Māori Health, Wellbeing, and Disability in Aotearoa New Zealand: A National Survey

TL;DR

This study explores the health and wellbeing of Māori in New Zealand using a culturally relevant approach, revealing significant disparities and the importance of indigenous-centered research.

Contribution

The study introduces a culturally aligned methodological approach to assess Māori health, wellbeing, and disability.

Findings

Strong cultural identity was reported, with high levels of whānau (family) connection among participants.

Over half of participants experienced discrimination, and many faced barriers to healthcare due to cost.

Socioeconomic challenges were common, with many struggling to afford basic needs like fresh produce.

Abstract

Māori, the Indigenous people of Aotearoa New Zealand, experience wide-ranging inequities compared with non-Māori. This survey aimed to explore the holistic health, wellbeing, and disability experiences of New Zealand’s Indigenous Māori population from a Māori worldview, addressing gaps in culturally relevant data often overlooked by standard health surveys. A robust cross-sectional survey was conducted with 7359 participants of Māori descent using Kaupapa Māori Research principles. Data were analysed using the Te Pae Māhutonga framework, a Māori health promotion model. Participants demonstrated strong cultural identity, with 32.3% understanding spoken Māori fairly well and 97.3% defining a broad non-nuclear concept of whānau (family). While over half reported high life satisfaction, 58.4% experienced discrimination, mainly based on ethnicity and appearance. Access to healthcare revealed that 32.6% were unable to contact a general practitioner due to cost. Socioeconomic challenges were prevalent; nearly a quarter borrowed from family or friends to meet daily living costs, and over a third economized on fresh produce to save money. This study reveals significant gaps in mainstream health data and demonstrates that a culturally aligned, methodological approach is feasible and crucial for informing policies that address the needs and rights of Māori, as guaranteed under Te Tiriti o Waitangi. These results could inform global, indigenous research addressing culturally relevant health, wellbeing and disability inequities.

Full text

1. Introduction

Historical and contemporary data have persistently demonstrated that Māori suffer a disproportionate burden of inequities in health, wellbeing, and disability compared with non-Māori in Aotearoa New Zealand (NZ). These inequities represent a loss of human capital and impose significant personal, community, and social costs on Māori and the whole country. Addressing inequities, from a purely health economic perspective, has the potential to save over NZD 800 million per year [1,2,3]. These current losses could be more productively invested in health and social services. From both human rights and legal perspectives, the government has an obligation to monitor inequities and proactively eliminate them through policy and system change. These obligations are non-negotiable under Te Tiriti o Waitangi, NZ’s foundational document. These requirements are reinforced by NZ’s ratification of international human rights conventions, particularly the Universal Declaration on Human Rights and the United Nations Declaration on the Rights of Indigenous People (UNDRIP) [4], and the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) [5].

As the Indigenous peoples of NZ, Māori possess holistic models of health, wellbeing, and disability that diverge from the prevailing Western biomedical frameworks [6,7]. In contrast, these Māori models are fundamentally collective in nature, emphasizing the interconnectedness of individuals within their social and environmental contexts. These models encompass vital cultural practices and concepts, including tikanga (protocols), te reo Māori (the Māori language), mātauranga (knowledge), whakapapa (genealogy), and social connectedness [7]. They explicitly recognize the inseparable link between individual health and wellbeing and broader holistic elements, such as whānau (extended family), environment, and spirituality, which are not fully captured in official statistical surveys [7].

To direct policy, it is important that valid quality data be collected; however, to date, data on the constructs of health, wellbeing and disability are typically constructs defined by governments and policymakers. A prime example of this is in the area of disability data, where the Waitangi Tribunal (a permanent Commission of Inquiry) found in 2021 that the government had a “practical absence of quality data on tāngata whaikaha” (Māori with lived experience of disability) [8] (p. 112), which negatively impacted the development and roll-out of a national COVID19 vaccination strategy. This is the result of decades of Māori health, wellbeing, and disability data being collected and presented using a biomedical perspective and excluding any meaningful sociocultural and economic wellbeing understanding. Te Kupenga is the only post-censual government survey specifically of Māori, providing social, cultural, and economic wellbeing perspectives [9]; however, this survey includes only one overall health question and uses linked Census data for disability information.

Government-administered surveys typically use data collection processes, analytical lenses, and interpretation of results based on the dominant colonial perspective. This approach does not align with a holistic Māori worldview; it largely reflects government priorities with the exclusion of Māori aspirations; and the reliance on administrative data means that the data collection and analysis are often removed from a specific context. Consequently, the results are not reliable interpretations of Māori health, wellbeing, or disability.

There are major demographic differences in the Māori population. For example, the age structure is markedly different from that of the NZ European population, with a median age of 25.4 years for Māori compared with 41.4 for NZ Europeans [10]. To understand these important differences, large surveys of Māori using a Te Ao Māori approach are required to provide a more nuanced understanding of Māori health, wellbeing, and disability. Currently, due to the sample size of Māori in national datasets, Māori are often considered a homogeneous group, with their data used particularly for comparisons with total population data [11]. The annual NZ Health Survey (NZHS) provides self-reported health, access utilization of healthcare, disability-related functional impairment, and sociodemographic data, but excludes collective wellbeing and cultural aspects. The 2022/23 NZHS collected data from 6799 adults and 2686 children, of which Māori comprised 1292 adults and 657 children [12]. This sample size is not large enough to describe diversity in health status measures within the Māori population.

Relationships between health, wellbeing, and disability are complex, and the current methods of collecting, analysing, and interpreting data miss culturally relevant and nuanced sub-group outcomes [11]. These surveys contribute to the portrayal of Māori from a deficit paradigm, i.e., only as experiencing health inequities in comparison with other demographic groups, rather than an independently rich and diverse population in their own right. Current Māori-specific health and disability policies are unlikely to be fit for purpose. Novel ways of exploring Māori health, wellbeing, and disability data, including sociocultural perspectives, will contribute to a more contextually relevant understanding of the determinants of health inequities.

We are a Māori-led collective of researchers whose research is situated within a Kaupapa Māori paradigm that critiques those underlying power dynamics of colonization and coloniality that drive and maintain Māori health and other inequities [13]. This article shares the findings of a novel cross-sectional survey of adults of Māori descent from across NZ and aims to demonstrate the value of a survey designed to describe the wellbeing of NZ’s Indigenous population from a Māori worldview.

2. Methods

2.1. Study Design

This study comprised a nationally representative, cross-sectional survey of adults of Māori descent across NZ. The survey design has been published previously (available here), but core features are summarized below [14]. Eligible participants were NZ citizens or residents aged 18 years and older, registered on either the General or Māori electoral rolls in 2021, and self-identifying as being of Māori descent (N = 527,598). A random sample of 70,155 participants was drawn, excluding those who had an overseas mailing address. The survey was conducted primarily online using Qualtrics Experience Management software (version designed in August 2022), and in accordance with the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). To ensure accessibility, telephone interviewer-administered and self-completed paper options were also available in English or te reo Māori. Recruitment was conducted in two tranches, from July 2023 to December 2023, with participants in each tranche receiving a personalized invitation letter and two reminder postcards.

2.2. Study Size

Based on previous national survey response rates, a sample size of at least 70,000 invitations was calculated to achieve approximately 8000 responses, given an anticipated 14% response rate and an 80% survey completion rate. This sample size was estimated to ensure the study would be adequately powered to identify key health-related outcomes among Māori. The sampling error was calculated per a simple random sample with post-stratification weights applied. The actual margin of error was 1.1% overall.

2.3. Bias

We included robust processes to ensure the sample was generalizable to the Māori descent population. This study was grounded in Kaupapa Māori Research (KMR) methodology, culturally appropriate, and accessible in terms of language and formats. Furthermore, robust validation measures were deployed and two-stage weighting was adopted to adjust to the electoral roll sample for non-response bias, and then to the Administrative Population Census (APC) [15], for under-coverage in the sampling frame [14].

2.4. Holistic Framework of Māori Wellbeing—Te Pae Māhutonga

We present our study outcomes under the framework of a Māori model of health promotion to approximate the holistic nature of Te Ao Māori (Māori worldview) conceptualizations of health and wellbeing. Te Pae Māhutonga (the Southern Cross star constellation), a culturally and historically significant Māori model of health developed by Sir Mason Durie [16], guides health initiatives by reflecting six elements applicable to Māori and broader NZ:

1. Mauriora: Access to Te Ao Māori

Mauriora, the flourishing of Māori identity, is essential for wellbeing. Embracing and strengthening Māori identity promotes positive health outcomes, highlighting the importance of cultural revitalization for overall wellbeing [16]. In this domain, we include various aspects of cultural identity such as cultural knowledge, practices, and language.

“Mauriora rests on a secure cultural identity. Good health depends on many factors, but among indigenous peoples the world over, cultural identity is considered to be a critical prerequisite”.(Durie 1999) [16] p. 2

2.Waiora: Environmental Resources

Waiora, the flourishing interconnectedness between people and their environment, is essential for wellbeing. It fosters a deep connection to the natural world, encompassing the cosmic, terrestrial, and aquatic realms. In this domain, we include connections to wellbeing resources such as physical resources (e.g., environment), social resources (e.g., culture, whakapapa, and whānau), and system (e.g., community and marae).

“Waiora is linked … to the external world and to a spiritual element that connects human wellness with cosmic, terrestrial and water environments”.(Durie 1999) [16] p. 3

3.Toiora: Healthy Lifestyles

Toiora, the active pursuit of healthy lifestyles, empowers individuals to reach their full potential. By making informed choices about nutrition, exercise, and safety, individuals can mitigate risks and prevent health issues. Embracing Toiora not only enhances personal wellbeing, but also contributes to the collective prosperity of the Māori community and the nation. In this domain, we include general measures of health and wellbeing, life satisfaction, and self-reported disability.

“Major threats to health come from the risks that threaten health and safety and have the capacity to distort human experience”.(Durie 1999) [16] p. 3

4.Te Oranga: Participation in Society

Te Oranga, active participation and equitable access within society, is a cornerstone of wellbeing. It empowers individuals through fair access to essential services, education, employment, and decision-making processes. When Māori actively participate and contribute their voices, the entire society benefits from increased diversity, resilience, and innovation. In this domain, we include items exploring societal influence on wellbeing, particularly healthcare access, societal inclusion, and discrimination.

“Wellbeing is … the goods and services which people can count on, and the voice they have in deciding the way in which those goods and services are made available. Te Oranga is dependent on the terms under which people participate in society and on the confidence with which they can access good health services, or the school of their choice”.(Durie 1999) [16] p. 4

5.Ngā Manukura: Leadership

Ngā Manukura, effective leadership, is a collaborative process that draws upon diverse skills and perspectives. It recognizes and empowers local leaders within communities, fostering a relational approach and building alliances between different groups. By uniting diverse expertise and forging connections, Ngā Manukura can effectively drive positive change and achieve shared goals. In this domain, we include items exploring both social and professional leadership.

“Leadership … should reflect a combination of skills and a range of influences. Regardless of technical or professional qualifications, unless there is local leadership it is unlikely that a health promotional effort will take shape or bear fruit”.(Durie 1999) [16] p. 5

6.Te Mana Whakahaere: Autonomy

Te Mana Whakahaere, the exercising of autonomy and self-determination, empowers communities to shape their own wellbeing. It fosters a sense of ownership and control over decision-making processes, enabling communities to prioritize their unique aspirations, values, and initiatives that lead to more effective and sustainable outcomes. In this domain, we include factors such as economic freedom and material wellbeing that act as precursors to the fulfilment of autonomy and self-determination.

“Communities … must ultimately be able to demonstrate a level of autonomy and self-determination in promoting their own health”.(Durie 1999) [16] p. 6

2.5. Variables

Participant Demographics

Gender was collected using the question from the 2021 What about me? nationwide survey of youth across New Zealand [17] and consistent with the StatsNZ statistical standard for reporting gender [18]. Age group was collected as the year of birth and reported using 15-year bands. The lowest age group was 18 years, while the highest age group aggregated participants 75 years and above. Ethnicity was collected in accordance with NZ Ethnicity Data Collection Standards v2.0. [19], reporting Level 1 total response ethnicity. Iwi is reported as the total response and categorized consistent with the StatsNZ iwi data standards used in both the Census and Te Kupenga [20]. Iwi was grouped into 18 categories with Iwi affiliation, while geographically bounded, not necessarily related to the geographic region of residence.

Region is reported as 1 of 16 geographic regions defined by StatsNZ per Census 2018. Urbanicity was derived from the address recorded on the electoral roll. The StatsNZ Urban Rural classification V1.0.0 was used to allocate each respondent to a rural or urban category based on the mesh block corresponding to the address [21]. All values were collapsed to three categories: major urban, minor urban, and rural.

1.  Mauriora: Access to Te Ao Māori

Māori language use and fluency were captured using Likert response questions from the StatsNZ Te Kupenga Survey [9]. These questions included an ability to speak in day-to-day conversation and understand spoken reo, and ability to read and write in te reo Māori. Cultural participation included a variety of traditional and contemporary opportunities to learn, engage with, express, and participate in Te Ao Māori contexts (e.g., cultural events, traditional oratory and song, cultural or marae-based gatherings, and traditional healing practices). Questions were selected from Te Kupenga Survey [9] and reported as dichotomous outcomes over a 12-month recall period.

2.  Waiora: Environmental Resources

Connection to Whakapapa (Lineage) and Whenua (Land)

Māori culture is widely acknowledged as a collectivist, tribal culture whereby kinship relationships and connection to the environment are seen as integral components of a person’s wellbeing [7]. Connection to whakapapa or genealogical ancestry was collected as knowledge of iwi (tribe) and hapū (sub-tribe), tribally linked prominent geographical features (mountains and rivers), tīpuna (ancestors), waka (canoe migrating from Hawaiiki), and feeling of connection to traditional lands referred to as tūrangawaewae (place to stand). We limited the scope to cultural knowledge and feeling of connection, thus circumventing measures of physical connection to avoid mixing those things with the ability to connect, which is likely confounded by socioeconomic and health-related limitations. Questions were drawn from Te Kupenga Survey for comparison.

Marae access was collected over two recall periods (ever; in the last 12 months) for both urban and ancestral marae. Whānau, or extended family groupings, are the fundamental unit of Māori society. As a result of colonialism and urbanization, there are increasingly diverse interpretations of whānau, with many non-Māori applying the Western concept of nuclear family [22]. Whānau connection was collected according to self-definition and self-assessed ratings of wellness, connection, and amount of contact using Likert responses. Dichotomous outcomes in relation to traditional food gathering, weaving, carving, and environmental protection activities were assessed over a 12-month recall period using questions from Te Kupenga Survey [9].

3.  Toiora: Healthy Lifestyles

Life satisfaction was collected from all participants using a well-validated 5-point Likert response (‘very dissatisfied’ to ‘very satisfied’). Quality of life was collected using the extensively validated SF-12 questionnaire. To minimize respondent burden, the physical functioning subdimension questions were not asked directly but derived from the equivalent Washington Group Extended Set (WGES) questions. The SF-12 ‘moderate activities’ referred to health limitations with ‘activities you might do during a typical day … such as moving a table, a vacuum cleaner, or bowling’. WGES-equivalent responses were assigned based on the highest limitation from ‘upper body‘ strength or ‘self-care’ questions. Similarly, the SF-12 ‘climbing stairs’ question referred to health limitations with ‘climbing several flights of stairs’. WGES equivalent responses were derived based on the limitation ‘walking or climbing steps’.

Self-reported disability was collected using the standard question from NZHS 2023 [12], including all health conditions, and long-term and mental health conditions, which affect a person’s ability to carry out everyday activities. Activity limitation was collected using the Washington Group Extended Set of Questions on Functioning (WGEF), a subset of which, the Washington Group Short Set (WG-SS), is the internationally accepted benchmark for comparisons and longitudinal monitoring of a sub-population of people with severe impairments likely at risk of experiencing ableism/disablism in unaccommodating environments [23].

4.  Te Oranga: Participation in Society

Data were collected for healthcare access as a key determinant of health. Questions were selected from NZHS questions regarding GP enrolment, healthcare contact in the last 12 months, unmet health need, unmet dental need, unmet mental health need, and cost barriers. All responses were dichotomous, except for dental access, which was collected semi-quantitatively.

A bespoke set of questions on social inclusion was developed in partnership with our community steering groups through hui (meeting), wānanga (workshop), and whakawhiti kōrero (negotiating) sessions. Each question used a 3-point Likert response (‘none’; ‘a little’; ‘a lot’) to self-reported sense of inclusion in three spheres of engagement: your community, Te Ao Māori, and broader NZ. We also collected the extent to which NZ policies, services, supports, and attitudes impact the person’s ability to perform day-to-day activities and achieve life goals.

Discrimination data were collected from all participants using ‘ever discrimination’, [3] from Te Kupenga Survey. ‘Ever discrimination’ was favoured over recent discrimination as a better proxy for long-term health and wellbeing, as it is likely to have impacted reported outcomes such as educational, employment, other health, and social opportunities.

5.  Ngā Manukura: Leadership

Data collected in this domain included current employment (dichotomous response) and occupation as classified by the Australian and New Zealand Standard Classification of Occupations (ANZSCO) v1.30 [24].

6.  Te Mana Whakahaere: Autonomy

NZDep2018 is a metric that measures the level of socioeconomic deprivation for people in each small census area of about 50 households, based on nine Census variables [25]. Quintile 1 represents areas with the least deprived scores; Quintile 5 represents areas with the most deprived scores. NZDep2018 was calculated based on the mesh block of the address provided in the electoral roll, which served as our recruitment mailing address [14]. Individual income was collected using the Census 2018 income question. Data are reported in NZD 5000 bands up to NZD 40,000, NZD 10,000 bands up to NZD 70,000, then a NZD 30,000 band to NZD 100,000, and a NZD 50,000 band to NZD 150,000, with all higher income collated into NZD 150,000 or more. These variable width bands reflect the skewed distribution of income and income-derived benefit thresholds.

Questions were selected from the Material Wellbeing Questionnaire (MWQ) of the Household Economic Survey [26]. The MWQ asks about ownership of items, performing certain activities, the extent that people economize, self-rating life satisfaction, and whether income meets every day needs. We report dichotomous wellbeing outcomes exploring income adequacy to meet basic needs: ownership and participation (e.g., owning: suitable shoes; affording: a meal out); economizing (e.g., going without fruit and vegetables, postponing healthcare); financial freedom/restriction (e.g., ability to pay an unavoidable expense); and financial strain (e.g., inability to pay bills, rent, or receiving welfare).

2.6. Statistical Method

Our sample-weighting protocols and related regression model are available in our published methodology [14]. Weighting was based on gender, age group, region, occupation, NZDep2018 quintile, and urbanicity. Data are presented as weighted percentages of the survey population, along with estimates of total APC-Māori descent population (n = 526,476), each with 95% confidence intervals.

3. Results

Responses were received from 7359 of the 66,175 eligible participants (11.1% response rate; 92.7% via online completion, 5.4% via telephone, and 2.0% self-completed on paper). Overall, 7230 participants (99.6%) provided sufficient ID and demographic details to be verified as eligible unique individuals and were therefore included in the analysis. Of those 7230, 6774 answered the survey fully, giving a survey completion rate of 93.7% [27]. A flowchart of recruitment and eligibility has been published previously [14].

Table 1 shows the gender, age group, and ethnicity variables; 51% of participants identified as female and 56.0% were aged 18 to 44 years. All participants were of Māori descent. Of these, 95.4% identified as Māori, while 56.4% also identified as European, and 7.0% as Pacific peoples. Table 1 also presents the geographic regions where participants lived. These data reflect the distribution of the Māori population, weighted to the APC. Most participants (60.2%) live in major urban environments; 16.3% live in rural areas.

Table 2 shows a range of iwi (tribal) representation with 26.7% of participants from Te Tai Tokerau/Tāmaki-Makaurau (Northland/Auckland) Region, 11.4% from Te Wai Pounamu (South Island) and 0.4% from Rēkohu/Wharekauri (Chatham Islands) imi/iwi.

1.  Mauriora: Access to Te Ao Māori

Table 3 shows that 16.9% of participants report being able to speak te reo Māori at least fairly well; 33.2% can understand spoken te reo Māori at least fairly well, 29.6% can read te reo Māori at least fairly well, and 20.8% can write it at least fairly well. Almost half (45.8%) of the participants reported finding it easy or very easy to access Māori language learning resources.

Table 4 reports cultural participation amongst Māori; 61.9% have sung a waiata (Māori song), performed a haka, given a mihi (Māori introduction) or speech, and 57.8% have said a karakia (prayer). There was lower collective participation in activities; for example, 15.1% had taken part in a kapa haka (cultural performance).

2.  Waiora: Environmental Resources

Table 5 presents data on connections to environmental and cultural resources. The table shows that most participants (89.2%) reported knowing their iwi; 70.0% reported knowing their ancestral marae; and 30.5% of the participants felt strongly or very strongly connected to their tūrangawaewae. A proportion of 96% of participants report having been to a marae, with 48.0% having been to a marae in the last 12 months; 59.3% have been to any of their ancestral marae; and 29.8% have been to their ancestral marae in the last 12 months. Table 5 also presents results on traditional resource-gathering practices; 44.7% of participants reported having gathered traditional Māori kai (food) or materials for carving/weaving in the last 12 months.

Table 6 reports meaningful social connections, including whānau identity and connectedness and level of recent contact with whānau. A high proportion of participants considered a broad concept of family as their whānau; over 80% defined aunts/uncles, cousins, nephews/nieces, and other in-laws as whānau; and 45.9% defined friends as whānau. Most participants (88.7%) reported that their whānau were doing somewhat or very well, and 87.7% felt somewhat or very connected to their whānau. Over half (52.8%) had seen whānau at least weekly over the previous 4 weeks; 44.2% reported that their level of contact was insufficient.

3.  Toiora: Healthy Lifestyles

Table 7 reports on general life satisfaction and general health. Half of the participants (49.9%) report feeling satisfied or very satisfied with their life right now; 71.4% report having at least good general health. Table 8 also presents data on self-reported disability and activity limitations. Over one-fifth (21.2%) of participants self-report having a disability, long-term condition, or mental health condition that limits their ability to carry out everyday activities. Activity limitation (‘a lot of difficulty’ or ‘cannot do at all’) in at least one functional domain was reported by 15.1% of participants.

Table 8 reports data on health-related quality of life in terms of both physical and mental health. A large proportion of participants reported accomplishing less than they would like (some, most, or all of the time) as a result of their physical health (42.9%), and their emotional health (35.3%) respectively. Concerningly, 31.5% of participants felt downhearted or depressed some, most, or all of the time, equating to 166,340 adults of Māori descent nationwide.

4.  Te Oranga: Participation in Society

Table 9 shows access to health system resources. Most participants (88.0%) report having access to a GP and (74.0%) attending that clinic in the last 12 months. Conversely, 34.6% reported not being able to access their usual GP within 24 h of needing care, and 32.6% reported not contacting a GP due to cost. Almost a quarter (24.0%) of participants had not received dental care in the last 5 years; 59.1% avoided dental care due to cost. In the past 12 months, 22.0% of participants reported unmet need for professional service for psychological or mental health needs.

Table 10 shows that 20.6% of participants feel well included within their community, 13.0% in Te Ao Māori, and 16.5% in broader NZ society. NZ societal structures, policies and attitudes were reported to have a lot of impact on 29.6% of the participants’ abilities to do day-to-day activities and 33.6% of the participants’ abilities to achieve their life goals.

Table 11 shows that over half of the participants (58.4%) report having been discriminated against during their life. Most (74.8%) of those reporting discrimination listed race or ethnic group as a basis for discrimination, with nearly half of discriminated participants reporting either skin colour or appearance as reasons for discrimination. Discrimination was reported in a diverse range of contexts, but the highest proportion (68.7%) was at school.

5.  Ngā Manukura: Leadership

Table 12 reports aspects of leadership in terms of community and professional leadership opportunities. Notably, 11.2% of all participants reported taking part in environmental planning on behalf of their iwi, hapū, or marae. Just over half of participants (52.0%) reported being in current employment, with the highest occupational category being professionals (10.5%); 11.5% were students; and 13.0% were not in the labour force.

6.  Te Mana Whakahaere: Autonomy

Table 13 demonstrates that participants were overrepresented among high deprivation NZDep2018 census areas, with 38.7% in the highest deprivation quintile; 16.4% of participants reported an individual annual income NZD 15,000 or less, and 33.6% of participants earned between NZD 15,000 and NZD 50,000.

Material wellbeing is reported in Table 14 (income adequacy) and Table 15 (economizing, financial freedoms, and financial capacity).

Participants reported (Table 14) generally high rates of vehicle access (83.0%) and internet connectivity (83.6%). Just over half (53.3%) of participants have home contents insurance, with fewer than half (47.2%) having a domestic holiday annually and fewer than a quarter (24.2%) having an international holiday triennially.

Many participants report economizing activities in the last year (Table 15). Over a third (36.3%) of participants have put up with feeling cold or going without fruit and vegetables (34.8%) to keep costs down; 56.6% have deferred dental care; and almost half of participants have deferred household maintenance activities due to cost. Nearly two-thirds of participants (63.8%) report having adequate financial reserves to be able to incur an unexpected cost of NZD 500; a quarter (24.4%) need to seek financial assistance or loans from family and friends to meet every day needs; and almost a fifth of participants (18.3%) report receiving charity assistance or welfare in the last 12 months.

4. Discussion

This survey is the largest ever community-initiated cross-sectional survey specifically of Māori health, wellbeing, and disability, and the first non-governmental study in two decades to rigorously examine the intersectionality of a broad, holistic range of domains. It offers unprecedented insights into indigenous health dynamics that are essential for effective public health policy. Importantly, this study was a Māori-led partnership between academic researchers and tāngata whaikaha Māori communities, grounded in a Kaupapa Māori Research paradigm. We have shown that it is possible to measure these things in a more culturally relevant way for the Māori population and generate robust descriptive data that will form the basis for comprehensive analysis.

The large sample size (7320 participants) enables us to account for heterogeneity within the Māori population and diverse experiences of wellbeing and disability across six culturally relevant dimensions (Te Pae Māhutonga domains) not previously described in a study of this scale. The nature and extent of the data collected necessitate that we present only the high-level findings. More detailed analysis, including an exploration of the intersection between different dimensions of Māori identity and experiences and the relationship with power structures (e.g., racism, ableism, and disablism), will be discussed in future publications.

This study used Māori descent for the sampling frame, rather than self-identified Māori ethnicity for the following reasons. Firstly, descent takes a tāngata whenua, indigenous rights-based approach; secondly, descent data provide a sampling frame more sensitive to the long-term effects of colonization (progressive acculturalization); thirdly, the use of descent aligns with iwi Māori data collection principles; finally, the electoral roll, which we used for recruitment, captures Māori descent, not ethnicity. Our results show that 4.6% of participants of Māori descent do not identify as being of Māori ethnicity. Had we collected ethnicity instead of descent, we would have missed this sizeable group (n = 333 in the study and N = 16,230 in Māori descent population).

Ethnicity is a social construct of cultural affiliation and is a marker of social perception which influences people’s experiences and outcomes; is pertinent to understanding and measurement of health and equity; and self-identification aligns with principles of self-determination and the right for Māori to name themselves as Māori [28]. Māori, as tāngata whenua, also have international human rights (UNDRIP), which recognize the right of indigenous peoples to self-determination and to be recognized collectively as Indigenous [29]. NZ domestic law confers specific legal rights to Māori relating to ownership of land and natural resources, cultural preservation, and political representation [28]. Most NZ statutes use ancestry criteria to define who is Māori, as the closest concept to whakapapa (genealogy), to determine who can enrol in a Māori electorate, make a claim under The Treaty of Waitangi Act 1975, and own Māori land.

Mauriora: Access to Te Ao Māori

We found that 32.3% of participants are able to understand, at least fairly well, spoken te reo Māori when it is spoken by others. Given that our survey was able to be completed in either te reo Māori or English, this is not likely to be an underestimate. This result aligns with data from Te Kupenga Survey 2018, which showed that 29.4% of respondents could speak it at least fairly well [9]. Protective effects of language on Indigenous wellbeing are well-documented [30]. However, despite its position as a valued possession of Māori [31] and an official language since 1987, most Māori participants report that they are not able to speak, write, or understand Māori very well, or not at all. Although the NZ Native Schools Act 1867 banning the use of te reo in schools was repealed in 1979, widespread use of te reo has yet to be achieved. The government needs to develop policies that would assist in the revival of te reo to maximise health gains from the protective effect of language.

2.Waiora: Environmental Resources

Connections to whakapapa, whenua, marae access, and traditional practices were explored under the Waiora domain as critical resources for the preservation of Māori wellbeing. Autonomy and social connection have been demonstrated to mitigate the negative effects of socioeconomic disadvantage and discrimination and enable fuller participation in society [32]. Our results show that, for 97.3% of participants, whānau Māori is much more than the nuclear family, extending into multiple generations, with 46.7% of participants feeling very connected to their whānau. Over 45% of participants also included kaupapa whānau (friends) as part of their whānau. This aligns with Kukutai [22], who reported that kaupapa whānau made up almost 50% of those whom Māori considered whānau. The collective notion of whakapapa whānau is a cornerstone of Māori society and continues to be a critical component of wellbeing that extends beyond those who live in the same household [22,33].

This sense of connection as whānau has been regarded by Māori as a critical element of the concept of whānau wellbeing and has arguably provided a level of resilience to decades of discriminatory oppression since colonization [34]. Māori view community resilience through the lens of collective responsibility; each whānau holds specific responsibilities contributing to the collective function and survival of the community or iwi [35]. Consequently, given the diversity of whānau contexts, the use of a narrow definition of family for policymaking is problematic and could contribute to further inequities for Māori [36]. Reluctance across government agencies to fully resource whānau ora concepts contributes to perpetuating inequities and fails to capitalize on the inherent strength and opportunities of te ao Māori to build health gains for Māori.

3.Toiora: Healthy Lifestyles

Life satisfaction and health-related quality of life are often used interchangeably in research, policy, and practice; however, these terms are connected to different theoretical concepts and need to be reported separately [37]. Life satisfaction involves conscious appraisal of life and includes emotional reactions to life events, whereas health-related quality of life is the match between a person’s self-rated health, independence, and social connections and their normative sociocultural value system [38]. This conceptual difference is highlighted in our results by discordant responses to these two questions; 49.9% of participants reported feeling satisfied or very satisfied with their life; however, 71.4% reported having at least good, very good, or excellent general health. These findings potentially demonstrate either internalized racism/ableism leading to the normalization of poor health outcomes for Māori, or significant negative contribution of non-health-related issues to overall life satisfaction.

Most health-related QoL measures do not incorporate Indigenous models of wellbeing, including domains prioritized by Indigenous peoples such as culture, spirituality, whānau, and connection to the land, nor elements, such as the experience of colonization, dispossession, and assimilation [39] that have been demonstrated to negatively impact Indigenous populations. The omission of these factors reduces the cross-cultural validity of these data [40] and likely inflates reported quality of life results.

4.Te Oranga: Participation in Society

Te Oranga describes the extent to which people are free from experiencing discrimination, to what extent they feel included in society, and whether they have reliable access to quality healthcare. Over 50% of participants reported discrimination in the last 12 months; many experienced multidimensional discrimination. Factors such as race (74.8%), skin colour (49.9%), and appearance (45.5%) were the most frequently perceived reasons for the discrimination. The primary care patient survey showed that 22.7% of Māori experience discrimination [41]. Our higher discrimination rate may be related to the approach used to collect the data, but further in-depth analysis is required. The most frequent setting for discrimination was school (68.7%), followed by ‘on the street’ (60.4%), at work (55.4%), and within the judicial system (35.2%). Experiences of discrimination within the education system have been reported previously [42], with accounts suggesting that the discrimination is usually by teachers and staff rather than fellow students.

Measures of self-reported discrimination in NZ reveal persistent structural and institutional discrimination, resulting in longstanding inequities in education, employment, income, justice, and health outcomes [43]. Structural discrimination also contributes to poorer social inclusion for marginalized groups. Discrimination fosters distrust in public services and reinforces exclusionary practices, limiting meaningful participation in community life and broader societal opportunities. In NZ, it also represents a breach of the guarantees of Te Tiriti o Waitangi by the government. For Māori, this systemic bias mirrors the challenges faced in healthcare, where policies perpetuate social isolation and diminished access to culturally responsive support systems [44]. Only 20.6% of participants reported feeling included ‘a lot’ within their community, 13.0% within Te Ao Māori, and 16.5% within broader New Zealand. According to Kitching et al., Indigenous populations face significant disparities due to systemic discrimination in healthcare exacerbated by inconsistent access to primary care [45]. The results of this survey reflect this finding; 32% of participants reported having an unmet health need and 32.6% cited the cost of accessing health as the reason.

5.Ngā Manukura: Leadership

This domain explores leadership opportunities such as employment status, occupation, and the level of involvement in environmental activities. Over 10% of participants were involved in iwi or hapū environmental planning and leadership. Due to limited comparative data, it is unclear how this value compares with other population groups; however, these data are consistent with the Household Labour Force Survey 2018 on organization-based volunteering among Māori (13.1%), which is higher than that of all ethnicities at 12.4%. Associations between health and wellbeing and community leadership are well-documented. Community volunteering improves happiness in older wāhine Māori [46]. Conversely, cultural or iwi leadership roles can present additional burdens if such roles bring additional workload pressures, leading to poorer wellbeing outcomes [47]. To counteract this, Māori, as kaitiaki (guardians), should be supported and resourced to fulfil cultural leadership roles which ensure protection of environmental, economic, cultural, and spiritual wellbeing.

Over 50% of participants reported being employed. The benefits of meaningful work have been shown to be effective in multiple ways, especially the expression of reaching one’s potential [48]. Among those employed, the highest proportion of people worked as professionals, followed by technicians and trade workers, labourers, then managers. In contrast, IDI data revealed higher proportions of managers, then professionals, labourers, and service workers [49]. This discrepancy emphasizes the potential inaccuracy of existing government survey and administrative data and the need to supplement it with other data sources that have been designed by and for Māori.

6.Te Mana Whakahaere: Autonomy

This domain examines the degree to which autonomy and self-determination are linked to economic freedom and material wellbeing for Māori. Material hardships were evident amongst the survey responses. Nearly a quarter of participants (24.4%) reported that they had to borrow from family or friends to meet everyday living costs. Participants reported economizing by buying cheaper cuts or less meat (60.1%) and less fresh fruit and vegetables (34.8%), and 36.2% reported having insufficient reserves to be able to incur an unexpected cost of NZD 500.

Financial strain not only limits the choices available to whānau to do the things that bring them satisfaction and lift their wairua (spirits), but such limitations also have downstream effects on social, cultural, economic, and behavioural wellbeing and can create psychosocial stress, unmet need, and intergenerational harm. These impacts are widely recognized as being associated with profound life-course effects, especially among children and young adults [50,51], and are mediated through complex pathways arising from social stratification via differential exposures to risk, vulnerability, and consequences that perpetuate social and life-course inequities [51]. They erode sustainability at an individual, community, and iwi level, resulting in loss of autonomy. This sustainability, along with resilience, is key to our future wellbeing and depends on strong community connections and access to adequate resources [52]. Our findings highlight the need for government policies and programs focusing on material living conditions to improve health and wellbeing outcomes for Māori and increase the ability of whānau and communities to be self-determining.

Implications for Indigenous People Globally

This research aimed to focus on Māori, as opposed to existing representative, non-indigenous surveys. We have demonstrated that an Indigenous-led survey, incorporating Indigenous methodology and interpretation, provides additional and more culturally relevant insights into health, wellbeing and disability. We argue that this type of approach is not only essential for understanding the experiences of Indigenous subpopulations globally, but it also has the potential to enable more targeted policies that effectively address existing inequities.

5. Strengths and Limitations

This is the first large-scale, nationally representative survey of Māori that provides a comprehensive assessment of holistic wellbeing cognizant of Māori and disability diversity. It addresses information gaps about Māori disability in a way that is shaped by Māori disability communities themselves and creates the tools to monitor outcomes beyond the accessibility and content limitations of Crown data sources. We were able to achieve a response rate comparable to that in other surveys using an electoral roll sample frame [53,54]. Given our high survey completion rate and the weighting of results to key variables, our data can be considered representative of the Māori descent population [14].

Previous reporting of limitations related to the survey methodology [14] recognized that the sampling frame, contact process, and response format are all sources of potential selection bias in the study results. The electoral rolls are the most comprehensive population sampling frames readily available to researchers, but they include only those aged over 18 years and enrolled to vote. While our data were weighted first to the electoral roll and then to the APC, differences in the coverage of both these resources are likely to vary by socioeconomic position and sex. It is not possible to quantify the impact of non-sampling bias, but the impact is likely to be the underestimation of results associated with low socioeconomic status, especially for men. Thus, our results showing poor social and health outcomes are likely to be underestimates; those relating to good outcomes are likely to be overestimates.

In the absence of culturally validated survey instruments for Indigenous Māori, our approach was to use a combination of whole-population and Māori-specific official statistical tools [14], thus enabling comparability with published population data, then adding questions sourced from the Māori disability community. Results for Māori in this survey may not be directly comparable with those of other government surveys, despite using largely identical survey items. This is due to the national surveys being administered at different time points, using different sampling methodologies; they also report by Māori ethnicity, rather than Māori descent, resulting in different denominator populations.

6. Conclusions

We used a Māori health promotion framework to present the data, as government surveys and other forms of data collection have failed to provide a comprehensive picture of Māori well-being from a Te Ao Māori perspective. As Crown decision-making relies increasingly on integrated data infrastructure, it is imperative that data collected be valid and reliable, or the policy developed through use of the data gathered will be flawed. Our model has highlighted gaps in most of the standardized questionnaire instruments, but we have demonstrated that culturally relevant and accessible data collection is possible through a national survey. Further analyses will examine the intersectionality of Māori experiences and their relationship with systemic power structures. These results can be used to fill critical data gaps for invisible populations, such as tāngata whaikaha Māori. Doing so would fulfil part of the guarantees to Māori under Te Tiriti o Waitangi and New Zealand’s human rights obligations.