lecture 34. Maori health Flashcards
why is it important to know what we idenify as Maori?
- statistics
- who is at risk of health inequities
- who are we treating and what are we treating?- genetics or social determinants?
2 ethnicity questions in the census
- have you descended from Maori( ancestry )- a bigger population. not everyone in his group identifies as Maori
- ethnicity. self-decided. What is the lifestyle?- more important for health priority. most people in this group have ancestry.
overlapping groups
Alienation of maori land began in
1840
How did alienation of land affect Maori health?
Evidence that we should have more Maori and Pacific in the workforce
-women who are treated by a HCP of their ethnicity have better health outcomes
Who has the duty to act on systematic inequities?
Individuals, professionals, families, communities, nations, governments
Universal declaration to human rights
– 1948
– UN General Assembly – Article 25 – right to a
“standard of living adequate for the health and
the well-being of himself and his family including
…. medical care and … the right to security
in the event of…
• Didn’t define parameters of the right to health but
noted they both include & transcend medical
care
• Determinants of health contextualized
International covenant on Economic, Social & cultural rights
– 1966 – UN –
Art 12 – explicit “right to health” and steps
states should take to “realize progressively”
“the maximum available resources” to the
“highest attainable standard of health”
Gives examples of inclusions, able to evolve,
“reasonableness” for different states, &
the expectation of international co-operation
governments should work to provide the opportunities for people to be the best they can be
In 2000, UN Committee on ICESCR issued General
Comment #14 clarifies
- R2H≠R2be Healthy
- Related to other Human Rights and Health Equity
- Itemises some “freedoms from” and “entitlements
to” - Obligations of States [R,P,F]
-No one ca guarantee health
right to health
- Enshrined in International Law
- Extends beyond health care to pre-conditions
- Includes freedoms and entitlements
- States are obliged to respect (e.g. no
discrimination), protect (e.g. no interference
from 3rd parties) and fulfill (e.g. adopt
measures to achieve equity) - Social epidemiology links health with social
justice & thus links to good government
heath inequity are evidence of..
laws, policies
& practices that distribute resources &
opportunities in a discriminatory manner &
limit full participation.
eg. less funding and development in poorer schools in poorer areas-> fewer opportunities
- easier to achieve health for some people than for others
why is health political?
(power,
social context & politics) and health policy
decisions have a legal dimension rather than
being purely political discretion.
What needs to be targeted to reduce health inequities?
-distribution of determinants of health
Tobacco control example of respect, protect, and fulfil
- respect no discrimination against smokers. Against tobacco, not against the smokers. Here to support people and not judge
- protect. from the interference of 3rd parties- tobacco companies. Ban advertising, block their influence
- fulfill( adopt measures to achieve equity). Know that Maori women are more affected. Have interventions just for Maori- leveling
Tobacco control example of respect, protect, and fulfil
- respect no discrimination against smokers. Against tobacco, not against the smokers. Here to support people and not judge
- protect. from the interference of 3rd parties- tobacco companies. Ban advertising, block their influence
- fulfill( adopt measures to achieve equity). Know that Maori women are more affected. Have interventions just for Maori- leveling
We will need a number of strategies including leadership, advocacy, policy, and political bravery against multi-national interference
International Convention on the Elimination of
all forms of Racial Discrimination (1965)
Mentions right to health explicitly
Discrimination in relation to the right to health
travels on various axes of identity( age, sex, etc)
Impacts on multiple layers of determinants
Acts on access to & thru’ care & quality of care
Even if not intentional, if discrimination causes impairment of enjoyment of rights = violation
The state has a moral & legal obligation to prohibit & eliminate, including acting affirmatively (disability car parks, crossing near schools)
R2H framework goes beyond medical, ethical and quality issues to focus on accountability
The Code of Health & Disability Service Consumer’s Rights- NZ
- Outlines 10 rights including freedom from discrimination and services of an appropriate standard
right to health is not explicit, but a response to women not being fully informed on the precursors and risks of cancer. - Aligns with Human Rights Act, NZ Public Health & Disability Act, (Pae Ora), R2H not explicit
- Code in part a response to ethical issues in health services research
NZ Public Health & Disability Act
- Reducing inequalities is one of the purposes
- No explicit mention of R2H but the main purpose a
DHB based health system to foster community
participation - Has a Treaty of Waitangi clause as well as a clause
that notes that no one will have special privileges
on basis of ‘race’. - Reducing inequalities focus reiterated in
overarching policy documents – NZ Health
Strategy, NZ Disability Strategy, He Korowai
Oranga.
Pae Ora Bill
- achieve equity among New Zealand’s population
groups, in particular for Māori;
2.No explicit mention of R2H but the main purpose to
support mechanisms for health reforms - Has Tiriti o Waitangi clause - to provide for the
Crown’s intention to give effect to the principles
of te Tiriti o Waitangi - Reducing inequities reiterated in overarching
policy strategy documents.
Does the Treaty offer any leverage?
- Affirms Indigenous rights as does the 1835 Declaration of Independence
- Various ways of using TToW as a framework with different strengths & limitations
- Good governance, Tino Rangatiratanga
- Didn’t sign for a bad deal!
- Active protection of taonga – Te Reo Claim
- Napier Hospital Claim – ? health as a taonga
- Ngāti Pōrou Claim – inequities as a breach
- Currently hearing Kaupapa Claims – Part 2 of
Health – Part 1 noted inequities as a breach
UN Declaration on Rights of Indigenous Peoples
-does not give indigenous people any more rights, but focuses on the ones that need to be supported and achieved
- Adopted by UN after 25 years of negotiations
in 2007, by ANZ on 20th April 2010 - Introduction/Preamble & 46 articles
- Preamble states
– Everyone has human rights
– Indigenous peoples have not rights fully realized
– Declaration seeks to facilitate full realisation of
rights and stronger relationships between
Indigenous Peoples and States
Right to health instruments
- Universal Declaration of Human Rights
- ICESCR( International Covenant on Economic, Social &
Cultural Rights) - Other international rights conventions
- Indigenous Rights
– Te Tiriti o Waitangi
– UN Declaration on Rights of Indigenous Peoples - NZ legislation & policies
– Human Rights
– NZPHDS
– Code of Patient Rights
-Pae Ora Bill
