Genetic Counseling in Aotearoa New Zealand: Context, Practice and the Future of Genomic Healthcare.

Genetic counselors have been practicing in Aotearoa New Zealand since 1995, and are now established across both public and private sectors of healthcare. While significant global efforts have been made to define the profession of genetic counseling, the distinct way in which genetic counselors practice in New Zealand has not been formally described in the literature. The genetic counseling profession has evolved within New Zealand's distinct cultural, political, geographical, and healthcare ecosystem and is committed to addressing health inequities experienced by Māori, the Indigenous people of Aotearoa. Clinical practice is informed by Te Tiriti o Waitangi (the Treaty of Waitangi), and incorporates te ao Māori (Māori worldview), Māori ethical frameworks and Māori models of health. Genetic counselors work with Māori whānau (families) to facilitate collective decision-making through hui (family meetings) for conditions such as familial hypercholesterolemia (FH), and contribute to Māori-led research initiatives, including work leading to the discovery of the CDH1 tumor suppressor gene. However, the genetic counseling workforce in New Zealand faces significant challenges, including limited local training opportunities, ongoing workforce constraints amid increased demand, the need to adapt to new models of service delivery, and underrepresentation of Māori and Pacific Peoples. This article provides the first published account of New Zealand's unique genetic counseling landscape and begins to map some of the strengths and challenges shaping the ongoing evolution of genetic counseling practice.