ISSN 1178-6191

Maori Health Review

Making Education Easy Issue 55 - 2015

Maori Health Review
Maori Health Review
Maori Health Review

Managing communication tensions and challenges during the end-of-life journey: perspectives of Māori kaumātua and their whānau

Authors: Oetzel J et al.

Summary: Using relational dialectics theory, these researchers explored the cultural practices and communication tensions arising among Māori kaumātua (elders) and their whānaunga (extended family) during the end-of-life journey. Interviews were conducted with 21 kaumātua and focus groups with 39 whānau members. The study identified three cultural practices (dying at home, prayer, and song) that helped to build connection among the family members and also helped to connect the dying person to the spiritual world. Four communication tensions were identified: (a) autonomy and connection; (b) conflict and connection; (c) isolation and connection; and (d) balancing the needs of self and other. The following strategies were used to manage these tensions: (a) coordination conversations; (b) inclusion in decision-making conversations; (c) emotional support within the whānau; and (d) passing on lessons to the next generation.

Comment: There has been a lot of great work undertaken recently on end-of-life and palliative care experiences for Māori and their whānau. This research focuses on the challenges in communication we face during this time, and takes a strength-based approach in presenting the ways in which we meet and address these.

Reference: Health Commun. 2015;30(4):350-60


The politics of relative deprivation: A transdisciplinary social justice perspective

Authors: Fu M et al.

Summary: This paper presents a critical analysis of relative deprivation as defined by Townsend (1987, p.125: “a state of observable and demonstrable disadvantage, relative to the local community or the wider society or nation to which an individual, family or group belongs”), which has been widely applied throughout social and health sciences to identify, measure, and explain forms of inequality in human societies based on material and social conditions. Based on a perspective grounded in Aotearoa/New Zealand, where colonisation has shaped the contours of racialised health inequities and current applications and understandings of ‘deprivation’, these researchers suggest alternatives to Townsend’s concept of deprivation that work better towards social justice. They argue that using deprivation measures without critical reflection can result in deficit framing of populations and maintain current inequities in health and social outcomes. Further, they contend that a central concern in studies of deprivation is their lack of consideration of (bio)power, privilege, epistemology and (bio)politics. They challenge the academy to interrogate political economic causes of inequalities and to measure the unequal distribution of power and privilege in populations.

Comment: Many have argued about the use of ‘deprivation’ in health research, and while this paper doesn’t provide the answers, the authors raise some good points here. For example, does it facilitate the examination beyond a person’s level of ‘deprivation’ per se to the larger macro forces in society, such as institutional racism, which influence the differential access to societal resources and opportunities (such as employment, income, education).

Reference: Soc Sci Med. 2014 Dec 23. [Epub ahead of print]


Ethnic discrimination predicts poor self-rated health and cortisol in pregnancy: Insights from New Zealand

Authors: Thayer ZM, Kuzawa CW

Summary: These researchers evaluated the relationship between perceived discrimination, self-rated health, and the stress hormone cortisol measured in late pregnancy among a diverse sample of 55 women living in Auckland, New Zealand. All were recruited from two antenatal care clinics in Auckland. Women were met in their homes between 34 and 36 weeks gestation, and were asked to complete a prenatal stress questionnaire and give saliva samples (morning and evening from two days). Offspring cortisol reactivity was assessed in 19 infants at the standard 6-week postnatal vaccination visit, in order to evaluate possible intergenerational impacts of maternal discrimination on stress reactivity. A total of 34% of women reported having experienced ethnic discrimination. Minority and immigrant women were more likely to report being angry or upset in response to discrimination experience compared with New Zealand-born women of European descent. Maternal discrimination experience was associated with worse self-rated health, higher evening cortisol in late pregnancy and higher cortisol reactivity in offspring, independently of ethnicity and material deprivation.

Comment: I don’t think I could say it any better than the authors when they conclude that “these findings suggest that reducing exposure to ethnic discrimination experience may not only improve health outcomes among exposed individuals, but also in future generations”.

Reference: Soc Sci Med. 2015;128:36-42


A tertiary approach to improving equity in health: quantitative analysis of the Māori and Pacific Admission Scheme (MAPAS) process, 2008–2012

Authors: Curtis E et al.

Summary: These researchers used an Indigenous Kaupapa Māori methodology to explore the admission processes of the Māori and Pacific Admission Scheme (MAPAS), a tertiary admission programme that targets Māori and Pacific applicants to nursing, pharmacy and health sciences at the University of Auckland. Data were analysed for the period 2008–2012. Multiple logistic regression models were used to identify the predicted effect of admission variables on the final MAPAS recommendation of best starting point for success in health professional study, i.e., ‘CertHSc’ (Certificate in Health Sciences, bridging/foundation), ‘Bachelor’ (degree-level) or ‘Not FMHS’ (Faculty of Medical and Health Sciences). Of a total of 918 MAPAS interviewees, 319 (35%) were Māori, 530 (58%) Pacific, 68 (7%) Māori/Pacific, 653 (71%) were school leavers, and 662 (72%) were females. The average rank score was 167/320, 40–80 credits below guaranteed FMHS degree offers. Almost half of all interviewees were recommended ‘CertHSc’ as the best starting point (n=428; 47%); 117 (13%) were recommended ‘Bachelor’ and 332 (38%) ‘Not FMHS’. Bachelor recommendation was strongly associated with exposure to Any 2 Sciences (OR 7.897; 95% CI, 3.855 to 16.175; p<0.0001), higher rank score (OR 1.043; 95% CI, 1.034 to 1.052; p<0.0001) and higher scores on the MAPAS mathematics test (OR 1.043; 95% CI, 1.028 to 1.059; p<0.0001). Multiple Mini Interview stations had mixed associations, with academic preparation and career aspirations more consistently associated with recommendations.

Comment: An excellent example of kaupapa Māori research that examines the pathways into and through university-led health programmes for Māori students.

Reference: Int J Equity Health. 2015;14:7