Pacific Health Frameworks
~2 min read
Lesson 5 of 5
Notes
Pacific peoples (Pasifika) in Aotearoa New Zealand represent multiple distinct ethnic groups from the Pacific Islands, each with its own culture, protocols, and unique context. In clinical practice, it is essential to recognise this diversity rather than treating "Pacific" as a homogeneous group.
The Pacific region is divided into three geographic and cultural areas: Melanesia (meaning "black islands" — Fiji, Papua New Guinea, Solomon Islands, Vanuatu, and others, including French New Caledonia); Micronesia (meaning "small islands" — Federated States of Micronesia, Palau, Kiribati, Mariana Islands, Marshall Islands); and Polynesia (meaning "many islands" — Samoa, Tonga, Cook Islands, Tuvalu, Tokelau, Niue, Wallis and Futuna, French Polynesia, New Zealand, Hawaii, Easter Islands).
The "realm nations" — Cook Islands, Niue, and Tokelau — are in free association with New Zealand; their citizens hold New Zealand citizenship and are entitled to all healthcare services available to New Zealand citizens born here.
The "big three" Pacific ethnic groups in New Zealand by population are Samoa, Cook Islands, and Tonga.
The Fonofale Model of Health was developed by Fuimaono Karl Pulotu-Endemann to support Pacific mental health services, particularly in the aftermath of the post-overstayer dawn raids of the 1970s. It is built on the metaphor of a traditional Samoan fale (house). The roof represents culture — Pacific culture as the overarching framework. The foundation represents the family. The four posts (pou) connecting roof to foundation represent four interactive health dimensions: physical, mental, spiritual, and other (economic, social, environmental). Surrounding the fale are time, context, and environment.
New Zealand''s special relationship with Samoa includes: NZ administration from 1920–1962; the mishandling of the 1918 influenza pandemic (killing one-fifth to one-quarter of Samoa''s population); the Mau movement for independence and Black Saturday (shooting death of Tupua Tamasese Lealofi III during a peaceful protest); independence in 1962; subsequent invitation of Pacific peoples to New Zealand for employment; and the dawn raids — described as the most blatantly racist attack on Pacific peoples by the New Zealand government. New Zealand has since formally apologised and signed a treaty of friendship with Samoa.
Cultural greetings for Pacific patients: Samoa — Talofa lava; Tonga — Mālō e leleī; Cook Islands — Kia Orana; Fiji — Ni sa Bula Vinaka; Tuvalu — Tālofa; Niue — Fakaalofa lahi atu; Tokelau — Mālō ni; Kiribati — Mauri.