New Zealand is an ethnically diverse country however the ethnic inequalities within

New Zealand is an ethnically diverse country, however the ethnic inequalities within the health care sector are very pronounced (Harris, Tobias, Jefferey’s, Waldegrave, Karlsen & Nazroo, 2006, p 2006). The first part of this essay aims to reflect on the disparities between Maori and Non-Maori health outcomes. It will focus on the statistical variations that exist, whilst utilizing the reflective framework of Rolfe, Freshwater and Jasper as cited in K. Usher and C. Holmes (2014).Additionally, it will analyse that effects of migration and employment as determinants of Maori health. Migration or urbanisation refers to the relocation of Maori to urban centres from traditional rural land, this was driven by employment opportunities (Pitama, Huria & Lacey, 2014, p 113). What?Equity is a moral concept that focuses on providing treatment that is just and fair to ensure everyone obtains the same health outcomes (Wilson & Hickey, 2015, p. 240). For most Maori equity is perceived as the goal, not the reality. Currently, Maori face significant barriers in gaining access to health services that meet their health and cultural needs (Wilson & Hickey, 2015, p. 236). So, why are there such significant gaps in the quality and availability of health services for Maori and their whanau when compared to their Non- Maori cohorts? Health inequalities for Maori are reinforced by the presence of differential determinants of health, different access to health care and a variance in the quality of care received (Russell, Smiler & Stace, 2013, p. 12). All these factors limit the desire of Maori to engage in services that support the wellbeing of not only themselves, but also their whanau. Evidently the system isn’t preforming well for Maori due to the structural biases.So, What? The lack of equity in health care, particularly for Maori is apparent in the rate of morbidity, mortality and service use (Wilson & Hickey, 2015, p. 239). Maori (41%) depict an increased likelihood of residence in areas of deprivation when equated to that of Non- Maori (15%) (Wilson & Hickey, 2015, p. 239). A lack of, or poor level of health literacy is also more predominant in Maori communities than any other ethnic group (Wepa, 2015, p. 239). Health literacy refers to the ability to understand and interpret information regarding one’s health (MOH, 2015). Unemployment rates of Maori (11.9%) also disproportionately exceed that of Non- Maori (3.9%) (Stats NZ, 2017) These factors all negatively affect the ability of Maori to access essential determinants of health. This is evidenced by the high proportion of hospital admissions that result from avoidance of primary care services for treatable conditions. For many Maori unexpected hospital readmissions and even death subsequent to hospitalization is 16% more likely. Cardiovascular disease, lung cancer, diabetes, chronic obstructive pulmonary disease and even suicide account for many Maori deaths (Wilson & Hickey, 2015, p 239). Health related complications impact the life expectancy of Maori, as they die up 7 years younger than most Non-Maori (Wilson & Hickey, 2015, p 239).Maori also fail to seek health interventions early due to the increased likelihood of experiencing biases such as discrimination or racism (Jones. P. C, 2000, pp. 1212-1213) There are three main forms of racism; internalised, personally mediated and institutional (Wilson & Hickey, 2015, p. 239). The classifications of racisms contribute to the poor health outcomes that Maori experience, by limiting their access to necessary health services and reducing the quality of care offered. Under the Treaty of Waitangi, New Zealand Registered Nurses (NZRN) are required to develop therapeutic relationships with Maori that are centred on the attributes of protection, participation, partnership and Tino Rangatiratanga (self-determination) (Wilson & Hickey, 2015, p. 242). This means that NZRN must consider cultural safety when engaging with Maori. Cultural safety refers to practising in manner that exhibits an awareness of the cultural needs of others, whilst putting aside one’s own cultural values (Vernon & Papps, 2015, p. 60). Despite the treaty values, equitable and optimal health outcomes for Maori still falter in comparison to Non- Maori. To achieve unbiased holistic health results, we must implement different approaches to constitute the same outcomes that others receive (Wepa, 2015, p 240). Without adaptation we continue to imply, that the same needs require the same solution. So, how does a system that is supposed to consider everyone, fail to recognise the disparities? We simply account for what is considered as ‘normal’. Now What?Education around the disparities inflicted on our Maori communities has made me more aware of the importance of my current role as a student nurse. It is not acceptable to simply ignore the social biases. The cultural competence of health professionals effects the interactions and experiences Maori and their whanau have when engaging in health services (Wilson & Hickey, 2015, pp. 242-247) A positive experience will entice Maori to actively revisit the services they require. So, what can we do to change the negative connotations Maori associate with our health services? Self-awareness and acceptance of Maori preferences is the key to making a meaningful connection (Lacey, Huria, Beckert & Pitama, 2011). For many Maori their language is a significant part of their culture, therefore, utilizing Te Reo when communicating with Maori and their whanau in a therapeutic setting will establish a sense of connection and trust (Wilson & Hickey, 2015, p. 243). This does not mean that the nurse is required to speak fluent Te Reo, but it does require an accepting attitude.The Hui process is also a therapeutic tool of cultural significance to Maori. This involves four aspects; Mihi the initial encounter, whakawhanaungatanga making a connection, kaupapa the main purpose of the encounter and poroporaki ending of the encounter, with mutual understanding of the outcome (Lacey, Huria, Beckert & Pitama, 2011). Engaging in the Hui process enhances the rapport that is built within the therapeutic relationship. Utilizing Te Reo Maori, the Hui process and practising in a manner that is considered as culturally safe will ensure Maori feel like their cultural needs are being respected. From the Wanaka Hauora seminar it is now evident to me that a collective appreciation and respect for the cultural values and practises of Maori, will break down the barriers that prevent health access. Taking the time to understand Maori culture will not only enhance their experiences with health services and increase heath literacy but also aid positive health outcomes (Wilson & Hickey, 2015, p. 245) The collaboration that is required to meet the health expectations of Maori is also generalisable when interacting with individuals from all cultures (De Souza, 2015b, p 120-121). Learning about the inequalities and prejudices Maori face in the health sector has made me more aware of the effects of my actions and the impact of asking the right questions. Simple interventions such as protecting Maori rights to fair treatment, participating in providing quality care and working in partnership to establish a collaborative therapeutic relationship will ensure that cultural safety is upheld (Wilson & Hickey, 2015, pp. 242-245).Both migration and employment have impacted the interactions that Maori have with health services in contemporary societies. Migration is driven by push/pull factors that attract or detract migrants to or from a destination (De Souza, 2015a, p 195). Historically, Maori tentatively migrated from their traditional iwi lands to regional urban centres within Aotearoa New Zealand (Pitama, Huria & Lacey, 2014, p 113). The rural to urban migration of Maori occurred due to their inability to support their livelihoods off existing land ownerships, and the attraction of stronger economies in regional centres. Maori perceived the move as a foundation to gaining “improved levels of health and living standards” (Gemmell, 2013, p 50). However, traditional Maori culture was not considered as an integral part of urban living, as a result Maori were subjected to a loss of culture, a loss of identity, deprivation and discrimination (Becares, Cormack & Harris, 2013, pp. 77- 78). Urbanisation also introduced a reduction in the solidarity, collectiveness and community focus exercised by traditional Maori and their whanau, this was in favour of European individualism which decreased the importance of whanaungatanga; a sense of family connection (McIntosh, 2005, p 49). The migration of Maori from rural communities to disconnected urban centres placed a strain on all aspects that symbolize health as perceived by Maori. These factors include one’s wairua, tinana, hinengaro and whanau support as exhibited by the Meihana model (Pitama. S, Robertson. P, Cram. F, Gillies. M, Huria. T, & Dallas-Katoa. W, 2007, p. 121). Features that hindered the holistic wellbeing of Maori encompassed poor quality living standards, changes in diet, long labour-intensive work hours, limited local familial ties and the stresses of urban living. Previously well-adjusted healthy Maori populations came to suffer, demonstrating no improvements to their livelihoods (Poata-Smith, 2013, p. 149).Diet changes due to the introduction of European staples of flour and sugar brought to focus obesity problems for modern Maori (Timu-Parata, 2009, pp 40-41). Traditional Maori lived of the land utilizing its resources. Food sources were hunted, gathered and grown (Timu- Parata, 2009, pp. 40-41). Maori survived off high protein, plant-based diets inclusive of foods such as fish, mussels, seaweed, kumara, potatoes and other vegetables. These healthier alternatives are now harder to obtain due to the ever-increasing costs of contemporary living. This means Maori and their whanau are exposed to poor quality eating habits that increase their likelihood of developing conditions such as type 2 diabetes (Wilson & Hickey, 2015, p. 239).Maori access to suitable health services and quality care is also a historical inequality made more evident through urban migration (Timu- Parata, 2009, pp. 40-41). Since European colonisation in New Zealand health services have exhibited discriminatory undertones, directing care towards fulfilling the health concerns of majority groups (Pakeha) with little consideration for Maori (Timu- Parata, 2009, pp. 40-41). This meant Maori had to manage and treat diseases with limited familiarity of the cause or consequences that would result. Maori health became dramatically compromised exacerbated by the growing socio-economic disparities between Maori and Non- Maori (Hill, 2008, p. 33). Migration has acted as a historical determinant for the health of Maori.Post-World War II employment opportunities in regional areas of New Zealand stimulated urbanisation of Maori. The drift was incentivised by the promise of work and accommodation (King, Smith & Gracey, 2009, p. 81). The economic prosperity generated after the war was however, not equally distributed (Poata- Smith, 2013, pp. 149- 150). This meant that Maori participated in labour intensive work within the primary sector for instance forestry jobs, for small social and economic gains (Poata- Smith, 2013, pp. 149-150). Maori endured the inequalities under the belief that their economic, cultural and social deprivations would soon resolve due to the thriving economy. In the early 1970’s, New Zealand’s economy entered a phase of economic and political crisis. Already struggling Maori families continued to experience excessively poor educational outcomes, high levels of unemployment and low income all of which contributed to the instability of Maori health and wellbeing (Poata- Smith, 2013, p 150).The social gap established because of European colonisation has remained predominant in modern communities (Poata- Smith, 2013, p. 154). Maori continue to face the same challenges working in low income jobs or battling unemployment with the aim to meet the needs of their whanau. The financial instability inflicted on many Maori families impairs how health is prioritized. Having a stable income increases health benefits by ensuring that one can access, afford and receive required health interventions (MOH, 2004, p. 5) One’s level of health can then be maintained by other social determinants such as access to nutritional food, education opportunities and residing in a warm, dry, insulated home (Hill, 2008, p. 34). Many Maori do not have the resources to maintain their health and the health of their whanau (Hill, 2008, p. 44) Consequently, Maori exhibit high risk of ongoing health problems such as obesity, respiratory issues and cardiovascular disease (Wilson & Hickey, 2015, p 239). This is based on inadequate damp housing and the high level of cheap processed sugary foods available to low income families.The level of health based on income acts as a two-way process whereby good health reflects a higher income and poor health reflects a lower income (Hill, 2008, pp 35-36). Those living in wealth continue to reap the rewards not granted to the lower tiers within our communities (Poata- Smith, 2013, p. 154). Socio-economic inequalities persist making health unobtainable to those living in deprivation this has a significant impact on Maori as an ethnic group (Poata-Smith, 2013, p. 154). Employment has acted as an ongoing determinant for health of Maori. Health is distributed unequally in New Zealand; Maori societies bear the brunt of these inequalities. Engagement with, and prioritization of health is affected by societal factors of racism and deprivation alongside socio-economic barriers. The restrictions Maori face when accessing health are deep rooted historical challenges based on the impact of migration and employment. Migration and employment patterns of the past are mimicked in contemporary societies as the same disparities are still present. To reduce the social gap, it is important to respect the cultural values of Maori and apply culturally safe actions when engaging in a therapeutic relationship.

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