Elizabeth Sisson – Maori Take Charge of Health

The windows of Tracee Te Huia’s office at the Hawkes Bay District Health Board offices are almost obliterated by masses of post-it notes. There are hundreds of them and their careful layout outlines a change in the delivery of M?ori healthcare in the Bay. The notes represent 240 contracts let to accredited healthcare providers to work with M?ori. To Ms. Te Huia, director of M?ori Health for the HBDHB, they signal a better future for M?ori health.

“Much has been accomplished in the last three years toward the strategic approach for M?ori  health,” Ms. Te Huia said. “It requires a collaborative effort by both M?ori and non-M?ori to ensure a positive outcome for those who most need it.”

It’s needed. The Ministry of Health’s 2001 Health Survey found that the life expectancy for both M?ori men and women is more than eight years less than that for non-M?ori. M?ori have higher mortality rates for strokes, heart diseases and suicides; higher rates of disability; a greater number of preventable hospital admissions; two and a half times the prevalence of diabetes compared to non-M?ori; five times higher rates of sudden infant death; and more children who fail school-entry hearing tests.

Figures for Hawkes Bay are pretty much in line with national figures and the Bay has a relatively larger M?ori population than most areas in NZ:  based on the 2006 census, 23.5 percent of people in Hawke’s Bay Region belong to the M?ori ethnic group, compared to a 14.6 percent average in the rest of New Zealand.

The 2006/07 NZ Health Survey found little change: “Most concerning is the persistence of large disparities across a range of risk factors and health outcomes for Maori and Paci?c peoples compared to the total population, and also for children and adults living in neighbourhoods of high socioeconomic deprivation …”

Health status relates to socioeconomic status and M?ori people tend to be significantly more deprived than non-M?ori, based on nine socioeconomic variables used in the 2001 Census. In the “most deprived” category, the rate is 23 percent M?ori versus seven percent non-M?ori. At the other end of the scale, only three percent of M?ori are “least deprived” compared to 11 percent of non-M?ori. Discrimination based on race also has been identified as a factor affecting M?ori health.

Whanau ora

The dismal health statistics for M?ori reinvigorated efforts to address M?ori health issues. “The health of an Iwi is wider than the health of the people,” states Ngati Kahungunu, which includes about half of the M?ori people living in Hawkes Bay. “Environmental, economic, social and cultural wellbeing influence the health of the whanau (family), hapu (extended family) and Iwi (tribe).”

This holistic approach to health by M?ori does not fit well with the traditional Western healthcare model, which tends to focus on individuals and their specific diseases or injuries.

In February 2006, Ngati Kahungunu initiated a series of hui (meetings) on M?ori health at marae in the vast Ahuriri district, which runs from the Wharerata ranges in the Wairoa District to Cape Palliser in South Wairarapa, with coastal boundaries at Paritu in the north to Turakirae in the south.

“When participants talked about the barriers to whanau ora (family health) they acknowledged that there were both external (e.g., mainstream services) barriers as well as internal (e.g., within whanau) barriers,” reports Ngati Kahungunu.

“When they talked about internal barriers it was not to blame whanau, rather it was pointed out that whanau need to regain a sense of control over their own lives and that often things go wrong when whanau do not have this control. At the same time, people were not naïve about the dysfunction that exists within too many whanau.”

Among the barriers to whanau ora identified in the hui were Treaty of Waitangi and Crown relationships, social and economic status, mainstream lack of support for service providers, institutional racism, discrimination and disconnection.

The Treaty is inseparable from the effort to improve M?ori health. In its 2002 M?ori Health Strategy, the NZ Ministry of Health (MOH) declares, “The Strategy requires the Crown and Treaty partners to work together in good faith.”

The MOH expects District Health Boards to address M?ori health priorities, “taking into account the health needs assessments of their local population and the views of their Treaty partners, M?ori communities and providers.”

Treaty Claim

The closure of the Napier Hospital in 1998 generated a Treaty claim. M?ori had been guaranteed health services when the hospital was built. When the DHB closed it, local services to all residents, including M?ori, were curtailed. The M?ori claim was finally settled last October, and a Memorandum of Commitment was signed on 27 January 2009 between HBDHB and the Ahuriri District Health Trust setting out a new kind of partnership relationship, not simply another services contract, as DHB Commissioner Ngahiwi Tomoana emphasised.

As part of this agreement, two Crown-owned buildings in Maraenui are signed over to M?ori along with funding to develop and provide health services.

One of the buildings currently houses a private general practice with five physicians, which will continue. The appropriate services for the other building have been discussed with the community, said Piriniha Prentice, chairman of Ahuriri District Health Trust, part of Ngati Kahungunu. “Our responsibility is to build a far better health service than we have now, one with a holistic, coordinated approach.”

Ahuriri District Health Trust has other buildings in Napier, one of which will be used as a central hub for the district and for a mobile oral health program. The other will be used for mental health services. The District have until September to uplift contracts and get services underway.

Among other HBDHB contracted providers is one in Napier, Te Kupenga Hauora, managed by Audrey Robin. The organization was established 14 years ago with two part-time nurses and now has a staff of about 35, including nurses and social workers, most of them M?ori.  They work cooperatively with local physicians and have an ear, nose and throat specialist, Dr. David Grayson, who supports staff and clinics. The service has 5,000 clients.

“We go to the families,” Ms. Robin said, advising them about their health and the services available to them, such as a family program that focuses on early childhood, childcare and pre-school education. “The majority of our clients are the hard-to-reach. We’re actually making a difference, having a significant impact on the quality of life of local residents.”

With programs like this, now supported further by the Memorandum of Commitment, the devolution of health service management to Maori is well underway in Hawke’s Bay. This devolution is a “critical step in the journey to ensure that Maori are supported to reach their maximum health and well-being,” according to a recent report from staff to the HBDHB.

All local participants in the health care system seem to be committed to this partnership approach, backed by resources, which should inevitably introduce Maori sensibilities and approaches more effectively into health care for this part of the Hawke’s Bay community. And as Maori providers become more and more responsible for health care delivery to their community, they will take aboard an increasing sense of accountability as well.