Equity, Public Health Messaging, and Traditional Māori Knowledge: The Te Ranga Tupua COVID-19 Response

Abstract

Throughout the coronavirus disease 2019 (COVID-19) pandemic, the Māori, Indigenous people of New Zealand, public health response has been guided by the collaborative and relationship-centered principles of te ao Māori, the Māori world. This article presents the communications response to COVID-19 by Iwi, tribes, within Te Ranga Tupua (TRT), a collective of Iwi from the South Taranaki/Whanganui/Rangitīkei/Ruapehu regions of Aotearoa, New Zealand. This research uses a qualitative design based on a Kaupapa Māori approach. The research presented here focuses on the intersect between COVID-19-related public health messaging, and the application of Māori knowledge and worldviews to establish equitable protection for Māori. By prioritizing equity, self-determination, and adopting a holistic approach to well-being, TRT have been able to re-frame public health messaging in accordance with our tikanga, customs, and notions of Māori public health. We provide a snapshot of how a unique tribal collective deployed its resource to provide culturally appropriate information and communication responses to the first wave of COVID-19 in 2020, and then built on this knowledge and experience providing a modified and more strategic response to the pandemic in 2021.

Introduction

Globally, Indigenous populations experience worse health outcomes than non-Indigenous populations. This trend is true for Māori, the Indigenous people of New Zealand, who on average have a greater burden of disease than non-Māori, including higher mortality from cardiovascular disease, and a high prevalence of cancer, diabetes, and coronavirus disease 2019 (COVID-19) risk factors (Ministry of Health, 2015). The cause of this inequity is a complex combination of socioeconomic factors as well as racial discrimination and the impact of colonization (Abraham et al., 2018).

The Aotearoa New Zealand Context

Europeans began settling in large numbers in the late 18th century, at that time living alongside Māori, the tāngata whenua, original inhabitants (Anderson et al., 2014). In 1840, representatives of the British Crown and Māori chiefs signed Te Tiriti o Waitangi, the Treaty of Waitangi. This Treaty formed the basis of Crown settlement and sovereignty (Webb, 2017). However, a rapid erosion of the rights and guarantees of the Treaty followed, as the British and colonial settler state set about extending control over larger areas of land and racial assimilation policies and laws progressively undermined and disrupted traditional tribal practices, authority, and Māori culture (Mutu, 2011). The Treaty was declared a nullity and the validity of Māori rights were denied for nearly a century until the formation of the Waitangi Tribunal in 1975 (Webb, 2017).

The principles of Te Tiriti o Waitangi provide a framework within which government health agencies can meet their obligations under Te Tiriti in their day-to-day work (Tribunal, 2019). These principles are: (a) tino rangatiratanga, which provides for Māori self-determination in the design, delivery, and monitoring of health and disability services; (b) equity, which requires the Crown to commit to achieving equitable health outcomes for Māori; (c) active protection, which requires the Crown to act, to the fullest extent practicable, to achieve equitable health outcomes; (d) options, which require the Crown to provide for and properly resource Māori health and disability services; and support the delivery of these services in a culturally appropriate way; and (e) partnership, which requires the Crown and Māori to work in partnership in the governance, design, delivery, and monitoring of health and disability services (Tribunal, 2019).

For Māori, tino rangatiratanga is the practice of living according to our tikanga and recognizing Māori self-determination in all aspects of life, unimpeded by the Crown. However, the legacy of colonial history and the ongoing social marginalization of Māori have led to increased vulnerability to infectious disease. In 1918, the influenza pandemic infected more than 500,000 New Zealanders of a population of 1.15 million, with around 9,000 deaths in six weeks (Rice & Bryder, 2005). Māori were especially vulnerable during this pandemic with a death rate 7.3 times that of the European rate (Wilson et al., 2012). Despite a 100 years since the 1918 pandemic, the high vulnerability of Māori communities has not dramatically improved. Inequity has become entrenched through colonization, the ramifications of which have been passed to current generations (Hobbs et al., 2019). The prevalence of COVID-19 risk factors has remained unchanged leading an infection fatality rate 50% higher than non-Māori (Steyn et al., 2020). Māori experience differential access to health care services and on average, have the poorest health status of any ethnic group in New Zealand (Tribunal, 2019). On average, Māori live 7.1 fewer years compared with non-Māori in 2012 to 2014 (NZ Stats, 2021), twice the rate of cardiovascular mortality in 2010–2012, a total cancer mortality rate more than one and a half times higher to non-Māori rate in 2010–2012, and a self-reported diabetes rate twice as high as non-Māori (Ministry of Health, 2015). Structural bias and systemic racism are widespread in the health care system and are basic determinants of Māori health inequities.

The COVID-19 Pandemic in Aotearoa New Zealand

On March 21, 2020, in response to steadily rising numbers of COVID-19 cases linked to people recently returned to the country from overseas, the New Zealand government introduced a country-wide, four-level alert system (Jefferies et al., 2020). On March 25, 11:59 p.m., 2020, the whole country moved into to an Alert Level 4 lockdown, where everyone except essential workers was confined to their homes. The border was closed, and all international and domestic air travel was suspended. By April 19, 2020, daily reports of new cases dropped below 10, and on April 28, 2020, the country moved back to a lower alert-level setting (Alert Level 3). As the numbers of new cases continued to drop, the country moved down through subsequent levels, with New Zealand returning to pre-COVID conditions in late 2020 (Henrickson, 2020).

With the exception of several border-related incursions and smaller outbreaks, New Zealand was largely able to prevent widespread community transmission of COVID-19 through a combination of strict border measures and a rapid outbreak response until August 19, 2021. After nearly six months without a single coronavirus case detected in the New Zealand community, on August 17, 2021, the country entered a second lockdown after a 58-year-old man from Auckland tested positive for the highly contagious Delta variant. Māori have been disproportionately affected since this Delta outbreak, representing around 43% of all COVID-19 cases, despite making up only 16% of the population (Ministry of Health, 2021a).

Whereas, New Zealand began its COVID-19 vaccination rollout for border workers, health care workers, and at-risk individuals in February 2021, it was not until August 2021 that the government was able to secure sufficient supply of the Pfizer vaccine to allow for vaccination of the general public. New Zealand is now one of the most vaccinated countries in the world with around 95% of eligible people vaccinated with two doses (Ministry of Health, 2021b) However, the vaccination uptake by Māori has been slower to general population with around 88.5% of all eligible Māori population vaccinated with two doses versus 95.2% of total eligible population vaccinated with two doses, and 56.1% of all eligible Māori received a booster compared with 73.0% of the total eligible population (Ministry of Health, 2021b).

It was in a context of inequity and historical discrimination that Iwi leaders of Te Ranga Tupua (TRT) came together to respond to unique threat the COVID-19 pandemic posed for Māori communities. Iwi, roughly translated as “tribe,” are the largest social unit in Māori society and are based on whakapapa, genealogical ancestry, waka, canoes, in reference to the original migration voyages, and whenua, ancestral land. TRT is a collective made up of 12 Iwi entities and organizations from the Ruapehu, Rangitīkei, Whanganui, and South Taranaki districts of New Zealand. TRT trace their genealogical lines to tāngata whenua of these regions. The TRT collective is intrinsically linked to their community and serve all the members in the region that claim these ancestral links.

As TRT Iwi leaders became aware of the impending pandemic in March 2020, they initiated a range of activities to protect their people. These included, among other things, the establishment of a “Hub” that acted as the central coordination point for various welfare and support activities across the collective; the activation of a formalized process to meet, strategize and coordinate their response with government and other mainstream organizations; and the formation of a dedicated communications team, drawn from communications experts in Iwi-owned organizations around the region (Boulton et al., 2022). In the second August 2021 lockdown, TRT leaders were compelled to protect their populations once again. TRT were very specific in their response to the Delta outbreak with a more considered and strategic approach to communications that also incorporated vaccination as the main tool to fight COVID-19. TRT integrated the lessons from the March 2020 lockdown and specifically incorporated traditional Indigenous ways of thinking into their public health messaging.

Māori Public Health Messaging

Research indicates mainstream public health messaging is not always effective for minority populations, including ethnic or Indigenous populations (Harding & Oetzel, 2019). This difference was especially relevant in the initial stages of the COVID-19 pandemic. Encouraging Māori populations to undertake desirable health behaviors, such as social distancing, hand washing, and testing entails far more than simply placing information in the public arena and waiting for all people to respond positively. Previous studies have found that for Māori, the unrecognized cultural emphasis on the importance of family is their main impetus for behavior change (Brunton, 2007). The importance of family is central to Māori worldviews.

Throughout the COVID-19 pandemic, the Māori response has been guided by the collaborative and relationship-centered principles of te ao Māori. Specifically, from a te ao Māori perspective, the key message has been the need to protect whānau, extended family, and whakapapa, genealogical links—in other words, to protect the sanctity of the kinship’s relationships.

In te ao Māori, whānau, which is often translated as “family” has a more complex meaning. It includes physical, emotional, and spiritual dimensions, and can be multi-layered, flexible, and dynamic. For Māori, the relationship between the individual and whānau is subtle and complex. Individuals have rights of their own, but people are expected to express their individuality within the context of the whānau framework. One of the foundations of whānau is whakapapa, which has great importance in Māori society. Whakapapa is an organizing principle. It is through whakapapa that interactions and relationships are established, developed, and maintained within whānau, marae, sacred mountains, rivers, and ultimately the universe. It is through whakapapa that individuals often get their names, their identities, and their sense of belonging.

Having an approach that was grounded in Māori principles was particularly prominent in public health messaging and communications. By prioritizing equity, self-determination, and adopting a holistic approach to well-being, TRT have been able to re-frame public health messaging in accordance with our tikanga and notions of Māori public health. The research presented here focuses on the intersect between COVID-19-related public health messaging and the application of Māori knowledge, and worldviews to establish equitable protection for Māori. We provide a snapshot of how a unique tribal collective deployed its resource to provide a culturally appropriate information and communication response to the first wave of coronavirus in 2020 and then built on this knowledge and experience providing a modified and more strategic response to the pandemic in 2021.

Methods

Criteria and Data Set

The research design employs a Kaupapa Māori approach that captures Māori desires to affirm Māori cultural philosophies and practices, recognizing the strengths, and aspirations of Māori people (Mahuika, 2008). A Kaupapa Māori approach positions researchers in such a way to operationalize self-determination for research participants. Research issues of power, initiation, benefits, representation, legitimation, and accountability are addressed and understood in practice through the development of a participatory mode of consciousness (Bishop, 1999). This approach ensures the mana, authority, of participants is upheld throughout the research process (Smith, 1997), and that the research is ultimately used to benefit the Māori position.

Kaupapa Māori was specifically chosen as the preferred methodology to avoid the trap of Western epistemologies that either challenged the knowledge of parents or whānau, family, or approached this knowledge from a “compliance driven medical model framework” (Jones et al., 2010).

We generated our first data set through face-to-face interviews conducted between November 2020 and April 2021. Our inclusion criteria were individuals from Iwi and Māori organizations who were involved with or connected to the TRT Iwi collective COVID-19 response. Participants were interviewed to understand how their specific organization or Iwi responded to the needs of whānau and stakeholders during the March to June 2020 lockdown period and what learnings and lessons resulted from this pandemic. A total of 35 respondents who had links to TRT were interviewed. With participants’ permission, interviews were recorded. All interviews were conducted by Māori interviewers and transcribed by Māori (Boulton et al., 2022).

We generated our second data set by gathering and enumerating public Facebook posts, messages, dates, and other publicly available pānui, electronic notices, from the TRT response hub and Iwi organizations connected to the TRT Iwi collective, from August 2021 to December 2021. A total of 86 social media posts and 22 pānui were analyzed and themed.

Data Analysis

The framework for data analysis was also based on a Kaupapa Māori approach, with Māori researchers leading the data validation process to ensure it was congruent with Māori cultural philosophies and practices. The data were analyzed manually. For the first data set, two cycles of coding were completed to identify key issues and themes arising from the interviews (Braun & Clarke, 2006). In the first cycle, using open coding, individual members of the research team comprising two Māori and two Pākehā, New Zealand European, researchers, reviewed each transcript, applied codes and themes emerging from the data. In the second cycle, the research team came together face-to-face in a process known as mahi ā rōpū (Boulton et al., 2011) to conduct a form of axial coding by collectively sharing their analysis and interrogating each of the themes. The face-to-face analysis session provided team members with the opportunity to participate in a group discussion of everyone’s analysis, checking, and validating that analysis. During this session, researchers agreed on which individually selected themes were the most significant and whether themes required aggregation or disaggregation. A set of high-level themes and sub-themes was determined through consensus, and it is a selection of these themes that are reported. The two Māori researchers took a leadership role in the analysis and discussion of findings and together had the final say on the framing and presentation of the resulting analysis.

After familiarizing ourselves with the second data set, the Pākehā researcher undertook open coding on each communications piece. Codes and categories were discussed with two senior Māori researchers (authors of this article) again through mahi a rōpū, a face-to-face meeting, to analyze the coding and identify emerging patterns and themes. Each category and theme was refined through this process to accurately describe the findings and once again ensure the framing and presentation of the analyzed, and synthesized data were congruent with the principles of Kaupapa Māori research. It is these themes that are reported in the results.

Results

Lockdown 1

Drawing on the set of 35 qualitative interviews undertaken throughout November 2020 to April 2021 we examine how the TRT communications team undertook their work in a fast-paced and rapidly changing environment. Several themes were identified from these interviews including the inadequacy of central government messaging for Māori, the importance of local community expertise in a crisis, the connections & networks TRT had with their community, and the issue of building trust with Indigenous communities (Table 1). It should also be noted that the TRT communications, or “comms” team was brought together specifically by TRT Iwi leaders in response to the lockdown triggered by the incursion of COVID-19 into Aotearoa. Members of the comms team were able to leverage their genealogical and kinship connection with the community to quickly develop the trusting relationships required to provide public health information and share data in this intense environment.

Table 1.

Category and Themes of Qualitative Interviews (Boulton et al., 2022).

Category and themes

Communications

Inadequacy of government messaging

Local community expertise

Connection and networks

Building trust

Central government information, and particularly that coming from the Ministry of Health in the early weeks of lockdown required adjustment for it to be engaging for whānau Māori. Another reason for reworking the central government messages was because the Iwi leadership was offering alternative advice to central government agencies. One such example was advice to older populations around social distancing and self-isolation at the start of the pandemic. Iwi leaders determined that Māori aged over 60 would be at high risk due to health inequities pre-pandemic and should isolate. Whereas, official government advice on isolation was aimed at those 70 years and older, regardless of ethnicity (Ministry of Health, 2020).

One thing I did notice is that the TRT Hub communications had to amend the message to suit our audience. So, the message from the Ministry of Health was “be safe, stay at home and something else” whereas from a te Ao Maori lens it was more about “stay at home, wash your hands and be well.” So, it had a different effect for our people to approach it from a wellbeing perspective . . . I think that those messages that were coming from the Ministry just had to be tweaked to suit our audience and TRT did that well. (KI27)

It was difficult making sure that we kept in line with the government communications as the official source of information but made sure that it could be understood by our whānau because the government didn’t do a good job at communicating with our people . . . we were all trying to do the same thing get the messaging, translate it for our whanau. I don’t mean literal translation to Te Reo but make it in a language that could be understood because the government just didn’t put any time and effort into it until way too late in the piece and yet they were talking about vulnerable populations over and over again, but their comms didn’t reflect targeting vulnerable populations. (KI25)

Intentional work by the comms team was put into ensuring messages were translated and worded appropriately for whānau Māori. For example, government messaging was aimed at ensuring individual safety and health, whereas TRT comms focused on whānau or the well-being of the extended family, as a means of keeping well and connected (Devine et al., 2022).

The bit that I loved about the comms was that they would receive it and then they would recreate it into a language that our people could understand, and I am led to believe that there was significant feedback saying, because there was so much confusing information coming out via other media options, that many of our whānau really listened to the comms that came out from our TRT comms group. (KI20)

While a centrally coordinated response to comms was an effective means of getting important messages out to whānau, this was not always necessary. For example, individual Iwi was developing their own bespoke communications that augmented the collective TRT messaging. TRT’s comms approach was flexible and adaptable to allow for these localized responses.

We just got on with it, but we weren’t united in our comms efforts for various reasons, and I didn’t think we always needed to be united . . . because we do things a bit differently, so we have to acknowledge that. (KI26)

The communications team relied on the wider TRT network to assist in pushing our accurate and reliable information in a format that was easily accessible to those in the community.

. . . they were doing an amazing job of distributing that critical knowledge, passing information through the levels, making sure it comes down through the levels of leadership and through the network to the communities. Yeah, I thought the communications team did an amazing job. (KI22)

. . . I was quite lucky in that I was in that space just as comms but the likes of our friends [Name and Name] who were undertaking the comms for their organizations but doing a whole lot of other stuff across the board. So, at times, there was kind of three or four of us in there, but we did make sure that we talked amongst ourselves . . . because we just couldn’t do everything. (KI25)

The need for bespoke, Iwi-generated communications during this time to keep whānau informed was critical during this period, and the TRT comms team were an important vehicle for those messages. Iwi and Māori communications were regarded as the most trusted source of local information during the first lockdown of 2020 (Talamaivao, 2020).

. . . we had to have our own Iwi generated communications that dealt with the issues and reflected all of the mahi that was going on to support and protect our people. (KI22)

Lockdown 2

In the second lockdown, TRT used a more considered and strategic approach to public health messaging. This was achieved by deliberately contracting with a Māori-owned public relations and communication company; the use of innovative content utilizing local and community members to promote key messages; and more targeted messaging in the form of pānui that offered up-to-date COVID-19-related information.

We enumerated and analyzed 86 social media posts and 22 pānui released by three key Iwi-led, or Māori-owned organizations during the period August to December 2021.

Table 2 presents the total number of social media posts according to the high-level categories identified in our analysis, namely, risk reduction, community needs, and Māori perspectives.

Table 2.

Total Facebook Posts per Category Made by TRT Organizations and Categories From Pānui.

Category	Source of post
	Tribal organization			Total	TRT pānui	Total
	Ngā Tāngata Tiakia	Te Oranganui Trustb	Tukua Storytellingc
Risk reduction	15	18	3	36	27	63
Community needs	6	7	–	13	13	26
Māori perspectives	21	9	7	37	12	49
Total	42	34	10	86	52	138

Note. TRT = Te Ranga Tupua.

^aNTT is the Whanganui River post-settlement governance entity for Whanganui Iwi. At the time of the first lockdown, the TRT facilitator was also the Chair of NTT, and the CEO and staff were strong contributors to the TRT response.

^bTe Oranganui Trust is a large, Iwi-governed health and social service provider, located in Whanganui city, and provides health and social services throughout the wider Whanganui region. Te Oranganui was also asked by TRT Iwi Chairs to provide the central hub of operations for all the Iwi of TRT.

^cTukua Storytelling is a Māori-owned and operated communications service within the wider Whanganui region who were contracted by TRT to provide daily pānui and creative content for the COVID-19 response.

Our analysis indicates that the chief concerns on the part of the TRT leadership throughout the second lockdown were the reduction or minimization of risk; community need and Māori perspectives. This analysis illustrates how TRT public health messaging clearly integrated the lessons from the March 2020 lockdown and specifically incorporated traditional Indigenous ways of thinking resulting in a more focused communications response.

Figure 1 illustrates an example of risk reduction public health messaging that uses everyday situations, Māori faces, and Māori language to promote safe masking practices.

Figure 1.

Post About Mask Wearing From Te Oranganui on September 6, 2021 (Whakamau i tō ārai kanohi: Put on Your Face Covering).

Figure 2 provides examples of accessible TRT communications on the COVID-19 vaccine. These communications provided answers to questions about what the vaccine was, how it worked, its safety, how it protected against COVID-19, the short-term & long-term side effects, and the need for two doses. The communications used Māori language and worldviews to convey public health messages. In addition, TRT held information sessions online and in person to answer people’s questions and help whānau make informed decisions.

Figure 2.

Posts About Vaccine Information From TRT Pānui on (a) November 1, 2021 and (b) From Ngā Tāngata Tiaki on November 8, 2021 (Tinana: Body).

Figures 3 and 4 offer examples of how TRT public health messages included traditional Indigenous knowledge and Māori perspectives. Protecting whakapapa and whānau were common calls to action. Perspectives from tribes, ancestors, elders, Māori youth, Iwi leaders, Māori experts, and Māori community workers were included in TRT communications.

Figure 3.

Posts About Family and Genealogy as the Catalyst for Getting Vaccinated From (a) Te Oranganui on December 30, 2021 (mokopuna: grandchild) and (b) TRT Pānui on September 6, 2021 (Mā tātau katoa e ārai atu e COVID-19: Unite Against COVID-19).

Figure 4.

Posts About the Rangatahi Takeover Campaign From Tukua Storytelling on (a) September 30, 2021 and (b) November 11, 2021.

The rangatahi, young people, takeover campaign (Figure 4) was a TRT social media campaign involving a series of interactive videos and Facebook live sessions designed and run by TRT youth in the community. The young adults organized a session where they asked common questions about the vaccine with a trusted Māori clinician who was working at a national level advising the government on its response to Māori and a renowned local tribal leader. The rangatahi team actively engaged with their peers across a range of social media platforms to find out the questions that youth wanted answers for. Questions included what the vaccine does, how effective the vaccine is, the side effects, safety, speed of development and others.

Table 3 presents the three high-level categories and nine themes that emerged from our analysis of the social media posts and public notices released August to December 2021. Our analysis indicates that the chief concerns on the part of the TRT leadership throughout the second lockdown were the reduction or minimization of risk, community need, and Māori perspectives.

Table 3.

Analysis of Social Media Posts and Pānui From the Three TRT Organizations.

Themes	Descriptor
Risk reduction
Masking	TRT reiterated key messages reminding people to mask up when they were going shopping, heading outdoors, or going to get their vaccination. Communications about masking utilized different faces, ages, environments, and the Māori language
Vaccine information	Complex academic language was translated into more accessible content and vaccine information was provided directly from TRT social media platforms and information channels. TRT also held information sessions online to answer people’s questions and address in concerns
Vaccination clinics	TRT vaccination clinics were operated from many different locations including on-site clinics at provider locations but also traditional Māori meeting houses—marae. Communications used Māori faces and local community leaders and social media posts included pictures of kaumātua (elders), supported by their grandchildren, and families receiving vaccines
Ministry of Health guidelines	TRT provided relevant and timely information for government guidelines on tangihanga (Māori funeral ceremonies), mask wearing, COVID-19 symptoms, contact tracing, testing, and any requirements around indoor gatherings. TRT region-specific information was given the highest priority
Community needs
Local leaders and experts	TRT leaders shared their wisdom with the community, often reminding them of the foresight of their ancestors. Whānau were encouraged to look to their histories to find the strength to navigate the uncertainty of the pandemic. TRT also shared analyses from Māori public health doctors around the country
Planning and tribal services	TRT became a key connector with government agencies and income and welfare support services for whānau, operating a 0800 number out of their hub as well as offering COVID-19 testing centers and vaccination clinics. TRT set up a response effort with particular focus on establishing mobile testing and vaccination units, working with whānau to develop preparation plans, and exploring options for isolation facilities
Māori perspectives
Whānau (family)	In the TRT response there was an intentional emphasis on whānau when creating and disseminating public health messaging. Communications focused on the risk that COVID-19 posed to family members, particularly elders, young children, and those with health conditions and disabilities. Protecting whānau was the impetus for following the public health guidelines, masking, social distancing, and seeking testing. TRT used testimonials from families, grandparents, elders, and rangatahi to situate the messaging within a family context
Whakapapa (genealogy)	The TRT response was guided by the necessity to preserve whakapapa. This was conveyed in the TRT public health messaging with “protecting whakapapa” as the call to action in many of the social media posts. Testimonials from local community members, heroes, and celebrities shared their motivations to protect their whakapapa as the reason behind receiving the vaccination
Rangatahi	The TRT rangatahi takeover campaign was a social media campaign involving a series of interactive videos and Facebook live sessions designed and run completely by TRT rangatahi in the community. This campaign gave rangatahi the space to be able to ask questions and make important decisions for themselves

Note. TRT = Te Ranga Tupua.

Discussion

Macro-level government policies were a prudent enabler of positive outcomes for Māori in March-June 2020, for example, Māori made up approximately 8% of confirmed cases, far below the 16.5% they make up of the national population (McMeeking & Savage, 2020). However, it was the pivotal work of Iwi and Māori organizations which, on the micro-level provided social and welfare support, disseminated information in a timely and accurate way, and distributed resource to Māori communities in response to the government mandated lockdown. The Māori response to this uncertain environment was guided by traditional values and principles, the success of which was due in part to Māori self-responsibility and community-centered approaches to public health. In the 2021 Delta outbreak, TRT maintained their attention to equity, community health and Māori cultural needs with a more considered and strategic approach that clearly incorporated the lessons from the 2020 lockdown.

Structural inequities and systemic racism in the New Zealand health care system mean that Māori communities face a much greater health burden from COVID-19 (McMeeking & Savage, 2020). Despite the clear vulnerabilities of Māori to the virus, the COVID-19 response still perpetuated a system set up to benefit Pākehā. In March 2020, the government’s approach to COVID-19 communications, and indeed the wider COVID-19 health system response, followed a one-size-fits-all approach. This approach meant that, at best, the government were unaware that diseases, such as COVID-19 would impact ethnic groups unevenly or in the worst case, ignored this fact altogether. Psychologically, this was a highly volatile and anxiety ridden time, especially for Māori who had devastating historical experiences with previous pandemics. Yet, the government argues that the one-size-fits-all approach was necessary to act quickly and decisively to protect the country and implement strict public health measures. Community transmission of COVID-19 was eliminated through this first lockdown, and it was one of the few examples in recent history where Māori outcomes were not worse than non-Māori. International praise has commended the government’s response and the Prime Minister’s communications style (Henrickson, 2020). However, this fails to acknowledge the tireless work that took place on the ground in different Māori communities throughout the country. As well as logistical challenges, these community organizations were required to work within a health system plagued by institutional racism that was not designed to meet their needs.

Institutional racism is about a pattern of differential access to goods, services, and power. The government approach, however, intended, ignored the unique cultural needs of Māori. Due to historic discrimination and poverty, Māori were in greater need of emergency housing, food, electricity, social services, and income support. In addition, for Māori populations to perform desired health behaviors they needed adapted, culturally relevant, and uplifting public health messages. TRT Iwi leaders recognized that the government approach to communications in March to June 2020 was inequitable. Where the majority of the public health messages were aimed at ensuring individual safety and health, Iwi knew that Māori responded better to messages that used the traditional concept of “whānau ora” or the well-being of the extended family, as Māori do not often see themselves as existing in isolation as individuals but rather as members of a wider collective (Durie, 1998). The mainstream media was also negative, focusing on the threat posed by the virus, case numbers, hospitalization rates and deaths. In addition, the government language was often technical and academic.

TRT translated official messages into a form of language that their communities would better relate to and engage with. They also made specific effort to adjust the tone and situate the communications within a Māori perspective, using concepts of whānau ora and whakapapa to convey public health messages. The March to June 2020 Iwi communications were positive and strengths-based, encouraging the community to keep their family safe, use the lockdown period to reconnect with family or even reclaim and learn aspect of traditional Māori knowledge, such as karakia, prayer, or te reo Māori, Māori language. The key difference between the government public health messaging and the TRT response was TRT’s focus on establishing trust, utilizing Māori community connections, expertise, and networks.

Because TRT communications were coming from well-known Māori organizations, Māori in the community were more likely to trust and subsequently listen to these public health messages. In addition, the opportunity to see and hear from everyday people and local voices, which they have familial and personal connections with, helped to build trust and engagement. This contrasted with the government approach that relied of a select few government officials with whom Māori had no personal connection. As a result, a community survey showed that Iwi and Māori communications in the Whanganui region were the most trusted source of local information during the Alert Level 3 and 4 periods in March to June 2020 (Talamaivao, 2020).

Dissemination of this information was possible through a range of strategies including established relationships and networks, dedicated social media sites, as well as their presence, visibility, and involvement with the community. Iwi leaders, local champions, and role models were also used to broadcast on a range of platforms providing key messages around the safety and protocols during lockdown. Staff at all the organizations involved in the response were members of the various tribal groups around the region and had grown up and live in the community.

As in the first national lockdown in 2020, during the 2021 Delta outbreak, the TRT collective was again activated to help support their Māori community. Targeted communications delivered messaging on Ministry of Health guidelines, vaccination, masking, tribal support services, as well as focusing on specific areas of the community who were seen to be most in need of engagement, such as rangatahi. The urgent need to communicate appropriate, factual, and timely advice to Māori communities was highlighted by the NZ government’s failure to deliver a timely vaccination rollout for Māori. The vaccine uptake for Māori has been much slower to general population, with critics pointing to the government’s inequitable approach to age-banding of the rollout, failure to fund targeted initiatives or involve Māori health providers and experts earlier on in the planning. In the 2021 lockdown period, vaccines were a key tool to protect against COVID-19. TRT were very intentional with promoting vaccination by incorporating traditional Māori ways of thinking into their communications. TRT leaders had learnt from the March 2020 lockdown that this approach to public health messaging was the most engaging for Māori. In the Delta outbreak, they were able to refine their response even further to ensure equitable culturally relevant material that appealed to their people. Local community members, Iwi leaders, heroes, and celebrities shared their motivations to protect whakapapa as the reason behind receiving the vaccination and TRT used testimonials from grandparents, elders, parents and rangatahi to place messaging within a Māori worldview, an approach that resonated with the family-centered principles of te ao Māori.

In the TRT COVID-19 response, whakapapa and whānau were at the center of everything that they did. While a government may be motivated to respond to a crisis of this magnitude to protect the well-being of its citizens, the economy, and the continuity of the state, Iwi Māori are compelled in their duty to protect whānau and whakapapa, the key principles of the Māori identity and experience.

This drive to protect whānau and whakapapa is most clear in the communications of the TRT response. There was an intentional emphasis on whānau when creating and disseminating public health messaging. Communications focused on the risk that COVID-19 posed to family members, particularly elders, young children and those with health conditions and disabilities. Protecting whānau was the main impetus for following public health guidelines, such as masking, social distancing, and seeking testing. “Tiaki whakapapa” (protect whakapapa), was a common call to action in TRT social media content. Vaccination was promoted using testimonials from families, grandparents, elders, and rangatahi. Social media posts and TRT materials used pictures of all different kinds of families (grandparents with their grandchildren, parents, young mothers with their new-born babies, siblings, cousins, etc.) to situate messaging with the whānau context. TRT knew that this approach would be the most successful way to have public health messages resonate with and engage Māori in their community.

A particular focus of the whānau-centered approach was placed on rangatahi. During the vaccination rollout, young Māori were lagging behind every other population age band when it came to getting the COVID-19 vaccination. Much of the government’s messaging was not connecting with younger generations that left gaps for misinformation to take hold. From the beginning, Māori youth voices and ideas had not been included in the government vaccination rollout. Key barriers to vaccination in this group included a lack of understanding of the vaccine’s safety, the perceived risk of the Delta variant, online inaccessibility to messaging and misinformation. Increasing uptake in this population group involved appropriate messaging and vaccine accessibility. TRT knew that if rangatahi were going to be encouraged by anybody it would be by rangatahi they are familiar with. The TRT rangatahi takeover campaign was a social media project involving a series of interactive videos and Facebook live sessions designed and run completely by TRT rangatahi in the community. This campaign gave rangatahi the space to be able to ask questions and make important decisions for themselves.

Māori ideas of self-actualization are recognized in the principle of tino rangatiratanga. Tino rangatiratanga can mean self-determination, sovereignty, independence, and autonomy. The term is rooted in the Māori worldview and refers to Māori control over Māori lives with the centrality of mātauranga Māori, Māori knowledge. Unlike western ideas of self-actualization and determination, tino rangatiratanga is more likely to be realized at whānau, hapū, and community levels where there are opportunities for concerted action, partnership with others and leadership. The TRT response to COVID-19 demonstrated the numerous ways through which Iwi Māori expressed tino rangatiratanga. TRT realized the importance of ensuring their people were safe and did not rely on the state for permission, instead drawing on tikanga to justify their actions. The TRT response not only incorporated tino rangatiratanga into their work but also the other principles of Te Tiriti o Waitangi. Equity and active protection were front and center with TRT mobilizing its resource and expertise to ensure equitable health outcomes. The translation and provision of culturally appropriate health and social services gave Māori in the community options when they had been neglected by the Crown. And finally, TRT response was an exemplar of Māori engaging in true partnership, making decisions for Māori with Māori, and then engaging with Crown agencies in the design and delivery of health services where TRT saw fit.

Conclusion

In the context of inequitable health outcomes, TRT Iwi leaders have mobilized their resource and strategically targeted their populations using appropriate and innovative communications. The TRT response was noteworthy for addressing on delivery public health messaging that was holistic, not simply focusing on the physical safety, but addressing psychological well-being and safety as well. The experience with both lockdowns illustrates that for public health messaging to be truly effective for Māori, Māori need to drive those messages. Not only are Māori best placed to understand their own context and realities, but they are integral members of their communities, not separate from them. In the absence of culturally relevant public health messaging, our community leadership exercised their right to autonomy and took responsibility for that messaging to protect the well-being of their people. Future pandemic messaging on the part of central government must be cognizant that local responses are best placed to address local crises. Drawing on the expertise and knowledge that is present in these community is more likely to effect positive change and contribute to reducing inequity.

As illustrated by the success, innovation, and holistic nature of the TRT COVID-19 response, Māori ways of doing—with its recognition of the interconnection between all things human and non-human—have long held a more sustainable and equitable way of existing in the world. In times of global crisis, traditional Indigenous law and knowledge has protected and supported local communities irrespective of actions taken by governments. In the New Zealand context, Māori-led responses to COVID-19 have not only shown the strength of Māori leadership, but also more importantly the ability of that leadership to keep communities, irrespective of whether they are Indigenous or non-Indigenous, safe, cared for, and protected.

Author Biographies

Tom Devine is a Master of Public Health candidate at Columbia University in the City of New York on a Fulbright scholarship. Originally from Whanganui, he joined Whakauae in 2020 to help document the tribal response to COVID-19. He has also worked at the Ministry of Health on the COVID-19 response and vaccination rollout. More recently he has helped to design and build the New Zealand public health agency for his university placement, and currently works as a Principal Advisor at Te Whatu Ora Health New Zealand.

Tanya Allport (Te Āti Awa) is a Senior Researcher at Whakauae Research. Her passion is to make a positive impact on the health and well-being of Māori through aspirational, translational and kaupapa Māori focused research. She has a PhD from the University of Auckland and has worked in Māori health and education, Treaty of Waitangi research, and in urban community research.

Wheturangi Walsh-Tapiata (Te Āti Haunui-a-Pāpārangi, Ngā Rauru, Ngāti Rangi, Ngāti Raukawa) is the Chief Executive Officer of an indigenous health and social service organization called Te Oranganui Trust, based in Whanganui, New Zealand. With nearly 180 staff, research and evaluation of various programs is key to good practice. Te Oranganui Trust has established a strong relationship with Whakauae Research Services. She has a strong interest in looking at research from a culturally appropriate perspective.

Amohia Boulton (Ngāti Ranginui, Ngai Te Rangi, Ngāti Pukenga, Ngāti Mutunga, Te Āti Awa o te Waka a Māui) is the Director of Whakauae Research Services, a tribally owned, Indigenous health research center in Whanganui, New Zealand. She also holds Adjunct Professor roles in the Faculty of Health and Environmental Sciences at Auckland University of Technology and at the Health Services Research Centre, Victoria University of Wellington. A health services researcher of some 20 years, her research focuses on the relationship between, and contribution of, government policy to improving well-being outcomes for Māori. She is a member of the Healthier Lives, He Oranga Hauora National Science Challenge, Governance Group Kahui Māori, a Fellow of the Australian Evaluation Society and a Technical Advisor to the National Iwi Chairs’ Forum.