For information and reference only – not to be submitted as your own work.

This page shows a model extract for a postgraduate health essay titled “The impact of colonisation on health in Aotearoa”, written in the style expected for an EIT health science assessment (APA 7th, essay format, no bullet points). It uses cardiovascular disease as the chosen health topic and covers part of the main body: health status and determinants, and a critical reading of Te Tiriti o Waitangi principles. A full submission would also need a cover page, an introduction, Pasifika-specific evidence, evaluation of current research, Kaupapa Māori and cultural safety analysis, recommendations and a conclusion. Always check your own marking rubric and assessment brief. The full brief is on our MHSC8.002 Assessment 2 colonisation and health question page.

Extract: Cardiovascular disease, colonisation and Te Tiriti o Waitangi

Health status and the colonial context

Cardiovascular disease (CVD) is a useful topic for examining colonisation because it is common, largely preventable and strongly patterned by ethnicity. The most recent Ministry of Health chart book reports that, for 2018–20, Māori cardiovascular mortality was 2.33 times the non-Māori rate, with Māori females at 2.49 times the rate of non-Māori females (Ministry of Health, 2024). Hospitalisation rates were also higher, at 1.76 times the non-Māori rate for 2020–22 (Ministry of Health, 2024). Differences were sharper for some conditions. Heart failure mortality was 2.79 times and rheumatic heart disease mortality 5.07 times the non-Māori rate, while ischaemic heart disease, which accounts for over half of CVD mortality, showed a mortality rate 2.21 times higher (Ministry of Health, 2024). Because rheumatic heart disease is widely linked to housing conditions and access to early treatment, its gap points towards upstream social conditions rather than individual behaviour, a link that a full essay should support with a housing-specific source.

These disparities cannot be explained by biology alone. Colonisation changed Māori access to land, income, housing and political authority, and these structural changes underpin contemporary determinants of health. The Waitangi Tribunal (2019) concluded in its Hauora report that the Crown had breached Te Tiriti o Waitangi by failing to address persistent Māori health inequities through the primary health care system and by failing to give effect to tino rangatiratanga. The Tribunal therefore treated inequity as a Treaty matter rather than as a service delivery problem alone. A critical analysis should keep this framing visible: the gap is better understood as an outcome of historic and current policy choices than as a cultural or lifestyle deficit.

Determinants of health and their influence on CVD outcomes

Social determinants, such as income, housing, education and employment, shape exposure to CVD risk factors including smoking, poor nutrition and untreated hypertension. Racism operates as a further determinant, both directly and through its effect on how people are treated by services. Harris et al. (2006) examined the relationship between self-reported experiences of racial discrimination and health in Aotearoa New Zealand, adding to evidence that discrimination is part of the pathway to poorer outcomes and not a separate issue. Access to care matters as well. Ellison-Loschmann and Pearce (2006) discussed how access to health care for Māori might be improved, and the same concerns remain relevant to CVD, where early risk assessment and consistent medication use influence outcomes. Interestingly, the chart book reports that overall revascularisation rates for Māori were only 1.08 times the non-Māori rate despite much higher disease burden, and for Māori females the rate was 1.66 times (Ministry of Health, 2024). Readers should be careful here, because a rate of procedures reflects need, access and referral decisions together. It does not show equity on its own, and a strong essay would compare procedure rates with disease burden before drawing a conclusion.

Tobias et al. (2009) considered changing trends in Indigenous inequalities in mortality, using New Zealand as a case study. Trend evidence of this kind matters for CVD policy because it shows that inequalities are not fixed; they widen or narrow with the policy environment. Pasifika peoples also experience higher CVD burden in many reports, but this extract focuses on Māori because the cited chart book covers Māori data only. In your own essay you would add a verified Pacific-specific source and compare the two populations explicitly.

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Evaluating Treaty principles in CVD policy

The Waitangi Tribunal (2019) set out five principles for assessing the health system: tino rangatiratanga, equity, active protection, options and partnership. Applying these to CVD requires specific questions. For tino rangatiratanga, do iwi, hapū and Māori communities have authority over decisions about prevention and care? Whakamaua: Māori Health Action Plan 2020–2025 states this as its first high-level outcome, that iwi, hapū, whānau and Māori communities have authority over decisions that affect their health and wellbeing (Ministry of Health, n.d.). It also commits to a fair system that produces more equitable outcomes, to addressing racism and discrimination and to including and protecting mātauranga Māori (Ministry of Health, n.d.). These outcomes align closely with the principles of tino rangatiratanga, equity, active protection and options.

A critical reading must still test implementation. A plan that states the right outcomes does not show that CVD services have changed. The Tribunal’s finding that the Crown had failed to give effect to tino rangatiratanga (Waitangi Tribunal, 2019) is a reminder that commitments must be matched by funding, data governance and decision-making power. For equity, the rate comparisons above suggest outcomes are not yet aligned with the principle, because Māori carry a greater CVD burden. For active protection, the Crown would need to show that screening, risk assessment and treatment pathways are designed to prevent foreseeable harm to Māori, not left to universal programmes that have historically reached Māori less well. Options requires that kaupapa Māori and mainstream services are both available and supported. Partnership requires co-design rather than consultation after decisions are made.

Kaupapa Māori and culturally safe practice offer a practical route. Curtis et al. (2019) argued, in a literature review, that cultural safety rather than cultural competency is required to achieve health equity, because cultural safety directs attention to power relations and systems, not only to individual clinician knowledge. For CVD, this suggests assessing whether clinics, risk assessment tools and medication follow-up arrangements are experienced as safe by Māori patients and whānau, and whether Māori leadership shapes service design. Evidence-based recommendations in the full essay could include Māori-led CVD risk assessment pathways, equity targets monitored in public reporting and workforce investment, each linked back to the specific Treaty principle it supports and to the evidence cited.

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About the expert

This extract was reviewed by Daniel Carter, Evidence-Based Practice & Nursing Care Planning Specialist (Massey University, as shown on his profile).

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References

Curtis, E., Jones, R., Tipene-Leach, D., Walker, C., Loring, B., Paine, S.-J., & Reid, P. (2019). 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, Article 174. https://doi.org/10.1186/s12939-019-1082-3

Ellison-Loschmann, L., & Pearce, N. (2006). Improving access to health care among New Zealand’s Māori population. American Journal of Public Health, 96(4), 612–617. https://doi.org/10.2105/AJPH.2005.070680

Harris, R., Tobias, M., Jeffreys, M., Waldegrave, K., Karlsen, S., & Nazroo, J. (2006). Racism and health: The relationship between experience of racial discrimination and health in New Zealand. Social Science & Medicine, 63(6), 1428–1441. https://doi.org/10.1016/j.socscimed.2006.04.009

Ministry of Health. (n.d.). Whakamaua: Māori Health Action Plan 2020–2025. https://www.health.govt.nz/maori-health/whakamaua-maori-health-action-plan-2020-2025

Ministry of Health. (2024). Tatau Kahukura: Māori health chart book 2024. https://www.health.govt.nz/maori-health/tatau-kahukura-maori-health-chart-book-2024

Tobias, M., Blakely, T., Matheson, D., Rasanathan, K., & Atkinson, J. (2009). Changing trends in indigenous inequalities in mortality: Lessons from New Zealand. International Journal of Epidemiology, 38(6), 1711–1722. https://doi.org/10.1093/ije/dyp156

Waitangi Tribunal. (2019). Hauora: Report on stage one of the Health Services and Outcomes Kaupapa Inquiry (Wai 2575). https://forms.justice.govt.nz/search/Documents/WT/wt_DOC_195476216/Hauora%202023%20W.pdf