Lecture 25: Maori Oral Health

Question 1

how is oral health as a disease?

Answer 1

• dental caries is the most preventable chronic disease in the world
• periodontal disease prevalence in aotearoa is increasing

Question 2

why is oral health important?

Answer 2

without good oral health we won’t be able to speak, eat, smile and have confidence in life and mahi

Question 3

what changes have we seen in maori oral health?

Answer 3

pakeha brought gum disease and tooth decay with them when colonisation happened. Maori had good teeth because of limited access to sugar and had 3 meals rather than 6 snacks.

Question 4

how is oral health measured?

Answer 4

• index for caries in oral health literature is dmft (primary/baby teeth) and DMFT (permanent teeth)

Decayed, Missing, Filled, Teeth

Question 5

how is dental decay in 5 year olds changed over time?

Answer 5

european 5 year olds have consistently had between 1 and 2 decayed teeth, and maori 5 year olds consistently have between 3 and 4. clear inequity shown

Question 6

how is dental decay in 12-13 year olds changed overtime?

Answer 6

over decreases in the number of decayed teeth over time for maori and non-maori, but again maori have more decayed teeth than non-maori. inequities persist.

Question 7

who promotes Maori oral health?

Answer 7

Maori health providers established their own dental services to improve access for Maori. They exist alongside primary care services.

• However, there are only a few of these Maori health providers and there are none in the south island

Question 8

how is maori oral health addressed in dunedin?

Answer 8

Te Kaika
- opened in 2018
- it has Niho Taniwha - dental clinic
- there are 4 dental surgeries
- oral health/dental students rotate yearly for placements

Question 9

what strategies exist to improve Maori Oral Health?

Answer 9

• Good oral health, for life, for all (GOHFAFL)
• Maori Oral Health Quality Improvement Group (MOHQIG)
  -Te Ao Marama / WAI2638

Question 10

what is Good oral Health, For Life, For All

Answer 10

came out in 2006 as a strategic vision for oral health in New Zealand

• it aimed to emphasise prevention and early intervention, intergrate oral health into general health frameworks, have a variety of service providers, have community based dental services for all, funding, emphases pre school and early primary school year, more diverse workforce and have better primary care
• but only a few of these have been done since 2006, more work is needed

Question 11

what are the key actions of GOHFAFL?

Answer 11

• reorient child and adolescent oral health services
• reduce inequities in oral health and access
• promote oral health
• build links with primary care
• build the oral health workforce
• develop oral policy
• DHBs to contract Maori providers (by maori for maori)
• these visions attempted to increase participation of Maori in the redesign of the community oral health service

BUT
- there are financial challenges, historical and cultural institutionalism and traditional oral health care delivery models
- these things reduced that impact of the new vision and policies in communities that needed it most
- this most likely resulted in a new service that isn’t enough to overcome structural determinants of inequity which disadvantage Maori.

Question 12

what are the issues in the maori oral health workforce surveys?

Answer 12

• only 2.8% of the oral health workforce identify as Maori
• only 218 practising maori oral health practitioners

Question 13

what is the Maori Oral Health Improvement Group?

Answer 13

Kaupapa includes designing projects to achieve the following outcomes:
- equitable outcomes for all Maori
- inrase number of Oral health providers
- culturally competent and culturally responsive workforce
- equitable opportunity for Maori to train/work in the oral health sector
- increase number of new graduates working in maori oral health providers
- oral health and primary care practitioners are confident and capable in screening for health and oral health
- oral health workforce has reliable and available information about Maori and Maori health

Question 14

what are the priority areas of the national maori oral health equity action plan of the MOHQIG?

Answer 14

Being accountable to Maori

Four priority areas:
1. acheiving an equitable oral health system
2. responsive oral health services
3. greater whanau participation
4, building a fit for purpose oral health workforce

Question 15

what is te ao marama?

Answer 15

NZ Maori Dental Association

• formed 1995 to address inequitable Maori health

Question 16

what are the visions/goals of te ao marama?

Answer 16

Vision: good oral health for Maori, for life

Outcome: maori enjoying good oral health at all ages

Purpose: to provide leadership for Maori in oral health

Role: to advocate on behalf of Maori for improved oral health and to support and develop initiatives to lead to Maori oral health

Objectives:
- uphold maori oral health as guaranteed under te tiriti o waitangi
- pursue the delivery of oral health services to maori at the optimum level
- safeguard and promote oral health of te iwi maori
- promote opportunity for te iwi maori to access quality oral health services

Question 17

what did Te Ao Marama do in wai2575?

Answer 17

Te Ao Marama made a submission on behalf of the WAI2575 in the matter of Maori oral health in February 2017 which highlights that the Crown has a duty to address and remedy the causes of inequities in Maori oral health in WAI2638