Lecture 23. Maori Health

Question 1

Where are systematic disparities evident for Maori?

Answer 1

• In health outcomes (• Cardiovascular Disease • Cancer • Injury • Diabetes • Mental health including self-harm • Infectious diseases • Disability (among others))
• In exposure to the determinants of health. Unequal access to SDH(social determinants of health)
• In health system responsiveness
• In the representation/participation in the health workforce.

Question 2

Why is the definition of ethnicity important?

Answer 2

How we define ethnicity can change the statistics for the disease
It is important to use a consistent definition of ethnicity

Question 3

Social determinants of health

Answer 3

Housing, income, education, employment

Question 4

Difference between disparities, inequalities, and inequities

Answer 4

Disparities- differences

Inequalities- unequal but not unfair( eg mammogram for breast cancer for women but not for men)

Inequities: social justice/fairness element

does everyone have the same risks/odds?

Question 5

2 important factors underpinning inequalities

Answer 5

Structural issues( access to social structures)- power, resources, and opportunities of NZ society are organized by ethnicity [as well as class (deprivation)] in NZ.

Societal issues( social rules?) values and assumptions widely held in NZ society about the deservedness of different groups of people

Question 6

Differences between leveling or privileging

Answer 6

leveling- equitable distributions based on need and not privileging one team over another

Question 7

Questions to ask when determining what is implicated in the effect of ethnicity

Answer 7

internal(genetics) or external( how the external environment treats them)

Question 8

determinants of ethnic inequalities in Health

Answer 8

1. Differential access to health determinants or exposures leading to differences in disease incidence
2. Differential access to health care (access not proportional to need)
3. Differences in quality of care received( minorities generally benefit less from HCP services, not listened to, duration of the appointment, less likely to receive adequate explanations, more dissatisfied with the health system)

Question 9

Examples of structural and social issues from the titanic:

Answer 9

• why were women more likely to survive?
• Social issues: social values, women, and children given priority for lifeboats
• Structural issues: access to lifeboats, 3rd class passengers were less likely to survive because it took longer to get to the lifeboats( more barriers to lifeboats)

Question 10

What are the most evident inequities for Maori

Answer 10

• higher infant mortality
• Life expectancy
• Females are generally better off than males
• Disparities in all non-communicable diseases (higher rates)
• Neighbourhood deprivation

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Question 11

Structural and social interventions from titanic

Answer 11

Structural interventions- more lifeboats, exclude barries

Social interventions- rights-based approach, commitment to review, and ‘level playing field’

Neither are aimed at individuals!

Question 12

Lessons from titanic for Maori health

Answer 12

• Not aimed at “what’s wrong with you”
• Not trying to change individuals
• Radical intervention with unequal access- leveling intervention- is about leveling the risk and not prioritizing one group over another

Structural contribution/ issues: resources and opportunities are organized by ethnicity.

Social contributions: values and assumptions widely held in NZ society about the deservedness of different groups of people

Both driers have historical and contemporary underpinnings.