Waikato DHB systematically failing Māori and Pasifika - report

6:27 pm on 31 March 2021

Waikato District Health Board has been found to be systematically failing to meet the needs of its Māori and Pacific communities.

Waikato Hospital

Waikato Hospital Photo: Waikato DHB / Facebook

The Rapua Te Ara Matua Equity Report, written by the DHB, said it was "embedded in a healthcare system which has privileged the needs of the majority while failing to meet the needs of all".

"Waikato DHB is party to the systematic failure to adequately address and eliminate equity gaps and provide services that are culturally competent and holistic for Tangata Whenua," the report said.

The board services the highest population of Māori of any health board - with an estimated 23 percent of the region's 438,300 people identifying as Tangata Whenua. Another 3 percent identified as Pacific peoples.

It said this failure demonstrated an "acceptance that a lack of equity is both inevitable and tolerable".

"Equity gaps do not need to be a feature of Aotearoa society and in health they can be reduced and eliminated."

'Distressing life journey for Māori children'

The inequalities shown in the report "present a distressing life journey for Māori children born today".

"In Aotearoa, through no fault of your own or your whānau, being born Tangata Whenua Māori increases the risk of greater adverse health impacts than if you were born European/Other."

At birth, Māori children were at higher risk of low birth weight, ear infections, asthma, leukemia and sudden unexplained death in infancy (SUDI) because of limited access to maternity care, GPs and midwives, the report said.

It said it was also more likely for Māori to be living in poverty and in poor quality, cold and drafty housing which led to the higher possibility of being admitted to hospital in a child's first 1000 days of life for respiratory issues.

By the start of primary school nearly 65 percent of tamariki Māori have developed tooth decay, with almost 20 percent not having had their teeth checked by oral services at school.

Having experienced health and hardship issues as a child also presented challenges with maintaining a healthy lifestyle entering adolescence and young adult years, the report said. At this age Māori were more likely to have left school without a qualification and be unemployed or not in training, it said.

The report identified this was the time in a Māori person's life where they were most at risk of ending their life and becoming one of many rangatahi Māori who die by suicide each year.

Significant weight gain was another consequence of not being able to lead a healthy lifestyle, with the report adding this could lead to a number of significant health issues into adulthood.

"You will also be at higher risk of other chronic health conditions such as type 2 diabetes, cancer and renal failure which reduces both your quality of life and life expectancy."

Māori were more likely to be placed in a mental health facility by the courts as they aged as a result of the stress of living in a "high deprivation environment and the burden of health issues," it said.

Hospitalisation for avoidable conditions for Māori over the age of 65 "will continue at a significantly higher rate" than Pākehā or other ethnicities.

"It is expected that your life will end five to 10 years earlier than those born at the same time as you who have the privilege of a life within or closer to Te Ara Matua," the report states.

Waikato DHB's executive director of Māori, equity and health improvement Riki Nia Nia said in many cases trends were positive, but even where health outcomes were improving for all there remained a persistent gap between Māori and non-Māori.

"For some these figures may be quite confronting, but the reality is that for many people these inequities are well known and long-standing," he said.

"Behind each set of figures or spike in a graph there are individuals and whānau who experience hardship and loss, of opportunities to live a full life, or the loss of life or loved ones to causes which may have been preventable."

A Māori-led solution

Rapua Te Ara Matua concluded Māori-led structural change was needed within the DHB to address the gaps in health equity.

"The challenge is to design a health system which prioritises the healthcare needs of those who have the least access to adequate income, healthy secure housing, and other determinants of health," the report said.

The equality gap would not be eradicated by health services alone and is calling for a "whole-of-system approach" to improve health and well being outcomes for Māori and Pacific people, the DHB said.

Nia Nia said progress has been made in building partnerships with iwi, Māori providers and others in the community, and shifting to a localities approach in which communities are asked to help shape local services.

"This does reflect a significant change in our approach, with a view that services should be built around people rather than the other way around.

"It is clear that meaningful change will require everyone working together. Our hope is this report will encourage greater support and urgency to address inequities and that there is no tolerance for these persistent gaps between people living together in our communities."

Lack of Māori and Pacific GPs

The Royal New Zealand College of General Practitioners (RNZCGP) also found in its biennial Workforce Survey released Wednesday that the representation of Māori and Pasifika GPs was far from where it needed to be.

GPs identifying as Māori made up only 4 percent of respondents, while Pacific people made up 2 percent.

Rachel Mackie, chair of the college's Māori GP group Te Akoranga a Māori, said these low numbers came from "the long-standing disadvantage and injustice that New Zealand society and systems have placed on Māori."

RNZCGP President Samantha Murton said the nation was a long way off population parity for indigenous people, adding "frankly that's not good enough".

"Our health system is rife with disadvantages for indigenous people," she said.

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