Social and Health Inequalities in New Zealand
INTRODUCTION
Health care services in New Zealand are being delivered by various health organizations and people for the main goal to achieve optimum level of health among all. This assessment will give more insights about inequalities and disparities in healthcare system and services given to the consumers especially in the Maori context. As a healthcare provider, it is a must to study, understand, and adopt the healthcare system in New Zealand to render good quality nursing services to the consumers. Guided by the principles of the Treaty of Waitangi and Cultural Safety, health care providers have an in-depth realization of oneself and the people in New Zealand. This discussion highlights some inequalities and disparities in healthcare towards Maori and non-Maori population. This also provide some input on how the government is responding to this issues. This only limits to the Maori, non-Maori healthcare concerns within New Zealand. Some of the topics are related to political, social, housing, employment, and education inconsistencies of Maori and non-Maori individuals receiving healthcare in New Zealand.
POLITICAL DISPARITIES AND INEQUALITIES
According to Malcolm (2004), Maori receives only less than 50% of the governments’ expenditure or the primary healthcare services compared to the Europeans. This is believed to be partly economic issue but also of a cultural interests. But Primary Health Organization has been established to address this problem and this is the Access Funding. This provision is specially regulated for the benefits of the marginalized Maori population. But this policy is limited to the GP’s and Practical Nurse accessibility only, there are no provision for an improved funding of healthcare for Maori people. In this status, we can infer that because of lack of financial support, more Maori prefer not to seek healthcare consultation to specialist physician for proper treatment of health due to the limitation of the provision. Thus, more and more Maori are unhealthy and with high rates of disability and morbidity.
Healthcare disparities between Maori and non-Maori marked as a colonial history of New Zealand. This racial problem has mixtures of components to be considered and until now it is still a debate. Loschmann & Pearce (2006) said that, health inequalities will not be solve if there are no improvement in healthcare access. As evidenced, continues increased of variation of primary and secondary health care access between Maori and non-Maori. One survey showed that 38% of Maori adults reported problems in obtaining necessary care in their local area, as compared with 16% of non-Maoris. Maoris were almost twice as likely as non-Maoris (34% vs 18%) to have gone without health care in the past year because of the cost of such care. (Loschmann & Pearce 2006)
As primary health care services are the main place for health consultation and treatment in New Zealand, more Maori are going to seek healthcare to GPs clinic and medical centers. Access is not merely the entry to health care facility but it is also the provision of quality health services rendered. Since, most Maori go to primary health care clinics and centers, specific health concerns for Maori is not addressed because treatment for critical or complex case patient cannot be treated in a primary health care facility, specialize treatment is needed. Thus, unmet proper treatment. (The Health of New Zealand Adults 2011).
SOCIAL DISPARITIES AND INEQUALITIES
Social inequality issues are linked to ethnicity. Social disparity occur continuously in New Zealand. The impact of colonization to the Maori population marked to the very moment. There are issues in cultural identity as to which is more powerful and have the rights in the land and government. Discrimination and power imbalance still exist at present moment and its relation to healthcare is very significant. Social connectedness is the key determinant in gathering data related to social disparities among the two mentioned parties. According to Pollock, (2012) a healthy community has lower morality rate and higher expectancy rates. The data of life expectancy shows 83 years for non-Maori female and 79 years among non-Maori male, whereas, 75 years Maori women and 70 years in Maori men. Another determinant is the income of a particular person. Considering he/she can afford a high standard of living if he/she has a good and highly paid job. But in Maori context, they are marginalized, as shown in the data that median weekly earnings for Maori is $767 ± 15.43 compared to $863 ± 17.26 for non-Maori. This statistics views inequality among Maori and this has a big effect to their household income, thus their standard of living is low compared to the non-Maori people, based from Marriott & Sim (2014). Unhealthy practices also associates with low income which eventually leads to unhealthy behavior. Smoking is high in many depressed areas and mostly Maori are living in this areas. There are studies linked that smoking plays important role in socio-economic and ethnic status of Maori and it is interrelated to lung cancer occurrence. Maoris in living in poor conditions were three times likely to use tobacco than those with high standard of living person. There is a rise in lung cancer usage and deaths in the deprived areas and 30% of Maori died because of lung cancer compared to the 17% of non-Maori death rates, Pollock, (2012).
There are also studies that conflicting views regarding Healthcare Model in the work place. Maori still practiced their own context of health and healing and this understandings the viewpoints of conventional health services rendered. There are also medical practices that contradicting to their own cultural approach towards health. Marginalization is seen on staff insensitivity, judgmental, and disrespectful delivery of care, according to Elers (2014).
The healthier a person is, the lower the mortality rates. Engaging in a healthy lifestyle activities will make a person fit. More Maori experienced sicknesses at a younger age and it happen often and die young. While non-Maori have higher life expectancy rate even if they lived unhealthy. Mortality and morbidity percentage is significantly higher among Maori population. Male with good work shows low death rate than male working as laborers and cleaners. There are also data shows that, the more deprived communities are, the higher percentage of death and illnesses. (Pollock, 2012)
EMPLOYMENT DISPARITIES AND INEQUALITIES
Employment status is one determinant in healthcare inequalities in New Zealand. According to Pearson (2012), among other ethnicity in New Zealand, Maori and Pacific population has the highest unemployment rate. It comprises of 17.8% compared to non-Maori which is 14.2% in the year 2006. Most of the jobs Maori landed are occupation in the land and fishing. Some of the Maoris are working as laborers with a rate of 30% compared to 15% of European laborers. While, 18.2% of Western people are managers and 10.6% for Maori society. Labour forces are mainly the occupation of Maori. This is in relation to their low educational attainment as Pearson (2012) said. Healthy status can be achieved in many ways, one good factor that leads to a good personal shape would be their status in life. The ability and capability to support basic needs and necessity like food and shelter. Insufficiency in life’s’ basic needs will eventually make a person unhealthy and easily get sick. As Blakely & Simmers (2011) stated that, one of the leading disease of Maori is diabetes and it is mostly encountered in marginalized and low income individual and the predisposing factor would be obesity in the Maori race. How employment status affects the health of every individual is very important to discuss. Employment status is regarded as a main basis of health in a person. It has a direct and indirect effect on health and believed to have an increasing impacts over time. Another pointer to review is the funding of the government towards healthcare. Most Maoris seek health intervention in the primary health centers and GPs while the Europeans can afford to pay for specialist physician, thus, better health are achieved by the Western group. Another thing to consider is the discrimination views of Maori towards healthcare. Maori Health Review (2007), shows data that there are 76.3% Maori women wanted to receive transplant while 79.3% to non-Maori women and 80.7% for Maori men and 85.5% for non-Maori men respectively. This data indicates healthcare compliance to treatment and this a strong input for improvement of health. Thus, shows, Maoris have higher mortality rate. In addition to that, a person who are unemployed and have family will not able to sustain daily basic needs and health is our basic need. Thus, Maoris have more health vulnerabilities than compared to non-Maoris.
HOUSING
Family is the basic unit of society. It is the very foundation of social being in the community and it is also the most critical part in obtaining data regarding health and wellness of every individual more focus on children who are dependent of care from their parents or family members for physical and emotional development (Ministry of Health, 2009). In the middle of the 20th century, there is a significant increase in home ownership by the Maoris compared to the decreased percentage of non-Maori home ownership. This data is basically focus on the household proportion and not on the number of households, (Waldegrave, King, Walker, Fitzgerald, 2006). There are 47.0% of Maoris and Pacific people owned their homes as compared to 72.8% for Europeans. These varies with the quality of housing they had, Maoris lived commonly in two or more family sharing in bedrooms whereas, Europeans have enough space in the house and rarely shared bedrooms, as Pearson (2012) said. This pattern of living manifested a not well-designed standard of housing for Maoris, thus health risk is advantageous. Congestion and substandard housing may lead to poor health condition for Maori and most common are: colds, asthma, and post-natal depression. Pearson (2012) added that, there is a significant increase in obesity, smoking and alcohol drinking. There were 38.0% Maori alcoholic beverages drinkers whereas, 23.0% were reported for Europeans. Research shows that one of the leading cause of death for Maoris and non-Maoris are Ischaemic Heart Disease and the second leading cause is lung cancer for both Maori male and female, according to the Ministry of Health (2014). This is an evidence regarding the high number of Maoris who smoked as previously mentioned. The increased rates of respiratory diseases were due to the overcrowding of family members and contamination of molds in the home because of poor housing condition. These highly contagious diseases can be pass through droplet, personal contact and airborne transmission. Thus, Maoris are susceptible to many easily spreadable diseases and many lifestyle related health problems, (Ministry of Health, 2014).
EDUCATION
Education is said to be the key factor to success. This is in connection with many advantages and helpful product like high paid jobs, better income, great occupational chances and have relations to positive health outcome, (Marriott & Sim, 2014). Good education enables a person to be economically stable and high productivity in life which resulted in an improved standard of living. This also makes a person self-worthy, secured and a sense of belongingness. But there are some indicators to be considered to assess standard of living of every individual. This relates to the physical situations in which people lived, the availability of goods and services, and the accessibility of resources. These are the two pointers to considered, first is the income they get and second is the accommodation they have according to (Ministry of Social Development, 2010P). Maoris educational qualification has dropped enormously compared to non-Maori settlers. Pearson (2012), stated that there are 2 out 5 Maori have no school qualification compared to 1 out 8 Asians and a quarter of Europeans respectively. There are more Maoris who had no degree in education which is an evidence of many Maoris worked as laborers and cleaners. Data shows that many Maori school leavers who attended only the minimum level of education, NCEA level 2, 60.9 % of them completed level 2 compared to 82.1% for non-Maori in the year 2012, Marriott & Sim, (2014) said. There are 18.6% Europeans who had bachelor’s degree, while there are only 9.1% of the Maori population finished bachelor’s degree. There is also a great difference in the aged-standardised tertiary participation rates in 2012 data, it shows 9.9% of Maoris compared to 8.0% in Europeans. Across years of observations, changes in educational attainment enhances improvement in Maoris life as to their way of living. The implication of these findings are relatively connected to the education background of individual to achieve optimum of health. All aspects are interrelated to each other. As little knowledge about health would lead to unhealthy way of living thus Maori are more unhealthy people compared to other ethnic groups. There is also a premise that education starts at home and this shows relevant to healthy lifestyle. Smoking at home is prevalence among Maoris, and according to their living conditions, overcrowding is a health treat especially to the young generation. Second-hand smoker comprised a high rates among Maori children. There are 2.6 times exposure to SHS among Maoris compared to non-Maori children and a significant high rates of 7.8 times of Maori children living in remote areas. Studies shows that almost 24% of the smokers were diagnosed with many mental health conditions like depression, bipolar, anxiety disorder, and alcohol and drug related disorder, according to the Ministry of Health, (2014).
Conclusion
Based from the given facts and data, I can confer that health disparities and inequalities among Maori and non-Maori are ambiguous to discuss. However, history plays a vast implication to healthcare services in New Zealand, it should be of greater good of the citizens not merely the matters behind the past. As a result of my review, majority of Maoris were unhealthy compared to the Europeans. This is based from the sources of information I gathered form many research and studies. Thus, health organizations and health providers must collaborate to promote, protect, and sustain health of New Zealanders.
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