There are stark health inequities for Indigenous populations around the world. The 370 million Indigenous peoples worldwide have basic health rights which are not being met by their health systems. These rights are articulated in the United Nations Declaration on the Rights of Indigenous Peoples. Our focus is on the inequities for Māori in Aotearoa (New Zealand). In New Zealand we have Te Tiriti o Waitangi (the Treaty of Waitangi), which is a fundamental platform for our Indigenous rights – including the right to health equity.
Many of our biggest human health problems have tombs of evidence-based solutions – just sitting there on a shelf. We need implementation science to get them off the shelf and into routine practice. Translation from the research environment – or even from one country or population to the next – is not always simple. Implementation science addresses this complexity and provides guidance on approaches and tools to make sure the translation works.
Camara Jones, past president of the American Public Health Association, says that inaction in the face of need is a marker of institutionalised racism. Thus, our research team sought to take action and develop a framework that enhances the implementation, effectiveness, and sustainability of health interventions from an Indigenous perspective. In order to do this, we emphasized two key elements: 1) Indigenous knowledge, and 2) a collaborative/participatory approach throughout the process of design, implementation and evaluation. The result is the He Pikinga Waiora (HPW) Implementation Framework.
HPW was developed by centring kaupapa Māori (research philosophy grounded in Māori knowledge and perspectives) and best practice from the international research literature. Specifically, our framework emphasises self-determination, participatory research, and a systems thinking perspective that considers the end users of an intervention (both those who implement it and those who use or benefit from it).