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CHAPTER TWO:

2.2 Method and Analysis

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asserts it helps facilitate shared ownership and propels research findings to a wider audience.

My core mechanism for collaboration was a research whānau/reference group made up of Māori health leaders and a Pākehā crone based within Te Tai Tokerau.

I had pre-existing relationships with the individual members of the rōpū (group), each of whom are recognised leaders within their fields. Collectively they have decades of experience in Māori health and/or management and/or Tiriti work.

This includes extensive experience in dealing with Crown agencies and officials from a variety of organisational viewpoints.

The rōpū serve as kaitiaki for this study to ensure the work remained politically relevant and culturally safe. Through their governance role, they endorsed the initial research proposal before it was submitted through the university system.

They offered direction around structure and reviewed draft after draft of text. The rōpū provided direction over the selection of counter storytellers and advice about when and how to engage with the Crown, a matter that perplexed me throughout the study. The input of my research whānau and the dynamic cross-cultural debates, have been and continue to be invaluable sources of insight.

Historical Analysis & Literature Review

Kua tawhiti ke te haerenga mai, kia kore e haere tonu. He tino rawa ou mahi, kia kore e mahi nui tonu.

You have come too far, not to go further.

You have done too much, not to do more.

(Henare, 1987a).

There are many Māori whakatauākī (proverbs) that articulate the importance of understanding the past to make sense of the present. Indeed kaupapa Māori theory often emphasises the importance of historical socio-political context to understanding contemporary matters. In aligning to this tradition, this study includes a historical analysis to contextualise contemporary manifestations of institutional racism. The voices of indigenous historians are deliberately privileged within this account, which draws heavily on Waitangi Tribunal reports as respected historical sources. Indeed, I undertake a thematic analysis of health related Tiriti claims in chapter five.

Other literature was variously sourced from health, medicine, education, social science, management and psychology databases. Other Crown and activist produced documents accessed for this research are in the public domain. As a PhD candidate, I sought to situate my work in the international arena as a necessary aspect of this qualification and utilise the insights of others to deepen my understanding of racism, justice and activist scholarship. I engaged with these literatures with a robust sense of respect for the local and the possibilities that the local may influence the global. As critical management scholar D. Jones (1992), advocates those writing from the Antipodes need to find the confidence to speak

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from local perspectives and ensure the strengths of our analysis are not overly dependent on overseas texts.

Master Narratives

Within CRT, master narratives are the discourses of the powerful. Through this study, I examine several sets of master narratives, which articulate best practice and/or ethical conduct for both state parties and Crown officials. These master narratives include treaty obligations made between England and the hapū of Aotearoa, as outlined in Te Tiriti o Waitangi and commitments made through human rights instruments, which articulate agreed levels of conduct for state parties within the international community. I also examine accountability mechanisms within the New Zealand public sector to promote ethical conduct and minimise systemic discrimination.

Having established this web of macro accountabilities, I refined my focus to activities within the public health sector through a desktop review of Crown documents. This desktop review is taken as the Crown’s voice for the purposes of this study rather than the viewpoints of individual Crown officials. Through the desktop review, I examine the policy positions and articulations of mandatory conduct in relation to Crown procurement and funding practices between 1999 and 2010. In choosing this timeframe, I deliberately covered both the Labour-led coalition and the current National-led coalition governments to illustrate the continuity of institutional racism.

In relation to policy master narratives, I have used Northland DHB as a case study within chapter seven. This rohe (area) was chosen because this research was instigated in Te Tai Tokerau, the reference group is based in Te Tai Tokerau and a significant amount of my co-funding field notes related to my experiences working with Northland DHB. Having worked and had close contact with a range of DHBs I am not contending that Northland is “typical” of all DHBs but from a master narrative perspective, Northland DHB does have to fulfil the same planning requirements as all DHBs. I do note however that Northland DHB as with other Auckland-based DHBs have treaty-based co-funding partnerships.

Once the bulk of this data collection was complete and preliminary analysis undertaken, I met with a key senior official from the Ministry of Health to clarify points arising from my preliminary findings. For the purposes of this study, the Senior Crown Official identifies as a manager with experience of contracting as both a provider and as a contract manager in the Ministry of Health. Their contribution is woven through chapters seven and nine to inform the desktop review. A major theme of this exchange was the challenges and tensions of doing public health policy making and funding activity within the wider Ministry of Health environment.

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Together these pieces of analysis provide a platform from which to offer an assessment of Crown performance in relation to its own ethical benchmarks and as a point of reflection for my own findings.

Funding Analysis

Given the passionate conviction from those associated with this research that that allocation of funding was a site of institutional racism I was committed to undertaking a funding analysis. In the first instance, I reviewed Ministry of Health, Health Expenditure Trend reports (2005-10) and Treasury Vote Health appropriations for the same period. These documents provided disparate figures and only limited or no information about both public health and Māori health investment. I contacted the Ministry of Health to seek clarification and was passed around a series of officials who were not able to answer my questions.

I then drafted a collection of OIR to the Ministry of Health (see appendix A).

From my initial conversation with the Chief Financial Officer (Personal communication, December 10, 2010) it became apparent that the Ministry do not track Māori health expenditure nor maintain oversight of public health expenditure beyond what they directly fund. In order to complete my analysis I sent out a series of OIR to all DHBs (see appendix B). The interchange with DHBs ranged from friendly articulate responses within twenty-four hours, through to hostile administrators, letters from lawyers and refusals to release information.

Many of the Crown agencies involved were either unable or unwilling to respond within the required timeframes.

After utilising the services of the Office of the Ombudsmen12, eventually all Crown agencies were largely compliant. Collating the DHB data took several waves of correspondence to obtain a near complete data set. Due to changes in financial systems where gaps existed in the data, several estimates (as noted in the findings) were incorporated into the analysis.

Counter Narratives

Within CRT, master narratives are frequently contrasted with counter narratives, which are the perspectives of those not often heard. Within a dominant cultural paradigm, the unheard are frequently indigenous and other voices of dissent.

Within this study, I gathered counter narratives by engaging in collaborative storytelling with nine Māori leaders and a Pākehā crone. I also documented my experiences of co-funding activity with Crown officials. This information was then investigated further through a survey of public health providers.

Common across many of the epistemological and theoretic perspectives drawn on for this study is a tradition of storytelling. Stories are a way of representing perceived truth. Central to this study is a process of counter storytelling with

12 I made two complaints against DHBs (whom I choose not to identify within this study) in relation to their non-compliance with my OIR.

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leaders willing to share their experiences and analysis of Crown conduct. I utilised what Bishop (1996, p. 23) describes as collaborative story telling a co-joint construction of meaning. The mutual telling and retelling of stories by people who are living those stories allows knowledge to be generated that denies distance and separation and promotes commitment and engagement in the research journey. It allows for what Heshusius (1994) calls ‘participatory consciousnesses’ and deconstructs the traditional position of researcher as all powerful storyteller.

Discussions primarily took place kanohi ki te kanohi (face to face), others were conducted through extended telephone conversations due to geographic distance and resource limitations. Usually the storytelling was approximately an hour at a time though some marathon sessions took up to three hours (with kai breaks). All sessions were transcribed and then reviewed by storytellers to ensure they were comfortable with their text. Points of interest were identified for further discussion in subsequent encounters. Indeed 75% of the storytellers participated in more than one session.

All the dialogue took place within the context of ongoing relationships. Informal and often in-depth conversation about the unfolding research was ongoing with many of the storytellers beyond the data collection period as part of our ongoing professional and personal relationships. In citing the data, I did a thematic analysis and used direct quotations frequently and minimised paraphrasing. Relevant literature was weaved through the counter narrative excerpts to elaborate a point in the traditions of CRT. Likewise, field notes and the findings of the public health survey supplemented the excerpts.

Recruitment was guided by my research whānau, some of whom participated in storytelling processes themselves. The extensive collective relationship network within this rōpū provided a plethora of potential counter storytellers. I undertook purposeful sampling in that I deliberately worked with information rich cases (Patton, 1987). I also revisited dialogue with counter storytellers from my earlier post-graduate study (Came, 2007, 2008) with refreshed informed consent to deliberately build on this earlier sharing and resumed fruitful lines of enquiry.

Storytelling processes were conducted with people who have worked within Crown agencies, Māori and generic health providers. I secured a range of stakeholders from governance through to senior management as recommended by Griffith, Mason, Yonas, Eng, Jefferies, Pliheik and Parks (2007) from their work dismantling racism. Informed consent was negotiated with counter storytellers (see Appendices A and B). Many of those engaging in the storytelling chose to be identified within the research. The following biographical details introduce the counter storytellers.

Grant Berghan is from Te Tai Tokerau (Northland) with links to Ngā Puhi, Ngāti Wai and Te Rarawa iwi (tribe). He has extensive experience in the health and labour market sectors. He has been a general manager of Māori health, public

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health and mental health for a DHB, the Chief Executive Officer (CEO) of a regional Māori health provider, and a national Māori Employment Commissioner and Northland regional manager of government work programmes. He has also been an auditor of health programmes, a probation officer, a social worker, and a free-lance journalist for a French (Parisian) weekly newspaper. He has experience in policy and program development and implementation, contracting, funding, advocacy, facilitation and evaluation. He was a government appointed member to the Youth Suicide Advisory Panel and is a current member of the Māori Advisory Board (Public Health) with the Ministry of Health. He is the Managing Director of Berghan Consultancy Limited, specialising in Māori development issues.

Shane Bradbrook has links to Ngai Tāmanuhiri, Rongowhakāta and Ngāti Kahungunu. He has been involved as a Māori and indigenous advocate in the tobacco resistance movement for the last decade at both national and international levels with the primary role of advancing change at a political and policy level on tobacco use issues. Winner of several academic fellowships Shane was also the recipient of the international Nigel Gray Award in recognition of his work in tobacco control. He has been involved in various governance and advisory roles including session chair for United Nations indigenous forums and represented Aotearoa on the development of the Framework Convention on Tobacco Control (World Health Organization, 2003). He has received a world first apology from a tobacco company for the sale of Māori mix cigarettes, successfully advocated for the removal of cigarette brand from the New Zealand market, and worked extensively with a range of Pacific Island nations around tobacco issues. He continues to pursue passionately his vision: “Kia mau te kaupapa tupeka kore mō ngā uri Māori” as the ultimate expression that will greatly improve the overall physical, economic, social and cultural well-being of Māori.

Susan Friar da Silva is a sixth generation Pākehā from an old Auckland family.

She has been interested in issues of racism since attending a workshop of Mitzi Nairn in 1979 and has worked in Tiriti issues since 1985. Susan currently teaches on the social service programme at North Tec and provides professional training on Te Tiriti issues and cultural competencies to various health, education and community organisations through her consultancy Silva Service. Susan is an active member of Network Waitangi Whangarei.

Louise Kuraia is Ngā Puhi me Ngai Tai ki Tainui, of the Davis whānau from Karetu (Bay of Islands) and Torere (Bay of Plenty) and Makene whānau from Mangataipa (Far North). She also has Welsh, Scottish, Irish and English heritage.

Louise was born in Kawakawa, Te Tai Tokerau and bought up and schooled in Otara and Otahuhu (South Auckland) and is an alumnus of the University of Auckland’s Faculties of Art and Law. In 1994, Louise started in the health sector, coming to specialise over sixteen years in Māori health provider, services and workforce development; policy and structural analysis; and funding and planning.

Louise spent four years at North Health and the Health Funding Authority (HFA)

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then twelve years in Whangarei with Te Tai Tokerau MAPO. Louise was Executive Director of the Amokura Family Violence Prevention Consortium to June 2011, and it is currently working for Te Tai Tokerau Whānau Ora Collective, which brings together five Māori health, education, community and social service providers serving 86% of the Tai Tokerau Māori population under the Whānau Ora banner. Louise is married to Anton (Samoan, Cook Islands and Pākehā), a constable with Whangarei Police, and they are the proud parents of three boys Seb, Julius and Luca.

The counter storyteller identified as Māori Provider CEO has decades of experience in iwi development and the wider health sector. They have governance experience and have been involved in a range of regional and national advisory groups for Crown agencies. They have also led out a number of innovative intersectoral initiatives.

Maxine Shortland has links to Ngāti Hine, Ngā Puhi, Ngāti Wai and Ngāti Porou. She has more than twenty years experience within the health sector working within Māori and non-Māori providers, most recently in senior management roles. She has participated in a range of regional and national reference and advisory groups advocating for Māori health. Maxine currently manages Mātauranga Whānui, which is a service of the Ngāti Hine Health Trust.

She recently was awarded the University of Auckland Dame Mira Szaszy Alumni, Māori Business Leaders Award for her contribution to Māori health.

The counter storyteller identified as Senior Māori Health Advisor has worked within the Ministry of Health across a number of its departments. They have previously worked as a Manager within a Māori Provider and employed as a public health practitioner within a DHB. They have sat on a range of health advisory groups at national and regional level, and have an extensive background in community and hapū development. They also have extensive experience in program development, implementation, contracting, advocacy and facilitation.

They are passionate about working for Māori communities.

The counter storyteller identified as a Senior Māori Executive is a very experienced senior manager having worked for both Māori and mainstream organisations and whose whakapapa13 is intact. They have considerable governance experience and have been involved extensively in Crown regional and national advisory groups, advocating for Māori health and Te Tiriti o Waitangi.

They have been nationally recognised on several occasions for their contribution to Māori health, and presented and published on Māori health nationally and internationally. They have been involved in the development and rollout of a number of significant initiatives within the health sector.

13 Whakapapa meaning Māori identity in this context.

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Hayden Wano Registered Comprehensive Nurse, Post Graduate Diploma in Health Services Management, Advanced Diploma in Nursing, Masters in Business Administration, and Fellow of the Australasian College of Health Service Executives. Hayden is of Te Atiawa, Taranaki and Ngati Awa Iwi descent and is currently Chairman of Te Niho o Te Atiawa House, Parihaka. Hayden is married to Antonia with three adult children and one grandchild. He is a keen surfer and spectator of a variety of sporting activities and has a particular interest in local and indigenous art. He has over twenty years experience in senior health management, and is currently CEO of Tui Ora Ltd and General Manager Iwi and Community, Midlands Health Network. Hayden has over thirty five years health sector experience in mental health, community and medical services. He has held positions as Director of Clinical Services with Taranaki Healthcare, and Chairman of Taranaki DHB 2000-2007. Hayden also holds a number of other governance positions, including Chairmanship of the Health Sponsorship Council and is a member of the recently established National Health Board (NHB).

The counter storyteller identified as Māori Policy Analyst was born in Tolaga Bay and of Ngāti Porou, Ngā Puhi, and Te Whānau ā Apanui descent. She has two children and one mokopuna. She went to school in Tolaga Bay, Gisborne and Napier. She trained as a registered general and obstetric nurse at Napier Hospital and went on from there to complete a Bachelor of Social Science at Massey University with first class honours and a Doctorate in Philosophy at Waikato University. She has worked in the health sector as a registered nurse until seconded by iwi to assist in the establishment of Māori provider services. Her areas of expertise are Māori health and policy. Between times, she has been politically active in an endeavour to address the impact of colonisation on whānau, hapū and iwi.

Co-funding Field Notes

During the course of defining my research topic and during the preliminary writing of this thesis, I worked for a distinctive Māori co-funding organisation, Te Tai Tokerau MAPO Trust. From this vantage point, I was able to witness firsthand the behaviour of a range of Crown officials in their dealings with a cross section of public health providers. Through the course of my standard professional practice, my work was subject to detailed and systematic documentation for both internal and external reporting purposes.

As part of my research process, I kept a reflective research diary recording my participant-observations of racism through the course of my professional work.

These notes are reflective accounts of incidents and include information about how I felt about those experiences, in part as a mechanism to deal with my rage at what I was witnessing. These notes form part of a structural analysis of how racism manifests within the health system within this study. Although individual Crown officials appear within these field notes they are not identifiable so are

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protected from potential harm. Indeed considerable care was taken that in my willingness to expose aspects of my own analysis and responses I did not expose the identity of others.

Public Health Provider Survey

Paradies (2006a, p. 147) argues that actions and/or behaviours can only be objectively named racism when a comparison is possible. Heeding this insight, part way into my research process I made a decision to undertake a survey of public health providers. This survey (see appendix C) was a means to both test themes emerging from counter narratives with Māori and benchmark the experiences of different groupings of public health providers in their dealings with Crown agencies.

The survey was targeted at health providers who were contracted to deliver public health services by the Ministry of Health and/or a DHB(s) as of December 2010.

Fifty-six senior managers from public health providers agreed to participate in the survey out of a possible sample size of 243 providers. This survey therefore represents the viewpoints of nearly 25% of the public health sector but certainly not the entirety of the sector.

Recruitment occurred through my strong existing networks and relationships within the sector and involved a broad cross section of providers. These relationships were formed through nearly twenty years in the sector working in Taranaki, Waikato, Te Tai Tokerau and nationally (based in Auckland), attending conferences, workshops, seminars, hui and fono. The cohort included both small and large providers, located within both rural and urban settings. Senior managers from Public Health Units (PHU) (13), Primary Healthcare Organisations (PHO) and/or Community Health Trusts (10), national and local NGOs (19) and Māori health providers (14) all participated.14

The survey took place via the telephone to minimise confusion in relation to the questions and to ensure a high return rate.15 The survey benchmarked providers’

experiences of Crown officials in relation to the key areas of contracting and service delivery, relationships and influence, funding and financial accountabilities. The findings of the survey were analysed at group level and are presented in the body of this study in graph form utilising percentages of each group to enable easy comparison across the groupings.

Dissemination and Mobilisation Strategy

Within activist scholarship, dissemination of findings and mobilising people into action around those findings are an integral part of the research process. My

14 At the time of data collection it was agreed with public health providers that they would not be identified through this research.

15 Only three providers declined to participate in the survey as they were undergoing significant restructuring during the timeframe of the data collection.