Health Care of the Older Adult: An Australian and New Zealand Perspective

Improving Access to Health Care Among New Zealand’s Maori Population

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A study of informal competency determinations in primary care. The six step capacity assessment process. The core of self-neglect. Older people and permanent care: British Journal of Social Work, 35, Are persons with cognitive impairment able to state consistent choices?

The Gerontologist, 41 3 , Living alone with dementia: A case study approach to understanding risk. The importance of executive deficits: Cross-cultural aspects of geriatric decision-making capacity. Ethics, Law and Aging Review, 11, The ethics of care and social work with older people. British Journal of Social Work, 36, Physician assessment of patient competence. Journal of the American Geriatric Society, 43 6 , A conceptual model and assessment template for capacity evaluation in adult guardianship.

Improving Access to Health Care Among New Zealand’s Maori Population

The Gerontologist, 47 5 , When the mind fails: A guide to dealing with incompetency. University of Toronto Press. Mental capacity assessments and discharge decisions. Age and Ageing, 34, Maori fertility rates remained elevated both through the period of severe mortality decline and as mortality rates improved, resulting in a population with an age structure that is relatively young.

Life expectancy has increased among the indigenous populations of New Zealand, Australia, Canada, and the United States over time but has never matched that of the nonindigenous populations of these countries. In contrast, Maori life expectancy at birth increased from only Thus, during this period, the gap in life expectancy between Maoris and non-Maoris increased among both men from 6. Pomare used data from through to provide a comprehensive overview of Maori health status. Mortality rates have since declined for some diseases, but disparities between Maoris and non-Maoris remain.

Also, there is recent evidence of increasing cancer mortality rates among Maoris; age-standardized rates per were Similarly, although overall hospital discharge rates among both Maoris and non-Maoris increased in all age groups between and , Maori rates continue to be 1. A number of different explanations have been suggested for the inequalities in health between Maoris and non-Maoris. One common suggestion is that these differences are due to genetic factors.

The striking time trends in Maori mortality and morbidity during the 20th century demonstrate that environmental factors played the major role. Nongenetic explanations for differences in health between Maoris and non-Maoris can be grouped into 4 major areas focusing on socioeconomic factors, lifestyle factors, access to health care, and discrimination.

These explanations are not mutually exclusive, but it is useful to consider them separately while bearing in mind that they are inextricably linked. The first studies to assess the role of socioeconomic factors and health status differences between Maoris and non-Maoris investigated mortality in men aged 15 to 64 years. In addition, a number of studies have demonstrated increasing mortality and morbidity with increasing deprivation.

Area meshblocks which contain an average of 90 people are ranked by means of a decile score of 1 to 10; the higher the score, the more deprived the neighborhood.

However, lower Maori health status is only partially explained by relative socioeconomic disadvantage; Maori mortality rates have been shown to be persistently high even after control for social class. It can be argued that lifestyle factors, such as smoking, represent one of the mechanisms by which socioeconomic factors affect health status.

As noted earlier, a significant proportion of the excess mortality among Maoris stems from diseases for which effective health care is available, suggesting differences in access to health care. There is increasing evidence that Maoris and non-Maoris differ in terms of access to both primary and secondary health care services, 33 , 34 that Maoris are less likely to be referred for surgical care and specialist services, and that, given the disparities in mortality, they receive lower than expected levels of quality hospital care than non-Maoris.

The role of discrimination and racism in harming health is not new but has received increasing attention over the past 20 years. Another study reported barriers to accessing diabetes care among Maoris, including unsatisfactory previous encounters with professionals and experiences of disempowerment. However, the system was subsequently modified to a government-paid fee-for-service subsidy with secondary care under state control and funding and primary care largely state funded but controlled by individual doctors.

In , a series of major health service reforms were initiated, including 2 particularly important changes concerning the way in which public hospital and population health services were organized and delivered and a new funding scheme for the provision of primary health care that enabled health practitioners to work together to provide contracted primary care services.

At the beginning of the 20th century, Maori leadership played a key role in advancing health promotion and disease control activities within Maori communities. An opportunity for the focused development of Maori provider services emerged with the introduction of the health reforms. However, this restructuring of health and social services also led to a widening gap in inequality, as evident in such key determinants of health as income, education, employment, and housing.

Moreover, the reforms had direct effects on the health of Maoris, particularly that of children. What are the differences between health services provided by Maoris and those provided by non-Maoris? Crengle 48 identified use of Maori models of health and promotion of positive Maori development as 2 key philosophies underpinning Maori primary health care services.

Maori cultural processes used as a basis for developing and delivering contemporary health services that support self-sufficiency and Maori control are crucial to the success of these provider organizations. Maori provider services have specifically identified access issues as a key factor and have used a range of strategies to address these issues, including extensive mobile services and outreach clinics alongside a health center service base , free or low-cost health care, employment of primarily Maori staff who are more likely to have access to Maori consumers in their communities, 48 and active inclusion of the community in the planning and delivery of services.

The number of Maori health providers increased from 13 in to in However, these providers continue to face a number of difficulties. For example, a lack of good primary health data, such as ethnicity data, has limited the potential of many Maori health providers, and a small Maori health work-force has been quickly absorbed into the growing number of Maori provider organizations. Also, the short contract time frames in place require extensive renegotiations each year.

In addition, because Maori providers work primarily with families at high levels of need in terms of health services, increased costs are inevitable if health gains are to be achieved, and funders must take this situation into account. It is too soon to assess the effects that the Maori provider organizations are having on the health status of Maoris, and these organizations should be viewed as representing one of a package of necessary long-term measures.

Although the evidence that such strategies are effective is not yet available, there is certainly evidence that the reverse is true; that is, health service provision with little Maori participation results in poor Maori outcomes. One such initiative, cultural safety, is an educational framework designed to assess power relationships between health professionals and those they serve. The cultural safety initiative includes teaching of the history of New Zealand within its curricula and provides comprehensive information on the Treaty of Waitangi and the effects of colonization on the present-day health status of Maoris.

Therefore, it is important that cultural safety be taught by nurses and midwives who can relate their teaching directly to practice situations. The nurse acknowledges that the effect of his or her homophobia on the recipient of care may be unsafe and detrimental to care and that it would take a great deal longer to establish trust in this context. This example could be applied to a wide range of situations. The cultural safety initiative does not advocate a cultural immersion approach or the learning of customs of ethno-specific groups, in that this would promote a stereotypical view of culture over time.

Along with understanding and confronting issues of power and marginalization, a critical component of cultural safety education is recognizing the role of wider societal processes in maintaining health disparities between Maoris and non-Maoris through discrimination and racism. This resulted in a political response in , with the Nursing Council of New Zealand being required to review cultural safety education and report back to a parliamentary select committee. Cultural safety education is currently included in assessments of registered nurses and midwives within some regions of New Zealand as part of their clinical career development, and there has been support for it to become a core component of the training of all health professionals.

NEW ZEALAND SETTLEMENT AND THE TREATY OF WAITANGI

Although there have been significant improvements in the past years, recent evidence indicates that the overall gap in life expectancy between these groups is widening rather than narrowing. Explanations for these differences involve a complex mix of factors associated with socioeconomic and lifestyle characteristics, discrimination, and access to health care.

Maori-led programs designed to improve health care access are taking a 2-fold approach that supports both the development of Maori provider services and the enhancement of mainstream services through provision of culturally safe care. The driving force behind the new initiatives described here has been the evidence of the poor health status of the indigenous people of New Zealand and their clear demand for improved health services.

Maori provider organizations and cultural safety education are examples of initiatives that have emerged not in isolation but, rather, within a context of macro-level government policies that have been shown to either promote or greatly hinder the health status of indigenous peoples.

Ellison-Loschmann originated the review and wrote the article. Pearce assisted with originating ideas and reviewed drafts of the article.

National Center for Biotechnology Information , U. Am J Public Health. Find articles by Lis Ellison-Loschmann. Find articles by Neil Pearce. Author information Article notes Copyright and License information Disclaimer.

Health Care of the Older Adult - An Australian and New Zealand Nursing Perspective (Paperback)

Accepted July 26, This article has been cited by other articles in PMC. Abstract The health status of indigenous peoples worldwide varies according to their unique historical, political, and social circumstances. Socioeconomic Factors The first studies to assess the role of socioeconomic factors and health status differences between Maoris and non-Maoris investigated mortality in men aged 15 to 64 years.

Lifestyle Factors It can be argued that lifestyle factors, such as smoking, represent one of the mechanisms by which socioeconomic factors affect health status. Access to Health Care As noted earlier, a significant proportion of the excess mortality among Maoris stems from diseases for which effective health care is available, suggesting differences in access to health care. Discrimination The role of discrimination and racism in harming health is not new but has received increasing attention over the past 20 years.

Maori Health Care Providers At the beginning of the 20th century, Maori leadership played a key role in advancing health promotion and disease control activities within Maori communities. Notes Peer Reviewed Contributors L. The social force of nursing and midwifery. Maori Wellbeing and Development. Auckland University Press; The Penguin History of New Zealand. Te Mana, te Kawanatanga: The Politics of Maori Self-Determination. Oxford University Press Inc; Disease and Social Diversity: Land purchase methods and their effects on Maori population — Kia Ururu mai a Hauora: Being Healthy, Being Maori.

Conceptualising Maori Health Promotion [dissertation]. University of Otago; A Study of the Years —

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