Sarah-Jane Paine: the pursuit for Māori health equity

Growing up, political discussions were "the norm” around the dinner table, says Professor Sarah-Jane Paine.

“It was our Tūhoetanga, our mana motuhake, ingrained in us.”

That foundation would later shape Paine’s work in Māori health equity and Kaupapa Māori epidemiology.

On Thursday 25 June, Waipapa Taumata Rau, University of Auckland celebrated Paine’s inaugural lecture as professor, a significant milestone recognising her influence in Māori health research.

Born and raised in Te Wairoa, Hawke’s Bay, Paine grew up in a loving whānau where identity, community and politics were part of everyday life. Her father worked in the freezing works, later becoming manager, while her mother was a maternity nurse who, Paine says, “probably delivered half of Wairoa and their children too”.

“I grew up in the 80s and 90s, in a time where we could see that central government decisions and moves towards neoliberalism were impacting on smaller communities, Māori communities, and communities that relied on industries such as the freezing works.

“My father, who was the manager, would talk about the politics of the freezing works. My mother, a maternity nurse, would talk about the shift in healthcare services in Wairoa.”

For Paine, being Māori carried both cultural and political meaning.

“My mother taught me who I am and where I come from. My Pākehā father encouraged me to stand firmly in my Māoritanga and embrace the strength of being Tūhoe.”

A pathway into Māori health research

Paine's parents laid the foundation for her education. Paine first studied science at the University of Otago, with medicine in mind.

“I went to the University of Otago with thoughts of a medical degree,” she says. “That probably wasn’t unusual for people of my generation. Medicine, law and teaching were the kinds of pathways many of our whānau hoped education might open.”

Paine says she had not imagined academia or research as a career pathway until her whānau faced a major health issue.

“With the help of my supervisor and the encouragement of my whānau, we were able to turn this issue into a research question, which then led to my master’s degree in anatomy and structural biology, specialising in reproductive biology.”

"That period became pivotal. It brought academic research closer to my own life."

After completing her master’s, Paine was offered a role on a project led by the Sleep/Wake Research Centre and the Eru Pōmare Māori Health Research Centre, examining insomnia symptoms and sleep problems in Aotearoa.

The role also brought her alongside renowned Māori health researcher Professor Papaarangi Reid, who became one of Paine’s key mentors and introduced her to Kaupapa Māori epidemiology as a way to better understand and challenge Māori health inequities.

“Some might know her for her influence at Waipapa Taumata Rau, but she was a pioneer before she came here,” Paine says fondly. “She was my mentor and, at the time, the Director of the Eru Pōmare Māori Health Research Centre."

“I learned so much from her, including Kaupapa Māori epidemiology, which changed my life.”

During her sleep research, Paine received handwritten notes from people who completed her surveys, thanking her for asking about their sleep. Some wrote that no one had asked them before. Others simply thanked her for caring.

Paine still has those notes today.

“Sometimes, as researchers, we don’t get the opportunity to help people manage real-life challenges, but sleep was definitely an area where I got to do that.”

The research also reinforced the importance of centring the experience of mothers, wāhine and primary caregivers.

“Many women told us they wanted to take part in the study because we cared about them,” Paine says. “Wāhine Māori also experience sleep a lot differently than non-Māori, and we really underestimate the importance of sleep for mothers.”

That path later led Paine to a PhD at Massey University, which she completed in 2008, before undertaking the Eru Pōmare postdoctoral fellowship.

Whānau voice and Māori health equity

After a few years focused on her young children, Paine, her husband and children moved to Tāmaki Makaurau in 2016, where she joined Te Kūpenga Hauora Māori. She later became Research Director of Growing Up in New Zealand, the country’s largest contemporary longitudinal study of child development.

Growing Up in New Zealand follows the lives of thousands of young people and their whānau. In that role, Paine has helped ensure the research is responsive to Māori, bringing a Kaupapa Māori lens to evidence that can inform policy, strengthen wellbeing and better serve future generations and their whānau.

“Working with whānau from many different backgrounds across Aotearoa has taught me a lot about creating space, listening carefully, and being willing to learn from their feedback about what good research should look like.

“That has shaped how I think about my role in Growing Up in New Zealand. The study is not just about researching tamariki, rangatahi and whānau, but listening to them, learning from them." 

Paine says Māori health research should aim to serve Māori whānau, challenge the systems that create inequity and support Māori-led solutions.

“Kaupapa Māori approaches, for example, can use epidemiology to examine the Crown’s responsibilities under Te Tiriti o Waitangi and the conditions that produce inequity.

“Kaupapa Māori methodology gave me a language and a set of tools to describe what I was seeing in my own life, whānau life and experience as a Tūhoe person.

“It helped me understand how research has harmed Māori, how it has tried to extinguish our knowledge systems, and how it has tried to overpower our own ways of researching and understanding the world.

“Kaupapa Māori methodologies enable us to critique systems and structures, which I think is absolutely necessary if we want the future of Aotearoa to flourish.”