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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
What causes health inequities?
Health inequities are driven by the unfair distribution of health risks and opportunities (social determinants of health)
‘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
Models for health promotion
The Ottawa Charter
Te Pae Mahutonga
The Ottawa Charter prerequisites
Peace. shelter, education, food, income, stable eco-system, sustainable resources, social justice & equity
The Ottawa Charter
Create supportive environments
Develop personal skills
Re-orient health services
Strengthen community action
Build healthy public policy
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
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
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”
Te Pae Mahutonga - four key tasks
Maurioa
Waiora
Toiora
Te Oranga
Mauriora
Access to Te Ao Maori
Waiora
Environmental protection
Toiora
Healthy lifestyles
Te Oranga
Participation in society
Te Pae Mahutonga - two prerequisites
Nga Manukura
Te Mana Whakahaere
Na Manukura
Leadership
Health professional AND community leadership
Te Mana Whakahaere
Autonomy
Capacity for self governance
Community control & enabling political environment
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
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”
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
Maori SIDS Prevention and Te Pae Mahutonga - Maoriora access to Te Ao Maori
working with communities to incorporate/revitalise traditional practices
Maori SIDS Prevention and Te Pae Mahutonga - Toiora healthy lifestyles
Promoting smoke free spaces, safe bed sharing
Maori SIDS Prevention and Te Pae Mahutonga - Te Oranga participation in society
Advocacy to improve education, income support
Maori SIDS Prevention and Te Pae Mahutonga - Nga Manukura (leadership)
Maori professional and academic leadership
Collaboration with leaders in communities
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
Prerequisites
Peace
Shelter
Education
Food
Income
Stable eco-system
Sustainable resources
Social justice & equity
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