The School of Clinical Sciences at Auckland University of Technology (AUT) is now on a path that we consider to be divisive and negligent towards the 25% of New Zealand citizens who are non-Māori/non-European - and indeed to Europeans (see AUT, 2024). The extent of its embracing of Critical Social Justice for one ethnic and cultural group only, at the possible expense of quality of medical education, should be deeply worrying for New Zealand. So it is time for the present Government to step in and terminate the current drive towards highly imbalanced health and education.
Emeritus Professor John Raine has already discussed the problems in a recent article (Raine, 2024) which in fact may have underestimated the scale of the challenge now facing New Zealand. Others have commented previously (e.g. Lillis, 2024).
We support initiatives that promote equality of opportunity for everyone and that are intended to lead to improved outcomes. However, the statement from the School of Clinical Sciences (“Te Tiriti Ora” - see below), requiring that “all staff know who they are as a person of Te Tiriti, and as both teacher and learner”, is being forced on the university and will set a precedent for other universities to follow. It talks of disparities in health, but where do we see mention of the ethnic group that suffers the greatest shortfalls in health and wellbeing and socioeconomically - Pacific People (Lillis, 2023)?
Why does a single ethnic and cultural group and its world view dominate the new trajectory of the School of Clinical Sciences? What material will be taught and assessed in those components of the curriculum that discuss colonization and racism? For what purpose are staff and students expected to “unsettle the colonial-settler origins of structures and rules” and to create space for Indigenous knowledge”? How much indigenous knowledge is appropriate within programmes that are delivered by a modern clinical school?
Why is the university expected to create culturally safe environments for one ethnic and cultural group only, and educate all health students in how to care for whānau Māori only in clinical settings? In principle, we support cultural safety on campus but what about everyone else?
The Social Determinants of Health
Students are asked to “critically analyse institutions and systems that contribute to health inequities and identify potential solutions”. Such evaluations should indeed be undertaken, but what is expected of students’ analyses? Where do we read of the Social Determinants of Health? Across the world, disparities in health have to do mainly with the Social Determinants of Health, or those non-medical factors that influence health across populations. They comprise the conditions in which people are born, grow, work, live and age and additionally the wider set of forces and systems that shape the conditions of daily life (World Health Organization, 2024).
These forces and systems include economic policies and frameworks, development agendas, social norms, social policies and political systems. They include the following determinants: Income and Social Protection, Education, Unemployment and Job Insecurity, Working Life Conditions, Food Insecurity, Housing, Basic Amenities and the Environment, Early childhood Development, Social Inclusion and Non-discrimination, Structural Conflict and Access to affordable health services of decent quality.
The AUT statement does not appear to address an entire curriculum, but only that part that has to do with the Treaty. Do staff and students have the right to dissent in relation to being Te Tiriti-led?
We should indeed recognise and address racism in health and other contexts, but just how pervasive and severe is racism within New Zealand’s health sector or in education? Rather than assert systemic bias or racism as major causes of disparity and introduce new asymmetries in policy and delivery, perhaps it would be more productive to focus on those determinants that influence both education and health for all citizens. Such causes are mentioned in the statement, but the overall tone is highly unbalanced and exclusive of the majority of New Zealanders.
Te Tiriti Forced on Everyone
In demanding that all staff “know who they are as a person of Te Tiriti, and as both teacher and learner”, the statement presents an indigenisation polemic but relies on references (e.g. Tuck and Yang) that are themselves decolonisation polemics.
The statement is an insult to the generations from Sir Māui Pomare to Professor Garth Cooper, who have worked tirelessly to deliver better health for Māori and other New Zealanders. Further, it poses serious danger in its lack of balance and in its potential to diminish the quality of clinical teaching and therefore to clinical practice.
The AUT statement, essentially a curriculum framework, in effect demands the university to shape its curriculum around some 15% of the population, most of whom have mixed blood, and of those many might in fact not support the enforced indigenization of our universities. This situation represents an extreme form of Critical Social Justice in action, and can only lead to long-term damage to the quality of education at AUT.
Te Tiriti Ora is an excellent example of what is going on across the country and is very disturbing. Does the Minister for Tertiary Education, Penny Simmonds, have a view on such initiatives? It is time for Government to step in and bring common sense back to tertiary education.
References
AUT (2024). Study health sciences
https://www.aut.ac.nz/study/study-options/health-sciences
Lillis, David (2023). Our Prioritised Health System and Pacific People
https://breakingviewsnz.blogspot.com/2023/01/david-lillis-our-prioritised-health.html
Lillis, David (2024). Is Tertiary Education for Learning or for Indoctrination?
https://breakingviewsnz.blogspot.com/2024/08/david-lillis-is-tertiary-education-for.html
Raine, John (2024). Universities not Wānanga - Time for the Government to Step Up
https://www.bassettbrashandhide.com/post/john-raine-universities-not-w%C4%81nanga-time-for-the-government-to-step-up
Tuck, E., & Yang, K. (2012, 09/08). Decolonization Is Not a Metaphor. Decolonization, 1(1), 1-40. https://jps.library.utoronto.ca/index.php/des/article/view/18630/15554
World Health Organization (2024). Social determinants of health
https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1
The AUT Statement
Te Tiriti Ora
The School of Clinical Science is Te Tiriti o Waitangi led, and graduates are ready to take their place in a Te Tiriti based health system. Te Tiriti Ora is a curriculum framework that responds to the challenges set out by Te Aronui (the AUT Tiriti Framework) and embodies the School’s commitment to a Tiriti based education and health system.
Under the framework, it is the responsibility of staff to ensure safe teaching and learning spaces and experiences, manaaki learners, and tiakina resources. Te Tiriti Ora requires that all staff know who they are as a person of Te Tiriti, and as both teacher and learner; partner with students in their learning journey to create spaces where students feel a sense of belonging; facilitate engaging, dynamic discussions that are open and civil; welcome diverse perspectives; design courses that provide flexible ways for students to demonstrate mastery and competence, and assessment activities that offer students opportunities to grow; disrupt deficit framing about health, people, and communities; and recognise the classroom as a site of power, privilege, hierarchy, inclusion, exclusion and implicit norms.
Te Tiriti Ora sets out guidelines for school-wide Graduate Attributes; L7 learning outcomes; content, classroom, and clinical expectations; and assessment design philosophy, informed by the centring of:
• Anti-racism: the active process of identifying and opposing racism is through naming and interruption, and strategising for change (Jones, 2002)
• Decolonisation: a practical process that involves applying critical self-and-cultural reflection to analysing structures and rules in order to recognise and unsettle their colonial-settler origins and create space for Indigenous knowledge (Tuck & Yang, 2012)
• Cultural Safety: “requires healthcare professionals and their associated healthcare
organisations to examine themselves and the potential impact of their own culture on clinical interactions and healthcare service delivery” (Curtis et.al., 2019, p.14)
• Equity: “In Aotearoa New Zealand, people have differences in health that are not only avoidable but unfair and unjust. Equity recognises different people with different levels of advantage require different approaches and resources to get equitable health outcomes.” (MoH, 2019)
• Inclusion: working with notions of difference and social justice to form representative communities where marginalised groups are visible and powerful (Simon-Kumar, 2018)
• Kawa Whakaruruhau: creating culturally safe environments for Māori students, and
educating all health students in how to care for whānau Māori in clinical settings (Ramsden, 2002)
• Indigenisation: a systematic, planned shift towards valuing and including Indigenous knowledges including tikanga, kaupapa and mātauranga into decolonised spaces (Came et.al., 2020)
Of note, these are necessarily oversimplified and contestable definitions. Staff are encouraged to undertake independent readings to develop more nuanced understandings and strategies for introducing these topics into classrooms and clinical settings.
It is expected that the framework will be reviewed (at least) annually and revised every three years.
Whakapapa: A Te Tiriti Ora Steering Group, Piki Diamond, Jacquie Kidd, Ellen Nicholson first designed this framework in 2022. This version was reviewed in 2023 by Jacquie Kidd and Ellen Nicholson
Graduate Attributes*
Alongside discipline competencies, graduates from the School of Clinical Sciences will:
• Be culturally safe.
• Advocate for systemic (policy, practice, legislative) change.
• Challenge racism.
• Contribute to the delivery of health services that advance equity of outcomes for tangata whaiora, whanau and communities.
Te Tiriti Ora: Level 7 Learning Outcomes*
1. Consistently demonstrate cultural safety across a range of contexts.
2. Apply advocacy principles in order to challenge and change policy, practice, and legislation.
3. Recognise and address racism in the health context.
4. Critically analyse institutions and systems that contribute to health inequities and identify potential solutions.
*It is expected that the Te Tiriti Ora Level 7 learning outcomes will be evidenced at least once in appropriate Level 7 courses. Programmes are also expected to review their Level 5 and Level 6 courses and learning outcomes throughout the degree to ensure that students are scaffolded to successful achievement of the Level 7 learning outcomes, and demonstration of the Te Tiriti Ora graduate attributes.
Te Tiriti Ora: Curriculum Content, Classroom Practices, and Clinical Experience Expectations
Across the School of Clinical Sciences, and in the context of Te Tiriti Ora, it is expected that Departments will undertake to ensure that curriculum content across the programme will include:
• Social justice and equity
• Te Tiriti o Waitangi
• Tools of colonisation
• Determinants of health, and mechanisms that prioritise access to health determinants
• Recognising and addressing racism
• Māori history of Aotearoa New Zealand (delivered within a Te Tiriti partnership)
• Māori health models utilised in health service delivery and policy (including, but not limited to, Te Whare Tapa Wha (Durie, 1998), Te Pae Māhutonga (Durie, 1999), the Hui Process (Lacey et. al., 2011) and the Meihana Model (Pitama et. al., 2014) and their applicability to clinical practice in reducing health inequities (delivered within a Te Tiriti partnership)
• Working with whānau and Māori communities (delivered within a Te Tiriti partnership)
• The impact of research on Māori health outcomes (delivered within a Te Tiriti partnership)
• Mātauranga Māori (only conceptualised and delivered by Mātauranga experts)
Across the School of Clinical Sciences, and in the context of Te Tiriti Ora, it is expected that Departments will undertake to ensure that classroom practices include:
• Acknowledgment of beginnings and endings.
• Decolonisation of course readings and resources and the inclusion of Indigenous authors and concepts.
• Development of case studies that are respectful and values based.
Across the School of Clinical Sciences, and in the context of Te Tiriti Ora, it is expected that Departments will undertake to ensure that clinical experiences include:
• Opportunities to visit/work a diverse range of health providers and services.
• Prioritised opportunities for ākonga Māori to work alongside Māori health providers and clinicians.
• Opportunities to utilise a range of learning methods to reinforce Māori health models.
• Culturally safe engagements with Māori patients and whānau within clinical environments which supports application of the Hui Process and Meihana Model to clinical practice.
• Working within a team that has Māori patients and whānau within their care.
• Preceptorship, mentoring, and supervision delivered by culturally safe educators.
• Assessments of clinical competence that align with Māori models of health.
Te Tiriti Ora: Assessment Design Philosophy
As appropriate, assessment design should reflect assessment activities and events that provide flexible ways for students to demonstrate mastery and competence, and offer students opportunities to grow, through:
• Co-design with students
• Flexibility with regards to completion and submission requirements
• Applicability to a range of ‘real world’ practice experiences and contexts
• Responsiveness to student diversity and experiences
• A focus on students being appropriately resourced and supported to achieve
learning outcomes.
Implementation of Te Tiriti Ora
Courses presenting changes to Board of Studies are expected to include a justification aligned with Te Tiriti Ora as part of their proposed development.
Programme leaders, staff, and Programme Committees are encouraged to work through the following questions when implementing Te Tiriti Ora and embedding the principles and guidelines.
Guiding questions:
Whose values are primarily informing the pedagogy of your programme?
Are things Māori an ‘add-on’ to courses/curriculum, or are they embedded across the curriculum and Department?
Who is at the table when you are making decisions about teaching and learning?
Whose worldview is valued and respected when it comes to knowledge and what is considered academic?
How can these changes improve diverse students’ comfort, safety and success in our structures, spaces, classrooms, and processes?
Dr David Lillis trained in physics and mathematics at Victoria University and Curtin University in Perth, working as a teacher, researcher, statistician and lecturer for most of his career. He has published many articles and scientific papers, as well as a book on graphing and statistics.
References/Resources
Came, H., Warbrick, I., McCreanor, & Baker, M. (2020). From gorse to ngahere: An emerging allegory for decolonising the New Zealand health system. New Zealand Medical Journal, 133(1524), 102-110.
Curtis, E., Jones, R., Tipene-Leach, D., Walker, C., Loring, B., Paine, S.-J., & Reid, P. (2019, 2019/11/14).
Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition. International Journal for Equity in Health, 18(1), Article 174. https://doi.org/10.1186/s12939-019-1082-3
Durie, M. (1998). Whaiora: Māori Health Development. (2nd ed.). Auckland, New Zealand: Oxford University Press.
Durie, M. (1999a). Te Pae Mahutonga: a model for Māori health promotion. Health promotion forum of New Zealand newsletter, 49, 2–5 December 1999.
Retrieved September 2022 from: www.pha.org.nz/documents/tepaemahutonga.pdf
Jones, C. (2002). Confronting institutionalised racism. Phylon 50(1/2), pp7–22.
Lacey, C., Huria, T., Beckert, L., Gilles, M., & Pitama, S. (2011). The Hui Process: a framework to enhance the doctor-patient relationship with Māori. New Zealand Medical Journal, 124(1347), pp72-78.
Matike Mai Aotearoa. (2016). He whakaaro here whakaumu mō Aotearoa: the report of Matike Mai Aotearoa. Matike Mai Aotearoa.
http://www.converge.org.nz/pma/MatikeMaiAotearoaReport.pdf
Ministry of Health, (2019). Achieving Equity. https://www.health.govt.nz/about-ministry/what-we-do/achieving-equity
Mintz, S. (2021, June 22). Decolonizing the Academy. https://www.insidehighered.com/blogs/higher-ed-gamma/decolonizing-academy
Pitama, S., Huria, T., & Lacey, C. (2014). Improving Māori health through clinical assessment: Waikare o te Waka o Meihana. New Zealand Medical Journal, 127(1393), 107-119.
Ramsden, I. (2002). Cultural safety and nursing education in Aotearoa and Te
Waipounamu [Doctoral thesis, Victoria University of Wellington]. https://www.croakey.org/wp-content/uploads/2017/08/RAMSDEN-I-Cultural-Safety_Full.pdf
Simon-Kumar, R. (2018). Inclusionary policy and marginalised groups in Aoteaora/New Zealand process, impacts and politics [Article]. Kotuitui: New Zealand Journal of Social Sciences, 13(2), 246-260. https://doi.org/10.1080/1177083X.2018.1488750
Tuck, E., & Yang, K. (2012, 09/08). Decolonization Is Not a Metaphor. Decolonization, 1(1), 1-40.
https://jps.library.utoronto.ca/index.php/des/article/view/18630/15554
5 comments:
" most of whom have mixed blood" . They all do. Inconveniently for some of their arguments.
And, the first step in decolonization would be defunding it from the crown.
It is well beyond time. If you reverse the roles from maori world view etc to a euro-centric world view the cow dung would hit the proverbial.
It is purely an apartheid policy and worse really because it prescribes a compulsory cultural view upon all New Zealands and even the bokkies never did that in South Africa.
Methinks someone is getting paid very handsomely to come up with this utter tosh?
Minister Simmonds, it's time for you to step up to the plate and advise these deluded fools that the taxpayer will not be funding such nonsense.
Maori are over represented in poor health statistics because they are also over represented in lower socioeconomic status . They are over represented in lower SES because we have one of the longest tails of underachievement in the developed world. We have this long tail of underachievement because of ineffective teaching methods that selectively discriminate against lower SES students .But economic status is not the only factor.
I have helped a few women , including Maori who were diabetic to improve their health by diet . They were on welfare and solo mothers but were very pleased to learn how to eat healthily and cheaply. Perversely medical professionals had not instructed them about diet and the great harm of junk food.
Health is largely about nutrition, healthy lifestyles and knowledge of what the best food and life styles are. It is not how much exposure you have to medical professionals , especially if they are ignorant about nutrition as most are . The over weight statistic of Pasifica peoples is a problem but it is considered racist to mention it. More public health initiatives are needed as in taxing sugar content and restricting advertising of junk food especially for children These sorts of actions are needed not foolish racist / Marxist garbage.
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