Reflections on the Use of a Māori Conceptual Framework to Evaluate Complex Health Policy: The Case of New Zealand's Healthy Eating, Healthy Action Strategy Evaluation

R E F E R E E D A R T I C L E
E v a l u a t i o n J o u r n a l o f A u s t r a l a s i a , V o l . 1 1 , N o . 1 , 2 0 1 1 , p p . 5 – 1 0
Reflections on the use of a Maori conceptual
framework to evaluate complex health policy: the
case of New Zealand’s Healthy Eating, Healthy
Action Strategy evaluation
Amohia Boulton
Te Kani Kingi
Obesity among Māori is of growing concern in New
Zealand with rates for Māori being one-and-a-half
times that of the total population. The New Zealand
government’s Healthy Eating—Healthy Action: Oranga
Kai—Oranga Pumau (HEHA) Strategy has, in the past
seven years, been a significant policy mechanism through
which the health sector has been able to address the
increasing prevalence of obesity and associated chronic
diseases.
An evaluation of the HEHA strategy, commissioned by New Zealand’s Ministry
of Health in 2008, sought to determine the effectiveness of the strategy in
four areas: strategy implementation; resultant outcomes; improvements to
implementation that occurred; and value for money. Policy changes in 2009
Amohia Boulton (Ngāti Ranginui, Ngai te
resulted in the evaluation (originally planned for three years) concluding early in
Rangi, Ngāti Pukenga, pictured left) is a
2010. However, between 2008 and 2010 an overarching conceptual framework,
Senior Researcher at Whakauae Research
including a Māori conceptual framework, was developed to guide key aspects of
the evaluation.
for Māori Health and Development, an iwi
This article presents the Māori conceptual framework and discusses the
(tribal) research centre in Whanganui, and
usefulness of employing such a framework to evaluate health policy implemented
is Visiting Senior Research Fellow at the
in a rapidly changing policy environment. The article concludes that developing
Health Services Research Centre, School
the Māori conceptual framework at the outset of the evaluation not only
of Government, Victoria University of
provided a practical analytical tool for the Indigenous evaluators, but also the
Wellington.
means by which the wider team could ensure rigorous and robust data analysis
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thereby guaranteeing the production of relevant findings for the commissioners
of this complex policy evaluation.
Te Kani Kingi (Ngāti Pukeko, pictured
right) is the Director of Te Mata o te
Tau, The Academy for Māori Research
Introduction: obesity and the New Zealand response
and Scholarship at Massey University in
In 2008, a group of academic researchers and independent evaluators (the
Wellington.
Consortium) under the leadership of the University of Otago1, was commissioned
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by New Zealand’s Ministry of Health to undertake an evaluation of a key
government health policy: the Healthy Eating—Healthy Action: Oranga Kai—
Oranga Pumau2 (HEHA) Strategy. The HEHA Strategy was launched by the
Ministry of Health (MoH) in 2003 in response to growing concern about an
increasing prevalence of obesity among the New Zealand population, and the
associated increased risk of chronic diseases, notably diabetes, cardiovascular
disease and cancer (Ministry of Health 2003). Rates of obesity and of being
overweight have been observed to have been increasing, particularly in Māori3
and Pacific people and those living in deprived areas, since the 1980s (Ministry of
Health 2004a). Indeed, recent statistics report that 29 per cent of New Zealand
children aged 2–14 years and 63 per cent of New Zealand adults are classified as
overweight or obese. Furthermore, Māori adults and children are one-and-a-half
times more likely to be obese than adults and children in the population as a whole
(Ministry of Health 2008a).
Boulton and Kingi—Reflections on the use of a Māori conceptual framework to evaluate complex health policy
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These increased rates of obesity and overweight
guide key aspects of the evaluation; a framework
in New Zealand reflect a pattern in other Western
broad enough to be able to take account of the
democracies. In response to concerns over the rising
many elements and work streams that comprised
epidemic of obesity (Egger & Swinburn 1997; Mokdad
the Strategy in its entirety and robust enough to be
et al. 1999), the World Health Organization (WHO)
informative across the full range of HEHA activities
launched a global strategy for diet, physical activity
(HEHA Strategy Evaluation Consortium 2009).
and health in 2004 calling for governments to develop
The HEHA Strategy is required to coordinate
national strategies and action plans on diet and physical
activities between diverse groups, while also meeting
activity (World Health Organization 2004). The HEHA
the needs of different stakeholders. Furthermore, the
Strategy has been developed specifically to meet the
emphasis on Māori and Pacific models of health means
needs of the New Zealand population and, therefore,
that the HEHA Strategy must recognise a multiplicity of
takes cognisance of New Zealand’s unique historical,
different cultural approaches and views. Similarly, the
social and environmental context.
conceptual framework was also required to recognise
The strategy recognises the importance of both
these different approaches and world views, yet be
the Treaty of Waitangi4, in particular the three Treaty
flexible enough to be applied to a strategy that is
principles of partnership, participation and protection
dynamic and may be influenced by changing political
(Royal Commission on Social Policy 1988), and the
and social contexts (McLean et al. 2009).
drive to reduce health inequalities in its vision to create:
The framework draws on key constitutional
documents and health policies that guide New
an environment and society where individuals,
Zealand’s health sector; documents such as the Treaty
families and whānau5, and communities are
of Waitangi (1840), the Ottawa Charter (1986), the
supported to eat well, live physically active lives,
He Korowai Oranga: Māori Health Strategy (Ministry
and attain and maintain a healthy body weight.
of Health 2002), and the Pacific Health and Disability
(Ministry of Health 2003, p. 15)
Action Plan (King 2002). It both acknowledges that
An implementation plan accompanies the HEHA
environmental and socio-demographic factors influence
Strategy. Using the methods of health promotion action
nutrition, physical activity and obesity and caters
outlined in the Ottawa Charter for Health Promotion
for the Strategy’s horizontal and vertical complexity
(World Health...