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

Background Rangatahi Maori, the Indigenous adolescents of Aotearoa New Zealand (NZ), have poorer health outcomes than Pakeha (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 Maori and Pakeha 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 Maori 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 Pakeha youth there was a pattern of persistent Maori 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 Maori-specific policies, Maori 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 Maori. 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