Future Focus
Section 5 – Māori Health
2012
Population Health
Te Puna Oranga (Māori Health Services)
Future Focus is a planning document prepared by Population Health, Waikato District Health
Board. It provides data and information related to identified health priority areas and priority
population groups in Waikato DHB. This section covers Māori Health. A number of other
sections also discuss various aspects related to Māori health and may be read in conjunction with
this section.
Future Focus is a living document with emerging strategies, research and impacts incorporated
within its findings as needed. All efforts are made to ensure data is current.
All current sections of Future Focus can be found at:
www.waikatodhb.health.nz/futurefocus
Population Health Waikato DHB – Future Focus
Māori health
5.1
Mihi
Ka hoki, anō, ki ngā mihi whānui o te wā!
Ara, ngā mihi tonu ki te Runga Rawa;
me te inoi atu ki a Ia, kia tau, tonu, ōna manaakitanga maha ki runga i a Kiingi Tūheitia me te
Kahui Ariki nui tonu
E tangi tonu ana ki ngā mate o te wā – takoto mai koutou! moe mai! haere, haere, haere!
Kaati! Rātou ki a rātou; tātou, kua mahue nei, ki a tātou!
Ka whai iho nei ngā whakamāramatanga, e pā ana ki ngā āhuatanga o te kaupapa
whakahirahira, e kiia ana, ko „Future Focus:Māori Health‟ te ingoa.
Kua kohikohingia e „Te Puna Oranga‟ (Māori Health Services) me Population Health:
Waikato DHB; ngā tatauranga, e pā ana ki ngā āhuatanga e whakapiki ana, e whakaheke
ana, rānei, i te hauora me te oranga o te iwi Māori, e noho ana i te rohe hauora o Waikato.
Kātahi ka mātau pai rātou ki te whakamahere i ngā rautaki hauora, e tika ana mo Ngai
Māori; kia āhei te iwi ki te pupuru, tonu, ki te mau anō, rānei, i te oranga ma rātou, ahakoa
te aha!
Mauriora ki te kaupapa!
5.2
Introduction
This section of Future Focus was jointly developed by Population Health and Te Puna
Oranga (Māori Health Service). Background information has been provided that supports
planning for Population Health and Māori health improvement across the Waikato DHB
region. As highlighted in the main Future Focus Introduction section, health and wellbeing
can be influenced by many factors – some direct (e.g. smoking) and some indirect (e.g.
income). This section identifies some of the social, cultural and economic factors which
impact on Māori health and wellbeing outcomes. It provides summary information on factors
that influence Māori health and wellbeing from a Māori perspective. It also includes data
related to Māuiui (illness) for Māori with the inclusion of several health related hospitalisation
and mortality data where appropriate.
Māori participation was facilitated through Te Puna Oranga involvement in the planning and
development of this section. Waikato DHB Iwi Māori Council provided governance oversight.
We have included information relevant to the purpose of this Future Focus section and
acknowledge any unintentional omissions or oversights.
Many Māori views on health focus on wellbeing and see health as more than the absence of
disease. This view encompasses tinana (the physical element), hinengaro (the mental
state), wairua (the spirit) and whānau (the immediate and wider family). These aspects occur
in the context of the whenua (land providing a sense of identity and belonging), Te Reo (the
language of communication), tea o tūroa (environment) and whānaungatanga (extended
family)1.
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July 2012
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With this in mind, the Te Pae Mahutonga health promotion framework, developed by
Professor Mason Durie, was selected by Te Puna Oranga and Population Health as an
appropriate structural framework for the Māori Health section. There was debate about
whether or not Te Pae or Te Whare Tapa Wha or Te Wheke were appropriate frameworks
for a planning resource focused on Māori health and wellbeing.
The decision to adopt Te Pae Mahutonga as a framework meant that there would be
components of this framework for which there would be little available information. In other
sections the challenge was to select the most appropriate information for the component on
Te Pae Mahutonga.
Te Pae Mahutonga doesn‟t explicitly discuss how ill health might be considered in relation to
the framework. This Māori Health section focuses on health and wellbeing promotion
however it is appropriate when thinking about planning for health improvement in a
community to consider the prevalence of ill health. This information can be used by planners
and those interested in hospitalisation and other data.
This section presents the information on ill health in two ways: firstly as a backdrop to
environmental wellbeing within the Te Pae Mahutonga framework; and secondly within a
section called „Māuiui‟ which focuses on illness.
This document aims to increase understanding of the impact of social and environmental
factors on Māori health and wellbeing, identify health priorities for local body planning, and
provide an opportunity to better understand Māori health and wellbeing across the region.
With this in mind, these factors that influence Māori health and wellbeing are discussed
under the following headings:
5.1.
Mihi
5.2.
Introduction
5.3.
Ngā Māori o te rohe hauora o Waikato: Māori of the Waikato region
5.4.
Te Pae Mahutonga framework
5.5.
Mauri Ora: Access to te ao Māori
5.6.
Waiora: Environmental protection
5.7.
Toiora: Healthy lifestyles
5.8.
Te Oranga: Participation in society
5.9.
Te Mana Whakahaere: Autonomy
5.10.
Ngā Manukura: Leadership
5.11.
Te Māuiui me te Matenga rawa: Illness and mortality
5.12.
Evidence-based interventions
5.13.
References
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5.2.1 Data
Data used in the document was from a variety of agencies including:
Statistics New Zealand
2006 Census data was accessed via the Statistics New Zealand website. The Statistics
New Zealand population projections data was supplied to the Waikato District Health Board
(Waikato DHB) through the Ministry of Health (MOH). Although updated population
estimates have been made available since 2006, they provide only basic, high-level
information and therefore, in the interest of document consistency, Census 2006 information
has been utilised.
Waikato District Health Board
Including Population Health, Health Waikato and Planning & Funding Divisions – maps,
patient discharge data, payment data and other health related information.
Ministry of Health
Various reports on Māori health have been produced by the Ministry of Health (MoH).
National data has been used where appropriate and often sought from these reports and
publications.
Local Government
Local information has been sourced from various documents created by regional councils
and territorial authorities within the Waikato DHB area. Where possible, local data was used.
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5.3 Ngā Māori o te rohe hauora o Waikato: Māori of the Waikato
region
5.3.1
Aotearoa rohe, Waikato rohe: National area, Waikato region
Approximately 20% of the Waikato DHB region (67,476 individuals) identified as being Māori
compared with only 13% in New Zealand2 (Figure 1). The Māori population, as a proportion
of total population, varies considerably between each region. Within the Waikato DHB
region, there is differences in proportion across territorial authorities (TA‟s). While Māori
make up 13% of Waipa‟s population, almost 40% of Waitomo and Ruapehu (part) population
are Māori (Figure 2). Just over a third of the Waikato DHB Māori population reside in the
major urban area of Hamilton City (36.4%) and another quarter live in the minor urban
territorial authorities (TAs) of Waikato District (15%) and South Waikato (10%) (Figure 3). In
contrast, only a small proportion live in the rural centres such as Otorohanga, Hauraki and
Ruapehu (part). Hence, the majority of Māori in the Waikato live in an urban or semi-urban
setting.
Population structure
Māori and European age structures are very different. Approximately 60% of the Waikato
Māori population are aged under 30 years old, in comparison to only 40% of the non-Māori
population (Figure 4, 5).
Figure 1: Proportion of the population by ethnicity, Waikato DHB and New Zealand,
2006
70
60
Waikato DHB
New Zealand
Percentage (%)
50
40
30
20
10
0
European
Māori
Pacific peoples
Asian
Ethnic group
MELAA*
Other
Not specified
* MELAA: Middle Eastern, Latin American and African people.
Note: Percentages add to more than 100% as a person can belong to more than one ethnic group.
Source: Statistics New Zealand, 2006 Census of Population and Dwellings.
Although updated projections have been made available since 2006, these figures provide only basic, high-level information
and therefore, in the interest of consistency throughout this document, Census 2006 information has been utilised
Section 5: Māori health
July 2012
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Figure 2: Māori population as a proportion of total population, by DHB region and
Territorial Authority, 2006.
Note: Māori Population by DHB and TA (Insert Waikato DHB only)
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Figure 3: Proportion of total Waikato Māori population by territorial authority, 2006
Source: Statistics New Zealand, 2006 Census of Population and Dwellings.
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Figure 4: Population profile for Māori by gender, 5 year age groups, Waikato DHB
(2006)
Age Group
85 and over
80–84
75–79
70–74
65–69
60–64
55–59
50–54
45–49
Female
40–44
35–39
30–34
25–29
20–24
15–19
10–14
5–9
0–4
15%
10%
5%
Male
0%
5%
10%
15%
Percentage
Source: Statistics NZ, NZ Census 2006.
Notes: All Ruapehu District data used-data constraints prevent extract Waikato DHB only Ruapehu data.
As a comparison, the population profile for non-Māori in the Waikato DHB area shows that more people in this ethnic group are
represented in age groups 40-45 yrs and older and less aged 15 yrs and under when compared to Māori (Figure 7). This
reflects comparable data at a national level.
Figure 5: Population profile for non-Māori by gender, 5 year age groups, Waikato DHB
(2006)
85 and over
80–84
75–79
70–74
65–69
60–64
Age Group
55–59
50–54
45–49
40–44
35–39
30–34
Female
Male
25–29
20–24
15–19
10–14
5–9
0–4
15%
10%
5%
0%
5%
10%
15%
Percentage
Source: Statistics NZ, NZ Census 2006.
Notes: All Ruapehu District data used here -data constraints prevent extract Waikato DHB only Ruapehu data.
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Population growth
Between 2011 and 2026, it is projected that the Māori population will grow by 21%,
compared to 11% for the non-Māori population growth (Figure 6).3
New Zealand Deprivation Index (NZDep)
The NZDep index is a weighted average of the nine Census indicators of socioeconomic
status for a specific area:
car and telephone access
receipt of means-tested benefits
unemployment
household income
sole parenting
educational qualifications
home ownership
home living space.
The NZDep divides New Zealand into equal tenths (meshblocks). A score of 10 indicates a
geographic area is in the most deprived 10% of all areas in New Zealand. The NZDep index
relates to geographic areas rather than individual people.
In Waikato, a much larger proportion of Māori live in areas of high deprivation compared to
European (Figure 7). While only 5% of the population living in a NZDep one area are Māori,
around half of those living in a NZDep 10 area are Māori.
Life expectancy
Nationally in 2006, Māori males had a life expectancy at birth of 70.4 years, compared to
79.0 years for non-Māori. Māori females had a life expectancy at birth of 75.1 years,
compared to 83.0 years for non-Māori females.
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Figure 6: Proportion of Māori by territorial authorities, Waikato DHB, 1996-2006
(census), 2011-2021 (projections)
50
Waitomo
45
Ruapehu (all)
Percentage Maori
40
35
South Waikato
30
Otorohanga
25
Waikato
Hauraki
Hamilton city
Waikato DHB
20
Thames-Coromandel
Matamata-Piako
Waipa
15
10
5
0
1996
2001
2006
(base)
2011
2016
2021
Year
Source: Statistics New Zealand
(http://www.stats.govt.nz/browse_for_stats/population/estimates_and_projections/subnational-ethnic-populationprojections.aspx -Table 6
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Figure 7: Percentage of Māori and non-Māori living in each NZDep area, Waikato DHB,
2006
Percentage of the population
100%
80%
60%
Non-Māori %
Māori %
40%
20%
0%
1
2
3
4
5
6
7
8
9
10
NZ Dep (2006)
Source: Statistics New Zealand (Concordance spreadsheet, Meshblock download)
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5.4
Te Pae Mahutonga framework
The Māori health model used in this section of Future Focus is Te Pae Mahutonga
(Southern Cross constellation). This framework, created by Sir Mason Durie, brings together
elements of modern health promotion, as they apply to Māori health, but as they might also
apply to other New Zealanders. The four central stars represent four key tasks of health
promotion:
Mauriora – access to te ao Māori
Waiora – environmental protection
Toiora – healthy lifestyles
Te Oranga – participation in society.
The two pointers represent:
Ngā Manukura – leadership
Te Mana Whakahaere – autonomy4.
Figure 8: Te Pae Mahutonga framework
Source: Ministry of Health http://www.Māorihealth.govt.nz/moh.nsf/pagesma/446
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5.5
Mauri Ora: Access to te ao Māori
A secure cultural identity may have a significant impact on health. Promotion of
indigenous cultures has been shown to have a positive impact on overall health. This is
certainly true of Māori health. If a strong cultural identity is present amongst Māori
communities, this can make the targeting of health promotion messages straightforward
and effective. If however, this identity is insecure or fractured, this will have an impact on
how messages are delivered. This can result in worse health outcomes for Māori.
Waikato is the spiritual home base of the Kingitanga a kaupapa which seeks to unify
Iwi/Māori across Aotearoa. This highlights the importance of maintaining access to te ao
Māori within the Waikato region.
Access to te ao Māori can be seen through the level of Māori who can communicate in
Te Reo Māori, Iwi affiliation and Māori education.
5.5.1 Communication in Te Reo
An increase in the participation of Māori who can communicate in Te Reo may lead to an
increased security of Māori culture and values and thus strengthen cultural identity
amongst Māori.5 In all Waikato TA areas, the proportion of Māori who are able to speak
Te Reo increases with age. This is particularly apparent in those aged over 65 years.
Nationally and locally, approximately a quarter of Māori are fluent in Te Reo (Table 1). In
six of the TA‟s in the Waikato region, a higher proportion of Māori are fluent in Te Reo
than the national figure.
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Table 1: Proportion of Māori population who are Māori language speakers, by age
group and territorial authority, Waikato DHB region, 2006
Age group (years), N (%)
TA
0 - 14
15 - 29
30 - 49
50 - 64
65+
Total
Hamilton City
1590
18%
1932
26%
1656
28%
675
35%
369
53%
6225
25%
Hauraki
135
12%
108
15%
183
23%
93
27%
60
37%
579
18%
Matamata-Piako
345
25%
219
23%
234
25%
129
31%
69
43%
987
25%
Otorohanga
117
16%
174
28%
162
26%
87
37%
84
62%
621
26%
Ruapehu (all)
345
19%
273
25%
324
26%
195
33%
159
60%
1293
26%
South
Waikato
396
15%
294
20%
399
24%
201
29%
123
46%
1410
21%
Thames
Coromandel
225
17%
165
20%
234
22%
105
20%
96
35%
819
20%
Waikato
1020
26%
768
31%
774
29%
480
42%
312
68%
3354
31%
Waipa
267
14%
267
21%
324
23%
168
29%
111
49%
1134
21%
Waitomo
231
19%
213
26%
222
23%
162
40%
153
65%
981
27%
Waikato
DHB
(incl.
Ruapehu
[all])
4671
20%
4413
26%
4512
27%
2295
35%
1536
54%
17,403
26%
Source: Ministry of Social Development. (2008). Regional indicators supplement - Social Report 2007, Retrieved November 5,
2008 from http://www.socialreport.msd.govt.nz/regional/.
5.5.2 Iwi affiliation
Māori from a large number of Iwi are represented within the Waikato DHB area. The principal
Iwi tribal groups that affiliate to Tainui waka are Hauraki, Ngāti Maniapoto, Ngāti Raukawa and
Waikato6(Figure 9). However, Māori may associate with more than one Iwi and many Māori
are affiliated with Iwi from well outside the Waikato reside within the region. Māori populations
with affiliations to over 100 different Iwi live in the region. Whilst Waikato based Iwi have the
largest populations, others have significant populations who are affiliated as well, such as
Ngāpuhi (18% of Waikato Māori have an affiliation) and Ngāti Porou (10% have an affiliation)
(Table 2).
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Figure 9: Iwi boundaries across the Waikato DHB
Sources:
Iwi and Regional group‟s information provided by Te Puna Oranga (Māori Health Service), Waikato DHB (2008)
Please note that Iwi areas depicted are indicative only and do not represent official or legal standings. Some tribal areas may
overlap.
* Hauraki comprises of 12 respective Iwi:
Ngati Tamatera; Ngati Whanaunga; Ngati Maru; Ngati Paoa; Ngati Hei; Ngati Hako; Ngati Tara Tokanui;
Ngati Rahiri- Timutimu; Ngai Tai; Patukirikiri; Ngati Porou; Ngati Pukenga
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Table 2: Iwi affiliation, Waikato DHB, 2006
Iwi
Responses
% of Māori living in
Waikato DHB
Ngāti Maniapoto
11,379
19
Ngāpuhi
10,893
18
Waikato
10,245
17
Ngāti Porou
5,880
10
Ngāti Tuwharetoa
4,656
8
Tainui
3,834
6
Ngāti Raukawa (Waikato)
2,634
4
Tuhoe
2,532
4
Ngai Tahu/Kai Tahu
2,430
4
Te Arawa
2,172
4
Ngāti Haua (Waikato)
2,166
4
Ngāti Raukawa (region unspecified)
1,623
3
Ngāiterangi
1,539
3
Ngāti Kahungunu ki te Wairoa
1,419
2
Ngāti Kahungunu, region unspecified
1,380
2
Ngāti Awa
1,215
2
Ngāti Tamatera
1,086
2
Ngāti Maru (Marutuahu)
996
2
Ngāti Paoa
804
1
Ngāti Hako
633
1
Ngāti Tara Tokanui
315
<1
Ngāti Porou ki Harataunga ki Mataora
261
<1
Other Iwi*
23,028
39
Total Responses**
93,135
Total who answered question
59,367
Source: Statistics New Zealand, Table Builder (Iwi (Total Responses) for the Māori Descent Census Usually
Resident Population Count, 2006).
Notes:
Responses for Māori who stated they had an affiliation to at least one Iwi.
*Category “Other Iwi” includes responses that did not know their Iwi, or affiliated with Iwi who had a
population of less than 1% within the Waikato DHB region (over 100 other Iwi).
**„Total Responses‟ exceeds „Total who answered question‟. This is because an individual can indicate
more than one Iwi affiliation. This also means „% of Māori living in Waikato DHB‟.
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5.5.3 Māori education
Māori education is an important factor in access to te ao Māori. Māori schooling can take a
number of different forms, but the intent is to ensure the Māori language survives and thrives.
Kura Kaupapa Māori (Māori language schools) were established in the 1980‟s when it became
clear that Māori language, customs and cultures were under a threat of extinction, and the
population of Māori fluent in the language sharply declining. Kura Kaupapa Māori were
developed to protect the Māori language and promote cultural identity. The first was opened in
1985, and the first in the Waikato in 1991. Four years later, in 1989, the Education Act was
amended to provide formal recognition for Kura Kaupapa Māori and wānanga (Māori tertiary
institutions)7.
Māori education takes place from early childhood to tertiary, in various settings, including:
kōhanga reo in the early childhood sector
other bilingual and immersion programmes in early childhood education centres
Kura Kaupapa Māori (covering years 1-8) and Wharekura (covering years 1-13)
immersion and bilingual programmes in mainstream schools
wānanga in the tertiary sector8.
There are currently 73 funded Kura Kaupapa Māori, providing education to over 6,000
students. Of these, 11 are based in the Waikato region, teaching approximately 20% of all
Kura Kaupapa Māori students in the country9. Eight of the 10 TAs within the Waikato Region
have at least one Kura Kaupapa.
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5.6
Waiora: Environmental protection
The natural environment is a central source of identity for Māori. Therefore, protection of this
environment is a core aspect of Māori culture. There are a number of key natural features in
the Waikato that are of great significance to Māori in the region. These include:
waterways (The Waikato, Waipā and other rivers; lakes; wetlands)
mountains (Mt Taupiri, Mt Pirongia)
the coastline.
The quality of natural resources has a clear role in the health of the people who interact with
them. This is not just an issue for the health of Māori, but for all those who use natural
resources. Environmental protection therefore is a cornerstone of Māori health.
Both the natural and built environments are linked to health and wellbeing in many ways. This
section explores some of the links between heath and environmental issues such as water
quality and housing through a Māori perspective.
5.6.1 Water quality
The quality of both coastal and inland water bodies are of great importance to Māori for many
reasons. These can be areas for kai gathering, drinking water sources, provide recreational
opportunities and hold historical and spiritual significance. However these water bodies may
be affected by contamination from both natural and human sources which have the potential
to affect Māori health and well-being.
Naturally occurring contaminants in the Waikato region include arsenic and mercury in the
Waikato River from natural geothermal activity and the natural toxins from blooms of
cyanbacteria (blue-green algae) in fresh water or toxigenic phytoplankton is seawater. High
levels of silt also affect the suitability of waterbodies for some uses.
Natural water quality can also be affected by discharges from human activity. Contaminants
may come from the chemicals in industrial water, farm runoff, and the discharge of human
sewage to water. The discharge of human sewage to natural waterways is not only of physical
concern, but is culturally offensive to Māori.
5.6.1.1
Drinking water
Drinking water quality is an important determinant of health for a population. New Zealand has
relatively high rates of largely preventable enteric or gastro-intestinal disease, compared with
other developed countries, which is at least partly attributable to contamination of drinking
water10. Chemicals and toxins contaminants in source waters can also be a health risk,
therefore, ensuring water quality is maintained at a high level is of great importance.
The quality of drinking water may be an issue for some marae within the Waikato region. The
Ministry for the Environment has estimated that in the Waikato and Waipa river catchments
alone around 67 marae do not have access to a reticulated treated water supply. The number
of people reliant on marae water supply fluctuates as marae requirements are varied, and
may include daily use by small groups (such as kōhanga reo that operate from marae), or
larger gatherings of people on a more infrequent basis, such as weddings, tangi and
unveilings. With the marae as the centre of cultural identity for many Māori, local Iwi have
seen safe water quality at marae as a priority area.
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5.6.1.2
Recreation and kai gathering
The quality of waterways and coastal areas as a source of kai (food) and for recreational
activities is of great importance to Māori. A number of traditional Māori activities involve the
water, including swimming, fishing and the non-commercial collection of shellfish.
When swimming and other high-contact water sports are carried out there is risk that
contaminated water will be swallowed, inhaled or infection can enter the body through cuts,
contact with ears, nasal passages or mucus membranes. In addition, consuming shellfish and
other foods gathered from contaminated waters can pose health risks. As Māori are
traditionally involved in a number of activities involving such water uses, any exposure to
contaminated water is potentially high. This means these issues need to be managed
appropriately.
Local government plays an important role in the monitoring of recreational water sites and
warning the public when there are concerns. Population Health is involved in supporting
these activities through provision of advice and media releases. Monitoring is carried out in
selected sites around the region for microbiological and cyanobacteria (blue-green algae)
levels. Information collected can be used to make assessments on the suitability of a site for
contact recreation and/or non-commercial shellfish gathering. The Ministry for Primary
Industries (MPI) oversees a sampling programme to check shellfish are not contaminated by
biotoxins from algal blooms. Public warnings are issued by Population Health when shellfish,
or other kai, are likely to be unsafe to eat due to blooms. Information on current biotoxin
warnings and safe seafood gathering can be found on the MPI‟s FoodSmart website.
Additionally, when there is risk of contamination of coastal or freshwater swimming and
shellfish gathering areas due to one-off events such as sewage or chemical spills. Warnings
can be issued and additional monitoring maybe carried out
5.6.1.3
The Waikato River
For a number of Iwi within the Waikato region, rivers are of great importance. The Waikato
River is of particular significance. It is considered a taonga (treasure), and is strongly linked to
a sense of identity for Māori. The river had an abundance of benefits for Māori and is
consequently treated with great respect.
Māori have long considered that the health of the river has deteriorated, which may have in
turn led to poorer health for the people. In 2008, Waikato-Tainui and the Crown signed a Deed
of Settlement regarding the Waikato River. The purpose of the agreement was:
‘To enhance the relationship between the Crown and Waikato-Tainui; to recognise and
sustain the special relationship Waikato-Tainui have with the Waikato river; to enter a new era
of co-management over the Waikato river across a range of agencies; and reflect a unity of
commitment to respect and care for the Waikato river’11.
The focus of the agreement was on improving and maintaining the health of the Waikato
River, to ensure it remained a valuable resource for future generations.
An agreement signed between Waikato Regional Council and Waikato River Authority in 2011
looks to further improve the health of the river through collaboration. $210 million has been
committed to this project over the next 30 years12.
Section 5: Māori health
July 2012
‘Planning today for tomorrow’
Page 20 of 54
Update due: July 2015
Population Health Waikato DHB – Future Focus
5.6.2 Housing
Housing is an important determinant of health and wellbeing. Risk factors such as heating,
insulation and overcrowding which require improvements to progress and maintain the health
of its occupants13. Māori currently suffer disproportionately high rates of respiratory conditions
and infectious diseases that are linked to poor housing. Further information on housing can be
found in Section 8 of Future Focus: Healthy Environments.
5.6.2.1
Housing conditions
The type of housing that a person lives in has an impact on their health. Those living in cold or
damp housing with little or no insulation are more likely to suffer from health conditions
identified above. A concerning childhood illness linked to housing in New Zealand is rheumatic
fever. Rheumatic fever is of particular concern for Māori children (Table 3). Nationally, Māori
are 20 times more likely to be hospitalised for rheumatic fever than non- Māori14.
The government has signalled a commitment to healthier housing in New Zealand through
insulation and clean heat subsidies. To the end of 2010/11, over 114,000 homes had been
retrofitted nationally as part of the scheme15. Insulating low income housing is a stated priority
of the programme, and Māori are overrepresented in these figures. An additional $24 million
was also negotiated specifically for insulating Māori homes. Therefore, Māori health stands to
benefit from the programme.
5.6.2.2
Household crowding
One of the risk factors relating poor health to housing is household occupancy rates. A
common measure used for overcrowding is the „Canadian National Occupancy Standard‟; a
proxy measure to monitor the incidence of crowding, which has been adopted by the Ministry
of Social Development for use in the New Zealand Social Report16.Using this standard, a
quarter of Waikato Māori within the Waikato DHB region live in overcrowded conditions; five
times higher than for Europeans. (Table 4). This is a significant concern, as overcrowding can
be a risk factor in the spread of infectious diseases (Future Focus Section 9: Infectious
Disease).
However, there may be a differing view on overcrowding from a Māori perspective. Policies
and laws around New Zealand housing may not have always taken into account differences in
living arrangements and house size and design may not always be considered in a way that is
culturally sensitive to the needs of Māori. The structure of Māori families may be different to
the standard European model of parents and children, and may result in larger family units
needing to be accommodated for. Also, homes act as gathering points for significant whānau
occasions. Accommodating family members for long-term stays is part of Māori society, and
this occupancy in a house may fluctuate. Such fluctuating occupancy may be difficult to
accommodate in many houses. In addition, there may be potential health benefits of larger
family units living together, including the removal of social isolation for many. Therefore,
housing that isolates Māori from whānau or the wider family may have less potential to
contribute positively to their wellbeing17.
Section 5: Māori health
July 2012
‘Planning today for tomorrow’
Page 21 of 54
Update due: July 2015
Population Health Waikato DHB – Future Focus
Table 3: Number and rate of notified acute rheumatic fever cases by ethnicity and year
Waikato DHB, 2006- 2010
Year (N)
Rate per 100,000
Annual rate (100,000)
Ethnicity
2006
2007
2008
2009
2010
Total
(%)
(1-24 years)
(age 1-24 years)
European
1
2
4
0
1
8
10
13.0
2.6
Māori
8
6
22
16
13
65
81
177.7
35.5
Pacific Peoples
1
2
0
2
2
7
9
179.8
36.0
Total
10
10
26
18
16
80
100
63.3
12.7
Source: EpiSurv; Statistics New Zealand
Table 4: Household crowding, by ethnicity and territorial authority; Environment
Waikato area, 2006
Ethnicity N (%)
N (%)
TA
European
Māori
Hamilton City
4542
5%
6051
27%
1593
34%
2550
21%
14,082
12%
Hauraki
600
4%
693
24%
87
26%
48
17%
1269
8%
Matamata-Piako
840
3%
843
24%
36
13%
216
27%
1896
7%
Otorohanga
270
4%
432
22%
12
13%
24
19%
660
8%
Ruapehu (all)
450
6%
924
21%
45
19%
21
9%
1311
11%
South Waikato
888
6%
1314
21%
666
28%
45
11%
2436
12%
Thames-Coromandel
777
4%
636
18%
39
13%
63
18%
1338
6%
Waikato
1671
5%
2898
30%
255
28%
123
12%
4512
11%
Waipa
1272
4%
963
19%
96
22%
84
13%
2265
6%
Waitomo
354
6%
807
25%
54
29%
27
25%
1149
13%
Waikato Region
12,987
5%
17,238
25%
3219
30%
3315
20%
34,017
10%
Pacific
Asian
Total
Note:
The proportion of the population living in „crowded housing‟ with fewer bedrooms than required given household size
and composition, measured against the Canadian National Occupancy Standard.
A person can belong to more than one ethnic group, so the parts do not add to the total.
Source: Ministry of Social Development. (2007). Regional indicators supplement - Social report 2007. Retrieved November 5,
2007 from http://www.socialreport.msd.govt.nz/regional/.
Section 5: Māori health
July 2012
‘Planning today for tomorrow’
Page 22 of 54
Update due: July 2015
Population Health Waikato DHB – Future Focus
5.7
Toiora: Healthy lifestyles
Source: Waikato DHB
Case study:
Project Energize
Project Energize aims to improve nutrition and
physical activity levels in primary and
intermediate school children in the Waikato
region and reduce obesity rates and
cardiovascular risk factors. The project began
in 2005 and is funded by the Waikato District
Health Board. Partners in the project include
Sport Waikato, the Auckland University of
Technology, University of Waikato, Waikato
Institute of Technology, Sport and Recreation
NZ and the National Health Foundation.
A total of 44,000 primary and intermediate
schoolchildren are now participating through
244 Waikato schools. A number of project
evaluations have been carried out, the latest in
March-April 2011. Of those children evaluated,
over a third were Māori.
The 2011 findings found:
There are two factors that affect a person‟s
health in terms of lifestyle (protective factors
and risk factors). Health promotion looks to
reduce the risk factors and increase
protective factors. For Māori, there are a
number of contributors to each factor that
are of specific concern. Whilst areas have
been placed into one of these two factors it
is important to note that there is the clear
ability for them to fall into either factor. By
definition, an individual‟s choice will decide
if a lifestyle factor is protective or risky.
5.7.1 Protective factors
waist measurements for Māori children
were lower than during assessments in
2004 and 2006
obesity and overweight levels were 5%
lower for 6-8 year old Māori children
and 3% lower for 9-11 year old Māori
children, compared to 2004 and 2006
figures
healthy eating and physical activity is
increasing
schools are making changes to
encourage more healthy lifestyles
inequalities by ethnicity still exist, but
are decreasing.
Section 5: Māori health
July 2012
Lifestyle choices play a critical role in the
protection, maintenance and promotion of
good health. This is of particular
significance and interest in the area of
Māori health. For many lifestyle related
illnesses, Māori are overrepresented in data
related to lifestyle choices. However, it is
important to note that lifestyle choices are
heavily influenced by the wider social
determinants of health. Poverty in particular
has an a great impact on an individual‟s
ability to make healthy lifestyle choices. The
level of risk from lifestyle choices is likely to
be connected to deprivation and inequality
levels. Durie notes that „those in the
greatest levels of poverty are likely to
experience the greatest levels of lifestyle
risk‟4.
There are a number of protective lifestyle
choices which can result in improved health.
For Māori, it is important to emphasise and
promote these as much as possible.
Physical activity
Physical activity is a key protective factor for
health. Physical activity is of importance for
people of all ages, and when undertaken
regularly and combined with other
protective lifestyle choices, can decrease
the likelihood of a number of health
conditions such as heart disease and type 2
diabetes.
‘Planning today for tomorrow’
Page 23 of 54
Update due: July 2015
Population Health Waikato DHB – Future Focus
National standards for regular physical activity are provided by Sport and Recreation New
Zealand (SPARC), which recommends adults participate in 30 minutes of moderate-intensity
physical activity at least five days of the week.
Nationally, approximately half of Māori adults meet this standard, which is slightly higher than
the New Zealand population. Māori also had higher participation rates compared with other
ethnic groups for:
a variety of sport and recreation activities
an organised competition or event
membership of a sport or recreation club or centre
receiving instruction in a sport or recreation activity
volunteer levels for sport and recreation18.
Physical activity is just as important for children. The case study on Project Energize (above)
provides an example of a Waikato response to improve diet and physical activity of children.
Diet
Diet is a key contributor to good health and wellbeing, and has the ability to act as either a
protective or risk factor. Among risk factors for the 20 most common causes of death, poor
nutrition is ranked first19. There are a number of factors that will determine a person‟s ability to
access healthy food. This can include income, price and availability of healthy food. Low cost
food with poor nutritional value is often consumed at a greater rate by those with reduced
incomes and living in higher levels of deprivation. Price is currently an issue debated by
lawmakers around the cost of healthy food, and a number of programmes have been
developed to improve access to fruit and vegetables, especially in areas of high deprivation.
Māori are a group at higher risk from poor nutrition. The New Zealand Health Survey also
shows that Māori children are more likely than non-Māori children to consume fizzy drinks and
fast food, which can increase the risk of health conditions20.
A high fruit and vegetable intake can protect against a number of health issues, and has been
a common starting point in promoting healthy diet choices. The Ministry of Health
recommends that New Zealanders eat at least three servings of vegetables and two servings
of fruit daily. The 2006/07 New Zealand Health Survey states that Māori meet this
recommendation less frequently than non-Māori20.
Section 5: Māori health
July 2012
‘Planning today for tomorrow’
Page 24 of 54
Update due: July 2015
Population Health Waikato DHB – Future Focus
Source: Waikato DHB
Case study - immunisation
Immunisation is a health area that has shown significant improvement for Māori.
Immunisation is a key protective factor for health. The World Health Organisation states that
Immunisation „is a proven tool for controlling and eliminating life-threatening infectious
diseases and is estimated to avert over 2 million deaths each year. It is one of the most
cost-effective health investments, with proven strategies that make it accessible to even the
most hard-to-reach and vulnerable populations. It has clearly defined target groups; it can be
delivered effectively through outreach activities; and vaccination does not require any major
lifestyle change‟i.
The Ministry of Health has included childhood immunisation as one of New Zealand‟s 13
health priority population health objectives. The national immunisation target is 85% of two
year olds to be fully immunised by July 2010, 90% by July 2011 and 95% by July 2012.
Waikato DHB has achieved and surpassed the national immunisation target at July 2010
(86%) and 2011 (91%). There has been a vast improvement on the immunisation rates of
Māori children since 2007. This has seen not only the immunisation rates amongst Māori
increase, but has effectively closed the gap of immunisation rates between Māori and nonMāori.
I World Health Organisation. (2011). Immunization. Retrieved 15 August 2011 from the World Health
Organisation website http://www.who.int/topics/immunization/about/en/index.html
Section 5: Māori health
July 2012
‘Planning today for tomorrow’
Page 25 of 54
Update due: July 2015
Population Health Waikato DHB – Future Focus
Oral health and fluoridation
Oral health is an essential component of health throughout life. Poor oral health and untreated
oral diseases/conditions can have a significant impact on quality of life. Māori have poorer oral
health compared to non-Māori. In the Waikato region, Māori and other ethnic groups had a
higher proportion of children starting school who failed the dental component of their
B4School Checki (5.6% and 5.5% respectively), almost three times the proportion of European
children (1.7%) who failed and well above the Waikato DHB average (3.1%) (Figure 10).
Figure 10: Proportion of school entry children (aged four to five years) who failed the
dental component of their B4 School Check, by ethnicity, Waikato DHB, 2009
6%
Percentage
Waikato DHB
5%
Percentage
4%
3%
2%
1%
0%
Māori
Other
Pacific Islander
Not Stated
European
Ethnicity
Source: Pinnacle Group Ltd, B4 Schools database
i
B4 School Check is a nationwide screening programme offering a free health and development check for children
aged 4 - 5 years.
Section 5: Māori health
July 2012
‘Planning today for tomorrow’
Page 26 of 54
Update due: July 2015
Population Health Waikato DHB – Future Focus
Figure 11: The key contributors to community oral health
Fluoride toothpaste
Water Fluoridation
Diet and lifestyle
Professional care
and treatment
Oral health requires regular tooth brushing, a good diet, regular check ups and ideally access
to fluoridated water.
Oral health can be improved through fluoridation – the addition of fluoride to drinking water.
Water fluoridation is one of the most effective preventive methods for dental caries21. Those
with fewer socioeconomic resources benefit to a much greater extent from water fluoridation
than those with more socioeconomic resources. Therefore, at a population level, water
fluoridation works much better than personal care practice particularly for children, Māori and
the most disadvantaged.
Because of this, Māori can experience the same level of benefit from fluoridation as non-Māori
and this helps to reduce inequalities in oral health. The provision of fluoridated drinking water
supplies is largely controlled by territorial authorities. Within the Waikato DHB region, only four
local authorities add fluoride to drinking water supplies; Hamilton City Council, South Waikato
District Council (Tokoroa only), Waikato District Council (Ngaruawahia and Huntly) and
Thames Coromandel District Council. Matamata-Piako discontinued fluoridation in 1996 and
Ruapehu District Council discontinued fluoridation in Taumarunui in 2011. There are a number
of TA‟s within the Waikato DHB region with a high Māori population with no access to
fluoridated water.
Waikato DHB continues to advocate for fluoridation of water supplies within the region.
Section 5: Māori health
July 2012
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Page 27 of 54
Update due: July 2015
Population Health Waikato DHB – Future Focus
Access to primary health care
As first point of contact with the health
system, the utilisation of primary health
care services can be an indication of the
health of a population. In February
2001, the New Zealand government
released the “Primary Health Care
Strategy”22 document, which defines
primary health care as “health care
based on practical, scientifically sound,
culturally appropriate and socially
acceptable methods that is:
universally accessible to people in
their communities
involves community participation
integral to, and a central function
of, New Zealand‟s health system
the first level contact with our
health system.
National figures show that although
Māori were as likely to have a regular
health practitioner, they were less likely
to have seen their GP in the last 12
months and more than twice as likely to
have an unmet need to see a GP
compared to non-Māori 20.
There are a number of Māori PHO‟s
within the region that caters specifically
to the needs of the Māori population.
5.7.2 Risk factors
Risk factors for poor health are of
particular concern for Māori populations.
Exposure to risk factors can result in
negative effects on health, and Māori
suffer these at a significantly higher rate
than non-Māori.
Source: Waikato DHB
Case Study: Club Champs
The Club Champs project is a proactive approach
aimed at reducing alcohol related harm within the
grass roots King Country sports clubs of Otorohanga,
Te Kuiti and Taumarunui (all areas with a high
proportion of Māori). Club Champs is a joint initiative
between the Police and Population Health, with some
external funding provided by the Alcohol Advisory
Council of New Zealand (ALAC). Built around the
slogan „let your mates know when they‟ve reached full
time‟, clubs involved predominantly follow the rugby
code.
Many rural areas have local sports clubs as a central
point for social contact. These clubs are integral parts
of rural communities and contribute to the physical and
mental wellbeing of their communities. However, there
is recognition that many of these clubs have a history
and a culture of excessive alcohol consumption. This
means that if any positive changes are to be made
around reducing alcohol consumption and its
associated risks, it needs to be led by the clubs
themselves.
Population Health has worked with clubs to develop
alcohol management plans, and encouraged the
appointment of a “Club Champ”, who is a designated
person to put this plan into action and keep them
active. Findings to date report positive changes by
clubs. Examples include having "open" conversations
within the club around alcohol harm, raising awareness
and spreading the message to the wider community,
and supporting each other better when making the
hard calls.
Alcohol use
Final evaluation of the project was completed in
December 2011 with positive results.
Alcohol is the most commonly used
recreational drug in New Zealand and is
used socially and in moderation by the majority of users. However, misuse or abuse of alcohol
can lead to a number of health issues, from both:
direct health concerns from misuse of alcohol (cardiovascular and gastrointestinal
problems)
indirect results of alcohol abuse as a result of its affect on behaviour (traffic accidents,
domestic violence, assault).
Section 5: Māori health
July 2012
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Page 28 of 54
Update due: July 2015
Population Health Waikato DHB – Future Focus
Issues concerning alcohol misuse and abuse were brought to national attention with the Law
Commission‟s report in April 2010, Alcohol In Our Lives: Curbing the Harm, containing 153
recommendations to radically transform how alcohol is purchased and consumed in New
Zealand23. On 25 August 2011, the Government announced that the Alcohol Reform Bill would
implement 135 of the Law Commission‟s 153 recommendations (84 in full and 43 in part). The
Government also accepted in principle 8 of the Commission‟s operational recommendations24.
The way alcohol is used, and therefore health issues related to this use, are experienced by
Māori and non-Māori in different ways. While national statistics show that there was no
significant difference between the percentages of Māori who had used alcohol compared to
non-Māori, Māori were much more likely to have consumed a large amount of alcohol on at
least one drinking occasion. Māori men were more likely to have first tried alcohol at an
earlier age than Māori women.
Māori were also found to be more likely to combine drinking with other risk behaviours (such
as driving, operating machinery, or using tobacco or other drugs), to experience harmful
effects of drinking (such as injuries, assault, poorer relationships or financial situation) but less
likely to engage in moderating behaviour around alcohol25.
Tobacco use
Tobacco smoking is the leading cause of preventable death in New Zealand and is directly
linked to almost 5,000 deaths per year.26 Smoking is the main risk factor for lung cancer and
chronic obstructive pulmonary disease (COPD) and is a primary risk factor for cardiovascular
disease, cancers of the mouth, oesophagus, pharynx and larynx, and many others cancers
and chronic diseases. Results from the 2006/07 New Zealand Health Survey indicate that
there is a significantly higher proportion of smokers in the Waikato DHB area than many other
areas in New Zealand. Data shows that illnesses and disease attributed to tobacco use are
significantly higher for Māori.2 Particular high-risk groups include Māori women and youth, and
those in areas of high deprivation. In the Waikato region, almost 40% of Māori (aged 15 years
and over) were smokers, a much greater proportion than other ethnicities (Figure 12).
One of the Ministry of Health‟s key health targets is to provide better help for more smokers to
quit. Several recent law changes by the Government promote smoking cessation, including
progressive tax increases on tobacco, restricting tobacco displays and making New Zealand
prisons smokefree.
Section 5: Māori health
July 2012
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Page 29 of 54
Update due: July 2015
Population Health Waikato DHB – Future Focus
Figure 12: Age standardised1 percentage of smokers aged 15 years and over, by gender
and ethnicity2, Waikato DHB and New Zealand, 2006
MELAA (Middle Eastern, Latin American, African)
(1) Standardised to World Health Organisation Standard Population.
(2) People can belong to more than one ethnic group.
Source: Statistics New Zealand, 2006 Census of Population and Dwellings.
Exposure to second-hand smoke
Second hand smoke is a recognised risk factor for a number of diseases and conditions in
New Zealand, including sudden unexplained death in infancy (SUDI), asthma, lung cancer
and ischaemic heart disease. According to the 2006/07 New Zealand Health Survey, Waikato
DHB has the highest prevalence of second-hand smoke exposure for children in the country.
Whilst the proportion of New Zealand children exposed to second-hand smoke was 9.6%, the
Waikato DHB proportion was 14.8%. Nationally, Māori children are almost twice as likely as
European children to be exposed to second-hand smoke in their home20.
Sedentary behaviour
Whilst physical activity can be a protective lifestyle factor in a person‟s overall health,
sedentary lifestyles can be a risk factor. Sedentary behaviour is increasing with children and
young people. Sport and Recreation New Zealand‟s study „Trends in Participation in Sport and
Active Leisure 1997 - 2001‟ shows that between 1997 and 2001, an inactive lifestyle for young
people rose slightly from 31.1% to 33.5%. Whilst this rise is relatively small, the change for
Māori was much more alarming; a rise from 24.7% in 1997 to 34.3% in 2001 27. In addition, a
high level of Māori children watch more than two hours of television a day; a very sedentary
activity. Nationally, Māori children were the most likely of ethnic groups surveyed to watch
more than two hours of television a day20.
Problem gambling
Gambling has been a part of Māori life since the time of colonisation. Gambling activities were
introduced in the mid-1800‟s and by the 1980‟s were an established part of mainstream New
Section 5: Māori health
July 2012
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Population Health Waikato DHB – Future Focus
Zealand culture through activities such as Lotto and TAB. The Skycity Riverside Casino was
opened in Hamilton in 2002.
The Gambling Act 2003 shifted the focus of gambling to public health, harm prevention and
community involvement in decisions related to gambling. The proliferation of Non-Casino
Gaming Machines (NCGM‟s), or pokies, is the main driver of gambling related risk behaviour.
Whilst the Act created a requirement of local authorities to develop gambling venue policies,
which consequently saw the number of NCGM‟s drop nationally, the problem created by these
machines still exists. They are considered particularly problematic due to the prolonged
manner that a person may use one. Of the total gambling market, NCGM‟s have 46%, twice
that of casinos. Whilst most gamblers will not experience problems, those that do may
experience psychological and biological issues, and reduced income which may lead to higher
levels of deprivation. Problem gamblers can affect a large number of people apart from
themselves.
Problem gambling is a significant risk to health for Māori. Ethnicity, deprivation and access to
a gambling venue are associated with gambling harm in New Zealand. Māori and Pacific
peoples are more likely to live in deprived areas and almost half of NCGM‟s are found in such
areas. As Māori are overrepresented within these areas, there is a greater risk of exposure to
NCGM‟s for Māori. The 2006/07 NZ Health Survey found that 7.0% of Māori had experienced
problems with gambling, compared with 2.2% of Europeans.
Fortunately, the issue of problem gambling is well recognised and there are many
interventions in place. There are 21 DHB‟s in New Zealand. On average, each DHB has five
problem gambling service sites. However, the Waikato DHB has 19. This is well above any
other DHB, and also compares favourably in terms of sites per head of population28. This
indicates that help is available more readily to problem gamblers in the Waikato DHB area
than in other areas of New Zealand.
It is important to note, however, that other forms of problem gambling are still prevalent. This
may also include informal and unofficial types of gambling.
5.8
Te Oranga: Participation in society
For Māori, participation in wider society is a key aspect of health. Some of the most significant
determinants of health come as a result from participation in society, and play a large role in
the health outcomes of a community. Whilst accessibility to a secure cultural identity is of
great importance for Māori, over 80% of Māori in the Waikato region live in urban or semiurban areas; therefore interaction with wider society is likely to be a part of life for many Māori.
This participation can be seen in both education and workforce fields. An active involvement in
the community can ensure that such areas remain accessible and appropriate for the needs of
Māori. However, if participation is minimal, this can lead to a decrease in such areas, affecting
such services ability to be responsive to Māori needs.
5.8.1 Participation in education
Education is an important determinant of the health and wellbeing of a population.
Participation in education and the eventual level of educational achievement plays an
important role in the protection and promotion of health.
Section 5: Māori health
July 2012
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Update due: July 2015
Population Health Waikato DHB – Future Focus
Early childhood education
Early childhood education may provide a range of benefits to children29. This has been
recognised by the Government, who currently offer 20 hours of free early childhood education
at a registered provider. Within the Waikato, just over a quarter of Māori children are attending
childcare; a higher rate than New Zealand (20%) (Figure 13). The greater participation of
Māori children in early childhood education in the Waikato probably represents the higher
proportion of Māori in the region.
Educational qualification
A higher level of educational achievement result generally in greater employment
opportunities. This is likely to lead to a higher rate of income, which is a contributing factor in
the health and wellbeing of an individual.
In the Waikato DHB area, Māori are more likely to have left school with little or no educational
qualification than non-Māori (37% compared to 25%), and are less likely to have completed a
degree or higher education (6% compared to 12%) (Figure 14).
Figure 13: Percentage of Māori children attending Early Childhood Education, Waikato
Regional Council and New Zealand, 2005-2010 (as at 1 July of each year)
Percentage of Maori children of the total children
in Early Childhood Education
40%
Waikato
New Zealand
35%
30%
25%
20%
15%
10%
5%
0%
2005
2006
2007
2008
2009
Year
Source: ECE Analysis Team, Ministry of Education
(http://www.educationcounts.govt.nz/__data/assets/excel_doc/0009/55467/ECE-Enrolments-by-Regional-Council-andEthnic-Group.xls)
Section 5: Māori health
July 2012
‘Planning today for tomorrow’
Page 32 of 54
Update due: July 2015
2010
Population Health Waikato DHB – Future Focus
Figure 14: Highest qualification for residents (15 years and over), by Māori and nonMāori, Waikato DHB area, 2006
40%
Non-Māori
Māori
35%
Percentage
30%
25%
20%
15%
10%
5%
School
Post-School
Not
Elsewhere
Included
Doctorate
Masters
PostGraduate
Bachelor
Level 6
Level 5
Level 4
Level 1, 2 or
3
Overseas
Level 3 or 4
Level 2
Level 1
No
Qualification
0%
Tertiary
Qualification
Source: Statistics NZ, NZ Census 2006.
Employment status and participation in the workforce
Participation and involvement in the workforce is a key part of participation in wider society.
Employment is a major determinant of health; apart from being the main source of income for
most people, it can increase participation within the community, provide opportunities for
social contact and interaction, and contribute to a sense of self worth. Such benefits can be
derived from either full or part time employment, and can have a major impact on a person‟s
overall health status.
Employment provides a main source of income for the majority of the population and therefore
an individual‟s participation in employment will be a major factor in their overall health. Those
who are unemployed are more likely to suffer from poor health. More Māori have experienced
unemployment than non-Māori. Non-Māori are more likely to be in either full time or part time
employment within the Waikato region, whilst Māori are significantly more likely to be
unemployed than non-Māori reflecting national figures (Figure 15). Research by the
Department of Labour has also shown that Māori have been particularly vulnerable to adverse
effects of the economic downturn. This is due to a relatively young and unskilled population
with lower educational achievement. Populations in such a situation are likely to be more
vulnerable to poor economic conditions.30
Occupation group
Māori are more likely to be employed as „plant and machine operators and assemblers‟ or
„elementary service workers‟, by comparison, and non-Māori are more likely to be employed
as „legislators, administrators and managers‟; „professionals‟; or „agriculture and fishery
workers‟ (Figure 16). There is little change evident in this data between 2001 and 2006.
Section 5: Māori health
July 2012
‘Planning today for tomorrow’
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Update due: July 2015
Population Health Waikato DHB – Future Focus
Industry group
Between 2001 and 2006, there was a small decline in the proportion of Māori employed in the
„Manufacturing‟ industry (down from 16% to 15%) and a small increase in the proportion
employed in „Business and Property‟ (up from 7% to 8%) (Figure 17). The proportion of Māori
in the Waikato DHB area employed in the „Health and Community‟ industry area is
comparable to non-Māori.
Figure 15: Employment status by Māori and Non-Māori, Waikato DHB region, 2006
60%
50%
Percentage
40%
Non-Māori
30%
Maori
20%
10%
0%
Employed Full-time
Employed Part-time
Unemployed
Not in the Labour
Force
Employment Status
Source: Statistics NZ, NZ Census 2006.
Notes: Work and Labour Force Status and Ethnic Group (Grouped Total Responses) by Sex, for the Census Usually Resident
Population Count Aged 15 Years and Over, 2006.
Section 5: Māori health
July 2012
‘Planning today for tomorrow’
Page 34 of 54
Update due: July 2015
Population Health Waikato DHB – Future Focus
Figure 16: Occupation sub-group for Māori, 15 years and over, Waikato DHB region,
2001, 2006
10%
2001
2006
8%
6%
2%
Not Elsewhere
Included
Labourers and
Elementary
Service
Plant and
Machine
Operators and
Trade Workers
Agriculture and
Fishery
Workers
Clerks
Service and
Sales Workers
-4%
Technicians
and Associate
Professionals
-2%
Professionals
0%
Legislators,
Administrators
and Managers
Percentage
4%
-6%
-8%
-10%
Occupation Sub-group
Source: Statistics NZ, NZ Census 2006.
Notes: Occupation (NZSCO99 v1.0 Major Group) by Ethnic Group (Grouped Total Responses), for the Employed Census Usually
Resident Population Count Aged 15 Years and Over, 2001 and 2006.
Section 5: Māori health
July 2012
‘Planning today for tomorrow’
Page 35 of 54
Update due: July 2015
Population Health Waikato DHB – Future Focus
Figure 17: Industry group by selected ethnic group (Māori and Non-Māori), 15 years and
over, Waikato DHB region, 2001, 2006
18%
Maori - 2001
16%
Maori - 2006
14%
Non-Maori - 2001
Percentage
12%
Non-Maori - 2006
10%
8%
6%
4%
2%
Health and
Community
Cultural and
Recreational
Personal and
Other Services
Not Elsewhere
Included
Education
Accommodation,
Cafes and
Transport and
Storage
Communication
Services
Finance and
Insurance
Property and
Business
Government
Administration
Retail Trade
Wholesale
Trade
Construction
Electricity, Gas
and Water
Manufacturing
Mining
Agriculture,
Forestry and
0%
Industry Group
Source: Statistics NZ, NZ Census 2006.
Notes: Industry (ANZSIC96 V4.1 Division) and Ethnic Group (Grouped Total Responses) by Sex, for the Employed Census
Usually Resident Population Count Aged 15 Years and Over, 2001 and 2006.
All Ruapehu District data used here -data constraints prevent extract Waikato DHB only Ruapehu data.
Section 5: Māori health
July 2012
‘Planning today for tomorrow’
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Update due: July 2015
Population Health Waikato DHB – Future Focus
5.9
Te Mana Whakahaere: Autonomy
Autonomy and self-determination are key drivers for Māori in attaining positive health and
wellbeing. The ability for Māori to make their own decisions and have a greater degree of
control over their own lives will lead to a greater degree of empowerment, and therefore
health. Durie notes that health promotion must make sense to a community, and if a certain
level of understanding and appreciation of a programme is not received, it is unlikely to be
successful4. If it is practical to have local health aims shaped by the marae or local Māori
community, this should be considered.
Self determination can be achieved and maintained through a number of paths. This can
include democracy, household tenure and income, all of which are discussed in this section.
5.9.1 Democracy
Māori autonomy and self-determination can be attained through participation in the democratic
process. One way this can be achieved is through Māori electorates in parliament. Currently,
there are seven Māori electorates. The Waikato DHB area includes the Hauraki-Waikato
(formerly Tainui) and the northern section of the Te Tai Hauāuru electorates.
Every six years, Māori can choose which electoral roll they wish to be registered on during the
Māori electoral option. This was last held in 2006 and will be next held in 2012. The results
shape the makeup of Māori electorates for the next two elections. Currently, 59% of Māori
within the Hauraki-Waikato electorate and 57% of Te Tai Hauāuru electorate are enrolled on
the Māori roll. This is comparative with other Māori electorates. Comparisons of 2005 and
2008 general election results can show turnouts and the proportion of Māori enrolled on the
Māori electoral roll, and how this has changed. As Māori electorates are frequently changed in
order to accurately reflect population, longer term analysis is somewhat difficult. Turnout in
Māori electorates are typically much lower than in general electorates. In 2008, Māori
electorate turnout was 62.41%, compared to the general electorate turnout of 80.88%.
Hauraki-Waikato turnout was one of the lowest Māori electorates, at 60.89%.
There are a number of possible explanations for this lower turnout. In an Electoral
Commission report of 2007, it was concluded that this was most likely due to the fact that
younger voters with lower standards of living typically have lower voter turnout, and the Māori
population would have a higher number who fit into this category. It may also be partly
explained by the lack of interest from Māori in what is essentially a European model of
democracy31.
5.9.2 Household tenure
Home ownership is a key way that Māori can build wealth and security, and increase self
determination. It is also an important way to support whānau.
The proportion of Māori who are homeowners in the Waikato region is one of the lowest in
New Zealand. Approximately 28% of Māori in the Waikato region own their own home,
compared to 30% nationally. Only Māori in Auckland has lower home ownership rates (26%).
Māori home ownership rates are not increasing. Home ownership rates have decreased from
32% nationally and 30% in Waikato in 2001 to 30% nationally and 28% in Waikato in 200632.
Māori are also less likely to own their home, compared to non-Māori of similar income.
Section 5: Māori health
July 2012
‘Planning today for tomorrow’
Page 37 of 54
Update due: July 2015
Population Health Waikato DHB – Future Focus
5.9.3 Income
Income is a clear determinant of health. An individual‟s income will increase their choices, and
determine their ability to pay for health services. Poverty is a critical element in creating
inequalities in health. It may not be the material deprivation associated with low income that
causes inequalities, but rather the psychological strains that low income can place on an
individual, causing stress, anxiety and a feeling of helplessness and inferiority33.
Approximately a quarter of Māori within the Waikato region earn low incomesii, substantially
more than all ethnicities, at 19%.
The TAs with over 30% of their Māori population receiving a low income are Hauraki,
Otorohanga, South Waikato and Ruapehu (all). More Māori are on low incomes in the Waikato
compared to non-Māori and significantly less Māori are on incomes over $40,000 (Figure 18).
Figure 18: Percentage of population aged 15 years and over, by income band, Waikato
DHB (including all of Ruapehu TA) and New Zealand, 2006
14%
Percentage of population
12%
10%
8%
6%
Māori – New Zealand
Māori – Waikato DHB
4%
Non-Māori – New Zealand
Non-Māori – Waikato DHB
2%
Not Stated
$100,001 or more
$70,001 - $100,000
$50,001 - $70,000
$40,001 - $50,000
$35,001 - $40,000
$30,001 - $35,000
$25,001 - $30,000
$20,001 - $25,000
$15,001 - $20,000
$10,001 - $15,000
$5,001 - $10,000
$1 - $5,000
Zero Income
Loss
0%
Income Band
Source: Statistics New Zealand – table builder (Total Personal Income and Work and Labour Force Status by Ethnic Group
(Grouped Total Responses) and Sex, for the Census Usually Resident Population Count Aged 15 Years and Over, 2006)
ii
The Ministry of Social development defines low income as the proportion of people living in households with real
gross income less than 60% of the median household equivalised national gross income benchmarked at 2001.
Section 5: Māori health
July 2012
‘Planning today for tomorrow’
Page 38 of 54
Update due: July 2015
Population Health Waikato DHB – Future Focus
5.10 Ngā Manukura: Leadership
Māori leadership plays a critical role in the overall health of Māori. Strong leadership within
and on behalf of Māori communities may be beneficial in improving their overall health status.
This can be achieved through the ability to educate on health issues, or the importance of
determinants of health. Leaders may be within their own communities, or in a wider context of
society, and may take a different form depending on the part of society the leadership is
representing. The effectiveness of leadership may be a significant determinant to Māori health
outcomes.
In wider society, the amount of influence a Māori viewpoint has will play a large part in
determining how issues relating to Māori health are addressed. Within the Waikato DHB area,
there are a number of ways the Māori voice can be heard as part of society.
5.10.1 Local body representation
Māori representation on school Board of Trustees
Representation by Māori on school boards of trustees can be seen as an indicator of positive
leadership in the wider community. By providing a Māori voice within local schools and their
communities, the unique needs of Māori are more likely to be addressed. The Waikato
region‟s rate of Māori representation on boards is 23.4%, higher than the Māori population of
the region. This rate is also higher than the New Zealand average of 18.9%.
Within the Waikato DHB region, TA‟s with the highest Māori population also had the highest
Māori representation on Boards of Trustees. Boards of Trustees in Ruapehu (all), South
Waikato, Waitomo and Otorohanga all had Māori representation at levels above 30%. Areas
of low Māori population had lower Māori representation on Boards of Trustees. Percentages in
Hauraki, Waipa and Matamata-Piako all had representation at levels lower than the national
average34.
Māori representation in local government
The issue of Māori representation in local government has been a topical issue recently. This
is mainly due to the government‟s decision not to follow the recommendation from the Royal
Commission on Auckland Governance. This recommendation was to include statutory Māori
seats on the newly formed Auckland Council.
Currently, only one regional council in New Zealand (Environment Bay of Plenty) has
dedicated Māori seats on council. In 2001, the Local Electoral Act was amended to enable
any TA or regional council to create such seats. No TA has done so35.
Regional councils and TA‟s within the Waikato DHB area have varying ways of formally
consulting with Māori (Table 5).
Section 5: Māori health
July 2012
‘Planning today for tomorrow’
Page 39 of 54
Update due: July 2015
Population Health Waikato DHB – Future Focus
Table 5: Types of Māori representation in regional councils and territorial authorities
within the Waikato DHB area
Authority
Current representation
Waikato Regional Council
Tai-ranga-whenua – Iwi unit within Waikato Regional Council
Horizons Regional Council
Memorandum of Partnership with local Iwi and consultation on
37
any issues affecting Māori .
Hamilton City Council
Council partnerships and service agreements with Te Runanga
38
o Kirikiriroa and Ngā Mana Toopu o Kirikiriroa .
Waikato District Council
Iwi Partnership Committee (Council committee) .
Waipa District Council
Waipā Iwi Consultative Committee .
Matamata-Piako District Council
Te Manawhenua Forum
41
Committee of Council) .
South Waikato District Council
Memorandum of Understanding with Raukawa Trust Board .
Thames-Coromandel District
Council
Memorandum of Understanding with Ngāti Hei .
Hauraki District Council
Memorandum of Understanding with Iwi either developed or
under development, Iwi Liaison Forum in development. Ongoing
44
consultation on issues of importance .
Ruapehu District Council
No official agreement between council and local Iwi but
progressing towards one in the future. Māori views are sought
45
on major issues .
Otorohanga District Council
Iwi Community Outcomes developed for Ngāti Maniapoto,
46
Waikato-Tainui and Raukawa .
Waitomo District Council
Regular meetings with Maniapoto Trust Board; processes for
47
consultation agreed on a case by case basis .
36.
39
40
Mo
Matamata-Piako
(standing
42
43
Source: Regional territorial authority Long Term Plans, as referenced.
5.11 Māuiui
Although not part of the Te Pae Mahutonga framework, it is not possible to discuss Māori
health without acknowledgement of the role that māuiui/ill health plays.
Māori feature disproportionately in māuiui figures therefore there is a clear need to discuss
this within Future Focus. Whilst this section has a focus on key aspects of ill health, further
information can be found in a number of other sections of Future Focus. Of particular interest
in regards to māuiui is Section 12: Chronic Conditions.
A health needs analysis undertaken by Te Puna Oranga identified health priorities for Māori
(Figure 19). Unless discussed earlier within the document, these will be the māuiui focus
areas.
Section 5: Māori health
July 2012
‘Planning today for tomorrow’
Page 40 of 54
Update due: July 2015
Population Health Waikato DHB – Future Focus
Figure 19: Ki te Taumata o Whānau Ora 2011-12 Māori health priorities:
Oral Health (children)
Mental Health and Addictions
Cardiovascular Disease (CVD)
Smoking (risk factor)
Overweight/obesity (risk factor)
Respiratory
Diabetes
Renal
Cancer.
Source: Waikato DHB. (2011) Ki te Taumata o Whanau Ora 2011-2012; Waikato DHB Māori Health Plan.
Hamilton: Waikato DHB
5.11.1 Mental health
Māori experience many types of mental illness at a disproportionately higher rate than nonMāori (Table 6).
Suicide
Nationally, Māori, particularly Māori men, are most at risk of suicide.48 For Māori, the grief and
impact of suicide is often felt beyond the whānau to the hapū and Iwi, and is viewed not only
as a tragedy, but also as a loss to the continuation of whakapapa, which is the foundation
stone of hapū and Iwi. Approximately 500 deaths are due to suicide each year in New
Zealand. Māori suicide rates are almost four times higher than non-Māori 49
Section 5: Māori health
July 2012
‘Planning today for tomorrow’
Page 41 of 54
Update due: July 2015
Population Health Waikato DHB – Future Focus
Table 6: Number and age standardised(I) discharge rate per 100,000 people aged under
75 years for schizophrenia, schizotypal and delusional disorders(II), by ethnicity, TA,
Waikato DHB, July 2001 - June 2006
Ethnicity N (Rate)
Area
Māori
Non-Māori
Total N (Rate)
Thames-Coromandel
46
294
77
82
123
128
Hauraki
36
278
57
97
93
138
Waikato
109
242
109
84
218
131
Matamata-Piako
54
331
76
61
130
107
Hamilton
599
547
742
146
341
221
Waipa
66
269
70
47
136
80
Otorohanga
23
198
16
56
39
100
South Waikato
59
201
90
131
149
156
Waitomo
36
231
24
111
60
159
Ruapehu (part)
56
395
26
91
82
209
Waikato DHB
1084
363
1287
102
2371
159
(I) Standardised to World Health Organisation Standard Population using the five year average.
(II) Primary Diagnosis ICD10 F20-F29.
Source: Waikato DHB, Various Hospital Discharge Collections.
Statistics New Zealand, 2001 and 2006 Censuses of Population and Dwellings.
5.11.2 Ischaemic Heart Disease (IHD)
Ischaemic heart disease is one of the leading causes of death in New Zealand50. Māori have
higher hospital admission and mortality IHD rates than non-Māori, and these present at a
much younger age for Māori (Figure 20). In 2007, less than 12% of non-Māori deaths from
IHD were in people under the age of 65 compared to almost 45% for Māori. Māori have
higher IHD rates for all age groups up to the age of 80 years compared with non-Māori. This
is particularly apparent in younger age groups (40-69 years), where non-Māori have almost no
IHD hospitalisations. Providing better cardiovascular services is one of the Ministry of Health‟s
targets (please see below).
Section 5: Māori health
July 2012
‘Planning today for tomorrow’
Page 42 of 54
Update due: July 2015
Population Health Waikato DHB – Future Focus
Figure 20: IHD mortality rate, by ethnicity and age group, Waikato DHB, 2005-2009
5,000
Non-Māori
4,500
Māori
Rate per 100,000
4,000
3,500
3,000
2,500
2,000
1,500
1,000
500
85+
80 - 84
75 - 79
70 - 74
65 - 69
60 - 64
55 - 59
50 - 54
45 - 49
40 - 44
35 - 39
30 - 34
25 - 29
20 - 24
15 - 19
10 - 14
5-9
0-4
0
Age groups
Source: Ministry of Health – Mortality spreadsheets; Statistics New Zealand – DHB summary spreadsheets (Table 2)
5.11.3 Obesity
The World Health Organization now describes the prevalence of obesity as a pandemic and
has recognised obesity as being one of the five greatest risk factors for global mortality.51
Obesity is a risk factor for a large number of health conditions including type 2 diabetes,
ischaemic heart disease, stroke and a number of types of cancer. New Zealand‟s obesity
prevalence has been increasing for a number of years. Currently there is limited access to
comparable data related to body size in the Waikato against New Zealand and therefore
obesity is examined from a national perspective in this section.
Obesity is of particular concern for Māori. Māori adults and children are more than 1.5 times
more likely to be obese than non-Māori20.
Obesity in children and young people is associated with many serious health problems,
including depression, cardiovascular risk factors, type 2 diabetes, musculoskeletal problems
and poor self-esteem. Children and young people who are obese are also more likely to be
obese as adults.
5.11.4 Respiratory
Asthma
Asthma is a chronic (long-term) lung disease that inflames and narrows the airways. Asthma
causes recurring periods of wheezing (a whistling sound when you breathe), chest tightness,
shortness of breath, and coughing. The coughing often occurs at night or early in the morning.
New Zealand has one of the highest incidences of asthma in the world 52. In Waikato for those
aged under 24 years, the rate of asthma hospitalisations for Māori was twice that of any other
ethnicity (Figure 21).
Section 5: Māori health
July 2012
‘Planning today for tomorrow’
Page 43 of 54
Update due: July 2015
Population Health Waikato DHB – Future Focus
Chronic Obstructive Pulmonary Disease (COPD)
COPD refers to a number of chronic lung disorders including emphysema and chronic
bronchitis. Smoking is the main risk factor. In Waikato, Māori COPD hospitalisation rates
were three times greater than non-Māori for all age-groups (Figure 22).
Figure 21: Asthma hospitalisation rate (0-24 years), by ethnicity, Waikato DHB, 20052009
450
Average (Waikato DHB, 0-24)
400
Rate per 100,000
350
300
250
200
150
100
50
0
Mäori
European / Other
Pacific Islander
Asian
Ethnic Groups
Source: CostPro – Waikato DHB hospitalisation database; Statistics New Zealand (Table builder - Age by Sex for 1996, 2001 and
2006 Censuses - 2006 only)
Section 5: Māori health
July 2012
‘Planning today for tomorrow’
Page 44 of 54
Update due: July 2015
Population Health Waikato DHB – Future Focus
Figure 22: COPD hospitalisation rate by age and ethnicity, Waikato DHB, 2005-2009
8,000
Rate per 100,000
7,000
Non-Māori
Māori
6,000
5,000
4,000
3,000
2,000
1,000
85+
80 - 84
75 - 79
70 - 74
65 - 69
60 - 64
55 - 59
50 - 54
45 - 49
40 - 44
35 - 39
30 - 34
25 - 29
20 - 24
15 - 19
10 - 14
5-9
0-4
0
Age groups
Source: Waikato DHB hospitalisation database – CostPro; Statistics New Zealand – DHB summary spreadsheets (Table 2)
5.11.5 Diabetes
In New Zealand, one in 20 adults have been diagnosed with diabetes. Almost all cases of
diabetes are classified as type 2 diabetes. However, a large number of diabetes cases go
undiagnosed.
Diabetes is associated with an increased risk of a number of the health conditions discussed
elsewhere in this section, such as cardiovascular disease, renal disease, and peripheral
vascular disease. Type 2 diabetes is becoming more common in children, and can be linked
to obesity and physical inactivity.
In general, Māori diabetes hospitalisation rates were three times greater than for non-Māori in
almost all TA‟s in the Waikato region (Figure 23). A 2010 study examining the ethnic
disparities in causes of death among diabetic patients in the Waikato region found that Māori
had nearly double the age adjusted mortality rates compared to non-Māori53. The study also
investigated how newly diagnosed patients with type 2 diabetes in the Waikato receive
education on diabetes. Results showed that diabetes is most commonly diagnosed in
asymptomatic patients attending appointments with their general practitioners. Around 67% of
non-Māori diabetics are identified through routine screening compared to only 43% of Māori.
This study found that patients from lower-socioeconomic backgrounds may be less receptive
to education and less likely to implement behaviour changes. These groups are often the most
at risk of developing complications of diabetes, and are often in regions of highest
hospitalisation. Finding appropriate education delivery methods is important in the selfmanagement of the disease54.
Ministry of Health targets for cardiovascular and diabetes services are:
90% of the eligible adult population will have had their cardiovascular disease risk
assessed in the last five years
increased proportion of people with diabetes will attend free annual checks
Section 5: Māori health
July 2012
‘Planning today for tomorrow’
Page 45 of 54
Update due: July 2015
Population Health Waikato DHB – Future Focus
increased proportion of people with diabetes will have satisfactory or better diabetes
management
90% of the eligible population will have had their cardiovascular disease risk assessed in
the last five years (from 1 January 2012).
Renal failure
Māori renal failure rates are up to 4 times higher than non-Māori. Disparities in renal failure
hospitalisation rates are evident for all ages and increase with age (Figure 24). As renal failure
is strongly linked to type 2 diabetes and hypertension, conditions with higher prevalence in
Māori compared to non-Māori, such disparities are expected.
Figure 23: Age standardised (I) mortality rate per 100,000 people, diabetes mellitus (II),
by ethnicity, territorial authority, Waikato DHB and New Zealand, 1999 - 2003.
Notes:
Lines Indicate the 95% Confidence Interval
(I) Standardised to World Health Organisation Standard Population using the five year average for 1999 - 2003.
(II) ICD9 250 (1999), ICD10 E10-E14 (2000 – 200(III), Underlying and any contributing cause of death.
Source: New Zealand Health Information Service, National Minimum Data Set – Mortality.
Statistics New Zealand, 2001 Census of Population and Dwellings.
Section 5: Māori health
July 2012
‘Planning today for tomorrow’
Page 46 of 54
Update due: July 2015
Population Health Waikato DHB – Future Focus
Figure 24: Renal failure hospitalisation rates by age and ethnicity, Waikato DHB, 20052009
1,000
Non-Māori
900
Māori
Rate per 100,000
800
700
600
500
400
300
200
100
85+
80 - 84
75 - 79
70 - 74
65 - 69
60 - 64
55 - 59
50 - 54
45 - 49
40 - 44
35 - 39
30 - 34
25 - 29
20 - 24
15 - 19
10 - 14
5-9
0-4
0
Age groups
Source: Waikato DHB hospitalisation database – CostPro; Statistics New Zealand – DHB summary spreadsheets (Table
5.11.6 Cancer
Māori have high registration and mortality figures for many cancers, compared to NZ
European. These include lung and breast cancer.
The Midland Cancer Network needs assessment provides detailed information regarding
cancer data for the region, and describes the inequalities in incidence and mortality (etc)
between Māori and non-Māori in Waikato55. It shows that Māori have the highest rates of all
cancer mortality compared to other ethnicities across all age groups, and particularly for Māori
aged 65 years and over. Māori also had lower screening rates for breast and cervical cancers
than European populations. Māori have significantly higher hospitalisation and mortality lung
cancer rates compared to non- Māori (Figures 25, 26) which is of particular concern.
Section 5: Māori health
July 2012
‘Planning today for tomorrow’
Page 47 of 54
Update due: July 2015
Population Health Waikato DHB – Future Focus
Figure 25: Lung cancer hospitalisation rates by age and ethnicity Waikato DHB, 20052009
1,200
Non-Māori
Māori
Rate per 100,000
1,000
800
600
400
200
85+
80 - 84
75 - 79
70 - 74
65 - 69
60 - 64
55 - 59
50 - 54
45 - 49
40 - 44
35 - 39
30 - 34
25 - 29
20 - 24
15 - 19
10 - 14
5-9
0-4
0
Age groups
Source: Waikato DHB hospitalisation database – CostPro; Statistics New Zealand – DHB summary spreadsheets (Table 2)
Figure 26: Lung cancer mortality rates by age and ethnicity Waikato DHB, 2005-2009.
700
Rate per 100,000
600
Non-Māori
Māori
500
400
300
200
100
85+
80 - 84
75 - 79
70 - 74
65 - 69
60 - 64
55 - 59
50 - 54
45 - 49
40 - 44
35 - 39
30 - 34
25 - 29
20 - 24
15 - 19
10 - 14
5-9
0-4
0
Age groups
Source: Ministry of Health – Mortality spreadsheets; Statistics New Zealand – DHB summary spreadsheets (Table 2)
Section 5: Māori health
July 2012
‘Planning today for tomorrow’
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Population Health Waikato DHB – Future Focus
5.12 Evidence-based interventions
5.12.1 Community engagement and behaviour change
Models of health and wellbeing can help shape health approaches to improving the wellbeing
of specific population groups. It can be challenging for mainstream health organisations to
provide appropriate and effective health services that are able to be accessed by culturally
and linguistically diverse populations. A number of community initiatives have been
undertaken to improve areas of Māori health. Some of these have been highlighted in case
studies within this section.
5.12.2 Taking a whānau ora approach
The Ministry of Health has made a commitment to a whānau ora focus in He Korowai Oranga
(The Māori Health Strategy). The intention of He Korowai Oranga is to deliberately focus and
draw attention to Māori health improvement and reduce Māori health inequalities by placing
whānau ora at the centre of good health for Māori. Whānau ora is defined in He Korowai
Oranga as „Māori families supported to achieve their maximum health and wellbeing‟56 (Figure
27).
Figure 27: He Korowai Oranga structure - themes and pathways to improving whānau
ora
Source: He Korowai Oranga (2002)
Section 5: Māori health
July 2012
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Since the 2002 publication of He Korowai Oranga, whānau ora has become the leading
catalyst for the promotion of Māori health. Wider whānau is now widely recognised as having
a major impact on the health of an individual. A whānau ora strategy was announced by the
Government in 2009, and a minister for whānau ora appointed. It has been designed
specifically not to be a “one size fits all” solution to social problems, but flexible and able to
adapt to the unique needs of the whānau who are utilising it. The Government allocated over
$134 million to the project in Budget 2010. In 2010, 25 whānau ora providers were appointed
nationwide. Te Kohao Health Limited on Kirikiriroa Marae, Hillcrest, Hamilton and Taumarunui
Community Kokiri Trust were announced as two of the first whānau ora centres in late 2010.
A whānau ora approach can be threaded through all service activities to improve health and
wellbeing for the population within the Waikato DHB region to strengthen public health
outcomes for Māori (and remaining population groups) to ensure their maximum health and
wellbeing. Refer to the main Future Focus Introduction section for further information. This
can be achieved through:
approaching activities with an inequalities perspective and addressing determinants of
health
involving people who are disadvantaged in the planning and development of services
and seek feedback from the target groups on whether the services are accessible,
appropriate and meeting their needs57
using age and culture appropriate health models and approaches to provide services for
diverse populations
developing relationships with health and other sector agencies to enter into cooperative
and/or collaborative intersectoral action (Regional councils, TA‟s , Ministry of Social
Development, Housing New Zealand, Ministry of Education , primary health
organisations, Iwi providers, etc) with the aim of providing public health expertise and
supporting co-ordination of reducing inequalities work58
supporting community capacity building to enable local and sustainable improved
outcomes with respect to physical, social, cultural and environmental wellbeing58.
A number of health models are briefly described below followed by a brief summary of
evidence-based interventions for identified Waikato DHB priority populations (i.e. Māori,
Pacific peoples, older persons and people of low socioeconomic status (e.g. refugees)).
5.12.3 Health models
Māori models of health have become cornerstones of population health practice, to support
the development of holistic approaches in community health interventions. Three examples of
Māori health models include „Te Pae Mahutonga4‟; „Te Whare Tapa Whā59‟ and „Te Wheke59‟
(refer Future Focus Appendix section).
5.12.4 Interventions to improve the health of Māori
A commitment to improving the responsiveness of the health sector to Māori with the aim of
improving health outcomes and reducing inequalities between Māori and non-Māori is
required. Future planning needs to build on steps that have already been taken.
The categories identified in a Māori Cardiovascular Action Plan developed by Bramley et al
(2004) are applicable to Māori health interventions in general60. This action plan includes:
policy development – prioritising Māori health gain in all health public policy
Section 5: Māori health
July 2012
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Population Health Waikato DHB – Future Focus
information systems – the need for a complete and consistent collection of ethnicity
data
needs assessment – health needs assessments are required for Māori communities to
identify the level of met and unmet need (along with barriers to preventative health
services and strategies to address these)
quality standards – Māori-specific and equity-based performance indicators are
applied across the healthcare continuum
workforce development – priority areas for recruitment include doctors, nurses, health
researchers and public health workers
research – both quantitative and qualitative research pertaining to access and equity
issues of healthcare for Māori
effective intervention strategies require a global view (multi sector, multi-system and
multi-level in approach), innovative models, partnerships and accountability to all
stakeholders61.
5.13 Conclusion
It is clear that there are a number of factors that influence Māori health and wellbeing. As seen
through the Te Pae Mahutonga framework, health is more than the absence of disease. The
various factors that contribute to overall health and wellbeing have been addressed. In many
cases, Māori suffer inequality at a disproportionate level. This can clearly be seen through the
additional burden of disease that Māori carry.
Given the high Māori population within the Waikato DHB region, it is critical to establish such
information and look to potential interventions to address inequalities.
Section 5: Māori health
July 2012
‘Planning today for tomorrow’
Page 51 of 54
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Population Health Waikato DHB – Future Focus
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Population Health Waikato DHB – Future Focus
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Update due: July 2015