The Maori health strategy

Maori people are seen to suffer poor quality of health and experience health inequality with that of rest of the nation. Studies have shown health gap between the Maoris and non Maoris. The former has shorter life expectancy than the later. Inequality in health services, poor cultural competency among the healthcare centres, poor socio-economic conditions, low level of education and many others often contribute to greater prevalence of different chronic ailments (Orange, 2015). Development of policies for addressing the different contributing factors for this health gap is needed to be introduced. In order to ensure meeting all the expectations of the Maori, incorporating the principles of Treaty of Waitangi is important. Hence, the assignment will critically analyse whether the principles of the treaty had been successfully incorporated or not and how well they have responded to the health issues in the Maori community. 

The Maori health strategy was established with the aim to ensure that all Maori families are supported in ways by which they can enjoy maximum health as well as well-being. Whanau which is one of the most important aspects of the Maori community (involving kuia, koroua, pakeke, rangatahi and tamariki) had been given high level of importance while developing the various strategies in the policy. Three important threads had been mentioned in the policy which when analysed carefully and critically can exhibit that the components of the Treaty of Waitangi had been successfully implemented.

The first thread called the Rangatiratanga, which advises of empowerment of the Maori people by being allowing them to have complete control over the direction and shape of their own institutions, communities and development as people. Martin (2015) is of the opinion that such aspects of the policy helps to show that the government is putting much significance of the maintenance of the cultural traditions of the Maori. Accordingly, they are allowing them to maintain their cultural preferences and inhibitions by developing infrastructures that align with their cultures.  It can be clearly seen that this aspect aligns with the principle of participation of the Treaty of Waitangi. This principle allows the Maori community and its members to participate proactively in developing and designing programs that are culturally aligned and also addressed the health issues they face in the community (Williams, 2017). This thread clearly shows that the policy had successfully identified the importance of participation of the Maori community in working along with the non-Maori authorities in designing and planning for the initiatives of health and well being.

Another important key thread is “reducing inequalities”. The policy has identified the importance of reduction of inequalities that the Maori community faces while accessing healthcare as well as in various health and disability outcomes. These disparities reflect the broader socio-economic inequalities that the community face in comparison to the non-Maori community (Orange, 2017). This aspect of the policy can be critically analysed. This shows that the principle “protection” had been successfully considered by the policy makers while developing the policies. The principle of protection dictates the importance of healthcare professionals and concerned governmental departments to take initiatives for protecting the Maori culture, health, protocols, customs and languages. By effectively reducing the inequalities faced by the Maori community, they can be well protected from poor health outcomes and lead better quality life as led by other New-Zealanders.

Pathways to Action

The Maori health strategy successfully develops four pathways of action that would help in the improvement of the whanau. These would be enabling them to enjoy quality lives with high quality health status, lessened prevalence of chronic ailments and living with their own cultural traditions. The first pathway of action was to ensure that the Crown encourages partnership and active collaboration from the whanau, hapu and iwi and Maori communities for effectively identifying the components important for prevention of the disorders and healthy living among the Maori communities. For these, the policy had focused on the significance of fostering Maori community development which would be built on the strength and assets of the Maori community (Stevens, 2016). Another objective that had been also set is the removal of barriers to Maori with disabilities and encouraging the whanau to participate on the New Zealand society, including te ao Maori. Another objective shows the importance of including Maori models of health and traditional healing procedures. Therefore, again in this section, it can be well analysed that the policy makers have encouraged not only the participation of the Maori community in the broader society of New Zealand but they have also tried to protect the community by effectively removing the different barriers they face when they try to participate in the broader society (Parsonson, 2017). Moreover, they had also ensured the principle of protection of the treaty of Waitangi by respecting their emotions that remain associated with their Maori health models and traditional healing. Although traditional healing is not practiced in western healthcare sector, but still the policy makers have protected their cultural traditions of healthcare and included it as an objective to achieve best health. Therefore, this policy is truly commendable as each of the aspects follows the principles of treaty of Waitangi.

Another important principle called the “partnership” in the treaty of Waitangi had been well followed in the pathway action two of the Maori Health strategy. The pathway of action two states the importance of participation of the Maori community at all important levels of health as well as disability and even in successful decision-making, planning, development and delivery of health and different disability services (Hayes, 2016). To achieve this, the policy had also planned to increase the number as well as improve the skills of the Maori Health and disability workforce at all levels. They had also talked about developing the efficiency of the Maori providers so that they can deliver effective health and disability services for Maori. Therefore, from this pathway, it can be well seen that policy makers had welcomes active partnership of the Maori community. When Maori people feel that their suggestions and actions are respected while developing plans and taking decisions, they feel empowered and respected (Came et al., 2016). Moreover, when they are made active partners in different initiatives, they can correctly pinpoint their needs and requirements and also help in ensuring that their culture is maintained. This helps the national government to identify their barriers easily as these are voiced by the Maori community themselves. This helps in ensuring harmonious communication and collaboration among Maori community and non- Maori community and hence positive outcomes on health are determined.

Implications of Treaty of Waitangi

Maori as well as the Pacific Islanders and even the children were still seen to be more than twice as likely for not having collected a prescription due to the cost as the non-Maori and non-Pacific children and adults after adjustment for age and sex were done (Oetzel et al., 2017).

From the above discussion, it becomes clear that each and every initiative that had been adopted in the Maori health strategy had successfully followed the three important principles successfully. The policy had been successful in ensuring a number of important aspects that had made it more suitable for aligning with Maori culture and Maori emotions. Firstly, the policy had rightly accepted that Maori iwi tribes have their own right to organise themselves and protect their ways of life and controlling their resources that they own (Morgan, 2015). Secondly, the policy had also understood the requirement of the Government in acting responsibly as well as in good faiths towards the Maori community. Third, the government had also responded to the grievances and tried to address them for the Maori community like the socioeconomic disparities and many others. Fourth, the Maori health strategy had successfully established equality as well as principles that all New Zealanders are equal under the law. 

New Zealand has been one of the leading nations in the world where people are seen to be suffering from the grip of one of the most harmful disorder or cancer with about 29% of people suffering from it. It has been seen to have experienced the highest death rate for the large bowel cancer (Dwyer et al., 2014). It is positioned to be fifth nation having the highest rate for cervix and prostrate cancers and sixth nation for having highest rate of breast cancers. Therefore, there was an urgency of controlling the disease burden of cancer in the nation of New Zealand and hence proposal of this policy was found to be helpful for the nation.

The policy had been able to correctly identify the health status gap between the Maori and non-Maori people suffering from cancer. They had provided a data which showed that mortality from cancer was about 51% higher in the male-Maori people whereas it is 78% higher in the female Maori people in comparison to that of the non-Maori people. Poor management and living conditions with lung cancer had been the highest contributor of death due to cancer in the Maori community.

This policy has been successful in maintaining the principle of “protection” by the treaty of Waitangi. Just like the Maori health strategy policy discussed above, it has also imposed importance of removal of the inequalities that the Maori community face regarding different aspects of the healthcare systems. The policy had clearly acknowledged that “Reducing inequalities for Maori is a Treaty of Waitangi obligation and a priority for the Government” which had clearly depicted the importance given to the principles of the treaty of Waitangi while developing policy initiatives (Ball et al., 2016). Health inequalities are seen to exist among the different ethnic groups, socioeconomic groups and people living in the different geographical areas of the New Zealand. The policy had been seen to acknowledge the fact that the inequalities to health services are not random and rather can be seen even in the distribution of the burden of cancer in the nation. People who are found to be less well-off have greater chances of exposure to health risks along with poorer access to health services. They are moiré likely to develop and die due to cancer. Maori is one such community and hence their prevalence of cancer is higher. Researchers are of the opinion that reasons for health inequalities are complex as well as based on unequal distribution of their wider determinists of health and not only biomedical causal pathways.

Conclusion

Therefore, the principle of protection of Treaty of Waitangi had been correctly implemented in the policy. The policy makers had taken initiatives for developing interventions that would help in the improvement of the health inequalities which would in turn manage the underlying determinants and address the risk factors for cancer in Maori. They have developed framework for care like that of the prevention strategies, early detection and screening programs, health education services, easy access to healthcare services and others.

One of the confusing approaches that the policy had undertaken is that it had mentioned that it would be based on following the treaty of Waitangi in their framework. They have also introduced one important section where they have highlighted the importance of the three “Ps” for developing a policy that aligns with Maori community expectations. However, close analysis shows that only the “protection” and “principle” had been maintained in the cancer control strategy and the other two principles of “partnership” and “participation” is not adhered to (Blakely et al., 2016). The policy does not take extra initiative for discussing any strategies by which effective partnership and participation from the Maori community can be encouraged or fulfilled. The policy looks more of a general intervention framework development for all New Zealanders although they claim to keep the Treaty of Waitangi as one of the foundation pillars of the policy. However, they talk about the needs of Maori community in every of their goal sections and they have also identified the different inequality areas or the cultural differences and issues that Maori community face. They had also provided separate interventions for them.

Scattered information about Maori interventions is present under each section which makes analysis much difficult. The policy should have contributed specific sections about the Maori health and how the three principles could be covered in their initiatives. Although, huge number of interventions had been proposed by the policy for both the Maori and non-Maori, they cannot provide substantial amount of information to the readers. The scattered information however, lacks discussion of the ways by which partnership should be developed and maintained with the Maori community (Seneviratne et al., 2015). It has even not discussed about significance of participation of the Maori community although the principles had been discussed. Therefore, the policy should be reconsidered as rewritten by clear objections and goals for the Maori community ensuring that all the principles are covered successfully.

The present data collected and accumulated by November 2018 had show that there had been no such changes in Maori cancer rates. The data shows that almost 5000 patients who have been studied, five-year bowel risk was found to be higher in pacific patients about 59%, which is then followed by Maori (47%) and then the Maori (38%). Maori patients were seen to be presented to emergency department for about 45% showing that screening programs had failed (Seneviratne et al., 2015). This can reflect the inequities in access to primary care and the barriers to early diagnosis as non-Maori non-Pacific account to only 30 per cent.

References

This policy can be found in two important components – “Cabinet paper: Report back on New Zealand’s Tobacco Control Programme” and “Appendix: Background Information: New Zealand’s Tobacco Control Programme”. The papers have shown that prevalence of smoking in the Maori community had decreased from the time of 2006 but it had still remained quite high as compared with other ethnic groups. They had provided a graphical presentation which shows that the prevalence of smoking was about 42.24% in the Maori community in 2006 which had decreased to 32.73% in 2013 (Marsh et al., 2016). Yet the percentage of present prevalence smoking rate in the Maori community is much higher than other groups like European, Asian, pacific and even the total population. The paper namely “Appendix: Background Information: New Zealand’s Tobacco Control Programme” had provided no specific information about strategies but has only discussed about the prevalence rates of smoking in Maori. Therefore, no principles of treaty of Waitangi can be found. A budget for the New Zealand Tobacco Control Programme had been discussed. About $6.17 had to be divided into 9 important healthcare sectors of the nation but no specific information about initiatives for Maori had been discussed in this paper.

The policy paper called “Cabinet paper: Report back on New Zealand’s Tobacco Control Programme” had discussed about different key figures in smoking prevalence in the nation. This paper had successfully identified the Maori community among with 35.5 % are seen to smoke daily and the number is higher than the rest of the population. However, their data had also accepted that the present gap that existed between the Maori (7.17%) and the non-Maori (2.81%) is indeed closing (Tucker et al., 2017). The policy had not discussed about the treaty of Waitangi unlike the above mentioned policies and strategies. However, some of the initiatives that had been taken cover some aspects of the principles of the treaty of Waitangi. The budget allocated for this project had taken in consideration of 42 community based smoking cessation services in the nation that includes 32 Aukati Kaipaipa to Maori along with 4 Pacific and 6 pregnancy focused services. Therefore, they are successfully following the principle of protection where they had allocated smoking cessation services for Maori communities helping them to overcome the negative habit of smoking. Therefore, although they had not mentioned of the principles along with the intervention, but strategies for protection can be found in the policy.

Active partnership which is another principle of the treaty of Waitangi is also followed by the policy program in the nation. The budget that had been developed had been seen to successfully provide information and advocacy services at the national level. This is done from four non-governmental organisations that are seen to be providing leadership and coordination. They are the tobacco control sector including ASH, Te Ara H? Ora (the National M?ori tobacco control leadership service), Smokefree Coalition, and the National Heart Foundation (Robertson et al., 2016). Thereby, this program is seen to invite effective partnership and participation if , Te Ara H? Ora (the National Maori tobacco control leadership service) which is a Maori organisation. Therefore, it can be stated that the program has successfully followed all the principles of the treaty of Waitangi.

Another instance that distinctively shows that the following has followed the three “Ps” is the establishment of the The Pathway to Smokefree New Zealand 2025 Innovation Fund. This was established for supporting of the achievement of the Smokefree New Zealand 2025. About twenty four projects had been seen to receive funding in two different rounds till date (Elwood et al., 2016). The Innovation Fund had been supporting the implementation as well as evaluation of the different types of innovative approaches for the reduction of smoking among the Maori people and even pacific people and pregnant women and young people of the nation. Therefore, the program is carefully trying to implements protective strategies that give better future to the Maori community. Government’s allocation of funds for the smoking cessation of Maori community and innovative approaches taken by them can fulfil the principle of protection as mentioned by strategy of Waitangi.

The policy had not typically allotted separate sections for the discussion of smoking issues in Maori and had also not incorporated the importance of following the principles of Treaty of Waitangi. They had not discussed about ways by which Maori community members should be included in decisions making and strategy development. In this way, they had not successfully followed the real essence of the three principles of the treaty. Moreover, effective participation was also not encouraged and decisions were mostly seen to be taken up by the Ministry of Health department (Ribeiro et al., 2017). However, one positive aspect was that some of the interventions developed effective participation and partnership as mentioned in the above paragraphs and this can help in reduction of the smoking prevalence by certain degrees. However, it is recommended that the policy makers allocate separate tobacco cessation policies for Maori so that their underlying social determinants of health, education level, cultural preferences for smoking can be achieved in an expertise manner. The leaders of Maori communities should be invited for decision making so that intervention align with their expectations and cultures successfully. This would help in ensuring better results.

The present data had seen successful outcome of the New Zealand’s Tobacco Control Programme but there are still long ways to go in order to achieve the goals set by the program. About, 60000 adults accounting for about 15.7% were found to be current smokers. This had come down from 20.1% from the year 2006/2007 (Minichiello et al., 2015). Out of them, 35% of the Maori adults were smokers and this had come down by the 42% from the year 2006/2007.

This strategy was revised and updated in the year 2017 after the extensive engagement and consultation processes which refreshed and replaced the Health of Older People Strategy 2002. This strategy plans the strategic direction for different types of changes as well as set of actions which helped in improvement of the health of older people into and throughout the later years of their lives. This policy is seen to take a life-course approach that helped in seeking and maximising health and well-being for the older people.

Maori men aged 65 years and above shorter days of lifetime left in comparison to non-Maori males without living with disability or with long term illness. The Maori people of aged 65 and above are expected to increase in by 79% in the coming ten years within 2026. Therefore, the policy had rightly understood the importance of the healthy aging interventions so to ensure better quality health for the Maori community (Yang et al., 2017).

The health strategy had been developed with effective participation of the Maori community. The policy is the result for extensive engagement with older people, their family members, communities, healthcare professionals and even the Maori and Pacific Islanders and other healthcare centres (Seneviratne et al., 2015). This helps to understand that the policy had correctly followed the principles of participation in the treaty of Waitangi. Until the older people of Maori community are aged in discussing their issues as well as their suggestions, their main concerns can never be understood and until then proper interventions can never be developed.

One interesting portion of the Health Strategy  cleanly depicted the importance of the treaty of Waitangi and had discussed the three principles in details. Therefore, one can come to opinion that the principles had been considered while developing the strategies. The policy had clearly stated that their strategies have been developed by taking the framework of He Korowai Oranga, M?ori Health Strategy and hence, it had covered all important aspects successfully. Pae ora: Healthy Futures for M?ori wai ora, wh?nau ora, mauri ora had successfully discussed about development of the healthy environments, wh?nau ora (healthy families) and mauri ora (healthy individuals). In this way, one can say that they have successfully covered the principle of protection as mentioned in treaety. Pae ora had been seen to encourage every of the member in the health and disability sector for working collaboratively and thereby to work across sectors for achieving wider vision of good health and active ageing for everyone (Alpass et al., 2017). This influences both participation and partnership with community members and this help to meet up expectations and needs of Maori community people.

Successful addressing of the health inequities had been discussed and developed plan for New Zealand Triple Aim Framework had shown that the policy had provided huge significance for the betterment of aging Maori community (Wiles et al., 2018). Quality development of health centres aligning with culture for Maori had been discussed in details. Ageing well Te pai o nga¯ tau o te kauma¯tuatanga section had also discussed several strategies by which all the three principles of treaty of Waitangi had been coved successfully. This had been one of the best policies as it had correctly balanced intervention for Maori and non-Maori needs and intervention management successfully.

Maori population had older adults who were seen to have higher rates of many heath conditions than people who are of the other ethnicities. The ratio of Maori people to that of non-Maori people in new cancer is seen to be 1 in new cancer, 1.5 in heart disorders, 1.8 in obesity, 1 in chronic pain and 1 in arthritis (Manson & Muir, 2017). Therefore, it can be seen that the gap in health status of the older citizen between the Maori and non-Maori had become successful. This showed the success of the Healthy aging strategy.

The New Zealand Disability Strategy is one of the best strategies for the betterment of the Maori population who has been facing different barriers due to disabilities in accessing their human rights to heath. It can be described as the comprehensive framework of objectives as well as actions that had correctly followed the principles of Treaty of Waitangi. The strategy had been able to achieve an inclusive society that would be valuing disabled people and thereby promoting full participation in the community life. The strategy had itself claimed that it would successfully incorporate the principles of the treaty of Waitangi to meet its vision. The objective 11 had shown the effective inclusion and participation of the Disabled Maori people.

The principle of the participation in treaty of Waitangi was promoted through the provision of opportunities to the disabled Maori people in their communities and in accessing disability services. The people were given equitable level of resources and services in a culturally appropriate manner. The principle of protection was also followed as the policy makers ensured establishment of more disability support services, ensuring mainstream provided of the disability services are accessible and are providing culturally competent care. They also allocated sufficient amount of resources for the different Maori Development framework. Even the principle of partnership had been maintained by ensuring that Te Puni Kökiri takes was able to undertake proper leadership role in the promotion as well as participation of the disable Maori (Hayes, 2016).

The Ministry of health has been funding a huge range of disability support services for the people who are mostly under the age of 65 years. The disability Maori people had been accessed as having a physical, intellectual or sensory disability (or combination of these) which is unlikely to be continuing for 6 months which had reduced their independent function. The Maori providers provide the services so that they can provide culturally safe care to them. Non-Maori people also provide the services as well. 

Conclusion:

The above discussion provides a critical analysis of four important strategies that ahdf been published in the nation. The Maori Health strategy as well as the Healthy Ageing Strategy had been successful in developing interventions that aligned with the needs and requirements for both Maori and non-Maori community. Not only the policies are structured well, but the information is presented in systematic manner helping the readers to understand the objectives that need to be met. The principles of Waitangi had been successfully followed in the two policies. On the other hand, the New Zealand’s Tobacco Control Programme does not follow a systematic approach and it had not represented the information in a systematic manner. Moreover, there is also no proper balance between the discussion of the strategies Maori and non-Maori. However, some of the strategies mentioned had followed the principle of the treaty of Waitangi. Cancer control strategies had mentioned the importance of the treaty in separate sections but had not been able to apply it successfully in the policy.

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