A critical review of key literature relevant to the underlying historical, social, economic and political processes that have contributed to the inequalities and disparities in the Maori and non-Maori health status.
Inequality means watching people close to you … persistently struggling … to keep their households afloat, to do their best for their children and to make good decisions by weighing up the constrained range of choices on offer.Karlo Mila
Inequality continues to dominate among New Zealand’s Maori and non Maori populations. There is unacceptable and intolerable inequalities exist among Maori and non-Maori in a range of social measures, economic status and many minor and major health care related measures and services.
Discrimination is unhealthy which shortens lives and wastes energy, time, material, potential and loss the confidence of an individual having good efficiency, experience and interpersonal skills. There may be various forms of discrimination in different areas and job palace.
According to a research, there is an 8–year difference in life expectancy between Maori and Pakeha is particularly galling to most of population. But for some conditions, Maori having risk of getting the disease or disorder as comparison to other community people. But there are much higher chances of dying from these disease conditions.
Moreover, there is also discrimination in renting or buying a house reported by Maori and firstly discrimination was associated with lifestyle factors of Maori people and discrimination in health care and health care delivery services was the second most commonly reported type.
The Treaty of Waitangi
The Treaty of Waitangi was an agreement, made in 1840, between theBritish Crownand various Maori chiefs. Major differences between both was language versions of the Treaty which make it difficult to understand exactly what the principles and promises are which are did. The Treaty gave the British some rights to govern in New Zealand, and the rights of the chiefs to ownership of their properties, and gave Maori the rights of British citizens.
- Historical review
As a population group, Maori have the poorest health status in comparison to other community people because most of the Maori people are living in rural area or small towns. Maori life improved dramatically after the second war. But it was less then Pakeha.
Moreover, District Health Boards (DHBs) are required to improve the health status of Maori people and reduce health disparities for Maori as compared to other population groups in New Zealand. Most of the times health providers tend to deliver good health services and also disability services to predominantly Maori clients according to their need.
One is the common examples of interpersonal racism with Maori and non-Maori people was demonstrated in ‘paired mystery shopper’ research where Maori and Pakeha with similar facilities and conditions applied for the same rental house and Maori were more likely to be refused.
- Socio economic review
Measuring inequality: Mortality trends are common method to know about health status and inequality. One fact is that increased income inequality contributed to increased inequality in mortality rates.The gap was leesen from the 1990s to the 2000s, a time when the economy improved and health policies started to address health inequalities.
Socio-economic factors and ethnicity are also contributed to people’s health. The Maori people’s health is mostly influenced by social factors such as diet, living area, education, income and lifestyle. But, in the later years, the gap between the mortality rate of Maori and non Maori people was increasing day by day.
Since European colonisation Maori consistently had lower life expectancy and poorer health thanPakaha, and people living in deprived areas or people living in rural areas have worse health than those in wealthier neighbourhoods.
The other aspect is that, Cancer is a main cause of death in New Zealand. The Maori people who are poor more likely to smoke, drink. But lack of use of good diet and also lack of exercise. Their houses are more cold, damp and polluting heating which is the main cause of respiratory problems like asthma.
But all these conditions were less and almost absent in non Maori people because of great lifestyle and well balanced diet and health care services provided by the government to the community people.
From the 1980s, with the expansions in the economic restructuring there was major job losses, shifts to user-pays for public services that may be health services, income sources, disability services and other facilities and wide-ranging benefit cuts of facilities, touched the lives of all the New Zealanders. However, Maori and other community people were particularly disadvantaged by these policies, and during the 1990s differences between Maori and non-Maori incomes sources and job opportunity increased again. The gap then decreased gradually in the 2000s. There was a reduction in unemployment among Maori, and significant improvement in the earnings of Maori women. The income of Maori men relative to non-Maori hardly changed from 1991 to 2006. When income of people was decreased it means that people likely to have more struggle to fulfils the needs and demands of their families.
To reduce the inequalities, the government made various policies for both social and economic initiatives. The policy aims to reduce the disadvantage or negligence of inequality and promote equality among the Maori and non-Maori people for opportunity so as to achieve a similar distribution of services between groups and community people, and also equal distribution of overall outcomes within people of various society. This aim was for:
- People will achieve minimum level of wellbeing of their health physical as well as mental for all people. So all people will participate in our society to reduce the poverty, inequality and other aspects, and
- Various efforts should taken by government to ensure the equal distribution of the services of wellbeing across whole the society, it means good way to improve equality of real opportunities, where family background are not major determinants of individuals’ life chances.
The government provides a better role for reducing inequalities, Reducing Inequalities Officials Committee (RIOC) and prepairing plan and providing advice and reporting on reducing inequalities activity to Government which will be helpfull for Maori people. In August 2003, Cabinet agreed to a work programme with the purpose of reducing inequalities and policy aimed to improve the coordination of the policy across agencies, and the future oversight, and also monitoring and review of the plans used for reducing inequalities policy. The Ministers also asked for giving and taking advice on the overall progress of the plan of reducing inequalities and improvement in the policy outcomes, and a preview light on priorities for the future plan.
This government sets out numerous goals, principles and priorities for improvement in their work and also describes and awareing the population groups about the target of policy.
The government had also to give services in health professionals which must be too attentive and attractive that health care persons to be ready to provide services without any discrimination and be ready to act if they observe that can learn and benefit more than others offering and do the best practice. For this learning is to be recognise discriminatory practice at the interpersonal level and institutional level, and it always being prepared to act against it.
In 2006, two-fifths of Maori aged 15 and over had no school qualifications. This contrasted with less than one in eight Asians and a quarter of Europeans. But the concentration of Maori people in manual jobs but they cannot get good job because of their educational qualification.
A community trust has set the funds for educational project that will be more helpful to promote Maori and other community people educational level. In the year 2011/12 it was recognised as financial year because in this year grants for the Education of Maori and non Maori people have been committed. A total of $20 million was launched for this work. Some Educational models aim to raise the academic achievement of Maori students. The projects funded in 2011 were:
- The Starpath project
- Computer Clubhouse Trust
- Maori into Tertiary Education
- Manaiakalani Education Trust
But the continued inability of policy makers was the serious challenge which alters the crises which led to growing Maori frustration impatience.
health is a vital statistic for every person, For enjoying a good life it is necessary to be well being. It may be possible only if people are having awareness about their health, and they are using policies and services provided by the government at health care centre. But Maori people are not getting these services because of inequality or discrimination.
Health inequality may be as follows:
- Inequality in the resources required for health
- Discrimination to and through health care
- Differences in the equality of care received
Maori people are discriminated in health factor also. Because various policies were started by the government in care of health but these services was not fully supported for the Maori people. So, they remained to get the quality of life. And Maori people were effected by the negligence.
It was the main reason that Maori people had more expose to disease conditions such as:
- Respiratory problems like asthma
- Lung damage due to excessive smoking
- Ortho disorders due to lack of exercises
- Obesity due to imbalanced nutritional diet
- Skin disease due to impaired life style
- Most chances of cancer due to lack of education about maintains of health
Most of the Maori people are living in inferior houses. It is mostly due to low income and unemployment of the Maori people. In 2001s Maori people household their own home but homes were more crowded. Also, some Maori found that the home they buy or on rent is not according to their culture and not well designed for their needs.
It is because Maori people have limited resources. It means they are facing the problem of housing because of discrimination. Moreover, for the Maori people there are segregated towns as living area. Maori people’s health is greatly affected due to overcrowding in their homes.
Improving access to health care among New Zealand’s Maori population
The health status of Maori people varies according to their unique historical , political, social circumstances. Disparity has been evident for colonial history of New Zealand .But various approaches are used for improving the quality of health care for Maori people. For this health services are improved and also various policies should prepared which were useful for Maori people. Most of the Maori people had concentrated on their health means for improvement in health, maintain of health. Because now they were aware that if they will maintain their health then they can protect himself from various disease conditions such as cancer, diabetes, and cardiovascular disease. For this they maintained various objectives such as follow:
- Increasing the awareness of people towards their health
- Provide various evidence to the people to encourage for health maintains
- Counselling may be given to Maori people for promoting their health status
Rights of others and legitimacy of difference
Definition of Legitimacy: Inpolitical science,legitimacy Whereas “authority” denotes a specific position in an established government, the term “legitimacy” denotes asystemof governmentis the popular acceptance of anauthority.
It is a value where something or any person is recognized and accepted as right and proper. It was described by numerous authors but according to Max Weberit has various types such as:
- and rational-lega
Power: is the ability to get things done for enforcing one’s own will or enforce the collective will of any perticular group over others.
Legitimacy: it is a socially constructed and psychologically accepted right to exercise power.
The Rights are divided into two types:
- Absolute Rights
- Non-Absolute Rights
Power relationship in health care
Power relationship are reflected in medical and nursing field. These relationship reflect the value of trust on each other, encourage for doing best efforts, respect for every individual and towards the staff members. In this relationship physician and nurse should be supportive to each other.
Moreover, with good power relationship it becomes easy to overcome the problems like inequality, negligency, and disperities among the Maori and non-Maori people.
It will also effect to the services which should be provided by the government for the people related to their health. Because if there will be power in relationship means higher authority have power on lower authority than lower authority will always be ready to follow the order of higher authority .As a result, there will be improvement in the quality of work.
With this professional boundries are also improved because it allow for a safe relationship between nurse and patient and other health care providers.
Due to power relationship racism is also decreased. People of various racism work together in any health organisation where they become able to know about the culture, religion, lifestyle of each other. With this staff become able to provide effective care to patient having any variety and diversity without any discrimination.
It is helpful to reduce discrimination and negligence among whole the community people either Maori or non-Maori population.
Overall, inequality among any individual, group, community, population is not good because it effect the other community people physically as well as psychologically. It badly hurts to one’s feelings and confidence level which later become the cause of ineffective interpersonal relationship .Not only of government but it is the duty and responsibility of each individual to cooperate to reduce the inequality among the Maori people.
This goal can be achieved only if every person at various areas have to respect the others such as at work place, living near their home etc.
It is also the responsibility of government to provide various services for the neglected population so as to improve their lifestyle and giving respect to their culture. Overall, care and cure the others not only for own benefit but for their wellbeing without any discrimination.
- Bhopal. r.,(2006), ”Racism, socio-economic deprivation, and health in New Zealand”, 367(9527), 1958-1959 retrieved from aut.researchgateway.ac.nz/bistream/handle/10292/…/Woodardw.pdf.txt.
- C. Orange., Willians.B.,(1987), The Treaty of Waitangi, Appendices P 260, Retrieved from en.wikipedia/treaty-of-waitingi
- Dahl, Robert A.Polyarchy., (1971):” Participation and Opposition“, New Haven (Connecticut) and London: Yale University Press, pp. 124–188.
- Ellison-Loschmann.L., & Pearce.N.(2006),”Improving Access to Health Care Among New Zealand’s Maori”, 96(4), 612-617. doi: 10.2105/AJPH.2005.070680
- Hauora.M.(2014),”Ministry of Health”, New Zealand.govt.nz, retrieved from www.teara.govt.nz/en/health-and-society/page-2
- Kerryn.P., ”Health and Socio-economic status, ethnicity and health inequality”, TeAra – the Encyclopedia of New Zealand, retrieved from URL: http://www.TeAra . govt.nz/en/health-and-society/page-2.
- O’Neil, Patrick H.(2010).Essentials of Comparative Politics. New York: W.W. Norton & Company. pp 35-38.retrieved from en.wikipedia.org/wiki/Legitimacy_(political).
- Pearson.d., (2012), “Ethnic inequalities – Occupation and education”, TeAra – the Encyclopedia of New Zealand, retrieved from URL: http://www. TeAra.govt.nz/en/ethnic-inequalities/page -6.
- Robert. B., (2009), Discrimination and Maori health, The student magazine of Victoria University, retrieved from salient. Org. nz/features/discrimination-and-Maori-health
- Rashbrooke(ed). M.(2013), Inequality A New Zealand Crisis, pp 296, DOI:10.7810/9781927131510
- www.bihr.org.uk>Human rights in action – a toolkit for change
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