Causes of Maori Health Inequalities and Policies for Change

Causes of Maori Health Inequalities and Policies for Change Managing Organizational Equality and Diversity Introduction For the past years, there had been a debate about the congruity in health between Maoris and non-Maoris in the colonial history of New Zealand. There are variations worldwide in the health of aboriginal people considering their historical, political, economic and social situations. An analytical review of the key literature concerning historical, social, economic and political processes will be discussed here. This led to the inequalities and incongruity in the Maori and non-Maori health conditions. [1] The health of the aboriginal people certainly affected by the invasion of the non native people which includes several components which are connected with changes related to socioeconomic and cultural differences, heathcare availability, life styles, inequality, and inevitable change in a specific environment and their mutual intercommunication. An example to this is the Maoris who were the native people of the New Zealand. Researchers states that there had been a considerable variation between the Maori and non Maori life span considering the health policies and health care designs as per the socioeconomic and values of the people not residing there. Presently, our focus will be in the health realities of the group namely Maori and resolve how these factors affected to the inequality and disparities in Maori and non-Maori health conditions. The New Zealand settlement: Polynesian Era The initial settlement of New Zealand took place around 1280 CE. It was found by the Polynesians as they were the ocean navigators and astronomers. The time from about 1280 to about 1450 is usually called the Moa hunter period. People became more settled, contented and less nomadic when they reached 18th century. They also developed several strategies to cook and cultivate and process food as well. Classical and indigenous Maori used to believe that having diseases means being punished or being cursed for leaving the group or tribe but later on the eventually found that the disease rooted from the family. Aside Phthisis, the chronic disorders like Tuberculosis and Leprosy were the common diseases found in colonizing Polynesians in that period. Isolating the diseased is the standard practice to save the patient and also the community from the contaminable disease. The New Zealand settlement: The Treaty of Waitangi 1000 years ago, Maori travelled through the Pacific Ocean and arrived to New Zeland from Polynesian. The communication between Maori and Europeans occurred in around 1800. In 1840 the Treaty of Waitangi the founding document of New Zealand and a formal agreement for British settlement with a assurance of protection of Maori interests was signed between British crown and some of the Maori leaders. It is through the treaty that Maori were going to have their unique rights as a native people of New Zealand. The treaty’s was assigned to save and preserve the well-being of all citizens and settlers and its health implications to the equity and participation of the people and the government.[2] Health Status of Maori The Effect of colonization on Maori Maori encountered a epidemiological transition because of the consequence of colonization on their diseases and death rates in which diseases of old age and lifestyle change infections as the primary cause of death. The Effect of European contact on Maori life expectancy Maori life expectancy at the era of Captain James Cook’s visits to New Zealand was greater than that in Britain between 1769 and 1777. The researches implied that Maori may have had a life expectancy at birth or more than compared to the people of Britain. After the communication with the European, however there was a considerable deterioration in Maori life expectancy. Maori peoplehad an estimated life expectancy of only 25 and 23 years respectively By 1891.[3] Population decline phase The population of Maori is estimated to be around eighty thousand in the beginnings of the 18th century having a population of about two thousand colonist. There was a large incursion of the intruders in 1958 after the signing of the treaty. After that, an increasing number of colonist found the two groups both numbering approximately equal number of fifty nine thousand. By 1901, the country’s demographics had exaggeratedly change with the population of settlers outnumbering the Maori. Musket warfare and The Effect of introduced diseases In the same era, warfare caused about 700 death per year but this is lesser compared to the deaths caused by secondary infections. Maoris weren’t resistant to acute infections although they were carrying chronic disorders, so newly introduced illness that were ordinary in Europe such as measles, whooping cough and mumps took a fast track among Maori. They influenced both elders and children with disappointing results. There had been a lot of reported deaths of Maori in the 19th century because of respiratory diseases specifically bronchitis along with tuberculosis. Loss of Maori land There was a displacement of large numbers of Maori because of the requisition of their lands in 1869s wars, British crown purchase and the greater demand and pressure over the government workers for selling Maori lands by using hook or crook process. Clarifying Health Disparities William’s basic cause model shows a conceptual process to show why inequities exist. It is useful in examining the part of the different factors in being mentioned above. Therefore, this will be used in showing possible reasons why Maori are influenced more by diseases more than their non Maori counterpart. [4] As from the above chart it can seen that a number of different elaborations have been suggested as a causative mechanisms for the inequalities in health between Maoris and non-Maoris. Broadly we can categorize these into genetic and non-genetic factors. Genetic factors It was recently suggested that these discovered differences are due to genetic factors. Genetic factors do not appear to have a major contribute in population and public health although it has a little contribution in health status. Non Genetic factors The non genetic elaborations regarding factors effecting Maori and non Maori heath can be classified into the following sections magnifying socioeconomic factors, lifestyle factors, political approach and access to health care, and inequalities.. Socioeconomic Factors Social Determinants of Health Factors like cultural, social and economic that influence health are usually reported as the Social determinants of health. The lifestyle and condition of people living and working directly affects their health ad life expectancy. [5] The Vicious Cycle of Disadvantage The above cycle shows that there is a well established link between poverty and poor health. People having lower socio economic status are more likely to have worse reported health higher rates of disability, morbidity and mortality because of different diseases and several injuries. And this happens to be the cause of having repetitive cycle that gives disadvantages in a lot of aspects of life including health. This cycle influenced the health of Maori in every aspect of their evolution. Level of income and its effect on health regains This is a very basic factor that defines the ease of the basic pre requisites for health. Several studies have shown increasing morbidity and mortality with increasing deprivation. However, lowering of Maori health status is only little explained by relative socioeconomic disadvantage and Maori mortality rates have been demonstrated to be consistently high even after control for social factors responsible. The table below shows an example of such difference and comparison. Smith and Pearce Data comparing social, life style and Disease associated factors accountable for the downfall of the health of Maori people (1974 to 1978) over non Maori Determinants factors affecting health status of Maori and non Maori males Difference between Maori and non Maori male mortality rates (%) Socioeconomic factors 20 Life style factors Smoking 15 Alcohol 10 Obesity 05 Accidents 17 Diseases associated factors 35 Life Style factors The table above shows that different life style factors like smoking and engaging to alcohol can also be one of the mechanisms on the socio economic factors that influence health status. However, when interpreting, it is necessary to consider the extent to which different life style may account for differences in health status of Mauri and non-Maori people. As for example the recent national surveys have shown the fallowing resultspresented in the form of a table given below. Concerned people class In (%) Rate of smoking Obesity Hypertension Maori Men 53 47 46 Women 53 39 50 Non Maori Men 20 17 43 Women 20 21 38 Nonetheless, there also other factors like, gender oriented, political, psychological and environmental factors equally participate in the decreasing health of Maori and non-Maori as can be seen from the chart below. Political approach to Maori and non-Maori Health Access to the Health Care According to the hon, Annette King(Minister of Health), the developments in Maori ealth status are important and that Maori on the average have the least health profile of any group in New Zealand. The government has addressed the focus of giving importance to Maori to Maori health gain and improvement by recognizing a need to decrease and eventually eliminate health inequalities that does not affect Maori positively.[6] [7] As written in the bar graph above, researchers suggest that a particular proportion of the excess mortality among Maoris community from diseases for which effective health care is available showing differences in access to health care. Various researches showed that a large number of Maori adults have problems in having important care in their local area, as compared with of non-Maoris. Maoris were twice as non-Maoris in terms of not having much of health care in the past year due to the cost of such care. Shown from the table below, in a whole range of perspective, the ratio of high income to low income households we can say that the profit inequalities are increasing. Discrimination Health inequalities Professor Blakely states that while in New Zealand rates are good considering different aspects of everyday life, social injustice is killing people on a large scale, health inequalities within the ethnic groups remain large and those between socioeconomic groups and regions are the same with those of other developed countries. Maori health inequalities Even though overall hospital discharges maori rates continue to be about twice as higher than non-Maori. There has been a tenacious addition in life expectancy among Maoris since the 1950s, but recent results states that a wide range between Maoris and non-Maoris. For example from the table below, we can get relevant information and compare the maori and non-Maori life expectancies in specific years. Life expectancy at birth Maori Non Maori Male Female Male Female 1986 1984 64.6 69.6 70.9 77.2 1996 1999 65.8 71.0 75.7 80.8 Pacific health inequalities The techniques and rules for Pacific Health promotion is traditionally inappropriate approach to specific people. The programs that should be introduced are those that doesn’t take for granted the social and cultural contexts of the people if we don’t suppose to be targeting the failure. There had been evidences that prove that culturally interventions improved. The evidence says that there were the times when the pacific health condition was even worse than the Maori health status as shown in the table below. We can see the information as shown above by Craig et al, 2007. It obviously shows us the picture of increased rate ratios of respiratory disorders for particular people. Similarly the chart below shows the focus on the hospitalization rates in a particular year and thereby signifying the deranged health condition of the pacific people in some phases in the past. Asian health inequalities Dr. Kawshi De Silva, the chairperson of the asian health Foundation says the policy would be void for the health of Asian people in New Zealand if there are no proper remarks to consider or manipulate Asian people when having a study or postulating policy. Asian health seem to have a little part in the health system outside the control of reference for the majority organizations providing public and personal health services. With the particular issues to Asian migrants, they also have to catch up with the problems being encountered from low paid work or long term employment..[8] A changing trend towards the Health for All The New Zealand’s national health care system was built with its objectives to provide free or low cost medical care to be delivered by the professionals. To deliver such primary and secondary healthcare and following steps were further tackled, (1) the era of Maori health care provider services and (2) the introduction of cultural safety education (3) DHB initiatives. Maori Health Care Providers and DHB Initiatives The provision of services and organizations and clubs that particularly contain Maori people and who can be exercised to acquire skills that will give them chance to serve their community in a good, disciplined and planned manner. The employment of basically Maori staff that is more likely to have access to Maori consumers in their communities, and active inclusion of the community in the planning and delivery of services. To develop the quality of result the number of Maori health providers increased in 2004. But these providers have encountered a number of trials in terms of lack of good primary health data. Also due to the Maori providers service primarily with families with high levels of need in terms of health services, addition on the costs are expected if health gains are to be achieved, and funders must take this situation into account.[9] Cultural Safety Education The idea or the concept of cultural safety depends on how it is being recognized, respected, and acknowledged considering the rights, customs and traditions of others. Encountering the practice of cultural safety, they should relate to other person in such a way that the person feels at ease or without restrictions in terms of their culture differences like values and customs. They felt they needed to develop the cultural safety because the Maori people weren’t able to ask for help in terms of care from the monoculture nonresident personnel’s clinic where they found it very hard to relate, adjust and communicate about what they feel and what they believe about their health and illness, death and dying, bodily modesty and gender roles. It was developed with a goal to develop health esults for Maori who were lagging behind in terms of health gains as compared to non Maori. The cultural safety in nursing now carries a broader and critical sense and meaning for health professionals in not only developing the health of Maori but also fro the training of health professionals for a better nursing for all. It brings critical awareness and concerns in terms of social and economic sector as well as varied cultiure. Through the development of the system in Maori service, they have also put emphasis on improving Maoris’ access to mainstream services. This also serves as an educational blueprint built to mutually understand the relationships between health professionals and those they serve. The initiative has been taught in nursing and midwifery programs since 1992 and it is now a requirement for nursing and midwifery registration examinations in New Zealand.[10] CONCLUSIONS To conclude, there are a lot of injustice that led to sufferings and inequalities in health between Maoris and non-Maoris have been reported for an entire period of the colonial history of New Zealand. On the other hand, there are also improvements but still it is not enough to fill the gap. It is suggested to have approaches to cope up with this. [11] The recent health programs and policies or rules are built to enhance health care access and the starting of cultural safety along with the DHB initiatives are taking a multi cultural approach that guides both the development of Maori provider services and the development of mainstream services through provision of culturally safe care. The strength behind the recent initiatives described here came from the poor health status of the native people of the New Zealand and their clear approach for developed health services. Maori provider organizations and cultural safety education and DHB initiatives are examples that have joined forces recently to vanquish the not only to upcoming government policies that have been presented to promote the health conditions of indigenous peoples but also to each and every healthcare professionals to be open minded and open for a change so that they will be able to adjust their personality or perception for the greater good that everyone expects to follow. Bibliography References from www.google.com Ellison-Loschmann, L., Pearce, N. (2006, April). APHA. Promoting public health research, policy practice and education: Improving access to healthcare among new Zealand maori population. Am J Public Health, 96(4), 612-617. doi:10.2105/AJPH.2005.070680 Maori culture.Wikipedia Pool, I.(2012, July). Death rates and life expectancies: Effects of colonisation on maori. The encyclopedia of New Zealand. Retrieved from http://www.teara.govt.nz/en/death-rates-and-life-expectancy/page-4 Lloyd, D.,Newell, S. Dietrich, C. U.(2004). Health inequalities: A review of the literature. Southern cross university. [emailprotected] Nursing Council of New Zealand. (2011). Guidelines for cultural safety, the treaty of Waitangi, and maori health in nursing education and practice. Wellington 6011. ISBN 978-0-908662-38-8 Story ethnic inequalities. The encyclopedia of New Zealand. Retrieved from http://www.teara.govt.nz/en/graph/29611/mortality-rates-for-males-by-ethnicity Public health association of NZ. (2008, Oct). PHA NEWS, 9(4). Retrieved from http://journal.nzma.org.nz/journal/121-1281/3235/ Robjcarr.(2012, August). Williams basic cause model: Equity and Inequalities in New Zealand health. Retrieved from http://robjcarr.wordpress.com/page/2/ Online Internet Articles. [1]RazasHumanas: Los alawa y los indegenasaustralianos.Retrieved from http://petalofucsia.blogia.com/temas/razas-humanas.php [2] Ellison-Loschmann, L., Pearce, N. (2006, April). APHA. Promoting public health research, policy practice and education: Improving access to healthcare among new Zealand maori population. Am J Public Health, 96(4), 612-617. doi:10.2105/AJPH.2005.070680 [3] Pool, I.(2012, July). Death rates and life expectancies: Effects of colonisation on maori. The encyclopedia of New Zealand. Retrieved from http://www.teara.govt.nz/en/death-rates-and-life-expectancy/page-4 [4]Robjcarr.(2012, August). Williams basic cause model: Equity and Inequalities in New Zealand health. Retrieved from http://robjcarr.wordpress.com/page/2/ [5]Lloyd, D.,Newell, S. Dietrich, C. U.(2004). Health inequalities: A review of the literature. Southern cross university. [emailprotected] [6] Nursing Council of New Zealand. (2011). Guidelines for cultural safety, the treaty of Waitangi, and maori health in nursing education and practice. Wellington 6011. ISBN 978-0-908662-38-8 [7] Story ethnic inequalities. The encyclopedia of New Zealand. Retrieved from http://www.teara.govt.nz/en/graph/29611/mortality-rates-for-males-by-ethnicity [8] Public health association of NZ. (2008, Oct). PHA NEWS, 9(4). Retrieved from http://journal.nzma.org.nz/journal/121-1281/3235/ [9] Ellison-Loschmann, L., Pearce, N. (2006, April). APHA. Promoting public health research, policy practice and education: Improving access to healthcare among new Zealand maori population. Am J Public Health, 96(4), 612-617. doi:10.2105/AJPH.2005.070680 [10] Nursing Council of New Zealand. (2011). Guidelines for cultural safety, the treaty of Waitangi, and maori health in nursing education and practice. Wellington 6011. ISBN 978-0-908662-38-8 [11] Maori culture. Maori culture listening. Retrieved from http://www.whakatane.info/activities/maori-culture