Louise Kuraia, BA, LLB, is the 2023–24 Aotearoa New Zealand Harkness Fellow in Health Care Policy and Practice. She is an indigenous wahine (woman) of the Ngāpuhi, Ngāti Manu, and Kōhatutaka tribes of the far north of the country who lives amongst her people and works from her ancestral homelands of Te Tai Tokerau (Northland). Louise is the Chief Advisor, Māori Crown Relations in the Māori Health Directorate of the Ministry of Health, who are chief stewards of the health system and policy advisors to the Minister of Health. She previously worked for more than 20 years in tribally owned partnership, primary and community health organizations to advance Māori health equity and address systemic racism through giving practical effect to the rights and responsibilities of Māori and the Crown under Te Tiriti o Waitangi (the Treaty of Waitangi) New Zealand’s founding document. Louise has served on multiple national health advisory and strategy groups, bringing her extensive expertise and experience in applying Treaty principles of partnership, equity, self-determination, options, and active protection of Māori knowledge to drive change in complex systems. She is a widowed māmā (mother) of three fine young men and is excited to bring her whole self to the Harkness experience.
Project Title: Culture Leads, Culture Knows, Culture Heals: An Exploration of Transformative Indigenous Health Systems on Turtle Island, Hawai’i, and Sápmi
Placement: Johns Hopkins Center for Indigenous Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University
Mentor: Allison Barlow, PhD, MPH, MA, Professor, Executive Director, Johns Hopkins Center for Indigenous Health; Associate Scientist, Department of International Health; international co-lead, LEGO Foundation Award (USD $28 million) for the expansion of Family Spirit; co-lead, NIH-funded Center for Excellence in culturally led approaches to substance abuse, prevention, and recovery
Co-mentor: Gerard Anderson, PhD, Professor, Health Policy and Management and International Health, Bloomberg School of Public Health and Johns Hopkins School of Medicine; Director, Johns Hopkins Center for Hospital Finance and Management
Project Summary:
Research Objectives
Culture Leads, Culture Knows, Culture Heals was the overarching theme of the 2023 National Tribal Health Conference; borrowed to guide me as an emergent Māori scholar and Harkness Fellow at Johns Hopkins Center for Indigenous Health. I spent a year exploring the transformative power of indigenous health systems, policy, and practice, experienced during site visits and while attending indigenous health courses, seminars, conferences, and cultural events within the continental US, Hawai’i, and Norway.
Māori share similar colonial histories with Native American and Sámi peoples, with imposed borders and administrative, judicial, educational, health, religious, and other settler-colonial systems designed to dispossess indigenous peoples of land, culture, language, and lives. Yet despite how harmful these systems are, the indigenous communities I visited are thriving, vibrant, and actively resisting through the re-storying of histories and reclaiming their ways of knowing, being, and living.
Study Design
I followed indigenous research principles and practices of listening, learning, sharing, and exchanging culture, stories, language, and kai (food) in wānanga (gatherings) with indigenous health leaders, kaimahi (workers), organisations, scholars, and communities. My nannies taught me the importance of being a good manuhiri (visitor — who would be invited back!) who is respectful of local kawa (custom), comes with a humble and open heart, and reciprocates the generosity of time, stories, and wisdom shared with me. I also embraced the roles of tauira (student), kaiako (teacher), and kaiwhakamārama (illuminator) — listening and learning from indigenous elders and experts, sharing Māori stories, culture, and tikanga (values and practices), and translating between Māori, indigenous, and western world views, values, and knowledge systems.
I started with research pātai (questions) such as: how are indigenous health leaders on Turtle Island and Hawai’i using traditional knowledge systems of healing to transform the health and well-being of their communities; and what can we learn from their mahi to advance indigenous sovereignty, self-determination, health equity, and the dismantling of systemic racism in health care policy and practice in Aotearoa?
Principal Findings
As the year progressed, more and new pathways opened up around how we meet the similar challenges we face as indigenous peoples; through international collaborations, sharing strategies for decolonizing, and indigenizing our spaces, places, institutions, and academies; and taking collective action to eliminate the harms of oppressive settler-colonial systems and create the conditions for Pae Ora or flourishing indigenous futures.
Conclusion and Implications for the US and Aotearoa
In Aotearoa, the Māori health policy environment changed significantly while I was away, shifting from relatively permissive to much more adverse. In the US, Native peoples have had to survive centuries of toxic policy environments which seek to invisibilize, dehumanize, assimilate, and eliminate them. We can learn from their resistance, survivance, and determination to live and be sovereign in the face of adversity.
“We are not a historically underserved population. My history is one of ancestors who survived so that I could thrive. My history didn’t start with ‘western civilization.’ I am colonially underserved. And I am historically resilient.” — Abigail Echo-Hawk, Pawnee, Director, Urban Indian Health Institute