Indigenous adolescent health in Aotearoa New Zealand: Trends, policy and advancing equity for rangatahi Maori, 2001–2019

BACKGROUND: Rangatahi Māori, the Indigenous adolescents of Aotearoa New Zealand (NZ), have poorer health outcomes than Pākehā (NZ European /other European/“White”) adolescents. We explored the influence of policies for Indigenous youth by presenting health trends, inequities and contrasting policy case examples: tobacco control and healthcare access. METHODS: Cross-sectional representative surveys of NZ secondary school students were undertaken in 2001, 2007, 2012 and 2019. Health indicators are presented for Māori and Pākehā adolescents (relative risks with 95% CI, calculated using modified Poisson regression) between 2001–2019 and 2012–2019. Policy examples were examined utilising Critical Te Tiriti Analysis (CTA). FINDINGS: Rangatahi Māori reported significant health gains between 2001 and 2019, but an increase in depressive symptoms (13.8% in 2012 to 27.9% in 2019, RR 2.01 [1.65–2.46]). Compared to Pākehā youth there was a pattern of persistent Māori disadvantage, particularly for racism (RR 2.27 [2.08–2.47]), depressive symptoms (RR 1.42 [1.27–1.59]) and forgone healthcare (RR 1.63 [1.45–1.84]). Tobacco use inequities narrowed (RR 2.53 [2.12–3.02] in 2007 to RR 1.55 [1.25–1.93] in 2019). CTA reveals rangatahi Māori-specific policies, Māori leadership, and political support aligned with improved outcomes and narrowing inequities. INTERPRETATION: Age-appropriate Indigenous strategies are required to improve health outcomes and reduce inequities for rangatahi Māori. Characteristics of effective strategies include: (1) evidence-based, sustained, and comprehensive approaches including both universal levers and Indigenous youth-specific policies; (2) Indigenous and rangatahi leadership; (3) the political will to address Indigenous youth rights, preferences, priorities; and (4) a commitment to an anti-racist praxis and healthcare Indigenisation. FUNDING: Two Health Research Council of New Zealand Project Grants: (a) Fleming T, Peiris–John R, Crengle S, Parry D. (2018). Integrating survey and intervention research for youth health gains. (HRC ref: 18/473); and (b) Clark TC, Le Grice J, Groot S, Shepherd M, Lewycka S. (2017) Harnessing the spark of life: Maximising whānau contributors to rangatahi wellbeing (HRC ref: 17/315).