Te Ngira Papers

Permanent URI for this collectionhttps://researchcommons.waikato.ac.nz/handle/10289/6536

Te Ngira Institute for Population Research is Aotearoa New Zealand’s only dedicated population research centre. We carry out world-leading research in the areas of Indigenous demography and data sovereignty, regional population change and diversity, and population health and equity. Our research is widely used by decision-makers in Te Ao Māori, government agencies, communities, and the private sector to help inform choices and responses to the demographic, social and economic interactions that are shaping Aotearoa New Zealand’s future.

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Disentangling assistive technology: Exploring the experiences of athletes with physical impairments in disability sport
(Taylor & Francis, 2023) Asare, Francis; Townsend, Robert C.; Burrows, Lisette
The use of assistive technology (AT) in sport raises critical questions about disability, access, equity, and embodiment in culture and society. In this paper, we seek to provide some clarity on the various ways that disabled people use, interact with, and experience AT through engagement in disability sport. Using semi-structured interviews, this paper centralises the experiences of twelve athletes with different physical impairments as they use AT for sports participation. We highlight a diverse range of experiences, illustrating how ATs function to provide athletes with a sense of embodied freedom and (im)possibilities, as well as exploring the influence of AT on athletes’ construction of self and other. Finally, we provide some insight into the dimensions of access that are required to fully utilise AT in sport, specifically focusing on the process of learning to use and respond to AT. We envisage this paper may inform disability and AT scholars, advocates, and sports sociologists as they build on and extend empirical work and advocacy at the intersection of AT, disability, and sport.
The elephant in the room: Precarious work in New Zealand’s universities
(University of Auckland, 2022) Simpson, Aimee B.; Jolliffe Simpson, Apriel D.; Soar, Max; Oldfield, Luke; Roy, Rituparna; Salter, Leon A.
Precarious working arrangements, defined by temporary casual and fixed-term employment agreements, are a complex, often hidden feature of academia in Aotearoa New Zealand (Aotearoa hereafter). At present, little is known about the conditions of insecure academic work, the size of this workforce, nor how these workers have been affected by the COVID-19 pandemic. This report provides an insight into the reality of insecure academic work in universities from those who responded to the 2021 Precarious Academic Work Survey. We highlight that in Aotearoa we have a highly trained, casual and fixed-term academic workforce who are engaged in long-term cycles of precarity. Among the 760 participants surveyed, more than one-quarter (28.9%) had been precariously employed for five years or longer. Further, nearly sixty percent (59.2%) had accepted extra work to support themselves or their whānau, even when it jeopardised their other responsibilities (e.g., completing their degrees). Over half (52.7%) of all students, and nearly two-thirds (64.4%) of PhD students surveyed, had held three or more employment agreements at a university in the last 12 months. Financial need (71.6%) was most frequently cited as an important factor in participants’ decisions to engage in precarious work, and over half (52.4%) of participants experienced a rise in their living costs due to working from home during the pandemic. Our report also adds further evidence of inequities present in the academic pipeline. Just one in ten Māori (10.8%) and one in thirteen Pasifika (7.7%) participants were PhD graduates, a smaller proportion than the nearly one-third (31.5%) of New Zealand European/Pākehā. Over two-thirds (66.8%) of international students indicated they were employed in the most insecure forms (Casual or fixed-term contracts of six months or less) of precarious work, compared with 60.5% of domestic students. Of those precarious workers completing a PhD, domestic students in our survey were far more likely to be receiving a stipend (73.9%) compared to international students (50%). Further, 63.2% of participants who were international students without a stipend reported that they lacked confidence in having sufficient ongoing academic work in the next 12 months. Instances of discrimination, bullying, and harassment were also reported by survey participants, with 33.7% citing that they had been impacted by such issues. Other workplace safety concerns were evident: nearly half of participants (45.7%) described their workloads as always or often unsustainable and negatively impacting their health and wellbeing. Meanwhile, one-quarter (23.9%) of precarious staff rated their current stress level as an eight, on a scale of zero (no stress) to ten (completely stressed). Two-thirds (66.3%) of participants were not confident they would receive adequate support from their employer in the event of a future crisis (e.g., a natural disaster or outbreak of infectious disease). On this basis, we encourage universities to do better for their casual and fixed-term employees through increasing job security, reducing inequities for Māori and Pasifika precarious staff, and improving conditions for postgraduate students, both domestic and international. In our final recommendations, we implore the government to work alongside universities to realise this change by investigating workloads, increasing, and rebalancing sector funding, and reinstating the postgraduate student allowance.
Māori data governance model
(Te Kāhui Raraunga, 2023) Kukutai, Tahu; Campbell-Kamareira, Kyla; Mead, Aroha Te Pareake; Mikaere, Kirikowhai; Moses, Caleb; Whitehead, Jesse; Cormack, Donna
This report describes the Māori Data Governance Model that has been designed by Māori data experts for use across the Aotearoa New Zealand public service. Māori data is a taonga that requires culturally grounded models of protection and care. The Model provides guidance for the system-wide governance of Māori data, consistent with the Government’s responsibilities under te Tiriti o Waitangi. The Model is intended to assist all agencies to undertake Māori data governance in a way that is values-led, centred on Māori needs and priorities, and informed by research. This is important because existing government data processes and practices are failing to meet Māori informational needs. The Vision, Tuia te korowai o Hine-Raraunga – Data for self-determination, enables iwi, hapū and Māori organisations, businesses and communities to pursue their own goals for cultural, social, economic and environmental wellbeing. Eight Data Pou or pillars define critical areas of data governance and specify the actions that should be undertaken to realise six desired outcomes. The Model does not cover every element of data governance; instead, it focuses on key priorities and actions, against which agencies can assess their level of data maturity. The Model explicitly recognises the need for changes to system leadership, policies and legal settings so that Māori can exercise authority over Māori data to reduce unethical data use and strengthen outcomes for individuals, whānau and communities. The report also identifies the need for strategic investment in a Mana Motuhake data system that sits outside of the public sector to ensure iwi and hapū sovereignty over iwi and hapū data.
Creating an environment to inform, build, and sustain a Māori health research workforce
(Taylor & Francis, 2023) Barrett, Nikki Maree; Morgan, Reigna; Tamatea, Jade; Jones, Amy; Atatoa Carr, Polly; Lawrenson, Ross; Scott, Nina
Ensuring the growth and development of the Māori health research workforce is key to achieving health equity for Māori and enabling positive change for all New Zealanders. The purpose of this study was to identify enablers and barriers to research for Māori staff in a large health organisation, and to understand how research is developed and undertaken. A Kaupapa Māori mixed-methods study was undertaken, using an electronic survey comprised of quantitative data and open-ended responses delivered to all Māori staff at the Waikato District Health Board. Following the survey were 10 one on one interviews. Survey data were analysed using descriptive statistics and open-ended responses summarised. A descriptive thematic analysis was undertaken of the interview data. Each of the interview responses was coded and five themes emerged. Frontline Māori staff affirmed their desire to conduct, design, and undertake health research. Challenges to staff included a lack of information on research opportunities, unclear processes for initiating research, and lack of support and resource. The evidence from participants provides insights into Māori health research priorities, considerations for those wanting to undertake research, and solutions for informing, building, and sustaining the Māori health research workforce.
Indigenous fertility in Aotearoa New Zealand: How does ethnic identity affect birth spacing and timing?
(Springer Nature, 2023) Rarere, Moana; Jarallah, Yara; Kukutai, Tahu
The survival of Indigenous peoples in the CANZUS states of Canada, Australia, Aotearoa New Zealand, and the United States is nothing short of remarkable. Not only have Indigenous peoples thwarted colonial tropes of the vanishing native but, for decades, Indigenous population growth rates have significantly outpaced those of the dominant settler populations. The future survival of Indigenous peoples fundamentally rests on continued natural increase, and understanding the causes and consequences of fertility behaviour is critical. While total fertility rates for Indigenous women in CANZUS countries are relatively low, childbearing tends to be concentrated at younger ages in contrast to the dominant white populations. The fertility transitions of both settler and Indigenous populations in the CANZUS states are well documented, however, a significant gap remains: how cultural factors shape contemporary Indigenous fertility behaviours. Using Aotearoa as a case study, we explore the relationship between Māori cultural identity, birth timing, and the duration of birth intervals. We use the 1995 New Zealand Women: Family, Employment and Education survey data to further test the impact of cultural identity on birth transition rates using the piecewise exponential model and Kaplan-Meier estimates. We find that women who identify Mainly Māori (exclusively or primarily) are at greater risk of bearing much earlier to first birth but not necessarily subsequent births. However, because of the earlier start, Māori have a longer reproductive window to bear more children, and at higher birth orders still bear earlier than non-Māori. The empirical evidence strengthens our case to suggest that cultural orientation has some influence on Indigenous fertility and contributes to the development of Indigenous-centred theories of fertility and demography more broadly.
The importance of whakapapa for understanding fertility
(MDPI AG, 2022) Rarere, Moana
The Māori fertility transition—which saw a shift from high to low birth rates between 1966 to 1976—was one of the most rapid fertility declines observed anywhere in the world. Since then, Māori fertility has hovered around replacement level (2.1 births per woman), somewhat above that of Pākehā (European) New Zealanders. More striking are differences in timing with Māori women bearing their children younger and over a longer duration. This paper sits within a broader research project that asks: What are the important influences that have sustained contemporary Māori fertility patterns? Drawing on Mana Wahine (Māori women’s discourses) and whakawhiti kōrero (interviews) with wāhine Māori (Māori women) this paper highlights whakapapa (genealogy) as an important concept in broadening and deepening our understandings of fertility, and situating individual fertility and reproduction within a broader set of relations.
“Landlords wouldn’t give my application a second look.” Discrimination exacerbates inequalities in access to private rental housing
(University of Waikato, 2024-08) Terruhn, Jessica; Collins, Francis L.
This report and the key insights are based on findings from a housing survey that was conducted with 800 residents in neighbourhoods in Auckland, Hamilton and Christchurch. • Perceptions of unfairness in Aotearoa’s housing sector are widespread. Renters, Māori, younger people and low-income groups as well as residents in neighbourhoods with high levels of housing deprivation are most likely to think that people are treated unfairly when trying to rent or buy a home in Aotearoa. • Nearly one in three respondents reported having experienced discrimination when trying to rent or buy a home in Aotearoa. Renters, Māori, younger people and low-income groups as well as residents in neighbourhoods with high levels of housing deprivation are most likely to report experiences of discrimination. • Advantage and disadvantage in securing a home are determined by a combination of interlocking factors, including income and employment status, age, family status, and race/ethnicity or skin colour. These patterns suggest widespread experiences of potentially unlawful housing discrimination. • People strategically try to avoid and mitigate discrimination. Expectations of being discriminated against and of being advantaged influence where and how home seekers search for housing. This finding signals that experiences of rejection play a role in constraining people’s housing choices. • The survey findings suggest that discrimination, as part of tenant selection, contributes to housing precarity and inequalities in access to rental housing. Therefore, this research points to an urgent need to address housing discrimination, especially in the context of high levels of residential mobility among renters and intense competition for rental properties.
Protecting hapū data privacy: A Ngāti Tiipa case study of technology considerations
(Te Ngira Institute for Population Research, 2025-02-11) Clark, Vanessa; Teague, Vanessa
This brief is a part of a series, produced for the Tikanga in Technology (TiNT) research programme, that provides a hapū perspective on data sovereignty, data governance, and data privacy. In this brief we focus on the Ngāti Tiipa ‘layer cake’ technology approach and assess it against the values of the TiNT Māori Data Privacy Framework. This brief should be read in conjunction with TiNT Brief #3 The Māori Data Privacy Framework: How useful is it for hapū?
Hapū data sovereignty: Tips for getting started
(Te Ngira Institute for Population Research, 2025-02-11) Clark, Vanessa; Kukutai, Tahu; Kani, Heeni; Pēpi Tarapa-Dewes, Ella; Teague, Vanessa
This brief is a part of a series, produced for the Tikanga in Technology (TiNT) research programme, that provides a hapū perspective on data sovereignty, data governance, and data privacy. The purpose is to provide practical advice for individuals, whānau, marae and hapū who are embarking on their own hapū data sovereignty kaupapa, with a particular focus on whakapapa data.
The Māori Data Privacy Framework: How useful is it for hapū?
(Te Ngira Institute for Population Research, 2025-02-11) Clark, Vanessa; Kukutai, Tahu; Teague, Vanessa; Kani, Heeni; Pēpi Tarapa-Dewes, Ella
This brief is a part of a series, produced for the Tikanga in Technology (TiNT) research programme, that provides a hapū perspective on data sovereignty, data governance, and data privacy. In this brief we focus on the Māori Data Privacy Framework developed by the TiNT team and assess how useful it is for hapū. To do so, we draw on a case study with Ngāti Tiipa, one of the 33 iwi and hapū of the Waikato confederation (Kukutai, Whitehead & Kani, 2022). This brief should be read in conjunction with TiNT Brief #2 Protecting hapū data privacy: A Ngāti Tiipa case study of technology considerations.
Māori data sovereignty and privacy
(Te Ngira Institute for Population Research, 2023) Kukutai, Tahu; Cassim, Shemana; Clark, Vanessa; Jones, Nicholas; Mika, Jason; Morar, Rhianna; Muru-Lanning, Marama; Pouwhare, Robert; Teague, Vanessa; Tuffery Huria, Lynell; Watts, David; Sterling, Rogena
Privacy is a fundamental human right. One of its most important aspects is information privacy – providing individuals with control over the way in which their personal data is collected, used, disclosed and otherwise handled. Existing information privacy regulation neither recognises nor protects the collective privacy rights of Indigenous peoples. This paper explores Indigenous data privacy, and the challenges and opportunities, in the context of Aotearoa. It has two aims: to identify gaps in existing data privacy approaches with regards to Indigenous data, and to provide a foundation for progressing alternative privacy paradigms. We argue that while personal data protection is necessary, it is insufficient to meet the needs of Māori and Aotearoa more broadly. In so doing, we draw on three areas of research: Indigenous and Māori data sovereignty; data and information privacy, including collective privacy; and Māori and Indigenous privacy perspectives. We examine key features of the Aotearoa privacy context – including the Privacy Act 2020 (NZ) – and consider the implications of te Tiriti o Waitangi and tikanga Māori for alternative privacy approaches. Future options, including legal and extra-legal measures, are proposed.
A critical race analysis of Māori representation in university strategic documents in Aotearoa New Zealand
(Informa UK Limited, 2024) Waitoki, Waikaremoana; Tan, Kyle K. H.; Roy, Rituparna; Hamley, Logan; Collins, Francis L.
Following the recent claims lodged at two universities in Aotearoa New Zealand alleging the existence of racism, there has been scepticism towards the professed commitments by universities to create an inclusive and safe environment for Indigenous Māori. As a Kaupapa Māori-informed study, we (a group of Māori and Tauiwi scholars) employed tenets of Critical Race Theory to examine how the representation of Māori is racialised and subordinated in university strategic documents. We located five predominant discourses portraying different mechanisms that reify whiteness in university practices such as the selective interpretation of Te Tiriti articles, targeted recruitment of Māori, framing of Māori as dependent on the Crown to succeed, commodification of mātauranga Māori, and avoidance of conversations about structural racism, colonisation, and racial equity. Our findings suggest that university strategic goal statements need to incorporate a critical race analysis, or else risk perpetuating practices that fall short of challenging the status quo.
Te Pūtahitanga: A Tiriti-led science-policy approach for Aotearoa New Zealand
(Ngā Pae o te Māramatanga, 2021-04-28) Kukutai, Tahu; McIntosh, Tracey; Durie, Meihana; Boulton, Amohia; Foster, Meika; Hutchings, Jessica; Mark-Shadbolt, Melanie; Moewaka Barnes, Helen; Moko-Mead, Te Taiawatea; Paine, Sarah-Jane; Pitama, Suzanne; Ruru, Jacinta
This paper examines the interface between science and policymaking and calls for a policy approach that is enabled by, and responsive to, Te Tiriti o Waitangi and Mātauranga Māori. For a science sector to have its greatest reach and impact for all citizens, it must demonstrate relevance, accessibility and inclusion. In Aotearoa, there has been concern about the exclusion of Māori and Pacific expertise from science advice and key decision-making roles. Te Tiriti offers a powerful framework for connecting systems and communities of knowledge in ways that are mutually beneficial and future focused.
'Cripping' care in disability sport: an autoethnographic study of a highly impaired high-performance athlete
(Taylor & Francis, 2022-02-18) Lowry, Amanda; Townsend, Robert C.; Petrie, Kirsten Culhane ; Johnston, Lynda
In this article we combine the fields of critical disability studies and the sociology of sport to disrupt and extend current understandings of athlete welfare and care. A focus on athlete welfare is producing heightened awareness of the need for institutional, structural and personal support for athletes. Notions of ‘care’ are proliferating in sport discourse, with sport organisations routinely described as having a ‘duty of care’ towards athletes. In high performance disability sport, however, the provision and arrangement of care is often based on a view of the disabled athlete as high functioning, autonomous and independent. This perspective is further complicated when considering the provision of care for people with high support needs. Drawing on cripistemology, we argue that a politics of knowledge confirms a certain squeamishness around care practices and care knowledge in disability sport. One of us – a high performance, highly impaired athlete in Aotearoa New Zealand, offers an autoethnographic account of her experiences of training and competing, illustrating the embodied and intimate care needed for her continued engagement in high performance sporting practices. In keeping with wider calls in critical disability studies to bring the study of the body and therefore impairment back into disability discourse, we offer this personal narrative to ‘crip’ care knowledge, focusing on the materiality of bodies as they intersect with sport. Finally, we argue that sport scholars, practitioners and governing bodies must consider the embodied care politics of disabled athletes in order to deepen understandings of impairment, inequalities, and social inclusion.
The Research Data Landscape in Aotearoa New Zealand: A report undertaken in partnership with the Aotearoa New Zealand Committee on Data in Research (CoDiR)
(University of Waikato, 2023) Sterling, Rogena; Blake, Michelle; Jones, Nick; Hartshorn, Richard; Kukutai, Tahu
Data and datasets are often described as a core strategic asset for Aotearoa New Zealand (Aotearoa) and indispensable for the government’s ambition of being a small nation with an advanced, adaptive, and inclusive economy. In the context of our research, science and innovation (RSI) ecosystem, the value of data cannot be overstated. The purpose of this report is to provide a review (the Review) of Aotearoa’s research data landscape. Research data are data that are used as primary sources to support technical or scientific enquiry, research, or artistic activity; as evidence in the research process; and/or are commonly accepted in the research community as necessary to provide a foundation for, or validate research findings and results. The Review covers four core areas: • Te Tiriti o Waitangi and data sovereignty • research data ecosystems • research data infrastructure • research data cultures. Although informed by international data landscape reviews, this Review emphasises the unique considerations and structural features of the Aotearoa data landscape. Based on our analysis and observations from a series of targeted workshops, we provide a set of recommendations on how to strengthen the system and advance shared aspirations for better outcomes. The recommendations are organised under the five headings from Nosek’s Pyramid of Social Change, setting out a phased strategy for culture and behaviour change. In implementing these recommendations, we recognise that the articles of Te Tiriti should be embedded throughout, consistent with sector requirements (MBIE, 2023d).
Mental health and wellbeing for young people from intersectional identity groups: Inequity for Māori, Pacific, Rainbow young people, and those with a disabling condition
(New Zealand Psychological Society, 2023) Roy, Rituparna; Greaves, Lara; Fenaughty, John; Fleming, Theresa; Clark, Terryann
‘Intersectionality’ describes the converging effects of ethnicity, gender, sexuality, disability, and other social group characteristics that influence life experiences. We draw on a representative study of year 9-13 students in Tai Tokerau, Tāmaki Makaurau, and Waikato (Youth19) to explore differences in mental health and wellbeing outcomes for young people from a selection of intersectional identities (Māori, Pasifika, Rainbow, and young people with a Disabling Condition). We found a pervasive pattern of inequity for young people who have intersectional identities compared to those from the majority groups (i.e. Pākehā, non-disabled, cis-heterosexual youth). Intersectional youth had higher levels of inequity and faced a greater array of inequities. There was evidence of an additive effect for some indicators. Thematic analysis of open-text survey responses found the need for positive inclusive environments, and support for all young people, including those at the intersections of identity. Drawing on the findings, we offered several systemslevel policy recommendations, including strategies to improve inclusiveness and reduce discrimination.
An ecological analysis of hope amongst Asian rainbow young people in Aotearoa New Zealand
(Taylor and Francis Group, 2023-08-11) Tan, Kyle K. H.; Roy, Rituparna; Ker, Alex; Fenaughty, John
Rainbow research tends to prioritise gender and sexuality experiences over the racialised experiences of Asian rainbow young people. Informed by an intersectional lens, we employed a hope-based ecological framework to examine how multiple overlapping axes of oppression (e.g. cisgenderism, heterosexism and racism) shape the aspirations of these youth. We drew on the voices of Asian participants from the 2021 Aotearoa New Zealand Identify Survey, who had responded to an open-text question on their hopes for rainbow young people (n = 217; age range = 14 to 26). The content analysis identified seven prominent categories of hope across three ecological levels (macro exo and meso). These categories were societies: 1) break away from cisheterosexist expectations; 2) confront racism and intersection with cisheterosexism; 3) promote rainbow-inclusive education; 4) ban sexual orientation and gender identity change efforts; 5) improve access to culturally safe health care; 6) dismantle white-dominated rainbow spaces; and 7) provide more rainbow-inclusive family support. These hopes were constructed amidst the desire to challenge unacceptance and exclusion by the wider society for not adhering to white cisheterosexist expectations. The study provides critical insights for community organisations, education settings, and government to consider in addressing the diverse needs of Asian rainbow young people.
Less talk, more action: (Re)Organising universities in Aotearoa, New Zealand
(Berghahn Books, 2023-06-01) Simpson, Aimee B.; Salter, Leon A.; Parna Roy, Rituparna; Oldfield, Luke; Jolliffe Simpson, Apriel D.
Despite the growing size of the academic precariat in the tertiary sector, this exploited group of workers lacks a voice in either their universities or their national union. In this article we draw on our experiences of transitioning from a small activist group to a broader research collective with influence and voice, while forging networks of solidarity. Through reflecting on developing the Precarious Academic Work Survey (PAWS), we explore how action research is a viable way of structurally and politically (re)organising academic work. We argue that partnering with changemakers such as unions as co-researchers disrupts their embedded processes so that they may be (re)politicised towards pressing issues such as precarity. Further, we highlight how research can be used as a call to action and a tool to recruit powerful allies to collaborate on transforming universities into educational utopias.
Inequities in Covid-19 Omicron infections and hospitalisations for Māori and Pacific people in Te Manawa Taki Midland region, New Zealand
(2023-04-24) Whitehead, Jesse; Gan, Han; Heerikhuisen, Jacob; Gray, George; Richardson, Trevor; Brown, Paul; Lawrenson, Ross
Covid-19 impacts population health equity. While mRNA vaccines protect against serious illness and death, little New Zealand (NZ) data exists about the impact of Omicron - and effectiveness of vaccination - on different population groups. We aim to examine the impact of Omicron on Māori, Pacific and Other ethnicities and how this interacts with age and vaccination status in the Te Manawa Taki Midland region of NZ. Daily Covid-19 infection and hospitalisation rates (01/02/2022 - 29/06/2022) were calculated for Māori, Pacific and Other ethnicities for six age bands. A multivariate logistic regression model quantified the effects of ethnicity, age, and vaccination on hospitalisation rates. Per-capita Omicron cases were highest and occurred earliest among Pacific (9 per 1,000) and Māori (5 per 1,000) people and were highest among 12-24 year-olds (7 per 1,000). Hospitalisation was significantly more likely for Māori (OR=2.03), Pacific people (OR=1.75), over 75-year olds (OR=39.22), and unvaccinated people (OR=4.64). Length of hospitalisation is strongly related to age. Covid-19 vaccination reduces hospitalisations for older individuals and Māori and Pacific populations. Omicron inequitably impacted Māori and Pacific people through higher per-capita infection and hospitalisation rates. Older people are more likely to be hospitalised and for longer.
Equity of travel required to access first definitive surgery for liver or stomach cancer in New Zealand
(2022) Gurney, Jason; Whitehead, Jesse; Kerrison, Clarence; Stanley, James; Sarfati, Diana; Koea, Jonathan
In New Zealand, there are known disparities between the Indigenous Māori and the majority non-Indigenous European populations in access to cancer treatment, with resulting disparities in cancer survival. There is international evidence of ethnic disparities in the distance travelled to access cancer treatment; and as such, the aim of this paper was to examine the distance and time travelled to access surgical care between Māori and European liver and stomach cancer patients. We used national-level data and Geographic Information Systems (GIS) analysis to describe the distance travelled by patients to receive their first primary surgery for liver or stomach cancer, as well as the estimated time to travel this distance by road, and the surgical volume of hospitals performing these procedures. All cases of liver (ICD-10-AM 3rd edition code: C22) and stomach (C16) cancer that occurred in New Zealand (2007-2019) were drawn from the New Zealand Cancer Registry (liver cancer: 866 Māori, 2,460 European; stomach cancer: 953 Māori, 3,192 European), and linked to national inpatient hospitalisation records to examine access to surgery. We found that Māori on average travel 120km for liver cancer surgery, compared to around 60km for Europeans, while a substantial minority of both Māori and European liver cancer patients must travel more than 200km for their first primary liver surgery, and this situation appears worse for Māori (36% vs 29%; adj. OR 1.48, 95% CI 1.09-2.01). No such disparities were observed for stomach cancer. This contrast between cancers is likely driven by the centralisation of liver cancer surgery relative to stomach cancer. In order to support Māori to access liver cancer care, we recommend that additional support is provided to Māori patients (including prospective financial support), and that efforts are made to remotely provide those clinical services that can be decentralised.

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