The issues of how to give Māori and groups such as refugees and rural communities a fair shot in the health system were discussed at Health Central’s recent Chalk Talks on the future of health care in New Zealand, with panel members offering insights from different perspectives.
Dr Janice Wilson, chief executive of the Health Quality and Safety Commission, said that health outcomes for Māori are 100 percent worse than those for non-Māori in a wide range of parameters.
“We know they don’t get the same degree of medications at the same rate that the rest of us will and it leads to poorer outcomes and mortality is nine or 10 years sooner than non-Māori. It’s a sad story for Aotearoa,” she told the panel.
“There are issues at every part of our healthcare system in the sense that Māori don’t access healthcare services. Services aren’t suited to their cultural needs, there often is no partnership about the kind of services that would suit them best and then when they do get in the system, they are often not treated in the same way,” Dr Wilson said.
Pharmac commissioned research from the University of Auckland and found there were huge inequalities of access around funding medicines for Māori and groups such as refugees and rural communities, said Sarah Fitt, CEO of Pharmac.
“We have started a significant piece of work around how we can help overcome some of those barriers. That’s not something Pharmac is going to be able to solve on its own, it means working with the wider health sector and engaging with the community because again, we can’t be telling people what to do.
“But there’s all sorts of barriers around access to funded medicines and it’s not necessarily the high cost, expensive medicines. It’s treatment of heart failure, diabetes – there are very effective treatments there and yet we see huge discrepancies and disparities in outcomes between Māori and non-Māori. We want to explore that further and engage with the community,” she said.
Professor Gregor Coster from Victoria University said he has recently done a review for the Government: The Independent Assurance Review of the National Bowel Screening programme. He found that Māori had poorer outcomes, but the actual incidence of bowel cancer in Māori men is less than non-Māori.
“Because they don’t get to access services in good time, their outcomes are worse. We can do something about it and the services should become more accessible for Māori in a way that is acceptable for them. We need to find different ways of doing things so that people will access the screening test and be detected earlier in a way that is culturally acceptable,” he said.
John Tamihere, a director of Māori health provider Hapai te Hauora, said that instead of herding Māori into a category, Māori should be included in the co-design of health care.
“What we learn is that brown men’s difficulties cannot be fixed with white men’s tools anymore. Unless we get brought into the co-design, co-roll out, power sharing, we aren’t going to crack this one at all.”
Mr Tamihere spoke of several provincial DHBs with a high percentage of Māori in the population where there are significant presentations of Māori with cancer, cardiovascular issues and strokes.
“When you go back into the primary health care history, you can identify across the whole of the DHBs that Māori in these GP clinics get less access to bloods and tests than non-Māori in the same clinic. They get less referrals to specialist care – that’s not because they don’t want screening or specialist care but because they are not given them.
“There are issues of socio-economic status and culture, but by and large, most Māori don’t have the apprehension that a lot of Pākehā will tell you they have (about health care). They just want a fair shot, but they shouldn’t be having a clearly worse deal than a non-Māori from the same socio-economic class,” he said.
Ian Powell, executive director of the Association of Salaried Medical Specialists, said it is heartening to see increasing numbers of Māori becoming doctors and that the chair of the Medical Council of New Zealand, Dr Curtis Walker, is Ngāti Porou.
“Auckland University now has the same proportion of Maori medical students as the proportion of Māori in society as a whole. That’s quite a strong foundation for the future.
“It will take time to feed through. There is the greater consciousness of cultural competency. Now it’s taken much more seriously – as long as we treat it as a journey, rather than a destination that’s been reached,” he said.