Home > CULTURE: A KEY INGREDIENT IN NUTRITION AND PHYSICAL EXERCISE HEALTH PROMOTION PROGRAMMES
MĀORI KNOWLEDGE:
A KEY INGREDIENT
IN NUTRITION AND PHYSICAL EXERCISE HEALTH PROMOTION PROGRAMMES FOR MĀORI
Wendy Henwood
Te R��pu Wh��riki
Massey University
Abstract
Nutrition and physical exercise health promotion programmes have been around schools and communities for a long time, but only recently has culture been acknowledged as an important feature of health promotion approaches. This paper draws on the experience of Korikori a Iwi, a community development action research project that used M��ori culture as a basis for encouraging good nutrition and regular physical exercise in five M��ori communities. Although community action objectives are grounded in research-based knowledge, the strategies used to achieve these objectives are grounded in the community��s knowledge base – in this case, that of te ao M��ori (the M��ori world). In addition to findings from across the project sites, the way in which one of the programme providers, Hauora Whanui, approached Korikori a Iwi will be used to demonstrate how culture laid the foundation for a health initiative that supported the building of M��ori capacity within the community. Formative evaluation assistance during the developmental phase of the programme provided a way to improve the link between research and public health practice, and to explore the significance of tikanga M��ori (M��ori customs and traditions) and related strategies as a vehicle for change, increased capacity and community resource development. The knowledge source drawn upon in this process is often referred to as Te Puna Matauranga, which implies that an existing pool or spring of knowledge is available and available to be accessed.
Five M��ori
health providers1 in Te Taitokerau region (Northland,
Aotearoa / New Zealand) implemented the Ministry of Health-funded Korikori
a Iwi project. The project sites involved a mix of rural and small-town
communities in the far north and the Whangarei area, which were led
by a coordinator appointed in each of the communities.
The broad health
policy goal for the project was to improve health and wellbeing through
health promotion programmes that promote healthy lifestyles. At a local
level the objective was to develop community physical exercise and nutrition
initiatives based on an integrated and holistic kaupapa M��ori framework
with M��ori in the participating communities.
Much has been
written about mainstream health promotion and its focus on improving
population health, about the importance of community capacity building,
and about the need to anchor community programmes in the local context
(Hawe and Shiell 2000, Raphael 2000). Despite this thinking being familiar
in the health arena for some time, there are only scant references to
specific indigenous examples in current literature.
The recent
Bangkok Charter for Health Promotion in a Globalized World (World Health
Organisation 2005), an international forum that built on the Ottawa
Charter (World Health Organization 1986), highlighted as one of the
key issues to be addressed, at both local and global levels, the links
between inequalities being faced by indigenous people and their health
status.
M��ori are
poorly represented in positive health and wellbeing statistics (Ajwani
et al. 2003, Durie 1994, P��mare et al. 1995). There are a number of
M��ori models being utilised as frameworks for public health and development
in Aotearoa. Te Pae Mahutonga (Durie 1999) is one example currently
finding favour with a range of programme providers. Based on the Southern
Cross constellation, the navigational guide comprises two ��pointers��
regarded as necessary to undertake tasks and roles – Ng�� Manukura
(effective leadership) and Te Mana Whakahaere (autonomy) – and four
��central stars�� depicting the cornerstones of wellbeing – Mauriora
(access to te ao M��ori), Waiora (environmental), Toiora (healthy lifestyles),
and Te Oranga (participation at all levels).
Whether or
not an identified model is used to guide community initiatives, common
M��ori themes apparent in health and wellbeing programmes are:
In discussing
aspects of validation, Park (1993, cited in Raphael 2000) suggests that
living experiences, or ��interactive knowledge��, that reflect a group��s
world views, values and principles are important in an evidenced-based
approach to health promotion. Raphael (2000) supports this notion when
he says ��recognise what is known, and how and why it is known��,
as do Joubert and Raeburn (1998) when they talk about health promotion
as building on individual and wh��nau strengths, and positive experiences.
Such strategies are neither new nor unique for M��ori, but they have been dormant and/or not credited with any value in many places. Physical activity was always an integral part of holistic wellness for M��ori. Traditional games and activities required coordination, stamina and fitness. Not only were they ways of having fun; they were also important in preparation for warfare, hunting, gardening, skills and leadership development, strengthening tribal development, and the transfer of cultural knowledge (Thomas and Dyall 1999). There is a current hunger for cultural approaches to be revived, and culture is slowly being recognised as an effective medium for change, learning and wellness in the health sector. The literature suggests that local capacity needs to be strengthened for change to occur, and therefore programmes seeking positive outcomes for M��ori need to be grounded in M��ori realities, knowledge and aspirations.
Korikori a
Iwi was a collaboration between a funder (the Ministry of Health), the
evaluators (Wh��riki Research group) and the M��ori health provider
organisations. The Wh��riki Research Group2 was contracted by the Ministry of
Health to undertake formative evaluation during the first year (May
2003 to 2004) of the five-site Te Taitokerau Korikori a Iwi projects.
Formative evaluation
involved working alongside the participating health providers and coordinators,
both individually and collectively, to maximise the effectiveness of
the project. This included assistance with sound programme planning,
the setting of clear objectives and evidence-based strategies, and working
through developmental and implementation issues. The process was an
opportunity to explore and draw on local experience and knowledge, relevant
evidence-based information and practical experience with similar projects,
and to provide critical feedback on the development and implementation
of the project. A user-friendly approach helped to break down negative
perceptions of research and demonstrated the utilisation of linked research
and practice.
In keeping
with the ��community action�� approach and within the broad parameters
of the contract, each site developed its own unique programme based
on the coordinators�� strengths and aspirations, the needs of their
community and the resources available to them.
The evaluation methodology was the same at each site. Given the limited time frame, information was gathered by the researcher working closely with each coordinator through regular visits, collective hui and email communication, and the review of project documentation. One face-to-face interview was undertaken with each coordinator at the end of the evaluation period.
Results from the evaluation across the five project sites are outlined below. A description of the Hauora Whanui approach follows these general findings to demonstrate a specific experience of positioning culture at the forefront of a health promotion programme.
The concept
of Korikori a Iwi straddled a range of approaches common to current
health initiatives, including health promotion, community development,
action research and community action. In this case the difference was
that the approach was underpinned by a M��ori world view. In addition
to the outcomes from the actual programme, the developmental stages
and milestones, the relationships involved and the side issues that
emerged along the way were all valued and regarded as a vital part of
the learning and understanding about the project.
The local and
M��ori cultural basis of the programme was seen as the critical strength
to emerge from Korikori a Iwi activities across the sites. Rather than
being a separate ��add-on�� component of the programme, the approach
taken ensured that these knowledge bases were central to planning and
working with health and wellbeing issues affecting M��ori: ��It wouldn��t
have happened without the cultural approach – culture is the binder
for exercise and nutrition�� (site coordinator).
The merging
of nutrition, M��ori culture and physical exercise in innovative and
holistic ways to effect healthy lifestyle change was seen as validating
M��ori approaches and ways of doing things. Rekindling M��ori knowledge
and practices, and a combination of strategies founded on the strengths,
passions and networks of the project coordinators, had a multiplier
effect.
M��ori traditional
games, activities and weaponry were repackaged as forms of exercise,
entertainment, learning and coordination skills development. For example:
All were able
to embrace local identity, whakapapa and community links and aspirations.
In addition to the hands-on community activity, the project coordinators also saw the need to be involved at a local policy level to influence places where wh��nau tended to group, such as schools, marae and sports clubs. Project work with school boards of trustees, for example, raised awareness of the importance of a holistic approach to wellbeing within the school environment. This challenged and encouraged specific policies about the food available to students in the school tuckshop at one site. It resulted in better associations being made between the tuckshop policy and student dental health, fitness, wellbeing, and the ability to learn. The process highlighted the positive spin-offs and broad implications of addressing nutritional issues within the school environment.
Early indicators
of success of the initiative point to the local knowledge that informed
the project as being paramount. Each coordinator contributed a wide
range of personal and local knowledge, skills and high levels of innovation
in applying M��ori frameworks to address physical exercise and nutrition
issues. Programmes were developed to capture the interest of, and engage
with, a wide range of participants, particularly those often considered
��hard to reach��, delivered in a user-friendly way, and utilised
resources available locally.
Appointed by
each participating M��ori health provider, the project coordinators
came with track records of ��walking the talk�� in M��ori health,
wide-ranging personal strengths, whakapapa (ancestral) links to the
community, a willingness to share their skills and expertise, and individual
passion and commitment. These attributes highlighted the leadership
dynamics involving young M��ori in high-profile community roles, and
the importance not only of the message they carry, but also of who they
are as the messenger for their people.
Even though geographically separate, the five-site team approach ensured an important collective dimension to the project that encouraged working together, where practical and appropriate. There was a range of benefits in developing these synergies, including: the sharing of individual strengths; the pooling of diverse and innovative ideas; expanding networks and alliances among colleagues, other M��ori health providers and M��ori-focused groups; and opportunities to showcase the project and practise a more coordinated and unified approach to regional health promotion.
Site coordinators
said that participants in local projects appeared to be more aware of
general health issues and were starting to make links between food and
exercise from their own cultural perspective.
Issues raised
by the programme tended to reflect community attitudes. Sport had always
enjoyed a high profile in the north, and sportspeople were held in high
esteem. Participation in the Korikori a Iwi project was reported to
have broadened the perception of exercise and fitness beyond sport for
a number of people. The project encouraged people to participate and
excel in a range of other exercise-based activities, particularly M��ori
culturally based activities that included a range of wellbeing components.
It promoted a range of alternative methods of exercise, and in many
instances physical activity was redefined. Instead of gymnasium training
being recognised as the only path to sports and physical excellence,
the connection was now being made between activities such as kapa haka
and mau r��kau (weapon training) as valid training and fitness regimes.
For example, a two-hour kapa haka practice was being acknowledged as a strenuous and intense physical workout. In addition, some participants found the kapa haka environment to be spiritually uplifting and more conducive to their total wellbeing than attending a gymnasium. It also overcame the cost factor associated with regular attendance at a gym, which had prevented some people from participating. Programme participants seemed keen to be working with all three components – physical exercise, nutrition and culture – together rather than in isolation, as had been the norm.
Although a
huge amount of potential was identified in working from a cultural base,
there was concern that there were insufficient resources and time to
consolidate the initial work undertaken or to pursue developmental ideas
that had emerged. This was seen as limiting what the project could achieve
in the longer term.
Although a
raft of innovative activities were introduced to Korikori a Iwi project
communities, the sustainability of these activities within a short time
frame was regarded as problematic. It was likely to take considerable
time for communities to understand the community development/action
approach and take ownership of the initiatives introduced by the coordinators.
Workforce development
was identified as an issue from the outset. Although the programme empowered
local people to build their skills and capacity to run community initiatives,
the coordinators�� role was vital in supporting and nurturing the new
leaders so that the work would continue at a high standard. The need
for ongoing investment in local human capability and capacity building
was identified as crucial in maintaining and further developing the
progress made. Site coordinators expressed the need for more professional
development to maintain and extend their skills and knowledge. Although
generic public health training opportunities were available, there were
not the same opportunities within the context of te ao M��ori.
The concept of health promotion within a cultural framework was widely accepted in certain sectors, but there were challenges in trying to promote and validate cultural activities at a health and wellbeing level in some instances. For example, there was a perception at one school that although sport was strong, regarded as important, and actively encouraged, M��ori cultural activities were not regarded as being able to provide the same potential or opportunities for students and so kapa haka was relegated to a lunchtime activity, thereby marginalising M��ori students. As a result of the Korikori a Iwi coordinator challenging the situation and assisting with policy development, M��ori cultural activities were subsequently integrated into the school��s physical education and health curriculum.
The broad strategy
taken by this site was to revive traditional M��ori skills and teachings
that had a bearing on exercise. The site coordinator brought personal
experience and expertise in traditional M��ori games, movement, exercise,
drills, dance and weaponry to the project. He developed a w��nanga (lesson)
series known as Ng�� Mahi a R��hia, based on reigniting the holistic
philosophy of Te Tuakiri o te Tangata. This involved understanding and
applying the philosophy to physical activity and movement, and the use
of te reo M��ori and traditional M��ori games and activities. The k��rero
(talk) about traditional forms of exercise and lifestyles for M��ori
provided an understanding of the purpose behind the movements and actions
being taught, and introduced another dimension to physical exercise
and cultural activities. The concept was not regarded as anything new:
it ��is not one that has only now been created, but rather one that
has been slowly forgotten�� (site coordinator).
The programme
provided a medium to involve wh��nau in healthy lifestyle activities
that linked both physical and spiritual dimensions of wellbeing, and
that would integrate health issues rather than address them in isolation.
As part of the training programme, participants were taught how to make
their own resources for the physical activities. Making a set of equipment
such as tirakau, taiaha and patu not only provided knowledge about the
items, but was also an opportunity to learn about local natural resources
and the environment.
The coordinator recognised that for Ng�� Mahi a R��hia to realise its potential and achieve some level of sustainability, a pool of trainers would be required to deliver the programme, rather than a sole facilitator for the whole region. The first stage of a train-the-trainer approach was to recruit people from throughout Te Taitokerau for Ng�� Mahi a R��hia training w��nanga. The programme was tailored for community people interested not only in building their own skills and capacity, but also in returning to their community in due course to deliver the programme. Once potential trainers were identified from the w��nanga participants throughout the region, they undertook a stage-two w��nanga programme, which involved specialised training and ongoing support to take up a trainer role in their local community. This process alone increased the numbers of wh��nau exposed to cultural forms of exercise and wellbeing practices. The trainees�� skills and expertise increased, capacity was being built, and communities started to run their own Ng�� Mahi a R��hia with the ongoing support of the coordinator. It was not long before mau r��kau training was established on a weekly basis in several locations. Strengthening the capacity of the wider community was the first step in ensuring more sustainable and viable activities would be available in each community.
Many examples
throughout the first year of Korikori a Iwi demonstrate the huge potential
for grounding healthy lifestyles programmes in culture for M��ori. Although
nutrition and physical exercise were the health focus of the project,
spin-offs were highlighted in education, community and wh��nau/hap��
(tribe) wellbeing and development, and longer-term economic development
and tourism opportunities.
As with all
health promotion programmes with short-term funding and time frames
trying to address long-term issues, sustainability is both important
and difficult. Building community capacity is crucial and requires a
mix of effective leadership, advocacy, skills development, and the sharing
of knowledge. The long and slow process requires facilitation by people
with expertise and local knowledge and therefore has implications for
public health workforce development. For the M��ori public health workforce
to be effective, appropriate training needs to be available and accessible.
Mentoring for emerging workers would be beneficial, as would assistance
for project managers within organisations, who also need to be up with
the play about public health strategies to actively support staff.
The Korikori
a Iwi project demonstrated the practical application of the theoretical
framework of Te Pae Mahutonga, where each component was entwined in
planning and delivery. Effective leadership was shown by the coordinators,
and the level of autonomy that allowed for local development provided
the impetus for development, while each of the cornerstones of wellbeing
was also evident across the project activities. The project clearly
worked from a M��ori cultural basis, which incorporated environmental
aspects of resource utilisation and learning, a holistic healthy lifestyle
approach to all activities, and the encouragement and promotion of wh��nau
to participate and be involved at a range of levels.
This strong convergence between theory and practice is a powerful and constructive development that bodes well for M��ori health and development in this location. The Korikori a Iwi cultural framework could be applied in other regions, focuses and settings where there is a commitment to using local cultural knowledge as a vehicle to promote health. For culture to be an effective component for improving M��ori health, public health policy development needs to acknowledge the small but important inroads being made by approaches such as Korikori a Iwi. A better understanding of the links between culture and health would contribute to more appropriate programme development. The use of community action/development approaches to health promotion is an important consideration because it acknowledges that each community is unique and has different needs and aspirations.
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1 Correspondence
Whakawhitiora Pai Community Health Service, Te Hauora o te Hiku o te Ika, Te Runanga o te Rarawa, Hauora Whanui, and Kia Ora Ngati Wai.
2 A M��ori research group working in partnership with Social and Health Outcomes Research and Evaluation (SHORE), Massey University.
3 The marae is a M��ori centre consisting of courtyard, meeting house and associated buildings and land. The wh��nau is the M��ori extended family, and the w��nanga is an institution of higher learning.
4 A traditional sailing canoe.
5 An outrigger canoe.
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