(L24) Health Promotion Frameworks in Action

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27 Terms

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The State of Maori Health

Systematic inequities

  • In health outcomes

  • In exposure to the determinants of health

  • In health system responsiveness

  • In representation in the heath workforce

Ethnic inequities in health can be eliminated and prevented

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What causes health inequities?

Health inequities are driven by the unfair distribution of health risks and opportunities (social determinants of health)

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‘Conventional’ health promotion

  • Based on Western models

  • Led and designed by (predominantly) non-Maori

  • Universal formula (one size fits all) - what fits for majority

  • Not grounded in Maori values and realities

  • Superficial vs structural approach

  • Has tended to benefit non-Maori to a greater extent than Maori

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Models for health promotion

  • The Ottawa Charter

  • Te Pae Mahutonga

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The Ottawa Charter prerequisites

Peace. shelter, education, food, income, stable eco-system, sustainable resources, social justice & equity

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The Ottawa Charter

  • Create supportive environments

  • Develop personal skills

  • Re-orient health services

  • Strengthen community action

  • Build healthy public policy

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Maori health promotion

The process of enabling Maori to increase control over the determinants of health and strengthen their identity as Maori, thus improving their health and position in society

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Rationale for Maori health promotion

  • Maori health status/inequities

  • Rights as Indigenous peoples and Treaty partners

  • ‘Mainstream’ health promotion intervention tend to be less effective for Maori than for non-Maori

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Te Pae Mahutonga

  • Developed by Professor Sir Mason Durie

  • Based on the Southern Cross as a navigational aid

  • 4 central stars (key tasks) and 2 pointers (pre-requisites)

  • Fundamental components of health promotion from a Maori world view - “but as they might also apply to other New Zealanders”

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Te Pae Mahutonga - four key tasks

  • Maurioa

  • Waiora

  • Toiora

  • Te Oranga

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Mauriora

Access to Te Ao Maori

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Waiora

Environmental protection

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Toiora

Healthy lifestyles

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Te Oranga

Participation in society

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Te Pae Mahutonga - two prerequisites

  • Nga Manukura

  • Te Mana Whakahaere

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Na Manukura

  • Leadership

  • Health professional AND community leadership

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Te Mana Whakahaere

  • Autonomy

  • Capacity for self governance

  • Community control & enabling political environment

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SIDS

Background:

  • Sudden Infant Death Syndrome (SIDS): the sudden death of an infant which remains unexplained after all known and possible causes ruled out

  • Most victims are between 2-4 months of age

  • Cause is not well understood

  • It cannot be predicted

In the 1980s, New Zealand had the highest rate of SIDS among developed countries

  • Interventions reduced SIDS (red nose day) but Maori SIDS remained high

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Why did the National SIDS prevention campaign lead to an increase in the gap?

“The primary reason this first reform failed to redress infant mortality inequities was that the educational outreach targeting the three primary risk factors were heavily biased to be more favourably received by non-Maori audiences”

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Maori SIDS prevention programme

  • Travelled the country listening to the realities of each community

  • Attended to their concerns and priorities

  • Assisted communities to develop their own interventions

  • Used Maori collectives, networks, values and approaches

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Maori SIDS Prevention and Te Pae Mahutonga - Maoriora access to Te Ao Maori

working with communities to incorporate/revitalise traditional practices

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Maori SIDS Prevention and Te Pae Mahutonga - Toiora healthy lifestyles

Promoting smoke free spaces, safe bed sharing

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Maori SIDS Prevention and Te Pae Mahutonga - Te Oranga participation in society

Advocacy to improve education, income support

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Maori SIDS Prevention and Te Pae Mahutonga - Nga Manukura (leadership)

  • Maori professional and academic leadership

  • Collaboration with leaders in communities

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Maori SIDS Prevention and Te Pae Mahutonga - Te Mana Whakahaere (autonomy)

  • Communities enabled to identify their own aspirations and priorities, and to lead the design of their own solutions

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Prerequisites

  • Peace

  • Shelter

  • Education

  • Food

  • Income

  • Stable eco-system

  • Sustainable resources

  • Social justice & equity

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Principles of Maori Health Promotion

  • Led + designed by Maori for Maori

  • Promotes self-determination and control

  • Based on valid models, frameworks and concepts

  • Works with Maori people, values and collectives

  • Used contemporary tools and methods

  • Allows for diverse realities

  • Focus on determinants of health

  • Evidence-based