Maori Health Issues: Statistics, Inequities, And Government's Role (essay).

a.Review a specific health related issue where Maori experience poorer health outcomes using both national and local health statistics to outline the context of the issue.

b.Critically examine the role of the government in addressing health inequities for Maori. You should include a knowledge of Iwi Governance and the role of Maori in health service planning.

c.Using the Principles of Te Tiriti o Waitangi, propose three recommendations to improve health outcomes related to your chosen health issue. Consider current or prior strategies or policies –what effect have these had on reducing the inequities?

d.Provide rationale for these recommendations to demonstrate how they would target inequities and improve health outcomes for Maori.

Related health issues at Maori

Maori came in New Zealand from Hawaiki and established in the fourteenth century. Maori is the area with quite a few population and they are treated different from Non Maori. The treaty of Waitangi is the funding document which formalizes the relationship between the Crown and Maori. The treaty of Waitangi was earlier known as the treaty of cessation known as the treaty of sovereignty. While some changes were ascertained as Maori placed some restrictions on the treaty of sovereignty. Basically the treaty of assigned to promote and facilitate the health issues at Maori. With increased number of health issues, Treaty of Waitangi provides various specific health related issues and their health outcomes. The treaty of Waitangi highlights the three major principles that help in solving the issues of health at Maori. The first principle is the principle of Partnership where is the obligation of the Crown to include the Maori in the health related policies, rules and regulations. The Maori has to participate in the plans devised for the improvement in the health of the Maori population. This principle is used to address the Maori health related strategies (Kingi & Hauora, 2006). Coming to the second principle of protection. It is the duty of the Crown to actively protect the Maori interests and help the Maori people to enjoy the same position just as the Non Maori people. This principle was designed to eliminate the issues of health problems and promote Maori wellbeing. This was developed to lift the health issues status at Maori. Also, the health issues of Maori were targeted in such a manner that eliminates the disparities in the Maori region. The strategies were established to promote health issues, to provide primary health care, which is not available at Maori. The third principle is the principle of participation, which is somehow linked to partnership and protection. This is the obligation that Maori is participating in delivering health services in the region. The participation of Maori was confined to the consumers. This principle aims at designing and planning the strategies that help in addressing the health issues and promotes the participation of Maori in delivering health services. By developing such plans and principles, it was noticed that increased rate of health issues and problems at Maori, no significant improvement has been considered at Maori (TRC, 2013). Coming to the end of these principles and framework of the Treaty of Waitangi is noticed that along with these principles, strategies were developed to promote and sustain health development. Broader issues like Maori education, well being, employment, social and cultural issues are also promoted to exhibit proper health promotion.

Role of Government in addressing inequities

Maori has the poorest health issue in New Zealand. Maori have the highest mortality rates in comparison to Non Maori. The rate of illness is considerably high at Maori. The health related issues are very high and significant at Maori, which need to address. The Maori infants die at a very high rate in comparison to the Non- Maori infants. They die due to the issues of SIDS. Also, the Maori women have higher rates of breast cancer, lung cancer and cervical in comparison to the Non- Maori women. The major issues and health problems that are faced by Maori are the problems relating to cancer (NZCPHM, 2015). This study highlights the related issues of cancer, where the Maori has the poorest health outcomes, which have to be improved. The Maori accounts to two third quarter to the male cancer and one third of the female cancer issues. The Maori faces the highest level of cancer issues. New Zealand has the major health related issues in comparison to any other country. Cancer is the leading disability and health related issue in New Zealand. Maori faces a disproportionate impact of cancer and inequalities (Slater, et al., 2016).

The recent researches have found that there is a major widening inequality in terms of cancer and its risks. There is a major increase in the cancer death rates among the Maori and Non-Maori region. It was found that Maori cancer patient rates were registered approximately 17%. Also, cancer death rates were approximately noted to be as 6%. The cancer issues at Maori and Non-Maori are somehow different to each other and some are common. The common types of cancer are stomach, cervix, liver and the non-common types of cancer are prostate, brain, bladder and etc. Overall, we can say that 18% of the Maori people are diagnosed with cancer in comparison to the Non-Maori. The survival rate of cancer patients at Maori is less than Non-Maori people. The Maori people are majorly diagnosed at a later stage of stomach, prostate, commercial, lung and other types of cancer diseases. The statistical data for both local and national regions at Maori is found to be 18% of lung cancer, 30% of breast cancer, 20% cervix, 47% prostate and 49% of colorectal cancer. The cancer specific morality rate is more in Maori in comparison to Non- maori (Centre, 2015). The leading cause of cancer in females are lung, breast, cervical and stomach cancer contributing to 60% of deaths. The prostate, lung, colorectal, stomach are the types of cancer that contribute to around 63% of the cancer deaths in males. Testicular cancer is also considered as one of the common types of cancer in the Maori population. Highest level of disparities are considered due to the level of cancer patients and issues in Maori. This can be noticed that Maori population has the highest rate of cancer issues in comparison to the Non-Maori region. The level of disparities is certainly very high. The need to address the serious health issues is must at Maori as there is a significant rise in the health problems of Maori. Thereby, the priority must be given to address the significant issues to the most common types of cancers that happen to exist in the Maori population (Elwood J. , 2002).

Recommendations based on Te Tiriti o Waitangi

The increased number of inequities in the Maori can lead to differential experiences in the health care among the population groups at Maori. The significant disparities between the health outcomes lead to the persistent inequities in the health care of the Maori. Major disparities in health care between the Maori and Non-Maori have been addressed. The access to timely, quality health services is the key element and need of the population of the New Zealand. It becomes the need of the Government to ensure such policies and regulations in order to provide better quality and timely health care services to the Maori patients in order to overcome the issues of inequities (Robson, 2006). The ethnic identity is the major determinant of health inequities. The health status at Maori is very poor in comparison to the health status of other New Zealanders. Actions by the Government must be taken in order to address the Health inequities and also to recognize the Treaty of Waitangi obligations. Also, there was a need for the Government to address the gender and geographical inequalities (Hauora, 2002).

While addressing the socio, economic, gender and geographical inequities, the population health approach has to be studied in order to identify the influence of these factors on the health of the Maori population. This aims at identifying the influence on the health and how can the actions be taken in order to improve the health disparities. The intersectoral action must be used in order to address the socio economic determinants of the health. In order to reduce the health inequities, it is very important to propose the principles that help in incurring such activities that further reduce the level of disparities and inequities in the health care and status (NZMA, 2011). The framework proposed by the Government was to imply strategies at the four levels. The four levels are the structural, intermediary pathways, health and disability services and impact. The Ministry of Health states the structural level that tackles the root causes of health that emerge from the social, economic disparities. The labor market policy, tax policy creates disparities in the distribution of the income, employment and educational facilities. This is turn increase the level of problems in the health status of the Maori people. Therefore, the government can take coorective measures in order to address the key actions at the structural level. The intermediary pathways must be tackled in order to impose actions on the psychological and behavioural factors that increase the level of problems at the structural levels. The focus on subsiding the impact of the intermediary pathways must be tackled in order to reduce the health inequities (Medical Council of New Zealand, 2008). The Government has and can reduce the health inequities by focusing on providing more facilities in the health and disability health care services. Specific actions must be taken and are currently addressed by the Government in order to overcome the ailment and inequities in the health and disability services. Also, by minimizing the impact of illness on the socioeconomic position must be addressed. The policies and actions are such that reduce the discrimination actions such as biasedness and stereotyping function. The government has implie various policies and obligations to address the differential impact of the illness on the socioeconomic position (Blakely & Dew, 2004).

Also, the Government is playing an active role in addressing the interventions at all the four levels. The actions must be taken nationally, regionally and locally by the policy makers, care providers and funders. This complete framework is used to address the current problems that help in contributing to the improvement in the health care services at the Maori. The levels when addressed help in shaping the health of the Maori population. Also, the Government seeks to initate the participation of the outside factors such as the treasury, social welfare, local markets and etc, to contribute significantly to the process of reducing inequities in the health services of Maori. The Ministry of Health aims at implementing all the possible actions and framework that has been designed also by compiling the interventions in order to improve the health status at Maori and reduce the inequities in the region (Woodward & Kawachi, 2017). The Principles of Treaty of Waitangi can also used as the proper and effective framework in order to reduce the inequities, which will help the Maori population in gaining and ensuring the best quality and timely health care services. The primary health care services are also not provided due to increased inequities, which are now addressed by the Government. The public health programmes are organized by the Government, which are highly cost effective that help in reducing inequities.

The significant and rising disparities in the health outcomes of Maori require immediate attention in order to overcome the problems of cancer care services. The need to basically identify the reason of the disparities in the cancer health outcomes is also the major concern to the study. Better access to the cancer care services must be energized by following the three main principles of Treaty of Waitangi. The three principles of Participation, Protection and Partnership must be carefully addressed in order to identify the disparities and their role in the cancer care services. Various recommendations have been formed in order to improve the health outcomes related to the cancer issue. The current and prior strategies will be highlighted in this part of the study that have been incorporated in order to overcome the cancer related issues and to reduce the inequities (Cormack & Robson, 2005). The three main recommendations are highlighted as follows:

Cancer control structure and governance: By determining the partnership, the extent and nature of the participation of the Maori in delivering best cancer services and development of the cancer treatment bodies. The resources are adequately distributed among the Maori participation bodies in order to provide primary health care services. The bodies and structures are properly evaluated and established under proper governance in order to address the Maori rights and reduce inequities. The proper development of the guidelines and regulations in order to address the cancer control priorities in Maori (Sheridan, et al., 2011).

Cancer control policy: The better integration of the principles that help in building cancer control strategies that lead to practice of reducing inequalities. This the current strategy that help in creating dual focus that further reduces the inequities and reduces the level of cancer in Maori. The ensurety of Maori participation in developing and funding the cancer policy. The assessment of policy and funding decisions in order to overcome the differential effect of various discrimination and thus, bringing a decrease in the inequities. Also, must aim at encouraging a planned approach that helps in addressing the interventions of cancer control services for Maori (Blakely, et al., 2010).

Cancer workforce: The comprehensive system must be build in order to increase the level of awareness among the cancer care providers. The cancer workforce must be trained and developed efficiently in order to address the cancer related issues in Maori. The workforce must be developed in such a manner that provides culturally safe treatment to the cancer patients. The funding system must be encouraged in order to motivate the cancer workforce.  Also, the support for valuable contribution must be initiated to the Maori service provider to enhance the access to the cancer care service. Development of tools and health professionals must be initiated in order to provide effective cancer related information to the Maori patients (Kram, 2014).

The recommendations suggested must have an equivalent rationale so that when these recommendations are applied, they give better results as per the thought and implementation. The rationale is must behind the recommendations so that the they help in reducing the inequities and further provide utmost cancer care services to Maori population (HRC, 2010). Following is the complete rationale that will support the three main recommendations suggested in order to overcome the health outcomes at Maori:

• Cancer control structures: The basic aim for this recommendations is to indulge the usage of the principle of partnership and participation being framed by the Treaty of Waitangi. This will help in building cancer care bodies and institutions with the partnership of Government and Maori population, which will further provide access to the primary health care services (Russel, Smiler, & Stace, 2013). The participation from Maori is encouraged in order to make use of the rights and bring equality among the population. This will help in overcoming the issues of inequities while providing proper health care services. By taking into account the policies and regulations effectively, it will further ensure in delivering such framework that is free from any kind of inequities (Elwood, Aye, & Tin, 2016).
• Cancer control policy: This policy is intended in order to focus on building a cancer care environment for the Maori population. The need to enhance the health services energized in order to formulate the cancer care policy where the regulations are framed that help in building such systems that somehow decrease the level of inequities. For providing enough facilities and space to the hospitals that help in treating the cancer patients was idolized. The main focus of this policy is to provide and deliver the best services to the cancer patients. Adequate funding and resources was the aim to build this policy so that the gaps of inequities can be fulfilled and overcome. The configuration of building cancer care centers helped in overcoming the geographical inequities faced by the Maori population. By following the policy, a substantial decrease in the cancer deaths among the Maaori population will be noticed (Pitama, 2013).
• Cancer workforce: The rationale of this recommendation is that by providing proper training and upliftment to the workforce, the cancer care systems will be encouraged and this will further help in delivering the best cancer services to the patients. The training will reduce the socio-economic incompetencies and will build effective workforce that is free from kind of imequities. Providing and building effective information systems will help in delivering necessary information to the cancer patients and the workforce as well, this will reduce the issue of communication and will lead to proper diagnosis (Heaton, 2016). By bringing the workforce together, irrespective of their culture will help in reducing the levels of inequities from the Maori population and will encourage the access to the cancer care services with trained health professionals and workforce.

Conclusion

It can be concluded that  Maori population faces immense trouble in the health outcomes in comparison to the Non-Maori population. The number of disparities are huge among the Maori patients. They are prone to various diseases and the most common type of disease is cancer. The Maori population does not gain access to the health care services, thereby, the actions taken by the Ministry of Health of New Zealand will help in reducing the disparities and inequities. Also, the above stated recommendations will and are playing an effective role in improving the health care services of Maori. The complete rationale states that by building cancer structures and by effectively following the cancer care policy, the serious issues of inequities and health can be improved. The encouragement of cancer workforce will also provide proper treatment to the cancer patients and will reluctantly decrease the ratio of cancer deaths in Maori.

References

Blakely, & Dew, K. (2004, January). Ethnicity, acculturation and health: who’s to judge? The NewZeland medical journal, 117(1188), 1-3. Retrieved from https://www.otago.ac.nz/wellington/otago024480.pdf

Blakely, T., Atkinson, J., Shaw, C., Bastiampillai, N., Sloane, K., & Cunningham, R. (2010). Cancer Trends: Trends in Cancer Incidence by Ethnic and Socioeconomic Group, New Zealand 1981–2004. Retrieved from https://www.otago.ac.nz/wellington/otago020230.pdf

Centre, S. M. (2015, October). Global cancer comparison highlights Maori inequality – Expert reaction. Retrieved from https://www.sciencemediacentre.co.nz/2015/10/15/global-cancer-comparison-highlights-maori-inequality-expert-reaction/

Cormack, D., & Robson, B. (2005). Access to cancer services for Mäori. Retrieved from https://niphmhr.aut.ac.nz/__data/assets/pdf_file/0019/6544/maoricancerserviceaccess.pdf

Elwood, Aye, P., & Tin, S. (2016). Increasing Disadvantages in Cancer Survival in New Zealand Compared to Australia, between 2000-05 and 2006-10. PMC journal, 11(3). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4777383/

Elwood, J. (2002, February). Developing Areas in Cancer in New Zealand. Japanese Journal of Clinical Oncology, 32, 43-51. Retrieved from https://academic.oup.com/jjco/article/32/suppl_1/S43/881582/Developing-Areas-in-Cancer-in-New-Zealand

Hauora, M. (2002, September). Reducing Inequalities in Health. Retrieved from https://www.health.govt.nz/publication/reducing-inequalities-health

Heaton, T. (2016, March). Maori cancer treatment inequity a complex issue. Retrieved from https://www.stuff.co.nz/manawatu-standard/news/77456803/maori-cancer-treatment-inequity-a-complex-issue

HRC. (2010). Guidelines for Researchers on Health Research Involving M?ori. Retrieved from https://gateway.hrc.govt.nz/funding/downloads/Guidelines_for_researchers_on_health_research_involving_M%C4%81ori.pdf

Kingi, K., & Hauora, T. (2006). The treaty of waitaingi; a framework for maori health development. Retrieved from https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.574.7481&rep=rep1&type=pdf

Kram, F. (2014). Improving Maori: Acess to cancer health care: Literature review. Retrieved from https://www.moh.govt.nz/notebook/nbbooks.nsf/0/92ACA1E3BA542EBACC257DD90005B480/$file/Access_CancerLit.pdf

Medical Council of New Zealand. (2008). Best health outcomes for Maori: Practice implications. Retrieved from https://www.mcnz.org.nz/assets/News-and-Publications/Statements/Best-health-outcomes-for-Maori.pdf

NZCPHM. (2015). New Zealand College of Public Health Medicine Policy Statement. Retrieved from https://www.nzcphm.org.nz/media/89786/2015_11_30_m_ori_health_policy_statement.pdf

NZMA. (2011). Reducing New Zealand’s health inequities requires urgent action. Retrieved from https://www.nzma.org.nz/news-and-events/media-releases/reducing-new-zealands-health-inequities-requires-urgent-action

Pitama, S. (2013). The role of health professional education in addressing M?ori health inequities. Retrieved from https://www.psychology.org.nz/wp-content/uploads/Pitama-keynote.pdf

Robson, B. (2006). Understanding health inequities. Retrieved from https://www.otago.ac.nz/wellington/otago067740.pdf

Russel, L., Smiler, K., & Stace, H. (2013). Improving m?ori health and reducing inequalities between m?ori and non- m?ori: Has the primary health care strategy worked for m?ori? Retrieved from https://www.victoria.ac.nz/health/centres/health-services-research-centre/our-publications/reports/phcse-maori-report.pdf

Sheridan, N., Kenealy, T., Connolly, M., Mahony, F., Barber, P., & Boyd, M. (2011, October). Health equity in the New Zealand health care system: a national survey. PMC journal, 10(45). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3216847/

Slater, T., Matheson, A., Davies, C., Goodyer, C., Holdaway, M., & Loschmann, L. (2016). The role and potential of community-based cancer care for M?ori in Aotearoa/New Zealand. The NZ medical journal, 129(1430). Retrieved from https://www.nzma.org.nz/journal/read-the-journal/all-issues/2010-2019/2016/vol-129-no-1430-19-february-2016/6813

TRC. (2013). TE Tiriti/treaty relationship framework: Community and Organisation Development Package. Retrieved from https://trc.org.nz/sites/trc.org.nz/files/Application/Te-Tiriti-Relationship-Framework-OD.pdf

Woodward, A., & Kawachi, I. (2017). Why reduce health inequalities? - Theory and methods. Retrieved from https://jech.bmj.com/content/54/12/923