Governance In Health Care: Inequality Assessment Answer



The health outcome of the indigenous population depends on social, political and environmental factors. According to 2013 census, the indigenous population in New Zealand comprises 14.9% Maoris, 11.80% Asian and 7.40% Pacific Islander people. Among them, Maoris has the poorest health outcome than any other population group in New Zealand (2013 Census QuickStats about national highlights. 2016). Disparities in health outcome between Maoris and non-Maoris mainly occur due to the difference in lifestyle factor and availability of health care and discrimination. Health expectancies and quality of life differs in this group (Pool, 2014). This finding suggests that new approach is required in closing the gap in the social determinant of health is required to provide equal access to care.  Therefore, this report mainly focuses on the issue of lack of access to care in Maori population. It will develop a plan using the main principles of Treaty of Waitangi to take relevant action that addresses the health need of the population.

Reasons for health inequity in Maoris

A research on social determinants of health in New Zealand suggests that gap in Indigenous disadvantage is not closing due to social and economic issues experienced by the Maori population (Mitro et al., 2014). Different studies suggest the different explanation for health inequality between Maoris and non-Maoris. Yon and Crimmins, (2014) interprets that health inequity in Maoris takes place due to genetic or cultural differences in indigenous groups. However, genetic variation is not dependent on race, and they are not the reasons for public health concern. Firstly, disparities in health occur due to the difference in socioeconomic factors between Maoris and non-Maoris. Unfair dissemination of social determinants like income, housing and unemployment triggers health inequalities (Harris, Cormack & Stanley, 2013). According to health status data, the life expectancy at birth in Maori male was found to be 73 years compared to 80.3 years in the non-Maori male. Similarly, life expectancy for Maori female and the non-Maori female was 77 years and 83 years respectively (Life expectancy, 2016). Maoris also had the high rate of disability compared to non-Maoris. About 17% of Maori children and 44% Maori adults are obese. The Maori smoking rate is also higher than general population (Sandiford & Bramley, 2013). Apart from suicide and accidents, it was found that major cause of death in both Maoris and non-Maoris were chronic diseases (Ngā mana hauora tÅ«tohu: Health status indicators. 2016). Therefore, Maoris are exposed to infectious diseases early in life. Besides this, lifestyle factors of Maoris also affect their health status. A survey on Maoris health showed that Maoris smoke more tobacco than non-Maoris (Gifford et al., 2016). Therefore this habit can act as a risk factor for many diseases.  46% of Maori men suffer from hypertension compared to 43% in non-Maoris. The rate of diabetes and obesity is also higher among deprived Maori population (Lis Ellison-Loschmann, 2006). The rate of mortality due to diseases in Maoris suggests the difference in access to care leading to the poor health outcome. Remote locations, unawareness about diseases and the high cost of treatment act as the barrier to access to care in Maoris.

Addressing health needs of Maori population by the principles of Treaty of Waitangi

The plan is to reduce the gap in health status between Maoris and general population by utilizing the Treaty of Waitangi and structuring health care services in such a way that addressed the health need of Maoris. To protect the Maori interest, the Treaty of Waitangi was signed between Maori and the British Crown in 1840 (Orange, 2015). The three principles of the Treaty of Waitangi are as follows:

Partnership principle- It involves engaging with the Maori community to establish health and disability services and improving health outcome in the population (Orange, 2015).Acting by this principle will mean taking the initiative to establish Maoris specific health services in their local areas and making it affordable for them.

Participation principle- It means Maoris should also be involved in all segments of health care such as decision making as well as delivery of care services (Johnston, 2013). Action can be taken to enhance health promotion and disease control activities by involving Maoris in health care delivery too. It will help in providing competent care according to social and cultural needs of the indigenous population (Ware, 2013).

Protection principle- In this case, the Government will intervene to ensure equal access to health in Maoris and Non-Maoris and also protect the Maori values and culture. Working according to this principle will mean developing policies for cultural safety and expansion of health service to treat diverse form of illness in this group (Makowharemahihi et al., 2016).

A detailed discussion of the chosen health issue as it relates nationally and locally

Smoking is the most prevalent health issues in Maoris compared to other ethnic group in Australia. They first came in contact with tobacco when the British gave it as gifts to them for the purpose of colonization. According to current estimates, 32.7% of them are regular smokers. The rate of smoking is 30.5% among men and 34.7% among women. The initiation of smoking among Maoris in Aotearoa begins at the age of 14 years (Maori smoking, 2016). Compared to non-Maori population, larger percentage of Maoris is exposed to second-hand smoke. It accounts for largest preventable cause of death in New Zealand. As smoking is linked to many diseases such as cardiovascular disease, it is also the reason for lower life expectancy among Maoris. Despite high rate of smoking, 62.3% of them had made attempts to quit smoking till the year 2011 (New Zealand Medical Journal, 2016).

Variation in social status also leads to disparities in health status of a population. A correlation has been found between the deprivation and the impact of social inequality upon smoking rate in Maoris. Women are mostly influenced by the effect of inequality and therefore women have high smoking rate. In case of men, it has been found that effect of social inequality is felt more in rural area compared to urban areas. Hence government health policies must focus on reducing the issues leading to social inequality to reduce smoking rates among this group in New Zealand (Barnett, 2016). 

A range of indicators related to the health status of Maoris such as life expectancy, the major cause of death, diagnosis of diseases, immunization, suicide rate, mental health and interpersonal violence suggest the lack of access to care as the major contributing factor for poor health outcome (Sheridan et al., 2011). The rate of immunization coverage in Maori children was also lower than that of non- Maoris (Health status indicators, 2016). Because of lack of access to care, Maoris receive lower than the acceptable standard of care. A survey investigating the reasons for the lack of access to care in Maoris shows that 38% Maoris complain about the problem in accessing required health care service in their local area due to remote locations. Many of them are deprived of high quality care services because they cannot afford the cost of medical services (Gibson et al., 2015). Therefore, cost also acts a significant barrier to access health care services in Maoris.

A New Zealand Health Survey investigated about the level of development chronic care management system across district health boards. It was found that addressing health inequity in Maoris is embedded only in policies and despite recognition of several unmet needs of the population, health professionals or services do not reach them. It was also found that many nurses are reluctant to deliver care to this group because of cultural barriers (Sheridan et al., 2011). It is necessary to provide care to vulnerable population by reducing the impact of health inequality in their life (Douglas et al., 2014). This highlights the issues of lack of access to care in the Maoris and the needs to train medical staffs to deliver care according to the cultural preference of the group. Thus, New Zealand struggles to put adequate equity principles in place. Hence, a major restructuring of the health care system in New Zealand is required to reduce the gap in health inequality present between Maoris and non-Maori population.

Use of Treaty of Waitangi to plan and address health inequity in Maoris

The principles of the Treaty of Waitangi can be effectively utilized by mean of proper planning to restructure the health system that looks after the health concerns of Maoris. It will mean understanding the cultural difference in the Maori population (Ramsden, 2015). As there is several evidence regarding the culture of Maoris acting as a barrier to access to care, the priority is to implement policies related to cultural competency skill in nurses and physician. Nurse also need to be aware of policy development in the area of health inequality (Nairn et al., 2014). This action is guided by the Protection principle of the Treaty of Waitangi. It will involve training all new health professional regarding developing cultural awareness and cultural sensitivity of the Maoris (Kirmayer, 2012). It will help in communicating in a better manner with the Maoris to understand their health issues and contribute to the achievement of positive health outcome. Simulation training can be given to nurses so that they can easily engage and interact with Maoris (Orr et al., 2013). Effective clinical practice will be possible not only by understanding their generation, sexual orientation, socioeconomic status, religious belief and disability but also by learning to reflect on health situations critically. It will help to preserve the cultural identity of Maoris and also empower them to improve their health status (Makowharemahihi et al., 2016). For example in case health eating habits in Maori population, it will be necessary that nurses engage which such people and understand the factors that lead to obesity in this group (Penn & Kerr, 2014).

The second plan of action is to enhance the delivery of care by encouraging Maoris also to enter health care profession by the participation principle of the Treaty of Waitangi. This will be a critical step as medical staff from the same cultural background can provide holistic care to patients. A responsible Maori nurse and medical team can communicate information about chronic and infectious diseases to them in a more efficient and timely manner too. It will minimize the need for cultural training and competency training as Maoris is themselves aware of the cultural sensitivities inherent in their community (Huey, Tilley, Jones & Smith, 2014). Health promotion activities can help in engagement of community and supporting them to get involved in health care service (Percival et al., 2016).

The partnership principle of the Treaty of the Waitangi can be utilized to develop and establish the health clinic and hospitals in the resident area of Maori population. This will be a critical step in improving access to care and make it easier for the population to seek emergency health services. Government action will require in this case to make the fund available for the establishment of health services in local areas. This reform will have a direct impact on the health outcome of the group and lead to reduced rate of mortality and morbidity associated with diseases. A reform of policy framework is needed to effectively implement culturally competent care and create an empowering environment for Maori population (Kirmayer & Brass, 2016).


From the report on increasing health disparity between Maoris and non-Maoris, it can be concluded that improving accessibility and affordability of care is essential in New Zealand. This report identified the major reasons for poor health outcome in Maoris and outlined the trend of lack of access to care in the group both nationally and locally. Finally, it proposed a plan based on identification of barrier in access to care and proposed a plan that utilizes the principles of the Treaty of Waitangi to improve health status in Maoris. Thus, delivery of a culturally competent care is expected to improve health outcome as well as reduce the gap in health care delivery in Maori population. 


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