Maori health
The burden of disease
National burden of disease studies in New Zealand have confirmed significant disparities between Māori and non-Māori. When years of life lost (YLL) as a result of disease or injury are combined with year equivalents lost to disability (YLD), the resulting measure is known as disability adjusted life years (DALYs). One DALY represents the loss of one year of healthy life. Using disability adjusted life years as a measure of the burden of disease, Māori have a 70% higher rate of years lost - 200 per 1000 compared to 120 per 1000 for non-Māori, reflecting a relatively greater burden of both fatal and non-fatal outcomes amount Māori. Cardiovascular disease accounts for around half of the years lost, while cancer contributes to about one third.
While for non-Māori, bowel cancer accounts for the greatest loss of cancer-related DALYs, for Māori the largest cancer burden comes from cancer of the lung.
The true burden of diabetes has historically been under-estimated in New Zealand because no-one knows exactly how many people have diabetes - diagnosed or undiagnosed. Estimates have previously been based on assumptions and modelling and haven't been very reliable. Diabetes is the fourth leading cause of death for Māori. Furthermore, 20% of Māori have pre-diabetes.
Disparities in mental health status between Māori and non-Māori have also widened significantly since the 1970s. There is a strong likelihood that urbanisation and its associated social disruptions, together with recent social and economic stressors might be directly associated with an increase in the incidence of mental illness.
Attention must also be drawn to national inadequacies in income, employment, education, housing and the ways in which culture can positively and negatively influence health. On most measures, Māori fulfillment is low, especially in employment, education and income levels. Poverty itself is a health hazard. Indicators show that Māori are deterred from visiting a doctor mainly because of cost.
In addition to socio-economic effects, the level of social cohesion can affect health. Strong ties with family or whanau, high levels of civil and political participation, good public transport, good social networks and a strong community identity can overcome some of the ill-effects of deprivation. Housing is another critical determinant of good health. Yet Māori are twice as likely to pay a greater proportion of income as rent and home ownership appears to be declining among Māori. The impact of socio-economic disadvantage on Māori people has been recognised as a major impediment to further health gains.
In the general practices, the increasing rate of doctor consultations with increasing socioeconomic deprivation is consistent with increased need. However, Māori and Pacific utilization rates are not higher than those for people of European ethnic identity and as it stands, Māori adults and parents of Māori children have been shown to be less likely to trust their GP. This is a cause for concern in light of evidence that Māori health status is poorer than European, even after adjusting for deprivation.
The New Zealand Health Survey is published as an annual report. Data is collected continually via face to face interviews covering topics including long-term conditions, health service utilisation and patient experience, health risk and protective factors, health status, and socio-demographics. Participants are selected by random from households invited to participate by the Ministry of Health. One adult and one child are chosen to represent the household. The 2012/2013 survey showed an unmet need for primary health care is more common among Māori and Pacific adults and children, and in those living in the most deprived areas while also experiencing high rates of most health conditions, particularly asthma, ischaemic heart disease, stroke and diabetes.
Māori health advancement comes from multiple interventions such as improved standards of living, better access to Māori cultural and physical resources, resilient whanau, supportive communities and effective political voice. In addition, opportunities for improved health can also come from health services.
While for non-Māori, bowel cancer accounts for the greatest loss of cancer-related DALYs, for Māori the largest cancer burden comes from cancer of the lung.
The true burden of diabetes has historically been under-estimated in New Zealand because no-one knows exactly how many people have diabetes - diagnosed or undiagnosed. Estimates have previously been based on assumptions and modelling and haven't been very reliable. Diabetes is the fourth leading cause of death for Māori. Furthermore, 20% of Māori have pre-diabetes.
Disparities in mental health status between Māori and non-Māori have also widened significantly since the 1970s. There is a strong likelihood that urbanisation and its associated social disruptions, together with recent social and economic stressors might be directly associated with an increase in the incidence of mental illness.
Attention must also be drawn to national inadequacies in income, employment, education, housing and the ways in which culture can positively and negatively influence health. On most measures, Māori fulfillment is low, especially in employment, education and income levels. Poverty itself is a health hazard. Indicators show that Māori are deterred from visiting a doctor mainly because of cost.
In addition to socio-economic effects, the level of social cohesion can affect health. Strong ties with family or whanau, high levels of civil and political participation, good public transport, good social networks and a strong community identity can overcome some of the ill-effects of deprivation. Housing is another critical determinant of good health. Yet Māori are twice as likely to pay a greater proportion of income as rent and home ownership appears to be declining among Māori. The impact of socio-economic disadvantage on Māori people has been recognised as a major impediment to further health gains.
In the general practices, the increasing rate of doctor consultations with increasing socioeconomic deprivation is consistent with increased need. However, Māori and Pacific utilization rates are not higher than those for people of European ethnic identity and as it stands, Māori adults and parents of Māori children have been shown to be less likely to trust their GP. This is a cause for concern in light of evidence that Māori health status is poorer than European, even after adjusting for deprivation.
The New Zealand Health Survey is published as an annual report. Data is collected continually via face to face interviews covering topics including long-term conditions, health service utilisation and patient experience, health risk and protective factors, health status, and socio-demographics. Participants are selected by random from households invited to participate by the Ministry of Health. One adult and one child are chosen to represent the household. The 2012/2013 survey showed an unmet need for primary health care is more common among Māori and Pacific adults and children, and in those living in the most deprived areas while also experiencing high rates of most health conditions, particularly asthma, ischaemic heart disease, stroke and diabetes.
Māori health advancement comes from multiple interventions such as improved standards of living, better access to Māori cultural and physical resources, resilient whanau, supportive communities and effective political voice. In addition, opportunities for improved health can also come from health services.
Best health outcomes for Maori: Practice implications
(recommended reading for any primary health practitioner)
best-health-outcomes-for-maori.pdf | |
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References
Coppell, K. (2013). Diabetes rates rising - one in five Kiwis at risk. Retrieved from http://www.maoridiabetes.co.nz/about-diabetes/what-is-diabetes-prediabetes-video/diabetes-rates-rising/
Durie, M. (2001). Mauri Ora - The Dynamics of Maori Health. Melbourne, Victoria: Oxford University Press.
Health Utilisation Research Alliance (HURA). (2006). Ethnicity, socioeconomic deprivation and consultation rates in New Zealand general practice. Journal of Health Services Reseach & Policy, 11(3), 141-9. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/1682426
Ministry of Health. (2013). New Zealand Health Survey Annual update of key findings 2012/13.
Tatau Kahukura: Māori Health Chart Book 2010, 2nd Edition http://www.health.govt.nz/publication/tatau-kahukura-maori-health-chart-book-2010-2nd-edition
Coppell, K. (2013). Diabetes rates rising - one in five Kiwis at risk. Retrieved from http://www.maoridiabetes.co.nz/about-diabetes/what-is-diabetes-prediabetes-video/diabetes-rates-rising/
Durie, M. (2001). Mauri Ora - The Dynamics of Maori Health. Melbourne, Victoria: Oxford University Press.
Health Utilisation Research Alliance (HURA). (2006). Ethnicity, socioeconomic deprivation and consultation rates in New Zealand general practice. Journal of Health Services Reseach & Policy, 11(3), 141-9. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/1682426
Ministry of Health. (2013). New Zealand Health Survey Annual update of key findings 2012/13.
Tatau Kahukura: Māori Health Chart Book 2010, 2nd Edition http://www.health.govt.nz/publication/tatau-kahukura-maori-health-chart-book-2010-2nd-edition