Discuss about the Health Inequity in Maori Population.
Differences of health status within a population are widespread all over the world. Health inequities can be defined as the unequal distribution of health status resources caused by social condition in which members of a population group is born. Such inequities are unwanted for and can be avoided if appropriate measures are taken. Life expectancy in poor countries is 37 years less that life expectancy in rich countries (“WHO | 10 facts on health inequities and their causes”, 2016). Socioeconomic gap between different population groups of a country is considered to be the fundamental cause of health inequities. This report aims to address the health inequities suffered by the Maori population of Aotearao New Zealand, its social and economic impacts on a local as well as national level and the application of the principles of the Treaty of Waitangi concerning the health issue of the concerned population group. The health issue selected for this report is Stroke. Throughout the report distinction between two terms, inequalities (unavoidable differences) and inequities (unfair differences) have been considered and appraised.
The life expectancy of the Maori population has seen marked decrease after the colonization of New Zealand by the British. The Maori population experienced a decrease from 100,000 in 1769 to 42,000 in 1896. The life expectancy and population has experienced a recovery since then due to various government policies and social awareness. Various health inequities are still prevalent among the Maori population because of colonisation in New Zealand. Several socioeconomic and ethnic factors were responsible for such discrepancies in the health status between the Maori and the non-indigenous population of New Zealand.
The Maori population consists of 14.6% of the total 4.7 million population of Aotearoa, the Maori name for the country of New Zealand (Limited, 2016). They are indigenous population of New Zealand inhabiting in the country since around 1300 A.D. The health inequities found in Maori and the non-Maori population of New Zealand is one of the most compelling health issues prevalent in the country presently.
Ethnic disparities may arise from various reasons. It has been proposed in studies (Mackenbach, 2005) that if all other socioeconomic and environmental factors are eliminated, genetic factors are the major determinant of health inequities among different population groups. The genome of a certain group of population may render them less or more susceptible to certain diseases and health disorders. Conversely, other studies state that 85% of genetic variations are not correlated to ethnicity or race of the population group (Ellison-Loschmann & Pearce, 2006). Hence, it can be conferred that the health status inequities suffered by the Maori population of New Zealand has non-genetic origins. The non-genetic factors can be influenced by socioeconomic position, access to healthcare facilities and lifestyle of the concerned group.
The social factors that contribute to such inequities are income, housing and employment differences between the two concerned groups. Inequities can be based upon various parameters like age, gender, ethnicity, the social and economic status, and the geographical location of the population group. There is substantial evidence of high mortality rates in old age in low socioeconomic position of the population (Huisman et al., 2013).
Several daily life practices like food habits, style of living and lack of awareness about nutritional importance on healthy living can contribute to the onset of various chronic as well as acute disorders. These factors can often be inherited and depend on cultural and social traditions followed by a particular section of the population. Hosseinpoor et al., (2012) studied the inequalities in risk factors of non-communicable diseases in low-income and middle-income countries and concluded that smoking and low fruit and vegetable consumption were prevalent in low socioeconomic groups among various countries. The risk factors of non-communicable diseases varied among different socioeconomic groups.
Several studies have examined the impact of accessibility of healthcare facilities on the health status of a population. There is high mortality rates for people with lack of optimum accessibility either due to the geographical location or due to socioeconomic constraints (Milea et al., 2015).
The treaty of Waitangi is the founding document of New Zealand that was signed on 6 February 1840 between the British Crown and the 540 Maori chiefs. The treaty was signed to establish political and social accord between the Maori community, which ruled New Zealand until then and the British settlers that had arrived in New Zealand during that period. The English and Maori translations of the treaty differed which has been debated to this day. The treaty promised to provide Maori autonomy and abstain from interfering with their cultural practices. It aim to establish a reciprocity between the two communities. The Maoris were allowed to have full control over their land transactions and way of living; in return, the British formed the laws and government of the country. In ultimatum, the Crown was to establish equity and equal treatment for all the inhabitants, both the Maori and the non-Maori population, in all the sectors including healthcare.
The principles of the treaty are based on three P’s: Partnership, Protection and Participation. Partnership aims to achieve a collaborative process between two groups to reach a particular common benefit or objective. Participation implies the involvement of individuals from all the groups in certain facilities to reduce inequalities in various sectors. Protection signifies the need to protect certain cultural and ethical values of different individuals in a common workspace and maintain a secular approach to avoid hurting the sentiments of any of the individuals included in the population.
Concerning health status of the Maori population of New Zealand, the three P’s can be applied in an efficient way to provide optimum healthcare facilities and prevent health status inequities between the Maori and the non-Maori populations (Kingi, 2007).
Studies show that there are several health issues in the Maori adult and children population that need to be addressed to mitigate the social and economic cost due to the same. The health conditions that are more prevalent in the Maori population compared to the non-Maori population are Ischemic Heart Disease, Stroke, Diabetes, Hypertension, Chronic Pain and Arthritis (“The Health of MÄÂori Adults and Children”, 2015).
Study of the epidemiology of stroke in New Zealand show great discrepancy in incidence of the same among the different ethnical or racial groups. New Zealand is a multi-ethnic country and studies show the burden of mortality due to stroke is highest among individuals of the Maori community as compared to rest of the population (Feigin, McNaughton & Dyall, 2007). Although such conclusions do not provide any insight regarding the direct causes of the medical condition and its higher incidence, it may make the issue of health inequity more conspicuous and aid in taking necessary preventive measures like culture specific treatment, planning and intervention. The mean age of stroke incidence in both Maori and Pacific people of New Zealand is significantly low compared to their European counterparts (Bonita, Broad & Beaglehole, 1997). Feigin et al., (2006), studied the risk factor profiles for stroke patients between the ethnic groups. The average age of stroke onset for the Maori Population is 61 years compared to 64 years for Pacific people and 75 years for European inhabitants of New Zealand. Considerable differences found in risk factors among the different ethnicities may be responsible for this discrepancy.
Stroke is one of the leading causes of mortality universally. Two kinds of strokes are prevalent: Ischemic and Hemorrhagic. Stroke is a medically emergency condition where blood supply to the brain is impeded either due to blockage in the blood vessels of the brain or due to rupture of blood vessels and damage of the tissues in the vicinity. Symptoms should be identified promptly and immediate medical attention is required.
Accessibility to emergency medical care can be a deciding factor in preventing adverse consequences of stroke patients. Stroke incidence is strikingly more in medically underserved region of the world compared to the economically developed countries; post-stroke disability and mortality were also significantly high in the unreserved countries (Norrving & Kissela, 2013).
There is a huge economic impact of stroke worldwide. Direct costs include medical costs including hospital costs, extended care facilities and medical care personnel. Indirect costs include both mortality and morbidity costs. many governments have opted for programs to create awareness regarding how to mitigate the risk factors associated with stroke in order to reduce the economic and social burden the condition poses on a national level.
The principles of the Treaty of Waitangi viz. Partnership, Protection and Participation can be applied at an organizational level to bridge the gap between Maori and non-Maori population of New Zealand in terms of medical healthcare facilitates.
The Maori population must be allowed to choose their health program policies for the well being of health of their community after considering their cultural and religious needs; although the policies need to be scrutinized to ensure that it meets standard scientific rationale. This comes under the principle of Protection of equal rights of the community as well as ensuring partnership in social well being of the country as a whole. Government must intervene with proper programs to spread awareness about the epidemiology of stroke in the Maori population. The importance of following a healthy lifestyle and a healthy balanced diet in fighting the prevalence and incidence of Stroke must be elucidated to the target population.
The people of Maori population should be encouraged to participate in healthcare facilities as healthcare professionals to understand the special needs of the Maori patients who are admitted in the medical institution. They must work together to reach centripetal health outcomes with an ultimate goal of providing emergency care to the patients who have experienced stroke.
The nurses and other healthcare professionals must be trained to be compassionate and empathetic in dealing with Maori patients, as they have specific cultural needs, which must be dealt with utmost sensitivity. Addressing health issues must happen in collaboration between the provider and the receiver of treatment or care. Partnership between the two is necessary for establishing health status equity all over the population of the country.
Government must take adequate actions to provide equal accessibility to all the different ethnic populations of the country. Infrastructural development is indispensible in and around the geographical locations where the Maori population is rich. Emergency facilities should be equipped such that immediate needs of a stroke patient can be addressed. Hence, intervention from the government is an absolute necessity to achieve the desired results and the policies must be formulated after acknowledging the principles of the three P’s of the Treaty of Waitangi.
Conclusion
Disparities between different ethnic populations of a country are widespread all over the world especially in healthcare sectors. The Maori population of New Zealand is a victim of health inequity compared to other ethnic communities. Stroke is one of the most alarming of all the inequities suffered by the population. The application of principles of the Treaty of Waitangi is fundamental in implementing equal healthcare facilities and bridging the ethnic gaps in the population of New Zealand.
References
Bonita, R., Broad, J. B., & Beaglehole, R. (1997). Ethnic differences in stroke incidence and case fatality in Auckland, New Zealand. Stroke, 28(4), 758-761.
Ellison-Loschmann, L., & Pearce, N. (2006).Improving access to health care among New Zealand’s Maori population. American Journal of Public Health,96(4), 612-617.
Feigin, V. L., McNaughton, H., & Dyall, L. (2007). Burden of stroke in Maori and Pacific peoples of New Zealand. International Journal of Stroke, 2(3), 208-210.
Feigin, V., Carter, K., Hackett, M., Barber, P. A., McNaughton, H., Dyall, L., … & Auckland Regional Community Stroke Study Group. (2006). Ethnic disparities in incidence of stroke subtypes: Auckland Regional Community Stroke Study, 2002–2003. The Lancet Neurology, 5(2), 130-139.
Hosseinpoor, A. R., Bergen, N., Kunst, A., Harper, S., Guthold, R., Rekve, D., … & Chatterji, S. (2012). Socioeconomic inequalities in risk factors for non communicable diseases in low-income and middle-income countries: results from the World Health Survey. BMC public Health, 12(1), 1.
Huisman, M., Read, S., Towriss, C. A., Deeg, D. J., & Grundy, E. (2013). Socioeconomic inequalities in mortality rates in old age in the World Health Organization Europe region. Epidemiologic reviews, mxs010.
Kingi, T. K. (2007). The Treaty of Waitangi: A framework for Maori health development. New Zealand Journal of Occupational Therapy, 54(1), 4.
Limited, M. (2016). Aotearoa – The Maori Name for New Zealand. Maori.com. Retrieved 29 September 2016, from https://www.maori.com/aotearoa
Mackenbach, J. P. (2005). Genetics and health inequalities: hypotheses and controversies. Journal of epidemiology and community health, 59(4), 268-273.
Milea, D., Azmi, S., Reginald, P., Verpillat, P., & Francois, C. (2015). A review of accessibility of administrative healthcare databases in the Asia-Pacific region. Journal of market access & health policy, 3.
Norrving, B., & Kissela, B. (2013). The global burden of stroke and need for a continuum of care. Neurology, 80(3 Supplement 2), S5-S12.
The Health of MÄÂori Adults and Children. (2015). Ministry of Health NZ. Retrieved 30 September 2016, from https://www.health.govt.nz/publication/health-maori-adults-and-children
WHO | 10 facts on health inequities and their causes. (2016). Who.int. Retrieved 29 September 2016, from https://www.who.int/features/factfiles/health_inequities/facts/en/index1.html
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