lecture 34. Maori health

Question 1

why is it important to know what we idenify as Maori?

Answer 1

• statistics
• who is at risk of health inequities
• who are we treating and what are we treating?- genetics or social determinants?

Question 2

2 ethnicity questions in the census

Answer 2

• 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

Question 3

Alienation of maori land began in

Answer 3

1840

Question 4

How did alienation of land affect Maori health?

Question 5

Evidence that we should have more Maori and Pacific in the workforce

Answer 5

-women who are treated by a HCP of their ethnicity have better health outcomes

Question 6

Who has the duty to act on systematic inequities?

Answer 6

Individuals, professionals, families, communities, nations, governments

Question 7

Universal declaration to human rights

Answer 7

– 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

Question 8

International covenant on Economic, Social & cultural rights

Answer 8

– 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

Question 9

In 2000, UN Committee on ICESCR issued General

Comment #14 clarifies

Answer 9

• 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

Question 10

right to health

Answer 10

1. Enshrined in International Law
2. Extends beyond health care to pre-conditions
3. Includes freedoms and entitlements
4. 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)
5. Social epidemiology links health with social
   justice & thus links to good government

Question 11

heath inequity are evidence of..

Answer 11

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

Question 12

why is health political?

Answer 12

(power,
social context & politics) and health policy
decisions have a legal dimension rather than
being purely political discretion.

Question 13

What needs to be targeted to reduce health inequities?

Answer 13

-distribution of determinants of health

Question 14

Tobacco control example of respect, protect, and fulfil

Answer 14

1. respect no discrimination against smokers. Against tobacco, not against the smokers. Here to support people and not judge
2. protect. from the interference of 3rd parties- tobacco companies. Ban advertising, block their influence
3. fulfill( adopt measures to achieve equity). Know that Maori women are more affected. Have interventions just for Maori- leveling

Question 15

Tobacco control example of respect, protect, and fulfil

Answer 15

1. respect no discrimination against smokers. Against tobacco, not against the smokers. Here to support people and not judge
2. protect. from the interference of 3rd parties- tobacco companies. Ban advertising, block their influence
3. 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

Question 16

International Convention on the Elimination of

all forms of Racial Discrimination (1965)

Answer 16

Mentions right to health explicitly

Question 17

Discrimination in relation to the right to health

Answer 17

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

Question 18

The Code of Health & Disability Service Consumer’s Rights- NZ

Answer 18

1. 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.
2. Aligns with Human Rights Act, NZ Public Health & Disability Act, (Pae Ora), R2H not explicit
3. Code in part a response to ethical issues in health services research

Question 19

NZ Public Health & Disability Act

Answer 19

1. Reducing inequalities is one of the purposes
2. No explicit mention of R2H but the main purpose a
   DHB based health system to foster community
   participation
3. Has a Treaty of Waitangi clause as well as a clause
   that notes that no one will have special privileges
   on basis of ‘race’.
4. Reducing inequalities focus reiterated in
   overarching policy documents – NZ Health
   Strategy, NZ Disability Strategy, He Korowai
   Oranga.

Question 20

Pae Ora Bill

Answer 20

1. 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
2. Has Tiriti o Waitangi clause - to provide for the
   Crown’s intention to give effect to the principles
   of te Tiriti o Waitangi
3. Reducing inequities reiterated in overarching
   policy strategy documents.

Question 21

Does the Treaty offer any leverage?

Answer 21

1. Affirms Indigenous rights as does the 1835 Declaration of Independence
2. Various ways of using TToW as a framework with different strengths & limitations
3. Good governance, Tino Rangatiratanga
4. Didn’t sign for a bad deal!
5. Active protection of taonga – Te Reo Claim
6. Napier Hospital Claim – ? health as a taonga
7. Ngāti Pōrou Claim – inequities as a breach
8. Currently hearing Kaupapa Claims – Part 2 of
   Health – Part 1 noted inequities as a breach

Question 22

UN Declaration on Rights of Indigenous Peoples

Answer 22

-does not give indigenous people any more rights, but focuses on the ones that need to be supported and achieved

1. Adopted by UN after 25 years of negotiations
   in 2007, by ANZ on 20th April 2010
2. Introduction/Preamble & 46 articles
3. 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

Question 23

Right to health instruments

Answer 23

1. Universal Declaration of Human Rights
2. ICESCR( International Covenant on Economic, Social &
   Cultural Rights)
3. Other international rights conventions
4. Indigenous Rights
   – Te Tiriti o Waitangi
   – UN Declaration on Rights of Indigenous Peoples
5. NZ legislation & policies
   – Human Rights
   – NZPHDS
   – Code of Patient Rights
   -Pae Ora Bill