“There’s no relationship there”: How healthcare encounters reproduce inequity—and how they can change
1
School of Health Sciences, Massey University, Palmerston North, New Zealand
2
School of Psychology, Massey University, Palmerston North, New Zealand
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Globally, Indigenous peoples experience persistent health inequities despite access to universal health systems. While these disparities are well documented, less attention has been paid to how inequity is produced and sustained through everyday healthcare encounters. This study centres Māori experiences to examine how relationships, authority, and care shape engagement with health services in Aotearoa New Zealand.
METHODS:
This qualitative study analysed narratives shared by Māori contributors (n = 114) through Wāhi Kōrero, an anonymous online story-sharing platform. Participants responded to the prompt “I felt too whakamā to go to the doctor,” reflecting on primary healthcare engagement. A reflexive thematic analysis was undertaken using a kaupapa Māori approach, guided by tikanga (ethical practice), whakawhanaungatanga (relational accountability), and manaakitanga (care and respect). Analysis was Māori-led and supported by a multidisciplinary advisory group including community, clinical, and Indigenous expertise.
RESULTS:
Findings show that healthcare inequities are reproduced through routine clinical interactions when Māori authority (tino rangatiratanga and mana motuhake) is marginalised. The absence of relational care—being known, heard, and believed—undermined trust and contributed to withdrawal from services. Paternalistic practices and gatekeeping constrained Māori autonomy in healthcare decision-making, while financial barriers intersected with cultural and spiritual harm, including racism and humiliation. Avoidance of care emerged not as disengagement, but as an act of self-protection to preserve dignity, mana, and wellbeing.
CONCLUSIONS:
This study shows that healthcare inequities are actively produced through everyday clinical encounters shaped by colonial power relations, and can be disrupted when Māori-led, relational approaches to care are upheld. Improving Indigenous health outcomes requires more than expanding access or workforce cultural training; it demands system-level commitment to Indigenous governance, shared decision-making, and relational accountability. These findings offer transferable insights for decolonising public health internationally, highlighting that equity is achieved through redesigning health systems to honour Indigenous authority and knowledge.
Globally, Indigenous peoples experience persistent health inequities despite access to universal health systems. While these disparities are well documented, less attention has been paid to how inequity is produced and sustained through everyday healthcare encounters. This study centres Māori experiences to examine how relationships, authority, and care shape engagement with health services in Aotearoa New Zealand.
METHODS:
This qualitative study analysed narratives shared by Māori contributors (n = 114) through Wāhi Kōrero, an anonymous online story-sharing platform. Participants responded to the prompt “I felt too whakamā to go to the doctor,” reflecting on primary healthcare engagement. A reflexive thematic analysis was undertaken using a kaupapa Māori approach, guided by tikanga (ethical practice), whakawhanaungatanga (relational accountability), and manaakitanga (care and respect). Analysis was Māori-led and supported by a multidisciplinary advisory group including community, clinical, and Indigenous expertise.
RESULTS:
Findings show that healthcare inequities are reproduced through routine clinical interactions when Māori authority (tino rangatiratanga and mana motuhake) is marginalised. The absence of relational care—being known, heard, and believed—undermined trust and contributed to withdrawal from services. Paternalistic practices and gatekeeping constrained Māori autonomy in healthcare decision-making, while financial barriers intersected with cultural and spiritual harm, including racism and humiliation. Avoidance of care emerged not as disengagement, but as an act of self-protection to preserve dignity, mana, and wellbeing.
CONCLUSIONS:
This study shows that healthcare inequities are actively produced through everyday clinical encounters shaped by colonial power relations, and can be disrupted when Māori-led, relational approaches to care are upheld. Improving Indigenous health outcomes requires more than expanding access or workforce cultural training; it demands system-level commitment to Indigenous governance, shared decision-making, and relational accountability. These findings offer transferable insights for decolonising public health internationally, highlighting that equity is achieved through redesigning health systems to honour Indigenous authority and knowledge.
| eISSN: | 2654-1459 |
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