A damning new report out by New Zealand's Health Quality and Safety Commission has called the healthcare system's failure by Pasifika "a national shame".
Bula Sautu - A window on quality 2021: Pacific health in the year of COVID-19 was launched at Parliament by the Associate Health Minister (Pasifika), Aupito William Sio.
'Bula Sautu' is a Fijian expression of good health for a life that is lived to its full potential; a life of abundance.
But the figures in this report show that for Pasifika life is anything but that. It outlines some of the worst health inequities in the country, with Pasifika at the tail end of most of them:
- Pasifika are 12 times more likely to be diagnosed with a mental illness than other populations.
- Pasifika experience higher cases and deaths from breast, lung and uterine cancers - but the lowest rates of screening.
- 63 percent of Pasifika five-year-olds have tooth decay - compared to 31 percent of non-Māori non-Pasifika.
- Pasifika live, on average, six years fewer than non-Māori non-Pasifika.
And the list goes on.
More than half of pregnant Pasifika women do not enrol with midwives, compared with just 19 percent of non-Māori or non-Pasifika.
For 10 years and counting, this has led to consistently higher rates of mortality for Pasifika mums and their pēpī.
Ngā Hau Māngere Birthing Centre manager Tish Taihia said expectant Pasifika mums were not aware of the process for finding a lead maternity carer (LMC).
The default options of midwives are those who work at their local hospital - who in most cases are ill-informed of the cultural needs of Pasifika mums.
"If they're low-risk and can have a midwife as their LMC and care for them and birth their baby and go through the whole gambit of post-natal care - then it's up to them," she said.
"They actually have to find the midwife themselves and sometimes that's daunting."
She said the cost of that to māmā and their wider whānau was unnecessary.
"It obviously isn't working because of the fact that DHBs are really struggling in maternity services, because the medicalisation of birth is skyrocketing," she said.
Where to from here?
Health Quality and Safety Commission board member Dr Collin Tukuitonga said the figures were not good.
He said a faife'au who blessed Bula Sautu's launch hoped the report would be the last in a long line or reports that have rehashed harrowing statistics with nothing actually done about them.
"The district health boards and primary healthcare providers, not Pacific, but everyone - is held to account for making those changes," he said.
Tukuitonga said despite years of evidence and advice requiring systemic change in health, Pasifika in New Zealand have been denied their right to good health and wellbeing.
"I just think it's unacceptable and unfair," Tukuitonga said.
In anticipation of next year's merger of district health boards into the mega-entity Health NZ, Tukuitonga said the government should look to this report to get an accurate picture of the state of Pasifika health.
He said a "business as usual" agenda would spell more disparities.
"We will have pregnant Pacific women not being able to access midwives in the numbers that are comparable to other parts of our community," Tukuitonga said.
"We'll have children continuing to miss out on vision and hearing tests and Well Child checks."
"We'll have Pacific people with diabetes continuing to have blindness, amputations and kidney failure."
Bula Sautu co-author Api Talemaitoga said universities and polytechnics must encourage more Pasifika students to join the workforce.
Pasifika doctors make up just 2 percent of the medical profession.
He said healthcare was a one-size-fits-all practise.
"You go to your doctor, you're told your blood test results, you're given a prescription and out you go - without any emphasis on the quality," he said.
Talemaitoga said the Covid-19 response from Pasifika communities proved solutions to the healthcare gap was in the hands of the people.
He said Pasifika providers must have greater freedom to act on their communities' needs.
"Let's draw a line in the sand. I feel for our people," he said.
"We go along, we see the doctors, we get the medications. Yet we're still not getting the same level of benefits as the rest of New Zealand."
Despite several government policy statements and strategies there have been no dramatic improvements to the health and well-being of Pasifika to date.
The report's authors hope that Bula Sautu will be used to bring about much needed change.