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Ngā mihi
Matire
Dr Matire Harwood
matire@maorihealthreview.co.nz
These researchers discuss the history of New Zealand’s health system, which was originally established as a universal, tax-funded national health service. They go on to describe how this universal orientation and strong commitment to social service delivery has contributed to favourable health statistics in this country and the establishment of unique institutions that have arisen in response to the needs of New Zealanders. These include innovative Māori services, a no-fault accident compensation scheme, and the Pharmaceutical Management Agency (PHARMAC), which negotiates with pharmaceutical companies to provide funded access to medicines purchased using public money. Nevertheless, the system is marred by persisting problems with access to care and an inability to deliver the promise of equitable health outcomes for all population groups. Structural changes during the 1990s have failed to deliver the expected efficiency gains and the system’s prioritisation of individual-level secondary services and performance targets have obscured the focus that is needed to address issues such as suicide, obesity, and poverty-related diseases through community-based health promotion, preventive activities, and primary care. The researchers reflect upon what changes are needed in order to strengthen the culture and capacity of the system and thereby achieve equity of access and outcomes for all population groups. In particular, the researchers suggest that the healthcare system expands the provision of Māori health services, integrates existing services and structures with new ones, aligns resources with need to achieve pro-equity outcomes, and strengthens population-based approaches to better deal with contemporary drivers of health status.
This investigation into geographical proximity and population access to prehospital emergency medical services (EMS) in New Zealand focused on people living in the smallest geographical units, areas where research suggests there are opportunities to improve survival for residents who experience medical or surgical emergencies. For each geographical unit, the study researchers examined the proportion of the usually resident population with theoretical timely access to advanced level hospital care within 60 min, to identify disparities in geographical access. Analyses revealed that around 700,000 (~16%) of all New Zealanders do not have timely EMS access to advanced-level hospital care via road or air. These geographically marginalised people tend to live in areas of low-moderate population density. In particular, Indigenous Māori, European New Zealanders, older New Zealanders and those residing in the lower South Island were less likely to have timely access.
These researchers examined data from 3 nationally representative New Zealand Youth 2000 surveys (undertaken in 2001, 2007 and 2012), which documented a decline in cannabis use among secondary school students over this period of time. This investigation sought to determine whether changes in adolescent cannabis use occurred across all demographic groups and whether this decline was offset by increasing use of other psychoactive drugs. The decline in adolescent cannabis use was consistent across all main demographic groups (including age, ethnic, sex and socioeconomic groups) and there was no evidence of an accompanying rise in the use of other psychoactive drugs. Ethnic and socioeconomic differences in adolescent cannabis use decreased between 2001 and 2012, with Māori, younger students and students from low decile schools exhibiting the greatest reductions in cannabis use over time.
It is already established that the burden of injury is disproportionately larger among Māori compared with non-Māori. Moreover, the impact of injury can be exacerbated by subsequent injuries, i.e. injuries that occur after, but not necessarily because of, an earlier or ‘sentinel’ injury. The Subsequent Injury Study analysed interview, Accident Compensation Corporation (ACC) and hospital discharge data within a 24-month period, to determine the number and timing of subsequent injuries experienced by Māori and reported to the ACC in the 24 months following a sentinel injury, the proportions who experienced subsequent injuries, and the nature of subsequent injuries. Of the 566 Māori in this analysis, two-thirds (62%) experienced ≥1 subsequent injury in the 24 months after the sentinel injury. Subsequent injuries were more common among those who drank moderate or high amounts of alcohol, or in those who had cognitive difficulties, before the sentinel injury. There were fewer subsequent injuries between 0–3 months after a sentinel injury than during later periods. Subsequent injuries were most commonly spine dislocations, sprains and strains.
These researchers analysed data from the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) registry for 3,857 patients who received acute reperfusion therapy for ST-elevation myocardial infarction (STEMI) between 2015 and 2017. The analysis examined ‘patient’ and ‘system’ delays: ‘patient delay’ was defined as the time from symptom onset to first medical contact (FMC); ‘system delay’ was defined as the time from FMC until reperfusion therapy (primary percutaneous coronary intervention [PCI] or fibrinolysis). Seventy percent of the study cohort received primary PCI; 30% received fibrinolysis. In the fibrinolysis cohort, 10.5% received pre-hospital fibrinolysis. Most patients (77%) were transported to hospital by ambulance. In analyses adjusted for covariates, the likelihood of travelling to hospital by ambulance was lower among people who were older, male and presented to a hospital without a routine primary PCI service. For ambulance-transported patients, the median symptom to FMC time was 45 minutes, but this delay was >2 hours for a quarter of patients. Delays were longer for self-transported patients (a median of 97 minutes), with a quarter experiencing delays of >3 hours. In analyses adjusted for covariates, a delay between symptom onset and FMC of >1 hour was more common with older age, for those of Māori or Indian ethnicity and for those who did not call an ambulance. For ambulance-transported patients who received primary PCI, the median time was 119 minutes. For ambulance-transported patients who received fibrinolysis, the median system delay was 86 minutes, with Māori patients more often delayed than European/Other patients. Among patients who received pre-hospital fibrinolysis, the median system time was 46 minutes shorter than in those who received in-hospital fibrinolysis. For the patients who underwent rescue PCI after fibrinolysis, the median needle-to-rescue time was 237 minutes (4 hours).
These researchers retrospectively analysed data from the St John New Zealand out-of-hospital cardiac arrest (OHCA) registry for 1,750 adults treated for an out-of-hospital cardiac arrest of presumed cardiac aetiology between 1 October 2013 and 31 October 2018. Significantly fewer older-aged patients (>65 years) compared with those aged 45–64 years and younger (15–44 years) were transported to hospitals with PCI capability (49.9% vs 59.7% and 52.1%; p<0.001). In a comparison of ethnicities, Pacific Peoples had the highest proportion transported to PCI-capable hospitals, followed by Europeans and Māori (86.2% vs 55.6% and 32.9%; p<0.001). Significantly fewer patients living in rural areas compared with those living in an urban location were transported to PCI-capable hospitals (34.7% vs 59.1%; p<0.001). Logistic regression analysis revealed significantly higher 30-day survival in patients conveyed directly to hospitals with PCI-capability compared with those taken to non-PCI-capable hospitals (adjusted OR 1.285; 95% CI, 1.01 to 1.63; p=0.04).
This report included 420 adult inpatients in a single tertiary New Zealand hospital who were assessed using the Reported Edmonton Frail Scale; those with scores of ≥8 were considered frail. The overall prevalence of frailty was 48.8% and increased significantly with age; ≥85-year-olds were significantly more likely to be frail compared with <65-year-olds (OR 6.25; 95% CI, 3.17 to 12.7; p<0.01). Compared with New Zealand Europeans, Māori patients were significantly more likely to be frail (OR 4.0; 95% CI, 1.45 to 11.9; p=0.02). Compared with patients admitted to a medical specialty, those admitted to a surgical specialty were less likely to be frail (OR 0.52; 95% CI, 0.31 to 0.86; p<0.01) and those admitted for rehabilitation were more likely to be frail (1.86; 1.03 to 3.41; p<0.04). Frail patients were significantly more likely to come from a rest home (OR 2.81; 95% CI, 1.38 to 6.14; p<0.01) or hospital-level care (9.62; 2.68 to 61.6; p<0.01).
This survey of the 1998 New Zealand birth cohort of 56,904 children through 2016 recorded cumulative childhood prevalence of reports to child protective services (CPS), substantiated maltreatment (by subtype) and out-of-home placements. The children were followed from birth to age 18 years. Child maltreatment and child protection involvement differed markedly by ethnic group; compared with other children, Māori and Pacific Islander children were much more likely to be reported to CPS, to be substantiated as victims, and experience an out-of-home placement. Across all levels of CPS interactions, rates of Māori involvement were more than 2-fold higher than those of Pacific Islander children and more than 3-fold those of European children.
This research was undertaken over a 3-month period in 2011 by Māori dietetic students with Māori supervision. Analysis of observational and discussion data was guided by Kaupapa Māori methodology. The 4 Māori households (18 individuals) in this investigation each contributed over 40 hours of data. The analysis identified 4 key themes around the experience of food insecurity in the household. All households had experienced income-related food insecurity and this was expressed by the theme ‘Overcoming socioeconomic hardship’; this insecurity was felt most keenly by the low-income family. In all households, food insecurity had short‐ and long-term impacts on hauora (well‐being). Whānau described strategies they had developed to reduce the severity of food insecurity: themes were identified around the sharing of food, gardening for food, and teaching food and nutrition skills. Thematic analysis of the texts used by the household members expressed Māori values and/or hauora influences, encompassing manaakitanga (sharing food/hospitality), whanaungatanga (family relationships) and kaitiakitanga (caring for the environment).
These researchers followed 2 cohorts of secondary school students from 5 schools enrolled in an Incubator Programme set up to encourage Indigenous (Māori) and Pacific students to consider a career in health. The students were surveyed before and after participating in the Incubator Programme, in an attempt to understand what influences Māori and Pacific students in New Zealand to choose nursing as a health career. Nursing was the most common career choice out of all possible career options. The survey responses indicated that the programme broadened and confirmed available career options. The students described various influences on career choices, including personal experience, exposure to the media, careers advisors and teachers.
These researchers describe how they developed a principles framework – Whare Ōranga – for guiding action on Māori/Indigenous homelessness in Aotearoa/New Zealand. This framework incorporates 3 pathways that create opportunities for action on Māori homelessness: Rangatiratanga (the Māori self-determination pathway); Whānau Ora (Government policy that places Māori families at the centre of funding, policy and services); and Housing First, an international pathway with local application for homelessness that is being implemented in parts of Aotearoa. These pathways and their potential opportunities informed the content of 20 interviews that were held with authoritative Māori, who talked about how Māori principles can be used as the foundation for action to address Māori homelessness. This issue can only be addressed by incorporating rights-based and culturally aligned practice empowered by Māori worldviews, principles and processes. Importantly, such action has to be embedded within Te Tiriti o Waitangi, which endorses Māori tribal self-determination and authority, and Whānau Ora as a government obligation to reduce inequities in Māori homelessness. Moreover, the root causes (colonisation and historical trauma) of Māori homelessness must be addressed, by adopting strong rights-based frameworks that will enact decolonisation and guide official policy.
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