New Zealand health status of Maori and non–Maori

Introduction

In New Zealand the health status of Maori and non –Maori varies according to their unique historical, political, social circumstances. In the history of New Zealand, Maori and non-Maori had a lot of disparities regarding their health status and this was associated with socioeconomic, availability of health care, discrimination and lifestyle factors. Like other ethnic groups Maori also face threats to their sovereignty and self determination which became barriers to access and inclusion and resulted in negative health status. The Ministry of Health identified the seriousness of the matter associated with Maori health and has acknowledged the importance of prioritizing it to reduce and eliminate disparities and equalities of health that negatively affect Maori.

In the history of New Zealand, when the first Europeans arrived in 1769 they brought with them virulent diseases which the Maori was not aware of. Significant diseases as well as venereal infections were brought such as measles, influenza, typhoid fever, dysentery and tuberculosis. Other venereal diseases were introduced during James Cook’s voyage around New Zealand such as gonorrhoea and syphilis and had an effect on birth rates through sterility and still births. The Maori population had declined by 10-30% by 1840 due to the effects from introduced diseases and also directly and indirectly by the Musket Wars which dislocated agriculture lands from Maori which were important to them as they provided access to ‘ mahinga kai’(food resource area).

Between 1840 and 1891 there was a significant impact on the population and serious negative effects on Maori health due to diseases, social and economic changes which lead to inequalities and disparities in the Maori and non-Maori health status and access to health care.

There was a large- scale and confiscations and tribal dislocation from the traditional Maori environment were brought about by the land wars. The Native Land Court was in operation and a widespread of land was loss and was used for economic activity. These directly affected the health standards of Maori as they changed their housing styles, water supplies, sanitation and diet. According to Maori the acts of the law was not only dislocating and losing their land but also the legislation in many areas affected Maori health by regulations put on Maori rights and discrimination against using Maori language in schools. During this period Maori was exposed to new diseases and there was a very large increase in European population. Due to diseases like pneumonia and respiratory infections many Maori children died in their first year of life. Many adults and older children also suffered viral and chronic diseases that often ended fatally. As a result of high death rates and low birth rates decline the Maori population between 1840 and 1878.

In 1840 the Treaty of Waitangi was signed by British Crown and some of the Maori chiefs, it was a formal agreement that guaranteed the protection of Maori interest and their unique rights as the indigenous people of New Zealand. The concerns were raised by the missionaries for Maori health decline and medical care was provided. In 1840’s Government hospitals were set up in few places for Maori but it also lead to inequalities and disparities among Maori and non-Maori population. As the increasing non-Maori population hospitals were built and administered by the local settler communities but many Maori were suspicious to visit hospitals due to cultural reasons and also unable to pay the fees which affected their health.

Maori health became a priority and the government subsidised a number of doctors who were mainly the native medical officers to provide medical care for Maori and for those who could not afford to pay the treatment. To improve Maori health teachers in native schools were also given medicines to treat pupils and their families who seek medical treatment. To educate Maori more about the diseases and health care a handbook entitled ‘Health for the Maori’ was written by education official James Pope which was translated in Maori and was widely used to improve health status.

The nursing workforce recognises and ensures that equal opportunities and services are provided to Maori as well as non-Maori in pursuing equality in health outcomes. Under the Health Practioners Competences Assurance Act 2003 the Nursing Council of New Zealand ensures safe and competent care of the public of New Zealand. The council sets and monitors standards and competences for registration of nurses and governs the practice through aspects of Cultural Safety, the Treaty of Waitangi and Maori Health.

The Nursing council require the nurses to practice nursing in a manner which is culturally safe and that compliance with the Treaty of Waitangi / Te Tiriti O Waitangi to create a functional partnerships with Maori consumers and respecting their culture and beliefs as well as providing quality health care services. The nursing association based their way of delivering care to the consumers by adapting and recognizing different cultures which include, age or generation, sexual orientation, religious belief, migrant experience, occupation and socioeconomic status, and disability. Maori as well as non Maori are provided with the same health services and their different cultural beliefs are respected.

[1]The Code of Health and Disability Services Consumer Rights(2009) states that “ every consumer has the right to be provided with services that take into account the needs, values and beliefs of different cultural, religious, social and ethnic groups including the needs , values and beliefs of Maori”.

Cultural Safety in nursing education enables them to extend their knowledge beyond beliefs and values of ethnic groups and learn about the rituals, customs and practices of Maori culture. It enables them to learn about Maori culture and their behaviours and social realities about life which focuses upon understanding an individual. Nurses and medical practioners normally come across social realities of people who do not have their own cultural information and therefore nursing education teaches them to gain knowledge and skills to deal with behaviours from social and personal events of people who are unique and different from each other.

According to Cultural Safety it requires that nursing services should be given to all human being taking into account all that which makes them unique. It promotes nurses to deliver health and disability services to Maori and non-Maori in a culturally safe manner identifying the power relationship between them with the aim of reducing disparities among Maori and non-Maori. The nurses provide service to people in a manner which is not biased and accepts and works alongside with Maori and non-Maori with their different cultural beliefs and personal analysis of power relationships.

People who use the service should be empowered to express the risk and safety of the services for example if they are not being able to get service which are strengthening their health in primary health care service should seek medical care in tertiary or secondary care service. Cultural Safety helps nurses to prepare themselves and understand the diversity within their own cultural reality and the impact on those people who differ from them. The service provider has more power compared to the person who receives the service as they are more aware of their health conditions and the safe and appropriate treatment required for the patient but the patient has equal rights and power to refuse any medical treatment or enquire about their condition.

Nursing education enables and prepares nurses to accept and understand the diversity within their own cultural reality and also the impact it has on other people who differ from them. Nursing practice is not only providing service to people but how effectively and efficiently they relate and respond to people with diverse needs in a safe and acceptable manner.

In conclusion Maori population is seen to have the largest proportion of using health services and the health status of Maori is recognised as a health priority area. The Maori receiving services from the nurses are fundamental which increases the effectiveness of interventions. The Treaty of Waitangi principles form basis of interactions when Maori consumers are receiving services provided by nurses.

Nurses working together with Maori help to create a partnership with them at the same time improving Maori health outcomes and reducing inequalities and disparities among Maori and non-Maori. The nurses are educated to act in good faith as the Treaty of Waitangi partners with Maori giving equal opportunities for non-Maori as well. They work together with cooperation with common interests and mutual understanding to achieve positive health outcomes and identify power relationship between the service provider and the people who use the service. Services are provided to Maori consumers where decision making and service delivered are agreed upon and well planned by both the service provider and the Maori. The Nurses work in partnership with Maori consumers ensuring that the integrity and well being is preserved.

References

1. Health devastated, 1769 to 1901 – Te hauora Māori i mua – history of Māori health – Te Ara Encyclopedia of New Zealand. (n.d.). Retrieved from http://www.teara.govt.nz/en/te-hauora-maori-i-mua-history-of-maori-health/page-2

2. Improving Access to Health Care Among New Zealand’s Maori Population. (2006, April). Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470538

3. Guidelines for Cultural Safety, the Treaty of Waitangi and Maori Health in Nursing Education and Practice. (2005, March). Retrieved from http://pro.healthmentoronline.com/assets/Uploads/refract/pdf/Nursing_Council_cultural-safety11.pdf

[1] Health & Disability Commission.(2009). Code of Health and Disability Services Consumers Rights.