Maori Health Flashcards
Where are systematic disparities exemplified in regards to Maori health (vs non maori)?
- in health incomes
- in exposure to detriments of health
In health system responsiveness - in representation in health work force
Do Maori or non-Maori have a higher life expectancy?
Non-Maori
Where are Maori health disparities seen? (Eg diabetes)
Cardiovascular disease (highest) Cancer (second highest) Injury Diabetes Mental health including self harm Infectious diseases Disability Participation in health workforce
What interventions could the titanic have?
Structural or social interventions
What are structural interventions?
Getting rid of barriers to healthcare (for example, more lifeboats, or more access of Maori to angioplasty or cabg
What are social interventions?
Rights based approach, commitment to review and ‘level playing field’
What is NOT a good intervention?
Individual accountability (eg swimming lessons for the titanic)
Why should you not provide interventions for everyone?
It’s a waste of resources
Do Maori have an increased deprivation?
Yes, the average decile 1 death rate in Maori is higher than a decile 10 non-Maori
Define disparity, inequality and inequity
Different
Unequal
Unjust
Why is equal not always equitable?
In examples with Maoris with a higher ischaemic heart disease, is equal fair if they need more procedures?
What are the determinants of ethnic inequities in health?
- Differential access to health determinants or exposures leading to differences in disease incidence
- Differential access to health care
- Differences in quality of care received
What’s an example of differential access to health determinants or exposures leading to differences in disease incidence?
Higher deprivation in Maori populations (as poorer housing, lower income and less access to health services all result in a lower health outcome)
What’s an example of differential access to health care?
Higher death rate due to ischaemic heart disease among Maori
What’s an example of differences in quality of care received?
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
Two components of Maori health with historical underpinnings?
Structural contribution
Societal contribution
What is structural contribution?
The power, resources and opportunities of NZ society are organised by ethnicity (so there are barriers)
What are societal contributions to Maori health?
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)
Brief history of Maori health?
Early contact: Maori initially flourished
Official engagement: colonisation, Declaration of Independence, treaty of waitangi
-era of depopulation, disease and dispossession
Implications of colonisation?
Racist assumption Superiority Entitlement Land use ...leads to today's societal barriers
What is article 1 of the treaty?
Construction of state sector, justice system, education, health, welfare
What is article 2 of the treaty and how is this disregarded?
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)
What is the treaty implication of Maori land?
It’s the historical basis of settler wealth: Maori Land Court 1860s
Active procurement, by dodgy means
Land alienation relationship to health?
Social disruption of community
Breakdown of political power and alliances
Economic resource depletion and poverty
Resentment by indigenous people
What policies disregarded article 3 (equal citizenship for all New Zealanders)?
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
Discuss the social security act
Underpayment continued until after ww2
How does unequal citizenship affect health?
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
When were the pre-emption Clause of the treaty established?
1840-1865
What was the pre-emption clause of the treaty?
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
When was the social security act?
1938
When was the constitutions act?
1852
What was the constitution act?
The creation of a settlers government that excluded Maori due to complicated land ownership
It set up NZ parliamentary systems
How does the treaty and history relate to Maori health today?
- Land alienation
- Policy alienation
- Unequal (inferior) citizenship
What is the leading cause of Maori death?
Ischaemic heart disease (so cardiovascular)
What age bracket had the highest death rate for Maori?
65-68
What is ancestry?
Comprises of an individual’s ancestors, but is not their ethnicity
What is ethnicity?
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)
