Lecture 25: Health Promotion In Action Flashcards
Why do we need Maori health promotion?
- Maori health status/inequalities
- Rights as indigenous peoples and Treaty partners
- ‘Mainstream’ health promotion interventions have generally been less effective for Maori than for non-Maori
- Maori health is everyone’s responsibility
Where are systematic disparities seen in Maori health?
- In health outcomes
- In exposures to the determinants of health
- In health system responsiveness
- In representation in the workforce
Can ethnic equalities be reversed?
Yes, they can be reduced, eliminated and prevented. They should NOT be normalised
Discuss Maori mortality rates?
Although the overall trend is decreasing, Maori overall life expectancy is far lower than non Maori
What causes health inequalities?
The unequal distribution of the social determinants of health
What are examples of social determinants of health?
- education, income, employment
- housing, place, area
- poverty, deprivation
- health care
What is an example of Maori being overworked enter in exposure to an adverse social determinant?
Neighbourhood deprivation
What are two models for Maori health promotion?
- The Ottawa Charter
- Te Pae Mahutonga
(Neither is better than the other, there are many more)
Who benefits most from health promotion in general?
Those already better off (ie the inverse care law)
-Maori/Pacific islanders tend to be worse off
What is conventional Health Promotion?
- based on universal models
- universal formula (one size fits all)
- often simply adapted for Maori
- doesn’t incorporate Maori values and realities
- superficial vs structural approach
- has tended to benefit non- maori to a greater extent than Maori
Examples of superficial promotion?
5+aday
smoking not our future
What are prerequisites for the Ottawa charter?
Peace, shelter, education, food, income, stable ecosystem, sustainable resources, social justice and equity
What are core aspects of the Ottawa charter?
- build healthy public policy
- create supportive environments
- strengthen community action
- develop personal skills
- reorient health services
Who developed Te Mae Mahutonga?
Sir Mason Durie
What symbol is the Te Mae Mahutonga based on?
The southern cross (as a navigational point)
What are the key components to the Te Mae Mahutonga?
4 central stars (key tasks) and two pointers (pre requisites)
What is the Te Mae Mahutonga?
Fundamental components of health promotion from a Maori point of view (but could apply to other New Zealanders)
Maori for autonomy?
Te Mana Whakahaere
Maori for community leadership?
Nga Manukura
Maori for physical environment/environment protection?
Waiora
Maori for healthy lifestyle?
Toiora
Maori for participation in society?
Te Oranga
Maori for cultural identity/access to Te Ao Maori?
Mauriora
What are the four key tasks of Te Pae Mahutonga?
Mauriora
Toiora
Te Oranga
Waiora
What are two prerequisites/ pointers of Te Pae Mahutonga?
Nga Manukura
Te Mana Whakahaere
Examples of Mauriora?
Access to the Maori world, eg connection to the land, whanau, Maori cultural resources
Examples of Toiora?
Eating
Drinking
Smoking
Examples of Waiora?
How healthy environments enable and unhealthy environments restrict
Examples of Te Oranga?
Participation in society
- Social economic resources (eg education, employment, income)
- Political participation (eg determine own future)
What is Nga Manukura?
Leadership, health professional and community leadership (so enabling, a partnership, not telling someone what to do)
What is Te mana Whakahaere?
Autonomy, the capacity to self govern, community control and enabling political environment (communities need control over own situation, otherwise they won’t truly achieve good health outcomes)
What’s the background of the SIDS Story (Sudden Infant Death Syndrome)?
Most causes 2-4 months old
Cause is not well understood, it can not be predicted
1980s: NZ had the highest rate among developed countries
What causes sudden unexpected death in infancy?
Unintentional suffocation
Other deaths
What ethnicity had highest SIDS rates?
Maori
Did the early health promotions (red nose) work?
Yes, for general non-Maori population. Maori rate was not significantly reduced
What did the Maori SIDS prevention programme involve?
- travelled the country listening to the realities of each community (Maori)
- attended to their concerns and priorities
- assisted communities to develop their own interventions
- used Maori collectives, networks, values and approaches
- not so much mass media
What happened after the Maori SIDS prevention scheme?
Noticeable reduction in Maori deaths (so could have possibly contributed to this)
How does SIDS prevention relate to Mauriora?
They worked with communities to incorporate/revitalise traditional practices eg woven cots (instead of bed sharing but is culturally appropriate, and child can still be close to parents while sleeping)
How is SIDS prevention related to Waiora?
Smoke free, safe bed sharing
How is SIDS related to Toiora?
Healthy lifestyle
Smoking cessation, breastfeeding promotion (not mainstream, revitalise traditional practice, inter generational knowledge)
How is SIDS prevention related to Te Oranga?
Participation in society
- improving education, income support
- advocating for better education (addressing underlying determinants)
How does SIDS prevention relate to Nga Manukura?
Leadership
Maori professionals and academic leadership
Collaboration with leaders in communities
How does SIDS prevention relate to Te Mana Whakahaere?
Autonomy
Communities enabled to identify their own aspirations and priorities, and to share in the design of their own solutions (went with questions not solutions- work with community to address problems)
What are the principles of Maori health promotion?
By Maori for Maori (for everyone) Self determination and control Valid models, frameworks, concepts Maori people, values, collectives Contemporary tools and methods Allows for diverse realities (not all Maoris read Maori, visit Maraes etc) Focus on determinants of health Evidence based (needs monitoring)
Does Maori health promotion benefit everyone?
Yes, addressing underlying social determinants to improve Maori health have been shown to improve for other populations
