Māori Health Review Issue 35

This US-based social experiment assessed the association of personal, individual health with the social and economic environments in which people reside. From 1994 through 1998, the Department of Housing and Urban Development randomly assigned 4,498 women with children living in public housing in high-poverty urban census tracts (in which ≥40% of residents had incomes below the federal poverty threshold) to one of three groups: 1,788 received housing vouchers, which were redeemable only if they moved to a higher census income tract, and counselling on moving; 1,312 received unrestricted, traditional vouchers, with no special counselling on moving; the remaining 1,398 (controls) were offered neither of these opportunities. During 2008–2010, the study collected data on health outcomes, including height, weight, and level of glycated haemoglobin (HbA1c). At follow-up, the rates of a body mass index (BMI) of ≥35, a BMI of ≥40, and a glycated haemoglobin level of ≥6.5% were lower in the group receiving the low-poverty vouchers than in the control group, with an absolute difference of 4.61 percentage points, 3.38 percentage points, and 4.31 percentage points, respectively; the between-group differences were not significant.

Data are reported from a national survey of health equity outcomes across the New Zealand District Health Boards (DHBs). The survey aimed to identify the extent of evidence-based practices in the chronic condition management of stroke, cardiovascular disease, chronic obstructive pulmonary disease, congestive heart failure and diabetes. The survey data were supplemented with interviews conducted with 31 expert informants on program reach and the cultural needs of Māori and Pacific peoples. Responses were received from 15 of the 21 DHBs surveyed and from 21 of 84 Primary Health Organisations. Analyses revealed that measuring, monitoring and targeting equity is not systematically undertaken. The Health Equity Assessment Tool is used in strategic planning but not in decisions about implementing or monitoring disease programs. Variable implementation of evidence-based practices in disease management and multiple funding streams made program implementation difficult. Equity for Māori is embedded in policy, this is not so for other ethnic groups or by geography. Populations that conventional practitioners find hard to reach, despite recognised needs, are often underserved. Nurses and community health workers carried a disproportionate burden of care. Cultural and diversity training is not a condition of employment.

This study analysed data from a 2007 national survey that assessed individual alcohol consumption and drinking consequences among 1,925 18–70-year-olds. The study participants’ addresses were mapped and compared with location of alcohol outlets. Outlet density was the number of outlets of each type (off-licences, bars, clubs, restaurants) within 1 km of a person’s home. Density of off-licences was positively associated with binge drinking, and density of all types of outlet was associated with alcohol-related harm scores, before and after adjustment for individual socioeconomic status.

These researchers sought to determine whether the effects of price discounts and tailored nutrition education on supermarket food purchases (percentage energy from saturated fat and healthy foods purchased) vary by ethnicity, household income and education. The study involved 1,104 New Zealand shoppers randomised to receive a 12.5% discount on healthier foods and/or tailored nutrition education (or no intervention) for 6 months. The analyses revealed an association of price discounts with healthy food purchasing (0.79 kg/week increase) that varied by ethnicity (p=0.04): European/other 1.02 kg/week (n=755); Pacific 1.20 kg/week (n=101); Māori −0.15 kg/week (n=248). This association of price discounts with healthy food purchasing did not vary by household income or education.

The association between albuminuria and ethnicity was evaluated in this New Zealand study involving 65,171 adults (median age 64.7 years) in primary care with type 2 diabetes (median duration 5.1 years) who were not on renal replacement therapy; 48.5% were non-European. Microalbuminuria or greater was present in 50% of Māori, 49% of Pacific people, 31% of Indo- and East-Asians and 28% of Europeans. In regression analyses that controlled for study site and other known risk variables (including age, sex, duration of diabetes, smoking status, socioeconomic status, body mass index, systolic and diastolic blood pressure, triglyceride levels, HbA1C and being on an ACE inhibitor or angiotensin II receptor blocker) and compared with Europeans, odds ratios for ‘advanced’ albuminuria (≥100 mg/mmoL) were 3.9 in Māori, 4.7 in Pacific people, 2.0 in Indo-Asians and 4.1 in East-Asians.

These researchers compared the self-reported subjective wellbeing of Māori and New Zealand Europeans in two NZ national postal samples. The first sample was collected in 2005 before the global financial crisis of 2007/2010. The second was collected in 2009 while the crisis was ongoing. The first sample contained 289 Māori and 2,769 NZ Europeans; numbers in the second sample were 964 and 4,073, respectively. While NZ Europeans’ scores on the Personal Wellbeing Index (PWI) were near-identical across the 2005 and 2009 samples, scores for Māori, which were already lower than NZ Europeans on the PWI in 2005, were further decreased in 2009.