The question of funding for Rongoā Māori is controversial. Late last year funding for Rongoā hit the headlines as medical specialists compared the traditional medicine to witchcraft and wizardry. Michael Laws put in his two cents suggesting that the idea to fund Rongoā was ‘seriously stupid’ while opponents commenting online highlighted a lack of randomised clinical evidence as a fact preventing Rongoā from being recognised as a credible medical practice.
These claims represent a reductive view of medicine, a conception of healthcare provision that has long failed Māori.
The fact that Māori experience stark and persistent health inequities may be considered to be evidence enough. But we can go deeper than that, let’s look at what health actually is.
How we talk about health is very much influenced by the definition that we’re using. The arguments against Rongoā fit within a biomedical model of health. The biomedical model posits that health is the absence of disease, however it fails to acknowledge social and psychological factors and therefore is an unhelpful model for public health.
A better definition of health is that issued by the World Health Organisation. According to the World Health Organisation health is a state of complete physical, mental and social well being and not merely the absence of disease or infirmity.
Sir Mason Durie, sometimes referred to as the godfather of Māori health has visualised this concept of health as Te Whare Tapa Whā, this model (as the image indicates) suggests that good health is like a house, for the house to be strong psychological, physical, family and spiritual health must all be in balance.
The current model of primary health care provision does not support these needs. Jamming patients into 15 minute set appointments fails to facilitate relationships between patient and provider. Furthermore, research suggests that Māori health needs are complex requiring understanding of te ao Māori, Māori identity and Māori attitudes towards health.
Rongoā is more than just a series of traditional practices. It is a holistic approach to health care that recognises the importance of taha wairua. It allows for care to be tailored towards the patients needs and it can be combined in association with westernised medical care to produce the best outcome for the patient. This may simply be providing an environment in which Māori patients can feel that their cultural concerns are being respected.
Gorman, Nielsen and Best suggest that when practices fit logically within people’s beliefs that services will be more acceptable to them and more likely to be effective. Rongoā is the realisation of this. It provides a space for Māori self determination, a space where Māori can reclaim control over their own health needs, a space where care provided is culturally appropriate and accessible.
There is still the association of Rongoā and witchcraft and wizardry however, the belief that as a traditional medicine, Rongoā Māori has not been tested and therefore cannot be funded as a possible medical treatment.
The World Health Organisation disagrees.
As it stands a large proportion of the worlds population is dependent on traditional medicine. Internationally, organisations are beginning to recognise that traditional medicine has stuck around despite colonising influences because it contains some important knowledge. This is visible in establishments such as the National Center for Complementary and Alternative Medicine in the US. They are dedicated to studying the use of traditional medicines as a sources for treatment for modern illnesses such as HIV/AIDs.
With this in mind, the WHO has accepted that traditional medicine has a valuable role to play in our world. In 2002 this was officially recognised in the first Traditional Medicine Strategy. Since then, traditional medicine has been incorporated into the mainstream official Medicines Strategy 2008-2013. These documents highlight the potential of traditional medicine to do good and urge that governments implement policy, ensure safety and quality and work to promote the knowledge of traditional medicine amongst practitioners.
In New Zealand, the pathway towards inclusion of Rongoā Māori in the wider health system has been slowly growing in momentum since 1993 when the National Organisation of Māori Traditional Practitioners was established. They aim to uphold, promote, protect and sustain the practice of Rongoā. In 1999 the Ministry of Health published a set of standards for traditional Māori healing and in 2006 the Ministry of Health released a Rongoā development plan to outline how Rongoā would be supported within the health and disability sector.
This plan titled Taonga Tuku Iho was a consequence of the Māori Health Strategy 2002 which reiterated the Ministry of Health’s commitment to support the ongoing development of rongoā Māori in New Zealand. This is considered to be part of the governments aims to achieve whānau ora by ensuring that Māori cultural values are included in the planning, funding and delivery of health services.
The issue remains of how do we quantify Rongoā Māori though – how do we tick those quantitative boxes? The problem with this is that Rongoā practices are not as simple as taking a pill, they are a holistic method of practice that is more in tune to qualitative methods. This is not to say that Rongoā cannot be evaluated however.
A method we can use to evaluate the quality of Rongoā Māori is Avedis Donabedian’s Seven Pillars of Quality. This model calls for health care to be defined for quality against the following attributes – efficacy, effectiveness, efficiency, optimality, acceptability, legitimacy and equity. Rongoā immediately can be identified as fulfilling the requirements of acceptability for patients and within te ao Māori that of legitimacy. Of the greatest importance is Rongoā’s potential to improve equity by improving the health status of Māori in this country.
We believe that Rongoā Māori fills a gap that our health system has long failed to address. The evidence is there. Māori do not experience good health and our current health system is not doing anything about it. Rongoā as a culturally acceptable and holistic model of health has the potential to change this. To get Māori into care and following treatment. This is why Rongoā Māori should be funded.
This work was part of a debate in Politics 229: Mana Māori Motuhake. The moot was ‘That Rongoā Māori should be publicly funded.’
If you are interested in Rongoā and are based in Auckland, Manurewa Marae provides Rongoā alongside other health services.