The deepening climate crisis generates specific impacts that will exacerbate the already disproportionately negative health outcomes experienced by Indigenous people. Disparate health outcomes have not spontaneously emerged, but rather have been foreshadowed by existing inequities. This article summarizes a sample of the work from a two-year research project in Aotearoa New Zealand to understand existing policy processes and ascertain the extent to which health institutions give serious consideration to climate change impacts on Maori (Indigenous people) with health vulnerabilities. Speaking to tangata whenua (Indigenous Maori), District Health Board (DHB) employees, and subject matter experts (SMEs), it was clear that policy processes were ad hoc and problematically silenced consistent Maori input. While research participants expressed their experiences of, and aspirations for, dealing with climate change, their voices were not evident in DHB policy development processes. The deficit within existing policy process reflects a lack of preparedness in the face of climate change. Despite clear resilience and adaptation strategies, structural change is needed to address identified disadvantages. Through a co-designed policy framework ("Haumanu Hauora"), we guide policy formation to mitigate climate change risk to Maori (and others). Central to the revised policy framework is the creation of space for both internal and external Maori voices to ensure consistent Maori input throughout the policy process. We also introduce a commissioning, refining, and monitoring stage (that includes evaluation). Haumanu Hauora considers whanau-centered healthcare knowledge, needs, resources, and aspirations, to contribute to a transformed and responsive health system. Above all, we believe that strengthening health institution responsiveness to Maori health needs is essential.
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