Maori Health Review

Making Education Easy Issue 14 – 2008

Maori Health Review

Ethnic differences in the management of lung cancer in New Zealand

Authors: Stevens W et al

Summary: This audit of secondary care management in Auckland and Northland of lung cancer patients diagnosed in 2004 aimed to assess whether management differences exist according to different ethnic groups, which may contribute to ethnic survival disparities. Of 565 eligible cases, 378 were European (67%), 95 were Mäori (17%), 56 Pacific Peoples (10%), 23 Asian (4%), and 13 other or unknown ethnicity (2%). Multivariate analyses adjusted for tumour and patient factors including comorbidity revealed that Mäori were 2.5 times more likely to have locally advanced disease than localised disease compared with Europeans (p<0.01), and four times less likely to receive curative rather than palliative anticancer treatment compared with Europeans (p<0.01). Mäori had longer transit times from diagnosis to treatment (p<0.001). Mäori were more likely to decline treatment and miss appointments than Europeans, although this only partially explained management differences.

Comment: This highlights the importance of undertaking clinical audit along the care pathway – particularly in lung cancer management given that it is a leading cause of cancer and deaths for Mäori. ‘Declining’ or missing appointments occurs for any number of reasons, many of them outside the patient’s control. Despite this, many clinicians and reception staff record ‘DID NOT ATTEND’ or ‘DNA’ in the patient notes without further information. Some clinicians admit that they are more likely to negatively stereotype a patient with ‘DNA’ recorded in their notes as non-compliant/difficult. Whether this has implications in the delivery of care is yet to be determined. Studies to explain unequal treatment rates between Mäori and non-Mäori are currently underway for IHD, colon cancer and other diseases – perhaps similar research in lung cancer should be a priority.

Reference: Journal Thorac Oncol. 2008;3:237-44


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Disclaimer: This publication is not intended as a replacement for regular medical education but to assist in the process. The reviews are a summarised interpretation of the published study and reflect the opinion of the writer rather than those of the research group or scientific journal. It is suggested readers review the full trial data before forming a final conclusion on its merits.

Research Review publications are intended for New Zealand health professionals.

Intimate partner violence and women’s physical and mental health in the WHO multi-country study on women’s health and domestic violence: an observational study

Authors: Ellsberg M et al

Summary: This WHO multi-country study interviewed women aged 15–49 years between 2000 and 2003 about their experiences of physically and sexually violent acts by a current or former intimate male partner, and about selected symptoms associated with physical and mental health. The women reporting physical violence by a partner were asked about injuries that resulted from this type of violence. 24,097 women completed interviews. Women who had experienced partner violence had worse selfreported health than women without such experiences, and specific health problems in the previous 4 weeks such as difficulty with walking and daily activities, pain, memory loss, dizziness, and vaginal discharge. Women who reported partner violence at least once in their life reported increased emotional distress and suicidal thoughts or attempts, compared with non-abused women.

Comment: Although women living in NZ were not recruited into the study I have included this paper because the results clearly demonstrate that the impact of partner violence on women’s physical and mental health occurs for women of many nations and varied backgrounds. As health providers we must address the major health needs for women who have experienced partner violence; as whanau, communities and nations we should also protect their rights to a healthy life.

Reference: Lancet. 2008;371:1165-72


Maori Health Review
Maori Health Review

Beyond Te Whare Tapa Whä: What do we want NZ medical graduates to know about Mäori health?

Authors: Jones R et al

Summary: Increasing evidence attests to the fact that Mäori receive poorer quality care than non-Mäori in the New Zealand health system, and that health care professionals contribute to these inequalities. Medical graduates need to be culturally competent, deliver care equitably to all patients, and be committed to improving Mäori health outcomes. While Hauora Mäori is included in New Zealand’s medical school curricula, the way it is taught and assessed varies considerably. This paper communicates the vision for Mäori health teaching and learning at the University of Auckland and seeks feedback on this approach. It presents an overview of work being undertaken to develop and integrate the Hauora Mäori curriculum in medical training, including a broad outline of proposed Hauora Mäori learning outcomes, teaching and learning activities and assessment methods within undergraduate medical education.

Comment: As a colleague often asks me, what do we want the NZ medical graduate to be? Rhys and others at the Auckland medical school have opened discussion in this paper which he presented at the recent Te ORA hui. The next step is to pin down some of the ‘learning outcomes’ but as Rhys says, this may be more difficult. Te ORA has not included a link to this article as yet on its website, so Rhys Jones invites readers to link to his webpage at Te Kupenga Hauora Mäori:


Factors associated with restoration and extraction receipt among New Zealand children

Authors: Jamieson LM and Koopu PI

Summary: Demographic socioeconomic, physical/lifestyles, dietary, food security and dental factors contributing to restoration or extraction receipt were assessed among 3,275 New Zealand children aged 5–14 years (37.4% were Mäori, 32.3% Pacific and 30.3% NZ European and Other [NZEO]). Mäori children had higher odds of having received a restoration than NZEO children after adjusting for age, gender and length of time lived in New Zealand and with addition of household SES, lifestyle, dietary, food security or dental factors. By contrast, Pacific children had higher odds of having received an extraction than NZEO children when age, gender and length of time lived in New Zealand were taken into account, and with addition of household SES, lifestyle, dietary, food security or other dental factors.

Comment: This paper highlights the significant ethnic disparities in dental health outcomes in Aotearora and provides evidence for the association between oral health and deprivation (lower socioeconomic status or reduced availability/access to nutritious food) for Mäori and Pacifica children. Public health strategies are required alongside other prevention programmes (access to fluoridated water, regular dental checks).

Reference: Community Dent Health. 2008;25:59-64


The impact of racism on Indigenous health in Australia and Aotearoa: Towards a research agenda

Authors: Paradies Y et al

Summary: This report summarises findings from a symposium on racism and Indigenous health held in Australia, November 2007. This symposium involved 35 researchers and policy-makers from Australia and Aotearoa in the area of racism and Indigenous health to discuss recent findings in this field and to set an agenda for future research. The symposium presents clear evidence that racism detrimentally affects the health of Indigenous peoples in Australia and New Zealand and highlights the need for further research to understand the extent and nature of racism, and to determine how it can be effectively addressed.

Comment: A great resource for Mäori health researchers and providers, the discussion at the symposium addressed a number of important questions including ‘how to measure the prevalence and experience of racism for Indigenous peoples’ and ‘how do we address systemic racism’. It covers concepts and definitions, the extent of racism and its impact on health. As the authors state, sound research is required.

Reference: Discussion Paper No. 4, Cooperative Research Centre for Aboriginal Health, Darwin


Did it fall or was it pushed? The contribution of trends in established risk factors to the decline in premature coronary heart disease mortality in New Zealand

Authors: Tobias M et al

Summary: Risk factor prevalence data by 10-year age group (35-64 years) and sex was examined from six national or Auckland regional health surveys and three population censuses to estimate the contribution of trends in three risk factors – systolic blood pressure (SBP), total blood cholesterol (TBC) and cigarette smoking – to the decline in premature coronary heart disease (CHD) mortality in New Zealand from 1980–2004. Approximately 80% (73% for males, 87% for females) of the decline in premature CHD mortality from 1980 to 2004 is estimated to have resulted from the joint trends in population SBP and TBC distributions and smoking prevalence. Overall, approximately 42%, 36% and 22% of the joint risk factor effect was contributed by trends in SBP, TBC and smoking respectively.

Comment: Useful information for primary care services and/ or PHOs. The study showed that ‘averages’ for readily available measures such as BP, cholesterol levels and smoking rates declined over the 24-year period and the decline was associated with reduced CHD mortality. Services may therefore wish to collect and analyse the same data from eligible patients in order to monitor health outcomes (CHD mortality) within the service. Reducing BP, managing blood cholesterol levels and supporting people to quit smoking are major priorities to improve CHD outcomes, particularly for Mäori.

Reference: Aust N Z J Public Health. 2008;32:117-25