The social determinants of health consists of various factors that determine health and wellbeing, for instance, socio-economic factors, genders, cultures and education (McMurray, 2010). Some groups of people are healthier than others. There is a relation between income and health, as well as they are strong predictors of health. People with low economic status have poor education, unemployment, job insecurity bad working conditions and lower class jobs (Marmot, Foege, Mocumbi & Satcher, 2008). It affects the access of healthy environments and appropriate medical care facilities (Dew & Matheson, 2008). In New Zealand, there is a significant disparity in health between the Maori and non-Maori people of Aotearoa New Zealand. Maori people and pacific people are highly vulnerable to ill health and disabilities. Maori mortality rates are approximately double as compared with European New Zealanders rate (Dew &Davis, 2005). However, many surveys found that Maori have similar or lower rates of hospitalization than other New Zealanders in spite of their higher demand of treatment. This shows that financial conditions affect not only production but also consumption of health care. (Ministry of Health, 2002). The poor health status of Maori may due to poor economic circumstances. Maori people aged between 45 years and 64 years are more likely to die than others in this same age in New Zealand (Dew & Matheson, 2008). Inequality in life expectancy and the risk of death rate are significant health inequality. The gap in life expectancy between Maori and non-Maori increased to 10 years. The early death rate in Maori population is mainly related to occupational class. More Maori people are doing unskilled works than others and it can cause higher risk of early death (Dew & Matheson, 2008).
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Nursing services should be organised according to demands of whanau rather than the needs of providers. Nurses must recognise, understand and remove financial, cultural, geographical, physical barriers for reducing inequalities in health. Economic barriers are unsafe working conditions with little jobs, unemployment, inadequate housing, crime, high disparities in income and wealth. Participation and encouraging them with proper support at all levels of the health and disability sector can improve their status. Maori participation should be ensured in planning, development and delivery of health and disability services (King & Turia, 2002). Therefore, they must get appropriate and effective nursing care. Moreover, Maori should be ensured with development and workforce enhancement. Nursing services should be culturally appropriate. Maori health models should be used for caring Maori. Build and recognize values of Maori models of health and traditional healing, for example, massage, herbal remedies and spiritual care. They want services that reflect Maori cultural values. Nurses must provide workplace education, health promotion and clinical services to keep the work place and its employers safe and healthy. They need high levels of communication skills, understanding of interpersonal and government standards and legislation. Plunket nurses provide family parenting support in community (McMurry, 2010). Treaty of Waitangi protects the rights of responsibilities of Maori. Therefore, it reduces in equalities in health in New Zealand ( McMurray, 2010).
The government introduces strategies to decrease inequality in health status. They are New Zealand Health Strategy as well as Health and Disability Strategy. This strategy makes sure accessible and appropriate care services for people from lower socio- economic group including Maori. It helps to identify and provide care according to their health needs. The Ministry of Health provides nutritional guidelines and policies for New Zealanders to address nutritional needs. Maori and Pacific people are the groups, who have the poorest health status in New Zealand. Improving the quality of health education programs focused at Maori can improve their status. Encourage the Maori health providers to participate in health section and organization of smoking cessation programs. Increase mental health services for Maori. People with poor health often find to get a good job. Health status determines socio-economic position. The main disability services are income support, disability allowance, accidental compensation, antidiscrimination legislation as well as education and support services for people with disabilities, chronic illness and mental health illness living in the community (King & Turia 2002).The government and the Ministry of Health provide key priority to reduce health disparity among Maori. Encourage Maori health providers to build Maori models of health. The New Zealand Disability Strategy pointed out the demand to remove the barriers like discrimination among Maori with disabilities. Improve the number of trained Maori clinicians, health professionals, managers, community and voluntary worker and researchers in order to strengthen the health and disability sector. Improving the skills of the Maori health and disability workforce can reduce inequality in health. Publicly funded hospitals and primary health care organisations have started to identify and meet the needs of Maori. Now many hospitals have Maori and whanau units, as a result they get better care and culturally safe treatment. District health boards are working with primary health care and it plays a significant role in reducing health inequalities (King, 2002).
Smoking is significantly prevalent among Maori in New Zealand. Many Maori women die early due to smoking related to illness at greater than others. There is no decrease in the smoking percentage among Maori for the last five years. There are many psychological factors that are associated with smoking. Depression and anxiety are closely related with smoking. Depression can cause smoking, whereas, addiction of smoking can lead to depression. Parental influence is another causative factor for smoking. If parents are smokers, children will be more vulnerable to smoking. Researchers found that, these children have four fold risks than other children. Suicidal tendencies, low self esteem, poor body image, low socio-economic status, and lack of academic performance at school as well as poor quality of life are also influencing factors for smoking. The psycho-social conditions of adolescents and their behaviour decisions can cause depression and risk taking behaviours (McMurry, 2010). In New Zealand, 42% smokers are Maori. These indigenous people with low levels of education, employment and home ownership are more vulnerable to smoking. People who have prolonged mental stress are also having a high risk of smoking. Many youngsters start to smoke as an experiment. Finally they gets addicted to these substances. Smoking can cause severe health problems like lung cancer, chronic obstructive pulmonary diseases, pneumonia and asthma. Passive smokers are also more vulnerable to lung cancer. When women smoke during pregnancy, it can lead to intra uterine death and deliver a baby with low birth weight (MOH, 2008).
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In conclusion, Maori have poorest health status in New Zealand. The socio- economic determinants of health are responsible for health equalities. Home ownership and property ownership are low in Maori than others. Therefore, salary is the main source of income for them. Labour market is a significant income for them. The low income negatively influences their health. The government introduced New Zealand Health Strategy to reduce inequality. This essay discussed about current nursing practice taking initiation to reduce this disparity. Moreover, Risk taking behaviour such as smoking causes many problems and psychological factors related with smoking.
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