ contributed to a long road of confusion, dishonour and mistrust.

Today, there are still gaps.  In the scientific world, rangatiratanga is virtually non-existent.  In Māori health research, many projects are subject to sign-off by non-Māori authorities who don’t seem to consider what Māori communities might actually know — or want to know — about their own wellness.

Ricky Bell, his university colleagues, and Northland hapū whanāu (sub-tribal families) are trying to change that.

Ricky (Ngāti Hine, Ngā Puhi, Ngāti Hau, Te Rarawa, Te Aupōuri) works as a physiotherapist in Kaitaia, a small town in an area of Northland known as Te Tai Tokerau.  Four years ago, local kāumatua and kuia (elders) came to him with concerns about their community’s wellness.

Motivated to help, Ricky applied for a Lottery Health PhD scholarship — and was awarded it. He is now part way through his PhD at the University of Otago and has just published the first paper on this research.

A fresh start

erasing the old wayThe paper, published in Obesity Medicine, explains why and how Ricky and his team didn’t do their research the ‘usual way’ but instead rebuilt the model so that the Indigenous Peoples were in the driving seat for once.

“The elders I spoke to wanted a fresh start and for it to be done their way,” Ricky explains. “They’d had enough of research being done in their community that was of no real meaning and had no meaningful outcomes. Koretake (useless) was the way one of the elders described previous efforts.”

“This was a real challenge for us, as we had to start all over again and work on a proposal together that firstly satisfied the Indigenous community, and then try and make it fit to the University way of doing things.”

They are now using this new research model to work with Te Tai Tokerau Māori on tackling obesity in a way that accounts for, and is part of, their culture.

Ricky wasn’t expecting to look at obesity, however. It was the locals who drove the research focus in that direction.

“We pretty much had an open book when we had our initial meeting with the community,” he recalls.

“Māori are on the wrong side of pretty much every health indicator, so we first had ideas about making the region’s health services better. They knocked that on the head fairly quickly, but in a gentle way. Instead, they knew that obesity was a real problem and wanted work done in that area.”

The hapū whānau at the meeting told Ricky that they wanted to find out what the issues were with obesity, why it was a problem, and understand its relationship to wellness.

The Māori philosophy of wellness — called hauora — isn’t just limited to physical health but includes mental, spiritual and social health, which are all interlinked and can affect each other. Mainstream science is gradually understanding the importance of this, particularly for Māori.

“Obesity research is a big step away from what I’m used to as a physiotherapist and sports injury researcher,” Ricky says. “Some would argue that physiotherapy can be very clinical, but there’s been a shift in the last decade or so where it’s now more encompassing in its approach. The medical professions are slowly catching up to the wellness rather than the sickness model and that remains the challenge for us all.”

The science also confirms obesity as a priority area for Māori wellness. The latest statistics show that almost 50 per cent of all Māori adults are considered obese. Yet until now there have been no research exploring why this is so high, the Māori perspective on what being obese means, or how Indigenous knowledge can help to lower it.

“Health professionals have been saying for more than 30 years to eat less and exercise more,” Ricky points out. “If that was the right approach, we wouldn’t nationally be where we are at now with obesity. I think we can do things a better way.”

The community also told Ricky that they wanted the research done in a way that nurtured strengths within their people, rather than focusing on what’s lacking.

Community connections

Kaitaia (credit: Flickr/42033648@N00)Ricky shares genealogical links with the people of Te Tai Tokerau, which puts him at an advantage because he is able to interpret their needs more easily.

“My line of work’s been helpful but it’s been my hapū whānau who’ve really trained me to do this research,” he says. “I’ve been fortunate to have lots of kaumātua and kuia who have groomed me from a young age to where I’m at.

“They have equipped me with the capacity to understand the nuances of Indigenous ways of being and customs. They’ve also tasked me with having to walk in both worlds — Te Ao Māori and Te Ao Pākehā — which is infinitely challenging and often quite draining personally. Without that knowledge, I’m pretty sure I wouldn’t have been able to do this research.”

Ricky’s local role means he has seen the impact of poor health with his own eyes, leaving him concerned for his community’s future.

“Our people are passing away before their time for reasons that are totally preventable,” he explains. “We need them to stay here longer in a well capacity so they can pass on their knowledge to the next generation and keep us connected to who we are and where we have come from. Like other Indigenous Peoples, for Māori whakapapa holds the world together and defines the nature of relationships between all things.”

The other researchers don’t have these local connections, however, so they’ve had to build their own relationships with the community members from scratch. While Ricky’s blood ties helped move things along quicker, the team explain in their research paper that anyone could do this work — as long as relationships were built and nurtured throughout all stages of the research.

Regaining rangatiratanga

hands piecing together a puzzleIronically, Ricky’s strong community connections are a ‘curse’ as well as a blessing. His close ties would mean he may inadvertently influence the accuracy of the research.

To prevent this, the elders and the research team agreed that they needed to have an independent panel of Indigenous experts as well as continually cross-check the research with other scientists.

The panel, called a taumata, is made up of leaders from several local hapū who were chosen by their community to contribute to the research but protect the knowledge of their people. The leaders were chosen based on their skills and knowledge, so they aren’t necessarily elders. Their role is to scrutinize every facet of the research process to ensure that it’s compatible with the Māori way of thinking, being and doing.

But above all else, it could be said that having the taumata exemplifies rangatiratanga. It gives the community the self-determination they need for reinstating wellness in their own people.

For Ricky, this approach will likely open doors for all New Zealanders and not just Māori.

“I strongly believe that Indigenous ways of being can be of benefit to all,” he says. “For me personally, one of the best things that I hope will eventuate from this research is that it’s a starting point to doing things better, a way forward to creating an improved quality of life for all.”

Ricky’s next paper, which will outline what they’ve come to understand about obesity in Te Tai Tokerau, will be published about seven months from now.

“We can’t go from the first rung of the ladder to the fourth or fifth without first laying the foundations,” he says. “This may seem too slow or even frustrating to some, but the process we are following happens within Indigenous time frames and ways of being. To me, that is the beauty of it: a blank canvas on which the Indigenous community paints the story.”

Ricky is keen to kōrero (talk) with others about this research and welcomes any questions or comments.
You can find him on Twitter as @BellRickyNZ.

Tēnā rawa atu koe, Ricky, for sharing your story.


References:

* Claudia Orange. ‘Treaty of Waitangi – Interpretations of the Treaty of Waitangi’, Te Ara – the Encyclopedia of New Zealand.

Bell, R., Tumilty, S., Kira, G., Smith, C., & Hale, L. (2016). Using a community based participatory research model within an indigenous framework to establish an exploratory platform of investigation into obesity. Obesity Medicine, 2, 19-24. http://dx.doi.org/10.1016/j.obmed.2016.03.001

Photo of Kaitaia: Phillip Capper.


11 Responses to “Reshaping the mould for Māori obesity research”

  • In law the failure to define the terms and conditions of the agreement voided it .The few chiefs that signed the treaty with the Queen of England had no UNDERSTANDING of the content of the document IE the concept ownership . The First boat people, before the European settlers to NZ did not “own” the land so could not pass it to the Crown corporation in the agreement. Currently a 90%/ 10% resource split that partnership allows the Crown NZ govt to project the illusion of having the right to govern NZ (without a constitution or mandate).
    The Crown is not the Queen of England (that had Hobson sign the treaty for her).All signatories are dead which voids agreements.

    All this “Maori obesity” as oppose to” Obesity” is racism commonly found in the apartheid nation NZ.
    Supporting the Crowns apartheid nation is always a great funding angle.
    As the Maori were colonists/boat people to NZ like the other early settlers they were not indigenous, or rather no more indigenous(sic) than any person on the land mass.

  • Tēna rawa atu koe for your comment Anabel and thanks for sharing another understanding about the Treaty of Waitangi. I’m no expert on this and just based what I said on what I read on Te Ara (referenced at the bottom of the post).

    I can see the negative connotations of splitting people into specific groups. But I have a question (not a pointed one, just trying to understand): how is it racist for Māori to improve the health of their own people in a way that reflects their way of thinking, being and doing? That’s what the research project’s aims are – to let the community find their own solutions to the health problems they have.

    Also, my understanding is that the ‘One Size Fits All’ approach does not always work in health — for any ethnicity or culture, Indigenous or not. This is because cultural/environmental differences mean that what works for one group of people will not work for another. For example, a person in a city will have different health problems and needs than a person of the same ethnicity who lives in the countryside. That is the whole point of this research project – to tailor healthcare to a specific group of people that works within their culture/environment. From my understanding, this approach would also work for any other unique group of people. Ngā mihi mahana.

    • You misunderstood, I believe it is racist to split “obesity” into Maori obesity and non Maori “obesity.”
      Why do you think obesity is about a race?
      It is due to overeating for the physiological need for more (the ego).

      Why only select one race for improved health?funding?
      No group has all the same beliefs, feelings and thoughts.
      All Maori, like all people, differ in the way they think and feel about themselves, about what and who they believe they are.
      How can a community that does not know the inner workings of an individuals mind ( why he/she overeats) solve the individual overeating and obesity ?

      The health needs of a person in the city (or any environment) are the same as the country (good food, water and exercise not overeating)
      My other point is that no culture or race in NZ is separate. To treat people in a group as one size fits all for obesity is what you said was not your desire, The plan to group and provide healthcare to individuals based on another persons beliefs will not work for obesity.
      You are forgetting (or not yet understanding) why people overeat in the first place.Sometimes the cultural beliefs of apartheid NZ( and reinforcing a victim mentality) reinforces the overeating.
      Overeating is physiological manifestation of the desire for more, It is the ego.

      How can you imagine positive outcomes for separating people into groups (to be judged by a panel and “leader” who claims to understand the mind of another) the act itself is dis-empowering .

      • To hamuti hoki! What a load of codswallop! According to the reo Maori version of the Treaty it was the term “rangatiratanga” that the Chiefs were to retain and it was “kawanatanga” that the Chiefs ceded. But if you’d made an effort to actually read the Treaty (both versions) and learn some Maori you might actually make something other than ignorant, misinformed, and, quite frankly, fear-mongering comments. How you are qualified to comment on the “few chiefs” having “no understanding” of what they were signing goodness knows. As for your misuse (abuse) of the term apartheid, a term that has seemingly been adopted by Pakeha who fear any attempt to improve social outcomes for “all” members of this so-called “one people”, let me just say that I doubt you’d have any inkling about what apartheid was like for the Black and Coloured people of South Africa. But how you love to make yourself a victim of apartheid! The only thing I agree with you about is the fact that obesity is, indeed, colour blind. Unfortunately, Government administration is not so colour blind. I’m not even going to comment on the ridiculous boat people reference, as if discounting the indigineity of Maori is anything other than a desperate attempt to justify the ongoing and systematic dishonouring of the Treaty. But to the science of the kaupapa, it is interesting that in the light of all the recent developments in epigenetics pointing to the interactions between genetics and environment, we (some of us) are still talking about obesity as if it’s simply mind over matter. The point, as far as I’m concerned, is that the whole personal responsibility argument really has had no impact at a population level and it perpetuates the implication that people who are a “healthy” weight are somehow harder working and more disciplined than (and therefore superior to) those who are overweight or obese.

  • Laura- It’s definitely an interesting (and hopefully helpful) way to progress things. It would be good to get reports on improvements to health outcomes.

    The approach seems to come from the same work in conservation, which often recognises TEK (Traditional Ecological Knowledge) as an important, if often neglected source of information. The work described above seems to echo some of the participatory research on titi harvests undertaken with Rakiua Maori and ecologists at the University of Otago.

    • Thanks Brendan – I will be sure to take a look at the titi harvesting work. I have heard of TEK and plan to blog about people who are incorporating that as part of their conservation work. Please do let me know if you know (of) anyone working in TEK in general who might be keen to contribute or be interviewed for future blog posts!

  • Laura I agree with Anabel, human beings for far too long have been separated into groups based on race, beliefs or other perceived differences. This separatist thinking is seen in the term used ” their people” which is wrong thinking as we are all people.
    Our people includes all and excludes none.

  • The understanding of overeating is missing completely in the “community or rather a “leader” treating individuals” theory of healthcare. Building a house on dodgy foundations is never a good idea.
    Communities have always had “healers” in the past, they were better than today as they had understanding of spirit and mind, now days they are called Drs and just drug and treat the body how they have been taught to by the medico pharma industry. Overeating is the mind.

  • Laura a few things you may want to consider when removing readers comments.
    This is funded by the Crown who takes the funds from the public so its public funded.
    Set up” facilitating reader interaction”
    Censoring readers is the opposite of facilitating interaction, it is removing interaction, I have noticed this censorship happens when readers have a different opinion this censorship it is a form of breach of contract.

  • Sorry Helen, my mistake. I didn’t intentionally remove your comment. There are some people who have been suspected of being the same person but commenting multiple times under several pseudonyms, which we’re now looking into.

  • Multiple readers at the same IP address?
    Thanks for putting back my comments, as to “facilitate interaction” censorship should have no place in science.
    I was saying the foundation of Mind body spirit (mentioned here to be used for healing) equals the contentedness of all people.So for healing to happen the disconnect of “their people” or “our people” would have to go and be just people. No obesity or Maori obesity just obesity.The cause in the mind is the same for all, a disconnect from spirit( wholeness).Spirit is seeing the oneness in all, seeing the other in self. We talk about mind body spirit without fully understanding.