Ngā mihi o te tau hou ki ngā whanau, whanui o te NZMJ.

The New Zealand Medical Journal (NZMJ) was first published 47 years after the signing of the Treaty of Waitangi. The NZMJ honours this legacy with the inclusion of a publication from 100 years ago in each issue. These past articles act as a signpost of changes in scientific knowledge and health practices over time. A review of these articles documents the culture of the medical profession and the NZMJ throughout this time. They prioritise authorship of the mainly white, male workforce reporting on specific patient cases and describe an experimental approach to further understand or treat the presenting complaints. These articles reflect the historical privilege of western science (such as anecdotal evidence being presented as fact) in the culture of the New Zealand medical profession.

By 2002 (when the journal migrated to an electronic format), the NZMJ had changed to embrace an evidence-based framework that was clinically relevant to the New Zealand health sector. This embracing of evidence-based medicine signposted a cultural evolution of the NZMJ. This evolution includes the publishing of evidence-based articles from New Zealand health practitioners and evidence relevant to the New Zealand health sector.

The year 2020 marked a further cultural evolution for the NZMJ , by the identification of the journal’s growing stakeholder group that includes tangata Māori, health stakeholders (clinicians, scientists, organisational administrators, researchers and health systems) and communities impacted by racism and inequity in health outcomes. This cultural evolution was highlighted by Selak, Rahiri, Jackson and Harwood’s editorial in the 4 September 2020 issue.1 They extended a call to the NZMJ to enact further structural changes that would ensure publications were responsive to the Treaty of Waitangi and utilised non-racist methodologies. It also encouraged potential authors of the NZMJ to undertake relevant professional development to produce responsive anti-racist research that has a focus on health equity. In another NZMJ editorial, Crampton (2020) also highlighted the lack of progress of Hauora Māori outcomes over the last twenty years. He called for a significant cultural change in the whole health sector “to rid our society of racism, and to demand equity in the structures, processes, and outcomes for Māori and Pacific New Zealanders.”2

Therefore the first issue of the NZMJ in 2021 provides an opportunity to respond to the need for further evolution with a clear kaupapa that not only accepts the critique of Selak et al (2020),1 but that also acknowledges recent changes in health research funding criteria (Māori Health Advancement Guidelines),3 health research guidelines,4,5 the influence of policy on health equity6,7 and the extensive body of evidence on the impacts of racism on hauora7–13 in its consideration of appropriate publications.

As the new Māori subeditors for the NZMJ, we will work alongside the editor and current subeditors to support these cultural changes:

1. Develop a framework for potential authors so they can work to submit articles that align with the cultural expectations of the NZMJ.
2. Utilise a Treaty of Waitangi framework, to advocate for a minimum target of articles that report on Hauora Māori outcomes.
3. Ensure the ongoing retention of themed issues in health equity (as was the 4 September 2020 issue).
4. Increase the number of Hauora Māori expert peer reviewers.
5. Increase opportunities for communities who are impacted by inequity in health to be published.
6. Provide a template to guide peer reviews to align with the cultural expectations of the NZMJ.
7. Oversee all publications and provide further peer review, or have the right to reject publications that do not align with the cultural expectations of the NZMJ.

So what are the aims of the NZMJ going forward in 2021? Perhaps these aims are best captured in the new NZMJ byline:

“te ara tika o te hauora hapora.”

In concept, these kupu express the intent of the NZMJ to provide a path by which learning, best practice, clinical practice, health policy and knowledges are presented to stimulate debate that supports leading our communities to wellbeing.

Like any cultural evolution it will take time, but resources such as the Māori Health Advancement Guidelines3 and the CONSIDER statement5 will provide foundation documents for these changes. NZMJ stakeholders within their own research and health environments are already enacting similar cultural evolutions. The Treaty of Waitangi, as a context, provides a way forward through partnership.6 This current evolution will now enable us to build on the gains and development of decades of Hauora Māori evidence, innovation and excellence.

Ngā mihi matou ki a koutou katoa.

Ngā mihi o te tau hou ki ngā whanau, whanui o te NZMJ.

The New Zealand Medical Journal (NZMJ) was first published 47 years after the signing of the Treaty of Waitangi. The NZMJ honours this legacy with the inclusion of a publication from 100 years ago in each issue. These past articles act as a signpost of changes in scientific knowledge and health practices over time. A review of these articles documents the culture of the medical profession and the NZMJ throughout this time. They prioritise authorship of the mainly white, male workforce reporting on specific patient cases and describe an experimental approach to further understand or treat the presenting complaints. These articles reflect the historical privilege of western science (such as anecdotal evidence being presented as fact) in the culture of the New Zealand medical profession.

By 2002 (when the journal migrated to an electronic format), the NZMJ had changed to embrace an evidence-based framework that was clinically relevant to the New Zealand health sector. This embracing of evidence-based medicine signposted a cultural evolution of the NZMJ. This evolution includes the publishing of evidence-based articles from New Zealand health practitioners and evidence relevant to the New Zealand health sector.

The year 2020 marked a further cultural evolution for the NZMJ , by the identification of the journal’s growing stakeholder group that includes tangata Māori, health stakeholders (clinicians, scientists, organisational administrators, researchers and health systems) and communities impacted by racism and inequity in health outcomes. This cultural evolution was highlighted by Selak, Rahiri, Jackson and Harwood’s editorial in the 4 September 2020 issue.1 They extended a call to the NZMJ to enact further structural changes that would ensure publications were responsive to the Treaty of Waitangi and utilised non-racist methodologies. It also encouraged potential authors of the NZMJ to undertake relevant professional development to produce responsive anti-racist research that has a focus on health equity. In another NZMJ editorial, Crampton (2020) also highlighted the lack of progress of Hauora Māori outcomes over the last twenty years. He called for a significant cultural change in the whole health sector “to rid our society of racism, and to demand equity in the structures, processes, and outcomes for Māori and Pacific New Zealanders.”2

Therefore the first issue of the NZMJ in 2021 provides an opportunity to respond to the need for further evolution with a clear kaupapa that not only accepts the critique of Selak et al (2020),1 but that also acknowledges recent changes in health research funding criteria (Māori Health Advancement Guidelines),3 health research guidelines,4,5 the influence of policy on health equity6,7 and the extensive body of evidence on the impacts of racism on hauora7–13 in its consideration of appropriate publications.

As the new Māori subeditors for the NZMJ, we will work alongside the editor and current subeditors to support these cultural changes:

1. Develop a framework for potential authors so they can work to submit articles that align with the cultural expectations of the NZMJ.
2. Utilise a Treaty of Waitangi framework, to advocate for a minimum target of articles that report on Hauora Māori outcomes.
3. Ensure the ongoing retention of themed issues in health equity (as was the 4 September 2020 issue).
4. Increase the number of Hauora Māori expert peer reviewers.
5. Increase opportunities for communities who are impacted by inequity in health to be published.
6. Provide a template to guide peer reviews to align with the cultural expectations of the NZMJ.
7. Oversee all publications and provide further peer review, or have the right to reject publications that do not align with the cultural expectations of the NZMJ.

So what are the aims of the NZMJ going forward in 2021? Perhaps these aims are best captured in the new NZMJ byline:

“te ara tika o te hauora hapora.”

In concept, these kupu express the intent of the NZMJ to provide a path by which learning, best practice, clinical practice, health policy and knowledges are presented to stimulate debate that supports leading our communities to wellbeing.

Like any cultural evolution it will take time, but resources such as the Māori Health Advancement Guidelines3 and the CONSIDER statement5 will provide foundation documents for these changes. NZMJ stakeholders within their own research and health environments are already enacting similar cultural evolutions. The Treaty of Waitangi, as a context, provides a way forward through partnership.6 This current evolution will now enable us to build on the gains and development of decades of Hauora Māori evidence, innovation and excellence.

Ngā mihi matou ki a koutou katoa.