Critical Tiriti Analysis, 2023 - Health Policy

Impact summary

Critical Tiriti Analysis is an original public policy development and evaluation method developed by Heather Came, Tim McCreanor and me. It is used extensively across the New Zealand public sector to inform policy development and evaluation. It is also used by Maori entities, NGOs and others to review and critique government policies.

Research and engagement activities leading to impact

Information about engagement activities is provided in the linked engagement case study titled: "Critical Tiriti Analysis and implications for policy evaluation"

Research outputs associated with the impact

1. Came, H., O’Sullivan, D., and McCreanor, T., and Kidd, J. ‘The WAI 2575 - Waitangi Tribunal Report: Implications for decolonising health systems’. Health and Human Rights Journal Vol. 22(1), 19 June 2020.

2. Came, H., O’Sullivan, D. and McCreanor, T., ‘Introducing Critical Treaty Policy Analysis through a retrospective review of the New Zealand Primary Health Care Strategy’. Ethnicities, 6 January 2020. (DOI) 10.1177/1468796819896466.

3. O’Sullivan, D., Came, H., McCreanor, T. and Kidd, J. ‘A Critical Review of the Cabinet Circular on Treaty of Waitangi and te Tiriti o Waitangi Advice for Ministers’. Ethnicities. Published December 2021.
https://doi.org/10.1177/14687968211047902

4. Came, H., O’Sullivan, D., McCreanor, T., and Kidd, J. Critical Tiriti Analysis: a prospective policy making tool from Aotearoa New Zealand. Ethnicities. Published 26 April 2023.
https://journals.sagepub.com/doi/10.1177/14687968231171651.

Researcher involvement

I was first author of one of these articles and second of all others. I provided expertise from the fields of political theory and Treaty of Waitangi policy to complement the public health expertise of my co-authors. I conceptualised, researched and wrote all four manuscripts in equal partnership with Prof. Came and, together, we provided 95% of the research and writing.

Outcomes of research leading to impact

The following public policy documents cited and used Critical Tiriti Analysis in 2023. The usages are summarised below. Three of these papers are unpublished and may be provided on request. Hyperlinks to the others are provided.

1. Health and Disability Commission (2023). Unpublished paper provided by the Commission to Heather Came.

2. Auckland Regional Public Health Service (2023). HIT (Health Improvement Team) CTA Guidelines . Unpublished document provided to Heather Came.

3. Williams M, McMeeking S. 2023. Best Practice Approaches to Addressing Racism - Lessons for the Aotearoa New Zealand Health System (Stage Two Literature Review). Wellington: Ministry of Health.
https://view.officeapps.live.com/op/view.aspx?src=https%3A%2F%2Fwww.health.govt.nz%2Fsystem%2Ffiles%2Fdocuments%2Fpublications%2F2-stage-two-literature-review-best-practice-approaches-to-addressing-racism-v2.docx&wdOrigin=BROWSELINK

4. Pharmac Annual Report 2021/22 (published in 2023).
https://pharmac.govt.nz/assets/Pharmac-Annual-Report-2021-22.pdf

5. Health Quality and Safety Commission (2023). Healing, learning and improving from harm:
National adverse events policy 2023.
https://www.hqsc.govt.nz/assets/Our-work/System-safety/Adverse-events/Publications-resources/Policy_user_guide_FINAL.pdf

6. Auckland District Health Board. Annual Report 2021/2022 (published in 2023).
https://www.tewhatuora.govt.nz/assets/Uploads/Annual-Report-2021-22-Auckland.pdf

7. Health Quality and Safety Commission and the Family Violence Death Review Committee. Responding to survivors of family violence homicide.
https://www.hauoratairawhiti.org.nz/assets/EMBARGOED-Thurs9March2023_FVDRC_eighth_report.pdf

8. Mental Health Foundation of New Zealand.  Submission to the Law Commission Review of Adult Decision-Making Capacity Law.
mhf-submission-law-commission-review-of-adult-decision-making-capacity-law-2023 (1).pdf

9. Pharmac. Te Tiriti o Waitangi policy.
https://pharmac.govt.nz/te-tiriti-o-waitangi/te-tiriti-o-waitangi-policy

10. Health Research Council (2023). Annual Report (2022) - published in 2023.
https://www.hrc.govt.nz/sites/default/files/2023-05/HRC%20Annual%20Report%202022%20digital.pdf

Beneficiaries of the impact

The New Zealand public through the Health and Disability Commission, the Auckland Regional Public Health Service, the Ministry of Health, Pharmac (the public pharmaceutical purchasing agency), Health Quality and Safety Commission, Auckland District Health Board, Family Violence Death Review Committee, Mental Health Foundation and the Heath Research Council. The purpose of these agencies use of Critical Tiriti Analysis reflects the ultimate beneficiaries of this research, the Maori population, whose health outcomes are likely to improve with the Maori leadership and privileging of Maori knowledge and epistemologies that CTA is promoting. Further beneficiaries are Maori policy-makers and health practitioners is privileged within policy-making and service delivery.

Details of the impact achieved

The Health Quality and Safety Commission explained how it used Crtitical Tiriti Analysis in this policy's design. It 'first undertook a critical Te Tiriti policy analysis to evaluate the 2017 national adverse events policy. This analysis used the critical Tiriti analysis paper ‘Introducing critical Tiriti policy analysis through a retrospective review of the New Zealand Primary Health Care Strategy’. The paper provides direction for policy makers wanting to improve Māori health outcomes and include Māori engagement, leadership and substantive authority in the policy process. It offered an approach to analysing policy that is simple to use and, inherently, a tool for advancing social justice. We then used the 2017 analysis to inform the changes in the 2023 policy and performed the same analysis on the new policy before finalising it' (p. 2).

Pharmac 'began building our leaders capability in critical te Tiriti analysis to support our assessment and decision making' (p . 33). It has done this through staff training workshops provided by Prof. Came which presents the model we developed in the above publications. Pharmac's Te Tiriti o Waitangi policy says 'We use Critical Tiriti Analysis routinely across our work to build our capability and ensure that te Tiriti is upheld.'

The Ministry of Health makes several references to CTA in its literature review. The Auckland District Health Board and Auckland Regional Public Health Services have begun training all staff in the use of CTA to support, they say, a comprehensive commitment to health equity.

The Health Quality and Safety Commission and the Family Violence Death Review Committee informed its report with our argument that 'Equitable policy development and service delivery, in turn, requires the expression of mana ōrite, Māori leadership, engagement, critique and peer review' (p. 24). The report connected this argument to the UN Declaration on the Rights of Indigenous Peoples with reference to my Oxford Human Rights Hub article 'Implementing the UN Declaration on the Rights of Indigenous Peoples in New Zealand'.

The Mental Health Foundation referred to CTA to inform its submission to the Law Commission's Review of Adult Decision-Making Capacity Law.

The Health Research Council's Annual report says that ', the majority of HRC staff members this year participated in the Critical Tiriti Analysis (CTA) workshop to support building Te Tiriti capability across the organisation. This workshop looked at using CTA to inform the development of policy, checking that documents comply with the Preamble and the Articles of te Tiriti, reflecting Kāwanatanga, Rangatiratanga, Ōritetanga, and Wairuatanga. The workshop provided applicable measures and direction for ensuring Māori engagement, leadership and authority in the policy-making process' (p. 40).

Impact date	2023
Category of impact	Public policy Impact
Impact level	National