Since the pandemic, there has been a growing emphasis on telehealth services – doctors appointments via online platforms or over the phone. This shift in focus is evident in government policy statements spotlighting telehealth options, increased government funding and the rapid expansion of providers.

Telehealth is seen by many as a way to expand access to care, reduce wait times and streamline services. But as my research shows, there are also negatives to moving care online. These should not be ignored. My complete article on telehealth is in The Conversation.

Heart risk 1 v Sore puku 0

Everyone over 20% heart risk needs pills,
is what the experts told me.
A little heart shaped one to thin out your blood,
a little white one to drop your pressure,
and a little oval one to clean out your tubes is what I told my patient.
…But I only have a sore puku,
is what my patient told me.

You are doing a good job by talking about pills, is what the experts told me.
Your heart might explode so keep taking the pills,
is what I told my patient.
…But the little heart one makes me bruise
and the little white one makes me dizzy
and the little oval one makes me ache
is what my patient told me.

Don’t forget to check for diabetes, ask about smoking and offer a flu jab
is what the experts told me.
Sugar is eating your veins
and smoke is blocking them up
and the flu might kill you is what I told my patient …But I really came in about my sore puku,
is what my patient told me.

Your numbers aren’t great you need to do more smears,
is what the experts told me.
I know that you are a man but have you considered a smear?
Is what I told my patient.
…I don’t think I want to see you again, you haven’t asked about my sore puku, is what my patient told me.

Homelessness is not uncommon in my work. In fact it is all too common. Pretty much every week our team deals with someone who has no home, or is coping with overcrowding or is living in unsuitable housing. I regularly read of homelessness in other parts of the country – people dying on park benches, non-government organisations like the City Mission and Te Puea marae assisting to the best of their ability those who through misfortune or other circumstances find themselves in the invidious situation of having inadequate shelter. The reports and news articles are sadly repetitive and yet it is as if this clarion cry to action falls upon the deaf ears of our leaders.

I use the term leaders with some disquiet because how can people who are in positions of power be called leaders when they are leading society into a culture of hubris and narcisim? True leadership requires followership in which people have the courage to ‘uphold ethical standards¹’. It seems to me that over the last nine years action only occurs when the rights of the most powerful are impinged and not the rights of the powerless and vulnerable. In this election year it becomes more incumbent on the citizenship that we develop true followership – to hold fast to our morals and ethical values and think compassionately about those who society does not favour.

Loneliness and the feeling of being unwanted is the most terrible poverty²

If we think that there are people in society who are not favoured then this tells us that we have a poverty of society. This is not the New Zealand that I want.

In thinking about horizontal violence I believe that this concept can also be applied to organisations, not just individuals. For example Māori organisations are required to compete for contracts, or unequal reimbursement for services are made or one organisation is seen as a favourite of a funder due to its acquiescence. These actions create a sense of unfairness and resentment and may lead to horizontal violence (not in a physical sense but through verbal or other non-physical means) between Māori organisations. This form of horizontal violence distracts from the task of addressing oppression by government agencies and perpetuates ongoing colonisation. In such a way funders maintain power and control and continue to set the agenda, consistent with Gaventa’s concept of the second dimension of power.¹

An alternative approach is the two-dimensional approach in which not only is power exercised upon participants, but also towards excluding certain participants and issues altogether. Power dynamics can therefore be altered by setting the agenda of struggle and inactivity is subsequently seen as a function of powerlessness in decision making. Oppressors become aware of threats and determine the decision making agenda thereby limiting the ability of the repressed to raise issues. While this approach goes someway towards offering an alternative to the criticisms of a one-dimensional approach to power there are some issues, namely that if oppressors are aware of threats and can mount a response why can not the repressed also become aware of injustice and take action? In other words what limits consciousness raising? Consciousness raising is seen as critical in Friere’s work Pedagogy of the Oppressed.² Freire argues that consciousness raising, through dialogue, leads to emancipation. Emancipation, through consciousness raising is also seen by Kiro³ as a critical element of Kaupapa Māori theory and suggests points of similarity with Kaupapa Māori theory and Gaventa’s power and powerlessness theory.

The three dimensional approach, described by Gaventa, conceptualises power further by taking the following premise – that oppressors exercises power over the repressed by acting in a manner contrary to their interests. There are a number of ways in which this is achieved.

1. Oppressors influence the conception of issues of the repressed.
2. Shaping wants or issues may occur in the absence of observable conflict (although latent conflict may be present).
3. Issues are kept out of politics through a range of mechanisms such as social forces and institutional behaviours.

The mechanism by which power is wielded involves a variety of processes. In the first dimension power involves manipulating political resources such as influence or contracts. A ‘mobilisation of bias’ occurs in the second dimension. Mobilisation of bias is also referred to as the ‘rule of the game’ in which institutional rules, values or rituals benefit one group at the expense of others. This bias may involve not only decisions but also non-decisions such as the threat of sanctions or consequences, force, barriers, or manipulation of the legal or political system. The mechanism of power in the third dimension involves thought control through social mechanisms or discourse.

Gaventa’s theory of power and powerlessness offers a conceptual framework for addressing powerlessness due to colonisation and may, through a decolonisation process led by consciousness raising, lead to a mobilisation of action and resistence against oppressive practices.

One way in which research enacts colonisation is by researchers taking a deficit approach in explaining their findings. In a deficit approach the impact of privilege, power and structural inequalities are not taken into account. Instead individuals are blamed for their situation, that somehow it is their fault that they didn’t climb out of the poverty in which they were born or that it is their fault that they didn’t receive the same opportunities in life that someone living in a leafy treelined suburb did. A deficit approach is insidious, colouring our language and placating our conscience. Health professionals, for example, may talk about patients being lazy or non-compliant as explanations for poor health and ‘life-style’ diseases. Researchers may attribute causal factors for disease to a person’s ethnicity. Politicians may use the rhetoric of treating people ‘equally’ and frame policy in such a way that responsibility shifts from society and the state to individuals. In a recent example of applying a deficit approach the National government established The Ministry for Vulnerable Children in 2016. In applying a label of vulnerability to children the government placed emphasis on weakness and fragility rather than stressing children’s strengths. The Children’s Commissioner, Judge Andrew Becroft, launched a blistering attack on the English name and vowed to only use its Māori name, Oranga Tamariki¹, which is aspirational and positive.

In a similar way Kaupapa Māori research looks for the positives in people. It avoids a deficit approach to explaining causality and instead digs deeper, teasing out the structural and institutional factors that contribute to health inequalities. In such a way policy action, that arises from research, may have more impact than the action that results from blame.

In the past I have experienced research in which the study researched upon Māori rather than with Māori. Despite a rhetoric, from the researchers, of Māori involvement, control and ownership of the study the promises were forgotten once the data had been collected. The end result was a study that polished the ego of the researchers rather than fed, nurtured and grew the capacity of Māori participants.

My PhD has arisen from concerns that research should not be an empty promise but instead lead to a fulfilment of potential. It should not be about lifting the ego of individuals but instead be about the empowerment of communities. It should not consume knowledge but instead transform that knowledge into action. For that reason my PhD utilises a Kaupapa Māori aligned (or consistent) methodology that counters the colonising aspect of Western-led research.