ISSN 1178-6191

Maori Health Review

Making Education Easy Issue 41-2012

Maori Health Review
Maori Health Review

Holding a mirror to society? The sociodemographic characteristics of the University of Otago’s health professional students

Authors: Crampton P et al

Summary: This paper describes the current sociodemographic characteristics of all students accepted into the 8 health professional programmes in 2010 at the University of Otago. Students were largely (88.1%) from outside the Otago region. Most (59.6%) were female and 84.8% were either New Zealand citizens or permanent residents. Within the domestic student cohort, 65.0% of students self-identified as being within the New Zealand European & Other category (vs 75.3% of the national population), 34.2% as Asian (vs 11.1%), 6.3% as Māori (vs 15.2%), and 2.3% as Pacific (vs 7.7%). A large proportion of students came from high socioeconomic areas; only 3.4% of students had attended secondary schools with a socioeconomic decile of <4.

Comment: Medical and dental schools “struggle to achieve a balance of students which reflects the ethnic and socioeconomic reality of the societies they serve”. The authors have identified various reasons for this, including the elitist nature of these courses and disparities in access to quality high school educational opportunities. Current policies at Otago either aim at attracting and recruiting students from diverse backgrounds, or respond to the specific learning needs of vulnerable student groups (for example, those from low-decile schools) through bridging or foundation courses. I’d suggest that such a response is required earlier (i.e. intermediate years) rather than later.

Reference: N Z Med J 2012;125(1361):12-28


Prevalence and factors associated with snoring in 3-year olds: early links with behavioral adjustment

Authors: Gill AI et al

Summary: The prevalence of sleep-disordered breathing (SDB) symptoms was explored in a community sample of 823 New Zealand 3-year-olds. Parents completed questionnaires exploring factors relevant to their children’s sleep, with a particular focus on snoring. Snoring was reported as occurring at least once a week in 36.9% of children and habitually (>4 nights per week) in 11.3%. In univariate analysis, factors associated with habitual snoring included Māori ethnicity (p=0.04), male gender (p=0.05) and more socioeconomically deprived neighbourhoods (p<0.01). Several other SDB-related symptoms were significantly associated with habitual snoring: mouth breathing, sweating profusely, waking during the night, sleeping with neck extended, constant runny nose, and suffering from tonsillitis. In multivariate analysis, snoring was strongly and positively associated with various health and familial factors, as well as parent-reported child irritability (OR 2.83) and hyperactivity (OR 1.6).

Comment: Take home messages here for me: parents and providers should consider sleep hygiene as one of the ‘organic’ causes for irritable or hyperactive behaviours; that sleep disorders can affect children as young as three; and that if not managed appropriately, poor sleep hygiene will have long-term consequences for the child, including learning difficulties.

Reference: Sleep Med 2012;13(9):1191-7


Methods for the scientific study of discrimination and health: an ecosocial approach

Authors: Krieger N

Summary: This paper contends that rigorous methods for the scientific study of discrimination and health require (1) conceptual clarity about the exploitative and oppressive realities of racism and other forms of adverse discrimination; (2) careful attention to domains, pathways, level, and spatiotemporal scale, in historical context; (3) structural-level measures; (4) individual-level issues of domains, nativity, and use of both explicit and implicit discrimination measures; and (5) an embodied analytic approach. The paper concludes that public health researchers must use the best science possible, to ensure that the public becomes aware of the extent and health consequences of racial discrimination.

Comment: For me, this article really extended thinking on the ‘life course’ theory, arguing that exposures to hazards, including racism, occur at multiple sites and times in people’s lives and the effects are cumulative. It has also provided many excellent and ‘scientifically correct’ examples of racism research from the US, confirming the need to build data through robust research in order to drive out inequity.

Reference: Am J Public Health 2012;102(5):936-45


An adolescent suicide cluster and the possible role of electronic communication technology

Authors: Robertson L et al

Summary: These researchers investigated a group of suicides of New Zealand adolescents thought to be a cluster. They also investigated the possible role of online social networking and SMS text messaging as sources of contagion after a suicide. Not all of the cases belonged to a single school; several were linked by social networking sites, including sites created in memory of earlier suicide cases, as well as mobile telephones. These facilitated the rapid spread of information and rumour about the deaths throughout the community and made it harder to recognise and manage a possible cluster.

Comment: A timely report in the sense that Minister Turia has called for urgent action following the rise in suicide numbers in Te Tai Tokerau this year. This paper highlights the fact that as modern communication tools are increasingly utilised, communities need guidance on how to best use or monitor them in relation to youth suicide.

Reference: Am J Public Health 2012;102(5):936-44


Maori Health Review

Policy approaches to address the social and environmental determinants of health inequity in Asia-Pacific

Authors: Friel S et al

Summary: Substantial health inequity exists in Asia Pacific and huge challenges remain, despite various actions that are addressing the structural drivers and conditions of daily living that affect health inequities in the Asia Pacific region. While gains have been made, they are not equally distributed and may be unsustainable as the world encounters new economic, social and environmental challenges. The article concludes that health inequities must be tackled as a political imperative and this will require leadership, political courage, social action, a sound evidence base and progressive public policy.

Comment: A comprehensive discussion from public health leaders including Don Matheson and Papārangi Reid from Aotearoa. I particularly enjoyed the section on ‘changing dominant paradigms’, as it raises the issue of economic versus societal progress.

Reference: Asia Pac J Public Health 2012 Oct 15. [Epub ahead of print]


Indigenous health and climate change

Authors: Ford JD

Summary: This research explored nonclimatic determinants that influence how indigenous people experience, understand and respond to climate-related health outcomes. It concentrated on place-based dimensions of vulnerability and broader determining factors. The majority of data were from Australia and the Arctic and indicated significant adaptive capacity, with active responses to climate-related health risks. However, this adaptability is challenged by co-existing nonclimatic stresses including poverty, land dispossession, globalisation, and associated sociocultural transitions. The article concludes that key foci for future research include addressing geographic gaps, a greater focus on indigenous conceptualisations and approaches to health, examination of global–local interactions shaping local vulnerability, enhanced surveillance, and an evaluation of policy support opportunities.

Comment: consider Dr Rhys Jones (Kahungunu) the kaupapa Māori expert in this area and so sought his comments on this paper. Although he thought it was ‘pretty heavily research-focused – e.g. identifying a roadmap for future research’ he agreed that it had some useful ideas for action.

Reference: Am J Public Health 2012;102(7):1260-6