Maori Health Plan

Policy Code: A1.8-2

Provisional Date: 31/05/2010

Date Approved: 11/02/2011

Dates of Reviews: 26/10/2014, 20/07/2016, 10/08/2019

Date for Review: 10/08/2022

Purpose:

To strive to ensure Maori have at least the same level of health as non-Maori, while safeguarding Maori cultural concepts, values and practices.

To complement and enhance the provisions of the Canterbury District Health Board Maori Health Plan

In the third article of the Treaty of Waitangi, the Crown gave an assurance that Māori would have the queen’s protection and all rights – ‘tikanga’ – accorded British subjects.  Today this is interpreted as the principles of Protection, Partnership and Participation.  Maori are equally entitled to the protection of the crown, to be treated in partnership and to have an equal chance to participate in the benefits of society.  The Crown made a promise and that must be upheld.

Today, Maori do not yet have as good health outcomes as the rest of New Zealand society so as part of our duties under the Treaty, we must work especially hard to ensure this is addressed.  Good health is essential for participation in society and we can only achieve this in partnership with our Maori patients.

This policy is a framework to help us work towards better health outcomes for Maori.  It is designed to align as much as possible with the CDHB Maori health policy, but has where possible and appropriate included our own particular way of working.  Feedback on this policy is always welcome.

Responsible Staff:

Implementation: Quality Administrator

Action: All Staff

Audit: Quality Administrator

Audit:

This policy also has CQI audits associated with it:

Training Resources:

MCNZ Statement on Maori Healthcare:  https://www.mcnz.org.nz/assets/standards/2afd3f32b0/Statement-on-best-practices-when-providing-care-to-Maori-patients-and-their-whanau.pdf

Maori Health Strategy Documentation: https://www.health.govt.nz/system/files/documents/publications/mhs-english.pdf

The Maori patient in your practice (ACC publication): https://www.acc.co.nz/assets/provider/02e8257bd9/acc1625-maori-cultural-competency.pdf

CDHB Maori Health Plans: http://www.cdhb.health.nz/wp-content/uploads/c410a7cd-canterbury-m%C4%81ori-health-action-plan-2017-18.pdf

Maori Mental Health Resource: http://www.bpac.org.nz/BPJ/2010/June/mentalhealth.aspx

Language Competency Resources:  https://www.heiheihealth.com/site/resources/language-and-pronounciation

The Treaty of Waitangi:  https://teara.govt.nz/en/treaty-of-waitangi/page-1

Linked Policies:

None

Policy:

Overview (summary of the 2014 to 2018 CDHB Maori Health Policy Statistics):

Our health statistics make bloody reading.  Maori people are not getting the equal health to which they are entitiled under Te Tiriti O Waitangi

Compared with non-Maori, Maori people are:

• Over five times more likely to die from diabetes
• Twice as likely to die in accident
• 2.4 times more likely to die from lung cancer
• 1.3 times more likely to die from heart disease or stroke
• 2.13 times more likely to live in a household with no access to a vehicle.
• Earn $4000 per year less on average
• 40% less likely to own their home
• 2.5 times more likely to live in overcrowded conditions
• 2.8 times more likely to smoke
• 40% less likely to access cervical cancer screening and 4.2 times more likely to die of cervical cancer

The leading causes of these problems are:

• A genetic predisposition to hyperlipidaemia and diabetes (syndrome X)
• Low levels of expectation and education predisposing to:
• Low paid and hazardous employment conditions
• Limited access to healthcare resources
• Distrust and disaffection due to past and present injustices
• Lack of engagement with Western healthcare
• Lower rates of enrolment with PHOs than other ethnicities.
• High rates of smoking
• Poor diet and obesity

 In Canterbury specifically, there are some differences from the national statistics for Maori. We have higher hospitalisation rates for respiratory, cardiovascular, mental health and pregnancy related problems but lower rates for injury, poisoning and digestive disorders.

Social Deprivation:

Maori in Canterbury generally have lower levels of deprivation than Maori in the rest of New Zealand but remain relatively deprived when compared with the non-Maori population of Canterbury.

They are more likely to live in cheaper accommodation and more likely to be living in overcrowded conditions.

A New Approach

Past attempts to manage the inequity in health outcomes for Maori have focussed on individuals.  These have been only partially successful so the the current strategy is to apply the principle of Whanau Ora (Family Health) recognising that it is not sufficient to deal only with the problems that present, but also with the underlying physical and social issues that may be affecting not just the individual but their entire famliy and support structures. 

There is now recognition that health determinants are often not the responsibility of agencies with a primary focus on health.  WINZ and social housing providers, the police and other agencies all needing to take a more whole-of-system approach to healthcare needs. 

The following action areas have been identified in Canterbury:

Ethnicity data collection:

If we don't know who is Maori, we cannot identify areas of need, and we cannot measure our outcomes to ensure they are having the desired effects.

We will help by:

• Ensuring we collect data about the ethnic identity of our patients on our enrolment form
• Trying to make our practice comfortable to Maori people to express their identity
• Making it worthwhile identifying as Maori (patients do have to benefit)
• Supporting patients who may be struggling with their identity - patients can change their primary ethnicity at any time
• Supporting patients who identify with more than one culture to record up to three ethnicities.

Enrolment in Primary Care:

Being enroled with a primary care provider like us means we can care for you.  Primary healthcare is the best way to ensure longer term better healthcare outcomes and that requires a longer term relationship.

We will help by:

• Making it easy to get care - increasing the availability of clinical staff and offering telephone consultations where appropriate.
• Keeping our fees low
• Offering the first appointment at the enroled rate even if you choose not to enrol after (we want there to be no barriers to access and no coercion to sign up)
• Making it worth patient's while to be enroled - providing long term care and reminders for key health events.
• Waiving our casual fee where appropriate so that we do not disrupt longer-term relationships with other doctors just to obtain a lower fee.
• Not permitting high levels of debt to build because debt creates an unhelpful dynamic in the consultation.

Lower rates of hospitalisation for Tamariki:

Children from Maori families are more likely to be hospitalised.

We will help by:

• Making it easy to get care - any child will be seen on the day.  Nurses can provide urgent care when well supported by doctors.
• Keeping our fees low - we will continue to support fees-free as long as the government maintains the value of the service.
• Using the Acute Demand service to keep patients at home when it is safe to do so.
• Supporting families to be well - we will employ a staff member specifically to help address the social and non-medical needs of Maori patients.
• Continuing to provide FREE appointments with the nurse right up to age 18.
• Using our medication database to identify children at higher risk of becoming seriously ill over winter.
• Support and encourage mothers with breast-feeding infants for at least six months after birth.
• Support and encourage full immunisation for all tamariki.
• Encourage enrolment in the children's dental programme, and discourage consumption of carbonated beverages.

Lower rates of hospitalisation for Adult Maori:

Maori adults are still more likely to be admitted to hospital as an emergency than non-maori.

We will help by:

• Making every effort to support Maori to quit smoking - smoking is the single biggest reason for this difference.
• Supporting Maori with asthma and diabetes to have better control of their illness.
• Ensuring that Maori are especially encouraged to have appropriate screening tests - these can catch disease early or prevent it altogether.
• Using the Acute Demand service to keep patients at home when it is safe to do so.
• Encouraging adult Maori to accept adult vaccinations including influenza and varicella vaccine.
• Assisting financially where appropriate to assist Maori patients to access non-funded screening options.
• Ensuring that we exceed our targets for the provision of cardiovascular disease screening to Maori

Improve cancer outcomes

Maori are more likely to develop cancers and more likely to attend the doctor when it is too late. 

We will help by:

• Making every effort to support Maori to quit smoking.
• Supporting Wahine to access breast and cervical screening.
• Making sure that Maori are aware of the earliest signs of cancer, so they can access treatment more quickly.

Improve Mental Health

Maori are more than three times as likely to be placed under a community treatment order as non-maori.  The reasons for this are unknown, but there is some evidence that earlier treatment might improve outcomes.

We will help by:

• Being a place Maori can trust.
• Being a place Maori feel comfortable.
• Spending time with Maori who are expressing mental distress.
• Reaching out to Maori who have been in contact with mental health services, and routinely offering free follow-up support where appropriate.
• Offering long appointments at no extra charge for mental health issues and offering reduced price or free follow-up appointments.
• Recognising that Maori may have difficulty explaining mental health issues in ways that we understand.

Sexual and Reproductive Health

Maori should expect to have the same outcomes and care as all as regards their reproductive health.  We would encourage all Maori to make use of our high quality reproductive health services.

We will help by:

• Ensuring that long acting contraception options are available free of charge to Maori women aged under 21
• Where appropriate provide free contraception services to Maori women aged over 21.
• Ensuring all women are supported if they choose to terminate a pregnancy.
• Providing free sexual health checks for all Maori aged under 21.
• Encouraging all Maori to receive the HPV vaccine.
• Continuing to provide free healthcare to all pregnant women regardless of gestation or outcome until 6 weeks after the end of pregnancy.
• Doing our best to provide the services in a way that respects the particular approach of Maori to sexual and reproductive health, and in particular the sanctity of human life.
• Contacting every new mother to offer support, immunisation and assistance if required with breast-feeding.

General Support:

There are a number of other actions we can take which will assist Maori to lead happier, healthier lives, including:

• Encouraging employment rather than welfare dependency.
• Prioritising the resolution of disabling illness.
• Assisting with access to appropriate initiatives (eg: insulation and heating grants)
• Employing a specific worker with the remit to work to improve non-medical determinants of health.

In addition to the above:

All staff shall:

• Be aware of Maori values, beliefs, protocols and cultural issues.

• Attend training in cultural competency at least every 3 years to enhance understanding and respect for Maori.

• Maintain an understanding of the Treaty of Waitangi (and in particular the importance of Partnership, Participation and Protection as mentioned above) as it is currently interpreted.

Every two years, a meeting shall be held at the practice, encouraging local Maori to attend to offer ideas and suggestions as to how we can improve healthcare provision for them. This meeting shall be advertised at the practice, on social media and by mailout to enrolled clients with Maori ethnicity.

Review:

Reviewed 09/03/2013. No changes made to policy.

Reviewed 15/01/2014. Minor semantic changes made to policy.

Reviewed 26/10/2014. Comprehensive update to bring policy in line with CDHB published priorities.

Reviwed 10/08/2019.  Comprehensive update including recognition of updated CDHB Maori health priorities.