Abstract
For Māori in Aotearoa New Zealand, land is not only an economic foundation but an anchor for tribal identity and a spiritual base. The forced alienation of Māori land since the 1800s, due to colonisation, has distanced communities from a direct relationship with their lands. There is little published research on Māori community gardens (māra) and their potential to reconnect Māori with ancestral lands. This study explores the motivations for developing māra and examines the role of māra in Māori health promotion. The paper describes findings from kaupapa Māori research that involved interviews with seven leaders of māra initiatives. Our findings suggest that the development of māra is motivated by a desire to empower Māori collectives towards a vision of vital communities thriving as Māori. Māra provide a rich site for community development grounded in a cultural connection to ancestral land. The utilization of ancestral lands enables groups to draw on a deep sense of shared identity that is rooted in those lands and fosters an intergenerational orientation. Māra offer activity linked with ancestral knowledge, customary practices and tribal connection. They provide opportunities to practice Māori language and cultural processes in functional everyday ways, and thereby strengthen a sense of commitment to protect cultural heritage as a resource for community life. Importantly, hands-on collective activity with shared decision-making, which is characteristic of māra, fosters social cohesion and collective efficacy. Overall our findings indicate that māra are land-centred community development initiatives that fit within the parameters of Māori health promotion and have much potential to contribute to achievement of Māori health promotion outcomes.
Keywords
Introduction
Māori health promotion is a process to increase Māori control over the determinants of health and strengthen cultural identity, and thereby improve the health and position of Māori in society (1). It is located within Māori worldviews and so builds on a foundation of Māori beliefs and values. Therefore, it is inherently oriented towards Māori people and our forms of community and concepts of health that recognise a secure cultural identity is fundamental to what it is to be healthy and well as Māori.
Land-based community development is essential to Māori health promotion (1,2). Māori groups, in the form of whānau (extended family), hapū (sub-tribes) and iwi (tribes), maintained an identity (and authority) prior to European contact that continues to act as a foundation for Māori land-based community development. Other constructs that characterise Māori health promotion include self-determination, Māori identity, empowerment and holism.
The aim of this paper is to describe the role of Māori community gardens (māra) in health promotion and to inform understandings of the potential of māra as Māori health promotion initiatives. The goals of our research were to identify motivations for establishing māra and to examine the role of māra in land-based community development for Māori health promotion.
Background
Community gardens are collectively gardened sections of land where local people grow fresh produce (i.e. fruit, vegetables and/or herbs) for consumption by their families and communities. They are widely acknowledged as enhancing the local environment and improving the health and wellbeing of individuals, families and communities (3–5). Teig et al. (6) describe community gardens as multicomponent socio-environmental health promotion interventions.
Indigenous community garden initiatives are increasingly described within the framework of Indigenous food sovereignty, that is, ensuring control of food and agriculture systems rests with communities (7). From a global perspective, this is appropriate given that food sovereignty concerns, such as the right to access culturally appropriate food and production through ecologically sustainable methods, are consistent with many Indigenous peoples’ values. Interestingly, there is a scarcity of literature that applies an Indigenous food sovereignty lens to the New Zealand context; however, we recognise the ground-breaking work being carried out in this field and its relevance to our research.
What we do see in the New Zealand context though, is land-based community development from a Māori health promotion perspective, which is the framework for this study. Within this framework, land has high prominence, and development is concerned with recognising and enhancing capacity and wellbeing in existing communities through collective self-determination.
Land, health and wellbeing, and community gardens
In describing ourselves as the Indigenous peoples of Aotearoa New Zealand, Māori use the term ‘tangata whenua’, a direct translation being ‘people of their land’. The term expresses an understanding of the relationship to land as being one of Māori ‘belonging’ to the land, rather than ‘owning’ it (8). Land is considered not only as an economic foundation but also an anchor for collective identity. Prior to colonisation, major shifts in group location were rare, meaning land remained a tangible expression of whakapapa (genealogy). It connected communities with their ancestors who had maintained authority over their lands. Land remains a fundamental source of identity and spiritual connection that establishes a grounding for wellbeing beyond individual aspirations and needs.
As for many Indigenous peoples, land is both an environmental and cultural determinant of health. Achieving optimal health and wellbeing as Māori therefore requires access to ancestral lands and quality interactions with those lands in order to sustain Māori identity (2). It is often difficult to achieve this relationship with ancestral lands because it is at odds with dominant capitalist values and the consequent commodification of land (9,10). However, this is where there may be a role for māra.
Historical context
Historically, cultivation was a foundation of Māori communities as a food source, as well as being important for social reasons. Working in gardens was a practical demonstration of a cultural reference point for peace and shared industry that had a long-held tradition. Rongo, a Māori deity, is associated with successful cultivation. Consequently, Rongo is widely used to denote notions of peace, reaching consensus, cooperation and unity, all considered elements of collective action in the garden.
With British colonisation, the escalation of hostilities and forced land alienation in the 1800s devastated Māori communities. The introduction of guns changed power relationships and led to warfare over control of natural resources, significantly impacting customary land authority. Land confiscation was a key legislative instrument used by the Settler Government to force Māori communities who resisted off their land under the guise of punishment. This was particularly the case in the Taranaki Region (West Coast of the North Island) where initially all Māori land, 526,000 hectares, was confiscated. In 1884, 103,000 hectares were returned as Native Reserves under government control. But by 1976 only 22,000 hectares remained (8).
Land use
Today, outside of conservation and urban development, land use is largely for primary production and driven by commercial imperatives (11). For example, Taranaki’s high rainfall and fertile land has meant it is prime milk production country and the intensification of dairy herds has been considered the common-sense land use. Increased demand for pasture drove up prices for land leasing and purchasing. Māori land owners often found it easier to lease out their remaining blocks to farmers or to sell to improve their living conditions in cities (12). Increasing mechanisation on farms has also reduced the workforce, making living in proximity to ancestral land more difficult. These conditions redefined Māori relationships with land, with whānau losing capacity for food production and many becoming distanced from ancestral lands.
In the 1970s, there was an awakening of whānau to the value of Māori language and culture, commonly referred to as a Māori cultural renaissance (9). Māori community debate about land contrasted its value as a cultural resource against its value for economic development. Given the geographical distance of whānau from ancestral land and land loss, little or no personal experience in agriculture, a lack of equipment, and few working models of viable alternatives to existing intensive farming, the options for managing Māori land in ways that enable reconnection are limited. It is at this point that whānau began to explore viable approaches to land use, and over the past 20 years there have been increasing numbers of māra. The renaissance of Māori culture has extended into food production.
Research methods and participant groups
Research methods
The research is guided by Kaupapa Māori Theory and applies Indigenous decolonizing methodologies (13,14). Therefore, the study is controlled by Māori and acknowledges the value of insider-research, prioritizes a Māori worldview in research design and interpretation, and is committed to transformative action. The research is based within a Taranaki Māori community organisation and research team members are Māori and affiliate to iwi of Taranaki or live in Taranaki.
In 2018, seven interviews were carried out with six Māori community leaders across four māra initiatives, and the Chairperson of Tahuri Whenua (National Māori Vegetable Growers’ Collective). Criteria for selection of eligible garden initiatives were: recognition by Māori stakeholders as Māori community gardens, establishment for a minimum of 6 years, and an inclusive approach (i.e. māra welcome wide community participation). Consistent with kaupapa Māori approaches, given the affiliations and location of the researchers, priority was given to the recruitment of Taranaki-based initiatives. Tahuri Whenua was included to provide a national perspective. Interviewees were asked about: motivations for development of māra; the role and benefits of māra; and links between māra and Māori cultural knowledge and practices. Thematic analysis was carried out to identify, analyse and report patterns of meaning (15).
Participant groups
The five participant groups (māra and Tahuri Whenua) included in the study are described below to provide greater context for participants’ anonymized comments reported in this paper.
Māra 1: Wahapakapaka is a Māori communally owned land block south of Onaeroa in Taranaki. It had been a Māori garden site, but was undeveloped for some years. The gardens were re-established with ongoing support from Kai Oranga, a healthy food program run through a Māori tertiary education institution.
Māra 2: Kātere ki te Moana is a re-established marae (Māori community centre) of Ngāti Tāwhirikura hapū in Taranaki. The garden is located in what was historically a thriving papakāinga (Māori communal living area), Tārereare, with extensive gardens. Over time, Tārereare became engulfed in an industrial zone on the outskirts of New Plymouth city. With little land left in hapū ownership, a small group started to garden a vacant lot next to their marae. The current garden was established 6 years ago and covers an area of over an acre.
Māra 3: Parihaka papakāinga is a Māori reservation of almost 20 hectares on the westernmost point of Taranaki. The community is founded on the historic non-violent resistance movement led by Tohu Kākahi and Te Whiti o Rongomai between 1865 and 1907. Land cultivation was the main form of protest. That is, ploughing confiscated land and resurrection of garden fences that had been torn down by soldiers, to demonstrate continued occupation and ownership. The current māra were established 12 years ago.
Māra 4: In the Central North Island at Taumarunui elders have occupied Government owned former railway land by establishing māra. The land is subject to negotiations for settlement of Treaty of Waitangi 1 breeches. Those involved view their community as including all the local tribal groupings, hence naming their group ‘Ngā Hau e Whā’ (‘The Four Winds’). The māra is run by retired elders who continually seek ways to engage youth. It was established 6 years ago and has extended to include a large tree nursery, with the intent to re-establish native forest and riparian planting.
Tahuri Whenua:
The organisation was established in 2004 with a membership of Māori community gardeners and represents Māori interests in the horticulture sector. It is supported by Massey University staff and students and provides advice and training, supports networking, and creates information resources. The organisation also shares seeds and cultivars, and researches gardening practice guided by Māori knowledge and Western science.
Findings
Six themes were developed through the thematic analysis. The first theme addresses the core motivations for establishing gardens. The second theme outlines cultural integrity as an important element of māra. The third theme explains how gardens are a form of peaceful resistance to cultural subjugation. The fourth theme describes the gardens in terms of cultural revitalisation. The fifth theme expresses how the gardens contribute to community wellbeing and connectedness. The sixth theme outlines how gardens are a vehicle for Māori community development.
Theme 1: motivations for establishing gardens
Three key overlapping motivations for establishing māra were expressed. The first was a universal desire to contribute to whānau and community through production and sharing of fresh and nutritious food for households and community events.
There’s always been the direct benefits of getting fresh kai (food) for the wider community. Sending the kids out to take kai to each house…Being able to contribute to the…18ths and 19ths
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…having that kai on the table means a lot. (Parihaka, Pungarehu)
Second, comments indicated that māra activities on ancestral land positively influence relationships between those involved and their land.
…it deepens your sense of tūrangawaewae (place of primary identity)… (Wahapakapaka, Onaeroa)
Third, as a vehicle to overcome the disempowered position of Māori communities such that they are enabled to take control of their own lives and futures. Most interviewees identified the multiple functions of māra in addressing local needs, including: reducing food costs, improving nutrition, promoting outdoor physical activity, encouraging wayward youth, engaging whole whānau and promoting good health and wellbeing in a holistic way. Māra were identified by some as an activity that is most able to address multiple community empowerment aspirations.
[māra] activity promotes all of those things that we are…hoping to foster as a community…māra came out on top… (Ngāti Tāwhirikura, Kātere)
Theme 2: cultural integrity in the garden
In terms of priority, cultural integrity in the garden was a close second to food production. Most interviewees expressed desires to reconnect to growing food using customary Māori knowledge and practices, retain heritage crops, and/or prepare food as it was in the past.
…the consciousness is shifting that we need to come back to [growing] our tupuna kai (ancestral foods)… (Wahapakapaka, Onaeroa)
Communities grapple with accessing localised traditional knowledge that has been severely impacted by Western gardening practices and crop varieties. They also have difficulty determining how to integrate traditional practices into gardening systems.
There are a lot of people who are trying to work out what it is they can build into their systems…to make it more Māori…more comfortable for themselves…But when you ask them how do you prepare the ground…they don’t generally talk about the spiritual activity… (Tahuri Whenua)
Using Māori language, reciting karakia (form of prayer), growing heritage crops, distributing food to homes and marae and establishing planting and harvesting events have been successful to different degrees. One cultural practice recognized by some of the groups was planting and harvesting crops by the maramataka (lunar cycle). Although the pressures of modern daily life among whānau interfered with the ability to adhere to lunar cycles, the intent was to grow food that was physically healthy and culturally authentic.
Theme 3: gardens as resistance
Some interviewees described māra as a site of peaceful resistance to cultural subjugation, including land loss. Some referred to their ancestors’ use of cultivation as passive resistance to land confiscation.
…pulling of survey pegs, not recognising Crown authority…ploughing the land…keeping…the movement going…even though it’s a peaceful activity…it is still [today] resistance because it’s about challenging peoples’…norms and worldviews… (Parihaka, Pungarehu)
Two of the māra groups are occupying, through cultivation, ancestral land that is in Crown ownership or is privately owned vacant land.
…the one [land] we are on now, taken by the Pākehā (non-Māori)…it’s under the Treaty [claim]…occupying the land to ensure it comes back to the iwi… (Ngā Hau e Whā, Taumarunui)
Theme 4: cultural revitalisation through gardens
Māra were described by all participants as a site of revitalisation of Māori knowledge, language and/or practice.
…that new garden is a reo Māori (Māori language only) garden…It’s flowed over to the other part of the garden…the kids will go down there, especially the teenagers…practicing tikanga (Māori practice)… (Parihaka, Pungarehu)
Participants explicitly discussed their aspirations for māra activities to build and reinforce localised Māori identity.
…one of the things that I hope to…create is…for us to be known for particular kai. So it becomes part of our narrative as we take it for koha (gift of reciprocity)…a characteristic of the menu on the marae becomes a part of the identity… (Ngāti Tāwhirikura, Kātere)
Elders who have experienced gardening in their childhood are empowered to be involved in practical ways. Their experiences are highly valued as younger participants seek information about the garden site and techniques, varieties of plants and local growing conditions. Importantly, their involvement enables intergenerational transmission of language, values and other cultural reference points.
The youth of today [have] got nothing left from our old people. We try to incorporate teachings from our old people, to young people. (Ngā Hau e Whā, Taumarunui)
Interviewees often referred to the expression of Māori values through gardening activities. Values commonly identified were kaitiakitanga (guardianship) of the land, mana (personal pride) through accomplishment, mana motuhake (self-determination) through cultivation for whānau and community, manaakitanga (caring for others) by providing fresh food and whanaungatanga (group cohesion), building a sense of belonging to the community.
A challenge for communities is to find a land use model that is regenerative for the land, for community relationships with ancestral land and for a Māori worldview that is physically, mentally, culturally and spiritually sustaining.
You have little choice but to lease out…How can we find different farming models that are regenerative…but also provide economic opportunities…to help families to get back on their land… (Parihaka, Pungarehu)
Theme 5: community wellbeing and connectedness through gardens
While the production of food was the most commonly mentioned benefit of māra, discussion with most participants emphasized the restorative effect on people and groups.
I love the healing aspects…the transformation of people… someone may arrive feeling stressed…They put their hands in the dirt…Their āhua (temperament) changes and the conversation changes…I saw the magic of a group… synergy…oneness…joy… people feel that they are achieving something and they have done it together… (Wahapakapaka, Onaeroa)
Māori community gardens strengthen community members’ ability to work as a collective. This includes making long-term shared plans and exercising collective decision-making, and shifting away from an individualistic focus. The form of engagement as community is positively altered as people physically work together towards common goals, with shared satisfaction at their achievements.
Wanting to work with others has become more important, at the start it was all about – let’s grow food. But now more of a focus on collective activity…as a community building activity in itself… (Parihaka, Pungarehu)
Māra also facilitate communication, drawing out the contributions of individuals from across generations to productive group discussions about local issues of concern.
…[gardening is] empowering and gives opportunities for us to re-engage in kaupapa (issues) that are really hard… we didn’t stop talking about [the issues], we were just talking about it while we worked together and it just entirely changed the dynamic of our conversation…Contributing rather than just being able to come along [to meetings], nut off or walk out… (Ngāti Tāwhirikura, Kātere)
Māra activities offer an additional location for community leadership to be grown in wide-ranging areas where passion, knowledge and ability may otherwise remain untapped.
Theme 6: community development through gardens
Some interviewees explicitly described māra as a vehicle for community development. This was not about individuals coming together to form a community centred on garden activities, but about gardens being a site for engaging, re-establishing and strengthening pre-existing communities. For some, māra were purposefully chosen as a best fit initiative within a planned approach to community development.
…part of our visioning was to have a…community, and māra would be part of that…entirely integrated, sustainable…I’m hoping we can change the narrative of our development into something that’s gonna be a lot more sustainable long-term… (Ngāti Tāwhirikura, Kātere)
One interviewee described how māra can contribute to a community’s aspirations for self-sufficiency.
Community sufficiency, that’s where we want to get to…We build on our ability to grow kai, we build on our collective ability to work together, we promote healthy activity and healthy kai at the same time. (Parihaka, Pungarehu)
Because gardening is such a tangible activity it is sometimes easy to overlook the broad long-term objectives. All interviewees were future-focussed, with the intent that succeeding generations will build on current achievements.
…It’s about people…and where we are heading - māra just happens to be one of the vehicles…I said right at the beginning this is intergenerational. So if we have got the next generation thinking already in the [empowerment] framework…hopefully the next young person will have initiative…Not just stand there and do what is always done…but push the envelope, push the agenda… Not ‘yes, we’re a successful māra’, but are we decolonised and have we got our communities back? (Ngāti Tāwhirikura, Kātere)
Discussion
Colonisation transformed relationships with land from a location of shared identity and collective action to an economic asset to drive advancement within a dominant capitalist system. Loss of land and being ill-prepared to function in the prevailing agricultural model of land use has contributed to widespread Māori impoverishment. Māra offer an alternative and pragmatic response (alongside wider initiatives to address determinants) to historical land loss and marginalisation. Our study demonstrates novel findings about motivations that spur the development and communal processes of māra, and the role of māra in land-based community development, which is inextricably linked to Māori health promotion.
Our findings show that māra are efforts by Māori to address a range of local needs and break a legacy of disempowerment. The health and wellbeing benefits of community gardens tend to be described in the literature in terms of consumption of fresh and healthy foods and food security, physical activity, nature contact, social cohesion, civic engagement, political activism, and cultural identity (6,16). All of these benefits were also identified by study participants. Participant groups began their garden activities with a few immediate goals (e.g. growing food for whānau), which quickly broadened as collective action and shared insights evolved. The role of māra can be understood in terms of identity, cultural revitalisation, social cohesion, intergenerational approaches to health promotion, and Māori resistance to colonial/capitalist systems of power.
First, gardens reinforce identity: the utilisation of ancestral lands enables groups to draw on a deep sense of shared identity rooted in those lands. A connection with land-based identity is most apparent in the selection of locations of past tribal authority and activity. For communities, the gardens provide regular access to, and quality interactions with ancestral lands and thereby sustain whānau and tribal identity.
There was interest in trialling new ideas or practices from other places for efficiencies. However, in most cases, localised approaches took precedence because groups were looking for multiple levels of benefit from gardening, and prioritised bolstering local distinctiveness. There is mention in the literature of the role of community gardens in reinforcing Māori cultural identity (17), and other Indigenous peoples have shown some success in using gardens to strengthen cultural connection (18).
Second, cultural revitalisation through gardens: beliefs, values, knowledge and practices linked with forebears strengthen a sense of responsibility and commitment to protect and preserve cultural heritage as a resource for community life. Those involved in māra aligned their initiatives with cultural awakening. Initiatives are carried out with a sense of cultural responsibility to demonstrate continued relevance of Indigenous knowledge and traditional gardening approaches, prioritise elders’ knowledge, and revitalise language and customs. Māra provide opportunities to practice Māori language and cultural processes in functional everyday ways outside of formalised customs of marae and other cultural sites. They are invaluable for Māori communities seeking to construct viable and innovative models for localised and sustainable land use.
Third, social cohesion through gardens: traditional notions of gardening are associated with concepts of mutual trust, cooperation, hospitality, and peace. Collective work in gardens offers ways for community interaction linked with these long-established concepts. Gardening is oriented toward hands-on and shared activity, and social cohesion is noted in the literature as a benefit of community gardens (19). Individuals’ thoughts and emotions become influenced within the collective motivations, everyone’s contribution is readily recognised and food produced tends to be shared rather than sold. Participants described a feeling of exhilaration experienced when they have contributed and their efforts have tangible outcomes. Furthermore, there are regular opportunities to directly influence change and development through shared decision-making and on-the-ground leadership. Inter-community relationships are strengthened when networks support the sharing of seeds, implements, knowledge and other group resources. This experience was contrasted with the tension and frustration that can escalate in large meetings and prolonged discussion forums on wider tribal issues with top-down leadership and limited opportunity for practical contribution or for influencing outcomes. Māra are inherently an authentic site for social cohesion, for whole community participation and for lasting interpersonal relationships of trust to form.
Fourth, intergenerational approaches inherent in gardens: the enduring nature of land and ancestral ties to locations of gardening initiatives compels communities to think and act intergenerationally. It is almost inevitable that māra activities foster reflection on the experiences of previous generations on that same land and inspire aspirations for improving the position of future generations on that land. The diversity of requirements and tasks in the māra brings together all age groups. Elders who were raised in a time when gardening was a part of normal daily life are able to make valuable contributions to the intergenerational transmission of local knowledge (17). Māra provide opportunities for socialising younger generations within an important cultural space building relationships with, and respect for, elders and other adults. Whole whānau involvement in māra is demonstrated in: building playgrounds in or around gardens; cultivating food that children will enjoy growing, gathering and eating; involving children in distributing food; and encouraging children to explore the natural environment. Land motivates an understanding that a community’s social resource extends into the past and the future.
Fifth, collective resistance through gardens: Māori community garden collectives stand within an interface of contesting ideologies of capitalism and Indigenous approaches to land utilisation and production. Māra build momentum behind innovative and holistic community solutions within this contested space. Following land alienation and urbanisation, whānau became distanced from the point of food production, self-sufficiency and land-based activity. Daily routines for most families are increasingly characterised by compartmentalised living arrangements, division of labour, ephemeral relationships and nuclear family units. Gardening leans against the prevailing wind resisting the drivers of impoverishment and the shared consequences of colonisation. Models of alternative systems of regenerative land use challenge the widespread dogma of commercial investment, wealth generation and productivity of private property. There is evidence in the literature that community gardens support collective efficacy and facilitate empowerment; that is, they provide environments where people feel connected to one another and therefore believe they can take action together (6,20,21).
Depending on the perspective of what constitutes resistance, Māori community gardens may be the most unlikely site of resistance and, at the same time, the most likely. One is less likely to observe confronting protests or banners in gardens. These are what some would feel is synonymous with Indigenous resistance. Instead, resistance (22) in māra activity is most likely embodied within continuous acts of challenging the norms of Māori disempowerment. There is a reason why gardening has become an obvious choice among Indigenous groups considering collective action and restoration of agency. Gardening engages Māori at the most fundamental sites of agency – to act in restoring one’s control over production of food, to act as a collective, to act with an optimistic vision of the future, to act with confidence grounded in one’s identity, to act with whole whānau participation, to act in determining what has value, to act in restoring the land, and to be recognised as an actor responding to one’s own problems and those of others. Gardening provides the opportunity to act.
Conclusion
Viewing Māori community gardening initiatives within the prevailing colonial/capitalist framework of land-based production greatly limits the value of māra. Our research indicates that māra have a distinctive high-level motivation entirely aligned with Māori health promotion thinking, and that distinguishes māra as a land-based Māori community development initiative. Māra seek to empower Māori collectives towards a vision of vital communities thriving as Māori. Groups themselves did not necessarily begin with specific Māori health promotion outcomes in mind. However, as initiatives evolved, within their ground up and inclusive processes of decision-making, new insights and broadened aspirations emerged.
Māra produce nutritious food and so much more that is required to sustain healthy and vital Māori communities. Māra is in itself a metaphor, regenerating a living environment of social cohesion by working together, reconstituting a cultural substrate in which development aspirations and authentic identity can be cultivated and realised. These intangible fruits are nurtured in the norms and nuances of local communities. Garden settings are immersion domains of language, socialised values and self-determined solutions constructed and adapted within the consequences of colonisation, impoverishment and debilitating stereotypes. They resist a prevailing tide of cultural oppression, the orthodoxy of intensive farming and separation from the means of production. They assert localised approaches, ever-evolving within an open-ended process of collective decision-making and action.
Since traditional times, identity has been located in the land. A strong sense of place reinforces social connection. Alienation of ancestral land was a critical factor in the subjugation of Māori authority and entrepreneurial capacity, and in undermining Māori health and wellbeing. It seems appropriate, therefore, that land should also become a site for Māori community empowerment. Māra are a land-based Māori health promotion response, a reinterpretation of the old, a reconstruction through Māori eyes of tangata whenua, people of their land.
Footnotes
Conflict of interest
The authors declare that there is no conflict of interest.
Funding
R.H. is supported by a Health Research Council of New Zealand Hōhua Tutengaehe Research Fellowship in Māori Health [grant number 16/586] and M.R is supported by a Health Research Council of New Zealand Ngā Pou Senior Fellowship [grant number 16/440].
