According to the definition provided by the World Health Organization, epidemiology can be defined as the study of the distribution as well as the determinants of health related states and events which may include diseases also. Application of this study helps to control diseases and other health problems. Descriptive studies and surveillance are often used to carry epidemiological investigations. They help to study distribution and analytical studies to determine determinants. With the advancement of the medical science in the present generation, the life expectancy of the people has increased. Therefore a larger population of old aged people is living happily with their families. The rate of mortality has decreased as more people are being benefitted by the modern medical amenities and services in the nation. However, the rate of morbidity is seen to been increasing. A large number of people are living in poorer health. This is because although the system has been successful in preventing early death but has not been capable of providing quality life to people living in co morbid conditions. Huge amount of researches and initiatives have been taken to develop the morbidity statistics of the nation and to give better lives. Out of these situations, the most vulnerable groups who suffer the most are the Maoris in comparison to the non-Maoris. Since many decades, a strong difference in health status has been noted between the Maoris and non Maoris where the rate of each kind of disorder is higher in Maoris and non Maoris (Mitrou et al., 2014). Therefore this report will mainly shed life how different diseases have various affecting rates between Maoris and non Maoris. The main factors for this difference will also be discussed. Following this, the different initiatives taken over the years and the initiatives which are still need to be taken will be discussed.
Morbidity and mortality:
Mortality means death especially on a large scale. Morbidity means suffering of huge number of individuals due to diseases, disorders, ill health and others. Among Maoris, the main causes of mortality and morbidity are ischemic heart disease, Diabetes, Lung cancer, Motor vehicle accidents, chronic obstructive pulmonary disease, cerebro-vascular disease (stroke) and suicide. Similar causes are also present among non Maoris but the rate of mortality and morbidity is much lower than the Maoris.
Cardiovascular disease is one of the major rates of death and suffering among large number of populations of New Zealand. In case of the Maori, total cardiovascular disease mortality per 10000 ranges for about 346.9 in males and 232.3 in females. The similar in the non-Maori citizens per 100000 in the year 2014 is 168.2 in males and 99.2 in females. This gives a clear indication of how disparities exist between both Maoris and non Maoris. Researchers are of the opinion that poor health literacy and maintenance of low quality lifestyles have exposed the Maoris to a greater danger. Even if the hospitalization rate if noticed, it will show that the hospitalization rate due to cardiovascular disorder per 100000 is 3725.6 in males and 2710.2 in females among to Maoris ("Cardiovascular disease", 2017). The same is 2537.2 in males and 1376.0 in females among the non Maoris. Thereby it can be seen that Maoris are subjected to more hospitalization resulting in higher flow of their resources than non Maoris. Besides, heart mortality rate among the Maoris are also found to be twice than the rate of the non Maori. Moreover statistics also stated that Maoris were likely to be 4 times more prone to hospitalization due to heart failure than the non Maoris. Ischemic heart diseases account for about half of the cardiovascular diseases mortalities. This disease reacted mortality accounts for about 205.5 in males to that of 109.5 in females in per 100000 Maoris whereas the same for the non Maori population was found to be much lesser like 103.3 in males and 44.0 in females per 100000 of the non Maoris ("Cardiovascular disease" Ministry of Health New Zealand, 2017). A similar high rate of hospitalization due to these diseases is found to be higher in the Maoris than the non Maori which signifies the presence of disparities in the number of Maori and non Maori population getting affected and hence the factors present at the base of the disparity needs to be discussed.
Diabetes is yet another concern among the populations of New Zealand. It has been found form the data collected in 2014 that diagnosed diabetes prevalence among the Maori males is 6.0 and Maori females is 5.3 in 100 people. The same is quite low in case of the non Maori people as in 100 non Maoris, the rate is found to be 5.2 in males and 4.3 in females. It has been seen that the Maori adults were about 1.5 times more likely than the non Maori adults to have been diagnosed with diabetes after 25 years of age in the year 2013 to 2014 ("Diabetes" Ministry of Health New Zealand, 2017). Self reported cases of diabetes were also found to be 50% higher than that of the non Maoris. Two important complications which are associated with diabetes is renal failure and lower limb amputation. Renal failure above the age of 15 due to diabetes is found to be 5 times higher in Maori than the non Maoris where lower limb amputation is 3 times higher in the Maoris.
Suicide and self harm:
For the cases of self harm and suicides, the rates of Maori males is about 1.5 times higher in males than the non Maori males and their rates of hospitalizations are also higher. Suicide rates are found to be about 24.7 in males and 9.8 in females among the Maoris and 14.0 in males and 4.4 in females among the non Maoris per 100000 populations ("Suicide and intentional self-harm" Ministry of Health New Zealand, 2017).
Other major disorders
Other major disorders which also show high rates of mortality and morbidity among the Maoris I comparison to the non Maoris are the cancer, respiratory diseases, infectious diseases and disabilities. Not only had that Maoris also represented poor oral health, mental health and infant health than the non Maoris and therefore it becomes extremely important to identify the factors which have resulted in the disparities in the health systems.
Factors that lead to ill health in Maoris in comparison to non Maoris:
Often researchers over the years have tried their best to recognize the social and economic indicators that are resulting in development of disparities in the health status of the Maori people (Hicks, 2014). Some of the most important factors which have been noted to be the contributing factors for ill health are economic insecurity and unemployment (Mitrou et al., 2014). Low education level and social exclusion and discrimination have also been some of the most important factors that have resulted in the disorders. More inappropriate access to healthcare services has been yet another reason behind development of poor health quality. Culturally and spiritually they also feel disconnected with the livings styles of the non Maori people which results in development of inappropriate approach towards the accessing healthcare services (Pega et al., 2014).
Income is one of the most of important determinant of health. Data shows that income inequality between the Maoris and non Maori have been one of the determining factor or health disparity it was fund that low income is intricately associated with inappropriate methods of living like improper housing, improper diet and improper maintenance of lifestyle. This in turn affects the Maoris physically and mentally (Pega et al., 2014). Researchers have clearly stated that greater the income inequality higher is the overall mortality of the individuals(Hicks, 2014). Although the poor living conditions and housing positions of the Maoris have declined over the year but the data still suggests of value at around 27% which is till compared higher to that of the 16% of the non Maoris. Poorer the income, poorer are the living conditions and hence greater the chances of health disorders. Total personal income is less than $10,000 is about 23 in males and 25 in females in Maoris where that for the non Maoris are 14.8 in males and 21.7 in females . This automatically gives an overview about how disparities occur in the two groups of populations (Wright et al., 2016).
The next determinants of health are called the employment. It is quite important as it determines the income of family or an individual (Hicks, 2014). Employment is found to enhance social status and at the same time also improves self esteem and thereby provides social contact. It often helps in determining the level of participation in community lives and thereby enhances opportunities for regular activities (Wright et al., 2016). This in turn helps to influence individual health and also well being. Researchers have suggested that unemployment is detrimental to both the mental as well as physical health. Researchers have also shown that unemployed individuals report of poor health in higher degrees in comparison to people who are employed. Although the level of unemployment among the Maoris had decreased over the years but unfortunately the number is yet high enough that requires attention (Sheridon et al., 2015). Maoris are still facing discrimination in the labor markets mainly in the case of getting a job, type of job oriented and the wages paid for a particular type of job also seems to vary between Maoris and non Maoris (Fatusi & Bello, 2015). It is astonishing to see that the number of unemployed Maoris individuals range form number 9.8 in males and 10.4 in female whereas 4.1 in males and 4.0 in females among the non Maoris. Therefore it becomes evident that the health status is poor in Maoris in comparison to that of non Maoris.
Education is also highly critical in determining the people’s social as well as economic position and hence their health (Hicks, 2014). Researchers are of the opinion that low level of education is highly associated with that of poor health status. Different forms of education systems had been introduced in the Maori schools like the Te K?hanga Reo and Kura Kaupapa M?ori. Other additional programs include Te Kotahitanga has also helped in the meeting requirements of education for the Maoris (Sheridan et al., 2015). However, successful results have not been obtained as many Maori individuals have been seen to leave their education half way without finishing them properly. The level 2 certificate or higher levels for school completion for individuals above 15+ age have also been found to be less in case of the Maoris for about 42.1 for males and 47.8 for females in Maoris in comparison to that of 65.2 in males and 64.3 in females in non Maoris (Rawson, 2016). Lesser the education attained, lesser will be the development of health literacy and proper ideas about good lifestyle habits. This would ultimately result in practicing improper habits that my lead to health disorders.
Housing is yet another factor that takes an important role in determining the different health status of the Maori people (Hicks, 2014). It is indirectly associated with unemployment and income. An individual who has no employment and income are forced to live in houses which do not have proper hygiene and is not of proper infrastructures. This is mainly because they cannot afford housing with good features (Wilson & Neville, 2017). Another perspective is that the cost of housing is too high for the Maoris and therefore they have less money left from their income for other budget items and therefore they cannot buy nutritious food, education as well as access to health services. Moreover increased housing cost has resulted in sharing the accommodation with many others leading to overcrowding as well as living in temporary conditions all are making them prone to develop health disorders. Such issues are rarely faced by non Maori and hence the disparity in health status prevails (Came et al. 2017). Statistical data shows that the household numbers with overcrowding, without the motor vehicle access, without internet access and without telecommunications are also found to be quite higher in the Maoris than the non Maoris and hence there requires an urgency to handle this situations effectively.
Ethnicity and race:
Ethnicity and race are yet another factor that leads to poor access to healthcare and hence results in higher chance of being affected by mental or physical disorders (Hicks, 2014). The Maoris face racism and are stigmatized due to their cultural preferences and inhibitions. Non Maori people develop stigma towards them due to their own stereotypes and biasness and hence these create a feeling of loss of self respect and self esteem among the Maoris (Nikora et al., 2015). There have been evidences where differences in quality of care have been noted in the New Zealand healthcare systems. There have been various evidences noted where the Maori people were found to be less likely to receive appropriate care. This is mainly noticed during the screening as well as treatment of ischemic heart diseases, pain relief during child birth. In appropriate and careless service delivery has also been noticed in case of the diagnosis and treatment of depression, diabetes screening and management (Harris, Cormack & Stanley, 2013). Moreover they are not cared by experts following their cultural traditions and preferences and hence they feel disrespected and los of will to visit healthcare centers.
Cultural factors have both positive and negative effects on their health. They have totally a different set of values which they believe will help them in overcoming any ill health and disorder. Their values like tikanga, maturanga moari and similar others strengthen them to fight against ill health. Te whare tapa wh? is believed by them to be the four cornerstones of their leading of proper Maori health. However, the socioeconomic status overrides their cultural beliefs and become the main reasons for their death. Researchers have clearly stated that ethnicity in New Zealand is associated with underlying socioeconomic causes. It is not clear about how much cultural and ethnic factors contribute to ill health but evidence suggests that ethnic and cultural inequalities in health is largely attributed to inequalities which underlie socioeconomic determinants of health.
Seven important determinants of health differences:
Whitehead had identified seven important determinants of health differences. The first one according to him is the natural and biological variation. Secondly, they also have health damaging behavior which put their lives at risk at the use of excessive tobacco, playing risky sports and many others. Thirdly, the non Maoris experience transient health advantage over the Maoris as they are mode adaptable to healthy good behaviors unlike the Maoris (Harris, Cormack & Stanley, 2013). Fourthly they also have health damaging behaviors where their choices of lifestyles make them more vulnerable to the development of disorders. Not only that, they are also subjected to unhealthy living as well as working conditions. Moreover they also get inadequate access to essential health and other public services. Moreover, natural selection of health related social mobility which involve tendency of sick people to move down the social scale is also noticed (Brownie, Davem & Giles-Corti, 2016
Initiatives taken over the years:
The main challenge is the reduction of the inequities which ultimately will help in the creating of the opportunities for all the people of the nation to enjoy good health. Successfully overcoming the challenges will lead to development of a fairer society where everyone will have the similar opportunity for good health (Hayes, 2014). There should be also a development of inclusive society where everyone would have a sense of belonging and at the same time feel their contribution is valued. The initiatives should be such that it would involve health and well being for the population as a whole which would also cover those who are experiencing poor health.
Over the years, various initiatives have been take to overcome the health inequities faced by the Maoris in comparison to that of the non Maoris. The government has accepted the treaty of Waitangi where three important principles have been proposed to meet the gap of involvement of the Maori people in the healthcare services. By signing the treaty the crown recognized Maoris as the co-signatories under the articles of the treaty. The government has also taken initiatives to fulfill all obligations as a treaty partner who would help the Maoris by supporting their determination of whanaus, iwis and hapu (Cram, 2014). By the three principles of the Waitangi,- participation, protection and partnership where the elders of the whanau would be included before decisions making so that their culture and traditions are respected and looked after. They have been provided the self determination power/ along with the treaty of Waitangi. Maori development, their capacity building, closing the socioeconomic gaps between Maori and non Maori, tracking expenditure of the Maori outcomes were observed and noted. The government’s closing the gap policy has helped to understand the gaps between the Maori and non Maori mainly in the condition like housing conditions and home ownership, educational achievement, rates and periods of unemployment, health status, number of prior inmates and children and also young persons who need care, protection and control (Humpage, 2017).
In the past decades, many important initiatives have been tried to be taken at different levels. The income inequality has been tried to be reduced in the 200s following the large increase in the ginis in the 1980s to 1990s. However, it is once again increasing. Social welfare policies have been implemented which are in part at least pro-equity. This would include working for families and Whanau ora. Intersectoral activities have also been implemented which had helped in the improvement of health as well as health equity. These include retrofitting as well as insulation of housing stock that included energy efficiency and also health benefits and also Before School Check and the National Immunization register (Anaya, 2015). Many policies have also been introduced relevant to health. This would include equity goals and purposes. This included Health Strategy, Reducing Inequalities in Health Strategy, Cancer Control Strategy, He Korowai Orange and Ala Mo’ui: Pathways to Pacific Health and Wellbeing 2010-2014. This had been done through researches, programs, health professional training as well as well being that included cultural competency. Moreover health equity impact tools (e.g. HEAT) was also used. Maori health provider along with that of the Maori development was also in focus and therefore included initiatives like treaty of Waitangi. Moreover proper legislation in New Zealand Public Health and Disability Act 2000 was also introduced. Other tailored programs had also taken place which included the service delivery for the DHB, PHO and other service provider level which ensured that the Maoris and low socioeconomic people would undertake immunization activities (Hamlin et al., 2016). It also helped in improvement in the rates of smoking cessation, cardiovascular risk factor detection and also type 2 diabetes management. Proper funding initiatives have been established. Moreover target and performance indicators have also been done that includes metrics by region, ethnicity and deprivation.
A proper framework is very important along with development of a comprehensive plan for overcoming the health inequalities faced by the Maoris and non Maoris. For that, unlike the singular policies and task done by the government and other organizations it becomes very important to develop a comprehensive close knitted plan so that all the issues can be controlled by the policies and the initiatives altogether. A framework can be established which would help in meeting the goals and objectives (Ball et al., 2016).
The first stage would be to reduce the health inequalities by the underlying social and economic determinants of health. Moreover factors which are intermediate between health and social determinants of health would include behaviour, environment and material resources and therefore the concerned individuals and organizations should provide importance to the factors. Thirdly, health and disability services should be increased in number for better service delivery. The feedback effect on the ill health on socioeconomic positions should also be introduced.
A comprehensive approach:
The first approach would be including the structural components which include social, cultural, economic as well as historical factors. This step would include systematic representation of the different principles of the treaty of Waitangi in policy development as well as planning and service deliveries. It would also include proper distribution of the funding with proper arrangements of resources according to the needs. It should also involve exploration of health impact assessment tools. .Proper monitoring of the health inequalities, social determinants and the relationship between the two should be learnt properly (Cram, 2014).
This would mainly include intermediary pathways. This would mainly constitute the different housing initiatives, setting based programs like development of healthy cities and health promoting schools in Maori regions. It also included community development programs. It also included community development programs (Smith and Jury, 2016). It also would involve looking over the workplace interventions like making the workplace safe for the Maori people. Local authority polices should be includes like building of cycle ways, playgrounds, transports and others.
It would be to check the health and disability services for reduction of disabilities. This would include ensuring equity in care services by proper distribution of resources in collaboration with communities. This would also involve removal of barriers which prevent the effective use of services for all ethnic and social groups (Ewen et al., 2016).
It would mainly involve the reduction of the impact of disability and ailments on the socio-economic positions. This would include providing income support like providing sickness benefits and others. Allowing disability allowance, accident compensations support services for disabled people, chronic ailments, mental health illness and others would also be included. Moreover anti-discrimination and legislation and education should also be introduced (Brownie et al., 2016)
A marked difference is observed in the disease rate among the Maoris and non Maoris. Cardiovascular diseases, respiratory diseases, diabetes, obesity, mental health problems, strokes, suicidal and intentional harms and many others are higher in rates among the Maoris and non Maoris. When the matters are researched deeply, a number of factors came into view which is responsible for higher disease burden in the Maoris in comparison to non Maoris. Although huge number of initiatives is taken and the diseases rates have reduced, the reduction is not at its best level to help the Maoris lead a better life. Lesser income, poorer employment opportunities, incomplete education, improper housing standards, culture and ethnicity and many other have been the main reasons which are increasing the diseases burden of the Maoris. Huge initiatives like introduction of treaty of Waitangi, immunization programs to prevent them from infections, establishment of schools following their values and many others have been done. Yet the result has not been satisfactory. More planned and comprehensive approaches should be taken which will help them by developing their lifestyle factors and increase their access to healthcare and better amenities. Proper policies and guided living standards should be proposed to them to make their lives happy and help them live quality lives.
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