ISSN 1178-6191

Maori Health Review

Making Education Easy Issue 109 – 2024

Maori Health Review

What we do matters: Supporting anti-racism and decolonisation of public health teaching and practice through the development of Māori public health competencies

Authors: Veenstra N et al.

Summary: A Kaupapa Māori study of public health competencies led to development of a competency document suitable for use by universities and workplaces. Increasing language expectations, the importance of strength-based approaches and self-determination, and the need for individual responsibility to address structural racism were key themes identified in the competencies. A fundamental cross-cutting competency was reflective practice. Planetary health and political ideologies were suggested for inclusion by participants as additional socio-political determinants of health with equity impacts. The need for cultural safety, and ensuring that all public health practitioners are ‘seen’, were key concerns related to application of the competency document.

Comment: Love the shift here in public health priorities - from the population level once about monitoring disparities to now focusing on strength-based and self-determined approaches; and the management of individual health risk moving from patients changing behaviour to physicians reflecting on their roles in maintaining institutional racism.

Reference: Aust N Z J Public Health. 2024;48(2):100132.


Perspectives and experiences of Māori and Pasifika peoples living with cardiac inherited disease

Authors: Fia’Ali’i J et al.

Summary: A gap between indigenous patients’ understanding of cardiac inherited disease and the western biomedical approach was highlighted in a qualitative study using Talanoa and Kaupapa Māori methodologies. Semi-structured interviews were undertaken with 14 Māori and 14 Pasifika patients with a cardiac inherited disease, and seven of their family members. Common themes identified as important in shaping participants’ perceptions and experiences of cardiac inherited disease were: (1) difficulty in understanding the disease as separate from symptoms; (2) considering ancestors and future generations; and (3) the role of spirituality and religion. Findings support the need for transparency and culturally appropriate practices in healthcare, concluded the study authors.

Comment: With heart disease, acquired ischaemic or infection-related (rheumatic fever) cardiac conditions are prioritised in Aotearoa. However, significant inequities also exist for inherited heart disease. I recently spent a morning hearing from whānau living with inherited cardiomyopathy, and the strain for caregivers, whānau finances and work opportunities. It is refreshing to see this paper present the whānau voice.

Reference: Psychol Health. 2024;39(6):728-748.


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Research Review publications are intended for New Zealand health professionals.

Perspectives of potentially eligible indigenous Māori on a lung cancer screening programme

Authors: Colhoun SR et al.

Summary: Another Kaupapa Māori qualitative study found support for future lung cancer screening in Aoteoroa New Zealand, and identified key barriers and facilitators of screening. A total of 21 Māori current/ex-smokers and members of their whānau participated in three focus group sessions held in Auckland in August 2019. Being more informed about lung cancer and screening, and enabling healthier future generations, were noted as perceived benefits of screening. Previous negative health service experiences, fear, stigma, and access were noted as barriers. Providers’ cultural competence, clear communication, having a one-stop shop, and support with transport were noted as enablers to screening.

Reference: N Z Med J. 2024;137(1593):45-55.


The prevalence and management of atrial fibrillation in New Zealand Māori detected through an abdominal aortic aneurysm screening program

Authors: Sandiford P et al.

Summary: Atrial fibrillation (AF) screening is a feasible, low-cost adjunct to abdominal aortic aneurysm (AAA) screening with potential to reduce ethnic inequities in stroke incidence, according to a study of Māori registered at primary health care practices in Auckland. Among 1933 Māori men (aged 60-74 years) and women (aged 65-74 years) screened for AAA, the prevalence of AF was 7.4%, including 2.4% without a code for AF on their medical record. However, more than half of those without a code had known AF, meaning the true prevalence of newly detected AF was 1.1% (n = 21). Among 19 individuals with newly detected high-risk AF, 10 started appropriate anticoagulation therapy within 6 months. Adverse clinical outcomes were noted in five of the nine individuals who did not commence anticoagulation therapy, including ischaemic stroke in one individual. Among those with previously diagnosed AF, use of anticoagulation therapy rose from 57% before screening to 83% at 6 months after screening. The study authors noted that effective measures are needed to ensure that newly diagnosed high-risk AF is managed according to best practice guidelines.

Comment: Two excellent examples of when we need targeted approaches based on ‘ethnicity’ in screening programmes; and why we need to continue building evidence. If implemented, the potential benefits are huge.

Reference: Heart Lung Circ. 2024;33(3):304-309.


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