Housework Metaphor for Gambling Public Health Action: An Indigenous Perspective

Housework,thosedutiesdoneathomeorinone’scommunitytokeepandcleanand tidy, is used in this paper as a metaphor for Māori involvement in gambling public health action in New Zealand. For over a decade Māori have been developing their own voice, public health actions, gambling services, research and workforce development initiatives to address gambling related harm at a whānau, community, local government, national and now international level. Involvement in gambling public health action has required Māori to utilise our Treaty of Waitangi and now international indigenous peoples’ rights to ensuring legislation and host responsibility requirements are met at all levels in New Zealand society. Housework which is a demanding task required to be done on a regular basis Māori have found never ends. To address this situation Māori have moved their focus to those organisations which have duty of care responsibilities defined under the Gambling Act 2003 and local government responsbilities to involve them in housework duties. By working together, Māori have assumed this will assist in reducing gambling related harm. Efforts made by Māori have been shared at our first interna- tional indigenous gambling conference held in New Zealand to warn our local Pacific nation neighbours of the risks associated with expansion of gambling

Nutrition risk: cultural aspects of assessment

Aim: To assess a nutrition risk screening tool amongst Māori and non-Māori of advanced age. Method: A cross sectional feasibility study was conducted in three North Island locations. One hundred and eight communityliving residents aged 75-85 years were assessed for nutrition risk using 'the validated questionnaire 'Seniors in the Community: Risk Evaluation for Eating and Nutrition', Version II (SCREENII) and level of physical activity using the 'Physical Activity Scale for the Elderly' (PASE). Physical assessments included height and weight. Results: Fifty-two percent of participants were assessed to be at high nutrition risk (SCREENII score <50; range 29-58; out of maximum score 64). Nutrition risk factors amongst Māori and non-Māori respectively differed for weight change in the previous six months (45.2% and 18.7%, p=0.005), skipping meals (54.8% and 13.3%, p<0.001), fruit and vegetable intake (77.4% and 18.7%, p<0.001) and the use of meal replacements (28.1% and 9.3%, p=0.013). Process evaluation showed that Māori took different meaning from the individual question items in SCREENII. Level of physical activity (PASE score) was higher for Māori, median (IQR): 125 (74) than non-Māori, 72 (74) (p<0.001) especially for leisure-time and household related activity. BMI was higher for Māori median (IQR): 31.5 kg/m 2 (6.8) compared to non-Māori 24.7 kg/m 2 (5.4) (p<0.001). Conclusions: The nutrition risk tool suggested that Māori were at high risk for malnutrition despite higher BMI and higher levels of activity. Several items of the screening tool were interpreted differently among Māori compared to non-Māori. Further development is needed to ensure accurate assessment

Health equity in the New Zealand health care system: a national survey

<p>Abstract</p> <p>Introduction</p> <p>In all countries people experience different social circumstances that result in avoidable differences in health. In New Zealand, Māori, Pacific peoples, and those with lower socioeconomic status experience higher levels of chronic illness, which is the leading cause of mortality, morbidity and inequitable health outcomes. Whilst the health system can enable a fairer distribution of good health, limited national data is available to measure health equity. Therefore, we sought to find out whether health services in New Zealand were equitable by measuring the level of development of components of chronic care management systems across district health boards. Variation in provision by geography, condition or ethnicity can be interpreted as inequitable.</p> <p>Methods</p> <p>A national survey of district health boards (DHBs) was undertaken on macro approaches to chronic condition management with detail on cardiovascular disease, chronic obstructive pulmonary disease, congestive heart failure, stroke and diabetes. Additional data from expert informant interviews on program reach and the cultural needs of Māori and Pacific peoples was sought. Survey data were analyzed on dimensions of health equity relevant to strategic planning and program delivery. Results are presented as descriptive statistics and free text. Interviews were transcribed and NVivo 8 software supported a general inductive approach to identify common themes.</p> <p>Results</p> <p>Survey responses were received from the majority of DHBs (15/21), some PHOs (21/84) and 31 expert informants. Measuring, monitoring and targeting equity is not systematically undertaken. The Health Equity Assessment Tool is used in strategic planning but not in decisions about implementing or monitoring disease programs. Variable implementation of evidence-based practices in disease management and multiple funding streams made program implementation difficult. Equity for Māori is embedded in policy, this is not so for other ethnic groups or by geography. Populations that conventional practitioners find hard to reach, despite recognized needs, are often underserved. Nurses and community health workers carried a disproportionate burden of care. Cultural and diversity training is not a condition of employment.</p> <p>Conclusions</p> <p>There is a struggle to put equity principles into practice, indicating will without enactment. Equity is not addressed systematically below strategic levels and equity does not shape funding decisions, program development, implementation and monitoring. Equity is not incentivized although examples of exceptional practice, driven by individuals, are evident across New Zealand.</p

Life and living in advanced age: a cohort study in New Zealand - Te Puāwaitanga o Nga Tapuwae Kia Ora Tonu, LiLACS NZ: Study protocol

The number of people of advanced age (85&thinsp;years and older) is increasing and health systems may be challenged by increasing health-related needs. Recent overseas evidence suggests relatively high levels of wellbeing in this group, however little is known about people of advanced age, particularly the indigenous Māori, in Aotearoa, New Zealand. This paper outlines the methods of the study Life and Living in Advanced Age: A Cohort Study in New Zealand. The study aimed to establish predictors of successful advanced ageing and understand the relative importance of health, frailty, cultural, social &amp; economic factors to successful ageing for Māori and non-Māori in New Zealand

Engagement and recruitment of Māori and non‐Māori people of advanced age to LiLACS NZ

Abstract Objectives : Life and Living in Advanced Age: A Cohort Study in New Zealand (LiLACS NZ) aims to determine the predictors of successful advanced ageing and understand the trajectories of wellbeing in advanced age. This paper reports recruitment strategies used to enrol 600 Māori aged 80–90 years and 600 non‐Māori aged 85 years living within a defined geographic boundary. Methods : Electoral roll and primary health lists of older people were used as a base for identification and recruitment, supplemented by word of mouth, community awareness raising and publicity. A Kaupapa Māori method was used to recruit Māori with: dual Māori and non‐Māori research leadership; the formation of a support group; local tribal organisations and health providers recruiting participants; and use of the Māori language in interviews. Non‐Māori were recruited through local health and community networks. Six organisations used differing strategies to invite older people to participate in several ways: complete full or partial interviews; complete physical assessments; provide a blood sample and provide access to medical records. Results : During 14 months in 2010–2011, 421 of 766 (56%) eligible Māori and 516 of 870 (59%) eligible non‐Māori were enrolled. Participation and contribution of information varied across the recruitment sites. Conclusion : Attention to appropriate recruitment techniques resulted in an acceptable engagement and recruitment for both Māori and non‐Māori of advanced age in a longitudinal cohort study. Implications : There is high potential for meaningful results useful for participants, their whānau and families, health agencies, planners and policy