Reproductive justice in Aotearoa New Zealand
Policies developed with a reproductive justice methodology are crucial for ensuring reproductive autonomy and safety of all people in New Zealand, according to a narrative review from Family Planning (now Sexual Wellbeing Aotearoa). Necessary changes include equity of access to contraception and abortion, reducing sexually transmitted and human papillomavirus infection rates in Māori and Pasifika women, improving access to gynaecological care, improving sexuality education, and ending intimate partner violence and sexual violence. Policies and practices aimed at facilitating reproductive autonomy must pay particular attention to tino rangatiratanga for Māori.
In this article, the authors explore the concept of reproductive justice for New Zealand, including ways it could be furthered. An excellent and comprehensive review of key issues are presented through a justice lens, highlighting the intersection of oppression and disadvantage in this space but also opportunities for transformation led by Māori in partnership with Sexual Welling Aotearoa.
Reference: Aotearoa New Zealand Social Work. 2023;35(4):136–143.
Distinct profiles of mental health need and high need overall among New Zealand adolescents
An analysis of data from the Youth19 Rangatahi Smart Survey has shown that youth mental health is not “one size fits all”. The survey, conducted in 2019, included 7721 adolescents aged 13-18 years. Six variables from the survey were analysed: wellbeing; possible anxiety symptoms; depression symptoms; past-year self-harm; suicide ideation; and suicide attempt. Five clusters of mental health were identified. The healthy cluster (40.3% of adolescents) reported positive mental health; the anxious cluster (28.2%) reported high possible anxiety symptoms but otherwise generally positive mental health; the stressed and hurting cluster (9.4%) reported subclinical depression, possible anxiety symptoms and some self-harm; the distressed and ideating cluster (15.8%) reported clinical depression, possible anxiety symptoms and high suicide ideation; and the severe cluster (6.4%) reported the least positive mental health across all indicators. The higher severity clusters included an overrepresentation of female, rainbow, Māori and Pacific students, and those from higher deprivation areas. Exposure to sexual harm and discrimination were also associated with increasing cluster severity. Future research should consider how to best support the mental health of each cluster, concluded the study authors.
Youth mental health issues are increasing in prevalence and complexity for a variety of reasons – we see it in a variety of settings including education, justice and our own whare. Importantly, exposure to harm – including discrimination and feeling devalued by society and its ‘leaders’ – is associated with increased severity. I worry that funding cuts which target young Māori will grow the problems described here.
Reference: Aust N Z J Psychiatry. 2024;58(8):678-692.
Emergent inequity of glycaemic metrics for Māori children with type 1 diabetes is negated by early use of continuous glucose monitoring
Use of continuous glucose monitoring (CGM) within 12 months of type 1 diabetes diagnosis ameliorates ethnic disparity in glycaemic control in children, according to an analysis of data from the KIWIDIAB network. Data were collected for 206 children aged <15 years diagnosed between 1 October 2020 and 1 October 2021. CGM use was 56.7% for Māori and 77.2% for European children. At 12 months post-diagnosis, glycosylated haemoglobin (HbA1c) was 10.8 mmol/mol (95% CI 2.3-19.4 mmol/mol; p = 0.013) higher in Māori vs European children without CGM, but was similar between ethnic groups in those using CGM.
Miharo to see these devices are now funded by Pharmac. Please check the website for more information – https://pharmac.govt.nz/news-and resources/cgms-and-insulin-pumps. Ka rawe!
Reference: N Z Med J. 2024;137(1598):14-21.
Real time continuous glucose monitoring in high-risk people with insulin-requiring type 2 diabetes
A randomised controlled trial found that real-time (rtCGM) improved glycaemia in a predominantly Māori population of adults with insulin-requiring type 2 diabetes. The trial assigned 67 participants with HbA1c ≥64 mmol/mol (8.0%), who were using insulin ≥0.2 U/kg/day, to rtCGM or self-monitoring blood glucose (SMBG). A total of 54% of participants were Māori. The primary endpoint was time in the target glucose range (TIR; 3.9-10 mmol/L) during weeks 10-12. Mean TIR increased by 13% (95% CI 4.2 to 22%; p = 0.007) in the rtCGM group but did not change in the SMBG group. Baseline-adjusted between-group difference in TIR was 10.4% (95% CI -0.9 to 21.7; p = 0.07). Mean HbA1c decreased from baseline in both groups (p < 0.001 for both). No severe hypoglycaemic or ketoacidosis events occurred in either group.
Can we have these funded for our pakeke with type 2 diabetes too please!
Reference: Diabet Med. 2024;41(8):e15348.
Outcome measures for Māori with non-traumatic dental presentations: a retrospective observational study and Kaupapa Māori approach examining emergency department inequities
The first study using a Kaupapa Māori approach to examine emergency department non-traumatic dental presentations (NTDP) found barriers to accessing primary oral healthcare and a paucity of Kaupapa Māori initiatives. The study reviewed 2034 NTDP to the Christchurch emergency department between 2018 and 2020. Māori and Pacific peoples were over represented compared to local population estimates (27.0% and 6.9% vs 9.4% and 3.2%, respectively). Māori had the highest age-standardised incidence of hospital admission, but shorter length of stay compared with Pacific peoples and NZ Europeans (0.9 vs 3.8 and 2.0 days, respectively). Provision of high-quality, equitable care for Māori requires further action and accountability, concluded the study authors.
Important that we continue to monitor this important health issue, as we now know that poor dental health affects pregnancy outcomes, nutrition and related conditions (diabetes, cardiovascular disease) and mental health (through pain and financial stress). I found this paper – Undoing structural racism in dentistry: Advocacy for dental therapy – really useful to unpick these issues, and to see how an Indigenous-led programme is delivering change.
Reference: N Z Med J. 2024;137(1599):16-26.
Exploring the impact of the COVID-19 pandemic on perceptions of national scheduled childhood vaccines among Māori and Pacific caregivers, whānau, and healthcare professionals in Aotearoa New Zealand
Māori and Pacific-led vaccination strategies should be embedded in immunisation service delivery to improve uptake and immunisation experiences for whānau, according to a qualitative study. Interviews and discussions were undertaken with Māori and Pacific caregivers (n = 24) and healthcare professionals (n = 13) between November 2022 and May 2023 to understand perceptions of routine childhood vaccines through the COVID-19 pandemic. Four themes were constructed from gathered data. “We go with the norm” reflected how participants’ acceptance of routine vaccines before the pandemic were promoted by social norms, health personnel and institutions. “Everything became difficult” explains how challenges were added to the daily struggles of whānau and healthcare professionals by the pandemic. “It needed to have an ethnic-specific approach” highlighted the Western-centric strategies that dominated during the initial pandemic response, that did not meet the needs of Māori and Pacific communities. “People are now finding their voice” expressed renewed agency among whānau about vaccination following pressure to receive COVID-19 vaccines.
Really important information here, especially given the contribution that timely immunisation makes to addressing health inequities; the focus of the government in this area; and the importance of supporting whanau agency and informed consent.
Reference: Hum Vaccin Immunother. 2024;20(1):2301626.
Provision of care for diabetic retinopathy in New Zealand: are there ethnic disparities?
There is a need to reduce barriers faced by Māori in accessing GP, optometry and retinopathy screening referrals, according to a retrospective audit of first specialist diabetic retinopathy clinic appointments at the Department of Ophthalmology, Te Whatu Ora Te Toka Tumai Auckland. Data from 388 patients was analysed, of whom 42% were European, 9.5% were Māori, 13.2% were Pasifika, 32.7% were Asian and 2% were Middle Eastern/Latin American/African. Compared with patients of other ethnicities, Māori patients were eligible for a significantly greater number of treatments (p=0.001). Across ethnicities, the comprehensiveness of history taking, examination, investigations and proportion of eligible treatments provided was similar but did not reach the gold standard of care.
Although the evidence presented here is disheartening, I am pleased that we have non-Māori health researchers and providers working with Māori Hauora leaders to monitor ethnic inequities in Aotearoa and focus on the significant system/structural factors at play.
Reference: N Z Med J. 2024;137(1600):12-20.
I have a dream: altering medical students’ ethnic bias towards Indigenous population (NZ Māori) using a digital training called cognitive bias modification
A single training session using a tool designed to address interpretation bias in medical students was effective in reducing overall bias, suggesting potential applications in addressing health disparities. The tool, cognitive bias modification for stereotype (CBM-S), uses an implicit learning task to create a less biased interpretation of Māori patients in common health scenarios. Following CBM-S training, stereotype interpretation bias scores were reduced over time, as well as post-training stereotype bias scores after adjustment for baseline bias scores.
How interesting – a specific type of training to reduce unconscious bias in Aotearoa. Although developed for medical students in working with patients, I’d love to see it being used to reduce bias toward fellow Māori students/peers and for other health professions. In fact, I’m already creating the list for other occupations!
Reference: Stigma and Health. 2024; Advance online publication.
Blood cancer incidence, mortality and survival for Māori in New Zealand
Ethnic disparities are apparent for incidence, mortality and survival of blood cancers, according to a study of the New Zealand Cancer Registry (2007 2019) and national mortality records. Blood cancers in 2653 Māori and 20,458 Europeans were identified. Incidence and mortality rates for leukaemia and myeloma were higher in Māori than Europeans. Cancer-specific survival outcomes were poorer for Māori vs Europeans across most blood cancer types, with age- and sex-adjusted hazard ratios of 1.77 (95% CI 1.57-2.00) for leukaemia, 1.18 (95% CI 0.65-2.16) for Hodgkin lymphoma,1.71 (95% CI 1.50-1.95) for non-Hodgkin lymphoma and 1.40 (95% CI 1.19-1.64) for myeloma.
The survival disparities between Māori and non-Māori observed here are consistent with other Indigenous peoples with blood cancer, and importantly for 23 of the 24 most common cancers in Aotearoa. Unequal detection and screening, and unequal treatment, are the most likely drivers, though others specific to blood cancers must be considered. Finally, although the results are disappointing, what is uplifting is the number of Māori and Pacific Admission Scheme graduates/Māori leaders heading this important research and contributing to healthcare in Aotearoa!
Reference: Cancer Epidemiol. 2024;93:102656.
