BMJ  2003;327 (23 August), doi:10.1136/bmj.327.7412.0-f

Editor's choice

Learning from indigenous people

"It would have been far better for the New Zealanders as a people if they had never seen a European," wrote a missionary, William Colenso, in 1865. When James Cook "discovered" New Zealand in 1769 there were estimated to be 200 000 Maori. By 1860 there were 35 000. Today Maori have a life expectancy about eight years less than the non-indigenous population. Next month's Asia Pacific Forum on Quality Improvement in Health Care will be opened in Auckland with a traditional Maori greeting, and the forum will consider not only how the health of Maori and other indigenous peoples might be improved but also how everybody in health care can learn from indigenous cultures.

There are some 350 million indigenous people, representing over 5000 cultures in 70 countries on every continent. They are ancient peoples who found a way to live in harmony with their environment. These "primitive" people lived in environments—deserts, deep forests, marshes, and tundra—where "advanced" people cannot easily survive. The lives of individuals may have been short, but indigenous people did not destroy their environment.

The arrival of colonists has always meant death and destruction for indigenous people. This happens not just because of guns, infection, destroyed lifestyles, exploitation, poverty, and political oppression but because of a deep spiritual oppression that comes from having your sovereignty and culture subjugated.

The answer to improving the health of indigenous people may lie less in increasing their access to modern health services and more in their rediscovering cultural values and ways. Tariana Turia—associate minister for health in New Zealand and "a descendant of the tribal peoples of Whanganui, Ngata Apa, Nga Rauru, Ngati Rangi, and Ngati Tuwharetoa"—describes how "as part of our drive towards self-reliance... our people decided to take our health into our own hands" (p 456).

Trying to fit into the government systems didn't work, but a breakthrough came when Maori health workers and officials developed their own strategy—He Korowai Oranga. The central idea is whanau ora—families supported to achieve maximum health and well being. The focus is shifted from the individual to the whanau, meaning that the strategy can embrace all the factors that affect health and tackle complex problems like family violence.

Such developments can provide rich opportunities for pakeha (Europeans) to learn. When I lived in New Zealand in 1978 the Treaty of Waitangi signed between Maori and Europeans in 1840 seemed part of history, but now its principles of "partnership, participation, and consultation" are part of everyday life and used in creating health policy (p 439). Romanticism would like an impossible return to precolonial days. Practicality calls for learning from indigenous people.

(rsmith{at}bmj.com)

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