Maori Health

Question 1

Where are systematic disparities exemplified in regards to Maori health (vs non maori)?

Answer 1

• in health incomes
• in exposure to detriments of health
  In health system responsiveness
• in representation in health work force

Question 2

Do Maori or non-Maori have a higher life expectancy?

Answer 2

Non-Maori

Question 3

Where are Maori health disparities seen? (Eg diabetes)

Answer 3

Cardiovascular disease (highest)
Cancer (second highest) 
Injury
Diabetes
Mental health including self harm
Infectious diseases
Disability
Participation in health workforce

Question 4

What interventions could the titanic have?

Answer 4

Structural or social interventions

Question 5

What are structural interventions?

Answer 5

Getting rid of barriers to healthcare (for example, more lifeboats, or more access of Maori to angioplasty or cabg

Question 6

What are social interventions?

Answer 6

Rights based approach, commitment to review and ‘level playing field’

Question 7

What is NOT a good intervention?

Answer 7

Individual accountability (eg swimming lessons for the titanic)

Question 8

Why should you not provide interventions for everyone?

Answer 8

It’s a waste of resources

Question 9

Do Maori have an increased deprivation?

Answer 9

Yes, the average decile 1 death rate in Maori is higher than a decile 10 non-Maori

Question 10

Define disparity, inequality and inequity

Answer 10

Different
Unequal
Unjust

Question 11

Why is equal not always equitable?

Answer 11

In examples with Maoris with a higher ischaemic heart disease, is equal fair if they need more procedures?

Question 12

What are the determinants of ethnic inequities in health?

Answer 12

1. Differential access to health determinants or exposures leading to differences in disease incidence
2. Differential access to health care
3. Differences in quality of care received

Question 13

What’s an example of differential access to health determinants or exposures leading to differences in disease incidence?

Answer 13

Higher deprivation in Maori populations (as poorer housing, lower income and less access to health services all result in a lower health outcome)

Question 14

What’s an example of differential access to health care?

Answer 14

Higher death rate due to ischaemic heart disease among Maori

Question 15

What’s an example of differences in quality of care received?

Answer 15

International report:
Minorities feel less likely they have been listened to, have less time with health care providers and inadequate explanations of problems, unanswered questions, more dissatisfaction with health care services

Question 16

Two components of Maori health with historical underpinnings?

Answer 16

Structural contribution

Societal contribution

Question 17

What is structural contribution?

Answer 17

The power, resources and opportunities of NZ society are organised by ethnicity (so there are barriers)

Question 18

What are societal contributions to Maori health?

Answer 18

Values and assumptions widely held in NZ society about the deservedness of different groups of people (so, asking who is more privileged ie: has better healthcare because of presumptions etc)

Question 19

Brief history of Maori health?

Answer 19

Early contact: Maori initially flourished
Official engagement: colonisation, Declaration of Independence, treaty of waitangi
-era of depopulation, disease and dispossession

Question 20

Implications of colonisation?

Answer 20

Racist assumption
Superiority 
Entitlement 
Land use 
...leads to today's societal barriers

Question 21

What is article 1 of the treaty?

Answer 21

Construction of state sector, justice system, education, health, welfare

Question 22

What is article 2 of the treaty and how is this disregarded?

Answer 22

Article 2 states the rights of Chiefs and tribes to keep their land (unless they wish to sell it to the crown). However, Maori land courts in 1860 still proceeded (so, laws and policies disregarded article 2)

Question 23

What is the treaty implication of Maori land?

Answer 23

It’s the historical basis of settler wealth: Maori Land Court 1860s
Active procurement, by dodgy means

Question 24

Land alienation relationship to health?

Answer 24

Social disruption of community
Breakdown of political power and alliances
Economic resource depletion and poverty
Resentment by indigenous people

Question 25

What policies disregarded article 3 (equal citizenship for all New Zealanders)?

Answer 25

Old age pensions 1898
-equal provisions for Maori and pakeha (Asian excluded)
-Maori access difficult through Maori land court
Maori regularly removed from rolls
Reduced amount paid to Maori

Question 26

Discuss the social security act

Answer 26

Underpayment continued until after ww2

Question 27

How does unequal citizenship affect health?

Answer 27

Entrenchment of poverty and dependency
Increased barriers to development
Acceptance of inequity by non-indigenous groups
Resentment, frustration, anger
Social breakdown, crime, high risk behaviour

Question 28

When were the pre-emption Clause of the treaty established?

Answer 28

1840-1865

Question 29

What was the pre-emption clause of the treaty?

Answer 29

Only the crown could buy Maori land, part of the “land claims accordance” in 1841
-although this was standard practice, it was deemed unfair due to monopoly

Question 30

When was the social security act?

Answer 30

1938

Question 31

When was the constitutions act?

Answer 31

1852

Question 32

What was the constitution act?

Answer 32

The creation of a settlers government that excluded Maori due to complicated land ownership
It set up NZ parliamentary systems

Question 33

How does the treaty and history relate to Maori health today?

Answer 33

1. Land alienation
2. Policy alienation
3. Unequal (inferior) citizenship

Question 34

What is the leading cause of Maori death?

Answer 34

Ischaemic heart disease (so cardiovascular)

Question 35

What age bracket had the highest death rate for Maori?

Answer 35

65-68

Question 36

What is ancestry?

Answer 36

Comprises of an individual’s ancestors, but is not their ethnicity

Question 37

What is ethnicity?

Answer 37

Self-perceived, can belong to more than one group, change over time

Is a social construct of group affiliation and identity (eg, common origin, history, cultural identity, collective solidarity)