ISSN Greetings

Maori Health Review

Making Education Easy Issue 48 – 2014

Maori Health Review

Developing an indigenous surgical workforce for Australasia

Authors: Aramoana J et al.

Summary: This literature review aimed to identify factors used to attract indigenous students into medical careers, interventions required to achieve graduation and factors that encourage entry into specialist training programmes and faculty appointments. All medical schools studied used elements of a ‘pipeline approach’ including secondary school contact to encourage aspirational goals and subject selection. Bridging courses are used to ensure students have appropriate skills before entering medical training and extensive practical help is provided. Elements required for primary medical qualification are also necessary for postgraduate achievement success (dedicated and focused study, development of appropriate skills, mentoring, support and institutional and collegial commitment).

Comment: It was fantastic to see the Hui for this particular topic – developing an indigenous surgical workforce – covered by Māori media last year. As the authors assert, a pipeline approach into and through medical schools is required.

Reference: ANZ J Surg. 2013;83(12):912-7


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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.

Barriers to Maori sole mothers’ primary health care access

Authors: Lee R and North N

Summary: This qualitative exploratory study, employing general inductive techniques informed by a Kaupapa Māori approach, considered the access of seven Māori sole mothers’ to health services for personal health needs, particularly focussing on primary health care. The major barrier to health care access was cost. Additional barriers included compounding cost, transport difficulties, service location and scheduling. Child-related issues that acted as a barrier to access, included the prioritisation of children’s needs and childcare over personal health.

Comment: Barriers in access to primary health care are often described as single factors that may or may not interact with each other; and that, in the end, influence a person’s behaviour. However, this study puts the focus back on a system that creates and maintains those barriers.

Reference: J Prim Health Care 2013;5(4):315-21


‘It’s whanaungatanga and all that kind of stuff’: Maori cancer patients’ experiences of health services

Authors: Slater T et al.

Summary: This research examined the experience of cancer screening, diagnosis, treatment, survival and palliative care of 12 Māori patients and their whanau through semi-structured interviews to identify factors that facilitate or inhibit use of cancer care services. Key areas identified include the experience of support, continuity of care and the impact of financial and geographic constraints. In conjunction with interpersonal rapport, a more positive experience was facilitated by a long-term relationship with a primary health provider, suggesting that those with a ‘medical home’ are more satisfied with their care and report fewer service coordination problems.

Comment: The experience of whanau with cancer has received little attention, despite the higher cancer rates, and ongoing calls to improve cancer care pathways for Māori. Māori health and primary care providers alike will hopefully use the information gained here to develop appropriate services.

Reference: J Prim Health Care 2013;5(4):308-14


Maori Health Review

Health and well-being of secondary school students in New Zealand: trends between 2001, 2007 and 2012

Authors: Clark T et al.

Summary: This analysis of data from three surveys between 2001 and 2012 aimed to describe indicators of wellbeing and health of secondary school students in New Zealand. Significant reductions (adjusted OR) between 2001 and 2012 were reported for cigarette use (0.27; 95% CI 0.23-0.32), alcohol use (0.39; 95% CI 0.33-0.46), marijuana use (0.37; 95% CI 0.31-0.43), sexual abuse (0.52; 95% CI 0.46-0.58), fighting (0.63; 95% CI 0.55-0.73), seatbelt use (1.47; 95% CI 1.31-1.65) and risky driving behaviours (0.39; 95% CI 0.33-0.45). There were also improvements (adjusted OR) in positive connections to school for variables including the perception that the school cares (1.22; 95% CI 1.10-1.35), liking school (1.55; 95% CI 1.33-1.82) and good family relationships (1.83; 95% CI 1.70-1.97). Parameters that failed to improve and were poor in comparison with international estimates were condom use at last sexual intercourse (adjusted OR 0.77; 95% CI 0.68-0.87), daily physical activity (0.88; 95% CI 0.78-0.99) and being overweight/obese (1.09; 95% CI 0.92-1.31). Other indicators that did not improve were exposure to family violence (adjusted OR 1.37; 95% CI 1.11-1.68) and depressive symptoms (1.03; 95% CI 0.91-1.17).

Comment: I was fortunate to attend the launch of the Māori Youth Health Survey Report in December 2013 and wish to commend the researchers for their determined efforts in this study, and Minister Turia for her speech at the event, where she provided a great analysis of the findings and what they mean for whanau. As the authors highlight, whilst there have been some outstanding improvements in youth health over the past decade, there is much still to be done.

Reference: J Paediatr Child Health 2013;49(11):925-34


Predictors of hospitalization two years after treatment for first-episode psychosis

Authors: Turner MA et al.

Summary: Researchers from Christchurch studied sociodemographic and clinical factors predicting hospital admission after early intervention for psychosis services treatment in 231 patients between 2000 and 2005. Most patients (78%) were admitted before or during treatment, while 29% were admitted after completing the program. Māori ethnicity, older age, a domestic partner at referral, a lower Global Assessment of Functioning score, and hospitalisation before and during treatment significantly predicted the number of post-treatment hospital admissions.

Comment: The authors, in identifying ethnic differences in outcomes for this intervention, have focussed on the need for services to improve cultural responsiveness. Whilst this is important, a review of the quality of care into and through the program by ethnicity, would also be useful.

Reference: Psychiatr Serv. 2013;64(12):1230-5


The burden of stomach cancer in indigenous populations: a systematic review and global assessment

Authors: Arnold M et al.

Summary: A systematic review was conducted to examine the burden of stomach cancer among indigenous peoples worldwide. Increased rates of stomach cancer incidence and mortality were observed in almost all indigenous peoples considered (indigenous Australians, Māori, circumpolar indigenous peoples, native Americans and Alaskan natives, and the Chilean Mapuche) when compared to the corresponding non-indigenous population in the same region or countries, particularly among the Inuit in the circumpolar region (standardised incidence ratios; males 3.9, females 3.6) and Māori (males: 2.2, females: 3.2).

Comment: Rates of infection with Helicobacter pylori appear to be higher for Māori than NZ European populations in South Auckland, as demonstrated in a paper included in the last issue of Māori Health Review. This paper goes further to link H. pylori infection, and other wider health determinants, to stomach cancer; as well as providing strategies to address these risk factors in order to reduce stomach cancer burden.

Reference: Gut. 2014;63(1):64-71


Maori Health Review

Perceived racial discrimination and hypertension: A comprehensive systematic review

Authors: Dolezsar CM et al.

Summary: This systematic review evaluated the association between perceived racial discrimination and hypertensive status including systolic, diastolic and ambulatory blood pressure (BP). A total of 44 published studies including a total of 32,651 subjects were included in the analysis. Perceived racial discrimination was associated with hypertensive status (Fisher’s Z score for hypertension 0.048; 95% CI 0.013-0.087), but not with resting BP (systolic 0.011; 95% CI -0.006-0.031), diastolic 0.016, 95% CI -0.006-0.034). Factors that amplified the relationship included male sex, Black race, older age, lower education and hypertensive status. Nighttime ambulatory BP was most strongly associated with perceived discrimination, especially among Blacks.

Comment: Normally a person’s BP will lower at night, when they are not stressed. However, as Nancy Krieger, David Williams and others posit, there is no such ‘dip’ in BP for people who experience racial discrimination. As a result, such people are subjected to sustained elevated BP or a form of ‘chronic stress.’ This in turn is said to cause early aging and is associated with higher risk for cardiovascular disease (heart attacks, strokes); and as the authors of this paper argue, may explain disparities in health outcomes by ethnicity

Reference: Health Psychol. 2014;33(1):20-34


Improved birth weight for black infants: outcomes of a healthy start program

Authors: Kothari CL et al

Summary: This study examined the effectiveness of the Healthy Babies Healthy Start maternal health program that emphasises racial equity and home visitation, in improving birth outcomes for Black relative to White women using Michigan state- and Kalamazoo County-level birth certificate records from 2008-10. In spite of a 2-fold higher smoking rate, Black health program participants delivered higher birth-weight infants than did Black nonparticipants (p = 0.05). Although White participants received significantly more prenatal care than White nonparticipants, they experienced similar birth outcomes.

Comment: Highlighting the fact that a Healthy Start Program designed with ‘equity’ in mind has the potential to reduce disparities by improving outcomes for all.

Reference: Am J Public Health 2014;104 Suppl 1:S96-S104


Racism and Health I: pathways and scientific evidence

Authors: Williams DR and Mohammed SA

Summary: This review of empirical research indicates that racism adversely affects health in a non-dominant racial population. Institutional racism results in policies and procedures that reduce access to housing, neighborhood and educational quality, employment opportunities and other societal resources. Cultural racism harms economic status and health through the creation of a hostile policy environment, initiating negative stereotypes and discrimination that foster damaging psychological responses. Experiences of racial discrimination are also an important psychosocial stressor that leads to adverse changes in health status and alters behavior to increase health risks.

Comment: A great review of the pathway from root causes (including racism) to health outcomes. The authors have followed this up with a paper that appraises current evidence of how to reduce racism; and how such interventions (including media-based interventions) can impact on health outcomes.

Reference: Am Behav Sci. 2013;57(8)