History of Hauora Maori Trends and Paradigms

Student Name: YI LI

Student ID: 12010316

1. Assessment Task 1 – Plan and Research of Hauora Maöri Trends and Paradigms from 1919 to the present day

1. a) Introduction

The research is investigated the trend of Maöri health which included the paradigms of cancer, obesity and diabetes in from 1919 to the present day. Maöri had the higher risk of suffering from these health diseases than non-Maöri population in Te Tai Tkerau (Northland). There is variety factors would affect these health issues, including cultural and historical socio-economic status, geographical place of residence, ethnic identity. According to Maöri concept, Hauora is a Maöri philosophy of health and well-bing unique to New Zealand, which include four accept: Physical Wellbeing, Mental and Emotional wellbeing, Social Wellbeing and Spiritual wellbeing.

The purpose of the research was to identify the traditional approaches to Hauora, the issues of access to primary and secondary health service. To analysis the health service system in recent years of Te Tai Tkerrau area.

1. b) Methodology

• Results of interview with local iwi, hapu and whanau

• The interview was holding on 1^st October 2013 which included 10 Maöri who is suffering breast cancer, diabetes and obesity. Before the interview, the researcher was calling to explain the research and the purpose of the interview, communicating the plan and related details for the interview and other whanau members.
• A powhire was present. Then whaikorero was followed the karanga. A waiata was sung after each whaikorero by the group of the orator represents. Koha were exchanged between researcher and leader. Then was hongi and shared hakari.
• Notes were taken during the interview.

• Ethical and cultural considerations within a Hauora context

• Researcher understands the importance determining and meeting cultural requirements, relevant legislation, and ethical practice.
• Request the permission of the leader and future support.
• An appointment was made before the interview.
• Mihi and pepeha were performed.
• Private information of the participants was kept confidentiality, their name, pictures, and interview notes and so on.

• Available recourses

• Had interview with Whanau leader and members
• Marae visit
• Social Work Maöri tutor guidance
• Access to Northland District Health Board website

• Data collection

• Online research

Online research is a major variety of literature for the study of research methods. The researcher research the main cause of cancer, diabetes, and obesity. As well as analysis the manifestations of three diseases.

• Statistical analysis

Statistical analysis is for data collection, collation summary. To identify the Hauora Maöri trends of the three different diseases. The data for this is from the New Zealand Health Survey, conducted for the Ministry of Health. The paradigm is draw up to show compare the data between Maöri, Pacific and Non-Maöri and Non-Pacific who were living Te Tai Tokerau (Northland), during the 1980 to present day.

• Document analysis

Document analysis mainly refers to the collection, identification, organize the literature, and through literature research, scientific understanding of the facts forming method. Therefore, the student researched the literature to find information about traditional approaches to hauora and issues of access to primary and secondary health services.

• Interview with the Whanau leader

The five questions were asked which related to their recent health service provider as below:

• Are you satisfied with the current health services?
• Do you have family doctor?
• Have you seen your provider within the past 12 months?
• Do you usually going to a Maöri primary health provider first when unwell or injured?
• What different of health service between now and before?

• Tikanga

Students used critical skills they had learned from discourse analysis to engage with participants’ talk. Acknowledging Tikanga helped the researcher to know the appropriate tikanga for a situation in order to make participant feel comfortable during the Hui. In addition, questions were designed and translated from English language to te reo Māori me ngā tikanga.

1. c) Methodology According with Research Ethics and Tikanga Maöri

• Compete a literature review

Literature review was conducted by researching for Hauora Māori trends in Northland region. The information included diabetes, obesity and cancer.

• Sourcing of information

Hapu leaders, whanau members, the internet, Tutors, lectures, document

• Procedures for recording and analyzing information

• Recording and analyzing were performed by notes, and computer.
• Maintained the quality of information with regards to recording of Ethnicity
• Recorded the consultation and discussion in where they took place.

• Presenting findings

• Findings were reported with evidences.
• Power point is needed
• Research findings are presented in papar.

2. Assessment Task 2 – Analyze Research Regarding Hauora Maöri Trends and Paradigms from 1919 to the Present Day

• Cancer

The cells of Cancer (Cancer Rates-Wairarapa DHB, 2010)

Main cause of Cancer:

The body in environmental pollution, chemical pollution Cancer is the body’s normal cells in a multi-cause, multi-stage and multiple mutations caused by a class of diseases. Cancer is not the definitive genetic disease, but there is growing evidence that cancer does have a genetic predisposition, have some genetic relationship

Manifestations of Cancer are:

1. Tumor: malignant proliferation of cancer cells are formed in the surface by hand or deep touch.
2. Pain: pain often prompts cancer has entered the middle and late.
3. Ulcers: Some cancer cancerous tissue growth surface quickly, nutrient supply, the resulting tissue necrosis.
4. Bleeding: cancer vascular invasion or rupture of small blood vessels in cancer tissue generated.
5. Obstruction: rapid growth of cancerous tissue caused by obstruction.

• Diabetes

Diabetes is a group is characterized by high blood sugar metabolic diseases. Hyperglycemia is due to the biological effects of insulin secretion or impaired, or both causes. Longstanding diabetes high blood sugar , leading to a variety of organizations , especially the eyes , kidneys , heart, blood vessels, nerves , chronic damage , dysfunction .

Main cause of Diabetes:

1. Genetic factors

Type 1 or type 2 diabetes are obvious genetic heterogeneity. The presence of diabetes onset familial tendency, 1/4 to 1/2 patients had family history of diabetes.

2. Environmental factors

Eating too much, reduced physical activity due to type 2 diabetes, obesity is the most important environmental factors that have type 2 diabetes, genetic predisposition morbidity. Type 1 diabetes patients immune system abnormalities, in some viruses such as Coxsackie virus, rubella virus, parotid gland virus infection causes an autoimmune reaction that destroys insulin β cells.

Manifestations of Diabetes:

1. polydipsia, polyuria, polyphagia and weight loss
2. Fatigue, weakness, obesity. More common in type 2 diabetes.

• Obesity

(Photograph: Steven Puetzer/Getty Images, 2009)

Main cause of Obesity:

Obesity is body fat, particularly triglycerides (triglycerides) as a result of excessive accumulation of a state. Usually because food intake too much or cause a change in metabolism excessive accumulation of body fat, resulting in excessive growth of body weight and cause human path physiological changes. According to the different causes of obesity, obesity and obesity can be divided into two major categories of secondary obesity. No clear cause obesity may be related to genetics, diet and exercise habits and other factors.

Manifestations of Obesity:

1. Mental performance: Obesity can lead to anxiety, depression, guilt, and so bad attitude, and even hostility to others.
2. Physical performance: such difficulty moving, panting, muscle fatigue, joint pain and swelling and other symptoms.
3. The performance complication: Different complications have their corresponding manifestations. Such as headache, dizziness, daytime sleepiness, difficulty concentrating, memory loss and other symptoms.

• Cancer

For total population and Maöri, by cancerous person

1980-1999 December years in Northland

For Maöri, pacific and Non-M Non-p,

Age-sex standardized rates per 100,000, ages 25+

By cancer mortality,

1980-1999 December years in Northland and other island

The above tables were draw up to show the trend of cancer and cancer mortality during the period in Northland.

We can see from the first figure, cancer rates for Maöri are 16 per cent higher than non-Maöri at the beginning, and continue increase steadily. However both Maöri and non-Maöri cancer rates declined between1996 to 99. During the whole period, Maöri cancer rates always higher than non-Maöri group. In the second figure, the rate of cancer mortality of Maöri group is always higher than Pacific and non-M, non-P people, and increase gradually. Cancers were causing 29 per cent of deaths in New Zealand. And the Maöri with cancer have a higher risk of dying than non-Maöri. Northland had significantly higher cancer death rates than nationally. The reason of the change was unhealthy behaviors can increase the risk of developing cancers.

• Diabetes

For total population and Maöri, by diabetic

1930-2010 December years in Northland

The chart above is drawn up to show the trend between Maöri and non-Maöri diabetic during 1930 to 2010. It can be seen that Maöri are easier to suffer diabetes than non-Maöri, it has a significant increased from 1930 to 1970, however it begin to drop slowly since 1970, until 2010 it has dropped 15 per cent during ten years. The non-Maöri population has a significantly increase during 1950 to 1990, after that, it is get effective control in 2010. Even thought, Maöri population who suffer from diabetic is still higher than non-Maöri population.

• Obesity

The data below was collected in Adult Nutrition Survey and New Zealand Health Survey.

For obesity, age-sex standardized rates per 100,000 ages 1-74 years, 1980-99.

The chart above is to show the increase of obesity of two different population compare with Maöri population from 1980 to 1999. The data was show that during 1980 to 1984 period, the Maöri and Pacific population are nearly the same, however, from 1985 to 1999, Maöri population rapidly in creased, especially from year 1985.

The growth rate of other two population groups never catch up with Maöri groups.

In traditional approaches to hauora from 1900 to 1940, government continued to subsidies doctors as native medical officers in Maöri districts, and to supply native school teachers with medicines for their pupils. More and more hospitals were built. They were only partially government-funded, and because of a perception that Maöri land-owners did not contribute their fair share of rates, there was a tendency for hospital administrators to resent having to admit Maöri patients. Although levels of immunity to new diseases had increased, and death rates were dropping, poor economic circumstances and unsatisfactory living conditions still made many Maöri susceptible to ill health.

Traditional health practices were still very common in all Maöri areas. In some districts people were reluctant to participate in any modern health programme, particularly programme that were associated with the government. This was the case in Taranaki and the Waikato, following land confiscations after the 19th-century wars. In the Urewera, too, the prophet Rua KÄ“nana chose to work for health improvement independently of the government and the Maöri councils. And also Many Maöri were suspicious of hospitals, and found them unsympathetic to Maöri cultural practices and values. A move at this time to establish Maöri hospitals was unsuccessful.

The issues access to primary and secondary health services:

• New Zealand settlement and the treaty of Waitangi

The settlers’ introduction of firearms and new infectious diseases had a major impact on death rates among the Maöris. However, the historical and socioeconomic context in relation to Maöri mortality after the colonization of New Zealand, specifically Maöris’ loss of land, was also important noted that death from disease did not occur to the same extent among those indigenous peoples who kept their land (such as in Samoa and Tonga) as among those who did not, because disruption of their economic base, food supplies, and social networks was far less widespread. For Maöris, this disruption not only occurred via land confiscation made possible through acts of law but also extended to legislation in many other areas, including regulation of Maöri rights and discrimination against the use of Maöri language in schools, all of which have affected the health of Maöri people

• Maöri health status

After reaching a low point of approximately 42000 in 1896, the Maöri population began to increase in subsequent years. Government-initiated public health services and Maöri-controlled health promotion programs, including the appointment of Maöri health inspectors to work within Maöri communities, contributed to this gradual recovery. Also, decreases in mortality were probably influenced by the introduction of a national health care scheme and social welfare system in 1938, along with improvements in treatment methods.

• Health disparities

A number of different explanations have been suggested for the inequalities in health between Maöris and non-Maöris. One common suggestion is that these differences are due to genetic factors. However, about 85% of genetic variation occurs randomly and is not related to race or ethnicity. The striking time trends in Maöri mortality and morbidity during the 20th century demonstrate that environmental factors played the major role. Thus, although genetic factors may contribute to differences in health status between Maöris and non-Maöris in the case of certain specific conditions, they do not play a major role in population and public health terms.

• Socioeconomic Factors

The first studies to assess the role of socioeconomic factors and health status differences between Maöris and non-Maöris investigated mortality in men aged 15 to 64 years. 21–23 The most recent of these analyses showed that Maöri men were more than twice as likely as non-Maöri men to die prematurely; also, mortality rates among Maöri men were significantly higher in each socioeconomic class grouping, and mortality differences among these men were greater within their own ethnic social class groups as well.

• Lifestyle factors

It can be argued that lifestyle factors, such as smoking, represent one of the mechanisms by which socioeconomic factors affect health status. However they are interpreted, it is important to consider the extent to which differing lifestyles may account for differences in health status between Maöris and non-Maöris.

• Discrimination

The role of discrimination and racism in harming health is not new but has received increasing attention over the past 20 years. The Maöri Asthma Review reported that conscious or unconscious attitudes of health workers contribute to reluctance by Maöris to seek medical care for their asthma until it is absolutely necessary. Another study reported barriers to accessing diabetes care among Maöris, including unsatisfactory previous encounters with professionals and experiences of disempowerment. Doctors have been shown to be less likely to advocate for preventive measures for Maöri patients than for non-Maöri patients, and Maöris may be less likely than non-Maöris to be referred for surgical care.

• The interview answer is now analysis as below:

The above table was draw up to show the interview answers which related to their primary and secondary health service. Most of the interview were satisfied with the currently health service, they usually visit the GP once a year, and they usually going to a Maöri primary health provider first when they feel unwell as they are closest, especially, the Maöri GP is understand their culture. They will to spend more time discussing with patients, and offered special services that they need. They said the service is much cheaper than before.

3. Assessment task 3 – Present Your Findings and Explain aPresent Day Health Priority for Maöri

According to the analysis, the Health services and quality differences may raise inequalities in disease survival rates, but generally not the incidence. For example: The main exception is Cervical cancer, and to a lesser extent, colorectal cancer and breast cancer, wherein Screening can detect precancerous lesions, thus reducing cancer Incidence. For this reason, these diseases incidence of the differences between minority or different ethnic groups to a great extent, reflects the differences in social conditions and way of life, and can be used as a ‘integral’ or marked differences. Therefore, in these disease incidences trend of inequality analysis can evaluate our success, to reduce social inequality and assist the development of health and broader social policy. This analysis also provides a planning tool, considering the future development and funding cancer services, to the trend of the past to predict the future trajectory. Trend about risk factors, can also be incorporated into the forecasting model, to improve the accuracy of the prediction.

Maöri health status is generally worse than that of non-Maöri where information is available. It validates the need to priorities Maöri health gain and development in order to reduce and eliminate health inequalities that currently exist. The developments of Maöri health research priorities need much funding to support and big investment of time in a wide range and strict cooperation in wider New Zealand community, policy makers and health workers (including health workers). The role of health researchers will be convenient.

Reference:

Hawke’s Bay District Health Board (2010), HBDHB Health Status Review: Diabetes

http://www.google.co.nz/url?sa=t&rct=j&q=&eloading="lazy" src=s&frm=1&source=web&cd=3&ved=0CD8QFjAC&url=http%3A%2F%2Fwww.hawkesbay.health.nz%2Ffile%2Ffileid%2F36070&ei=hk5WUu6xM4f2lAWXpYDACQ&usg=AFQjCNElsdtOGvhoBCBNQCx40rPvYNBnuw&sig2=fik4IgIX4RHQc_TCl-FVyQ

Ministry of Health (2013), National Cancer Programme: work plan 2013/14,

http://www.health.govt.nz/publication/national-cancer-programme-work-plan-2013-14

Ministry of Health (2006), Mortality and Demographic.

http://www.health.govt.nz/publication/mortality-and-demographic-data-2006

Ministry of Health (2010), Cancer: New registrations and deaths.

http://www.health.govt.nz/publication/cancer-new-registrations-and-deaths-2010

National Ethnic Population Projections: 2006 (base) –2026

http://www.stats.govt.nz/searchresults.aspx?q=Maöri%20population%20project

Health Needs Assessment Northland District Health Board For the Ministry of Health. (n.d.). center for public health research – See more at: http://reffor.us/index.php#sthash.n8DdYfxD.dpuf

Core Health (2013) Patient Rights, Retrieved: http://www.gorehealth.co.nz/rights-and-responsibilities/

Melanie Jordan (2008) Supporting Indiciduals with Autism Spectrum Disorders: Spectrum Disorders: Quality Employment Practices, Retrieved:

http://www.communityinclusion.org/article.php?article_id=266

Appendices

YI LI 12010316 1