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Maori Health

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This essay analyzes Hauora issues of Maori people in New Zealand, providing the most fundamental and crucial elements and moments of its continuous effects from the colonial era until now. In this essay I mainly discuss about the issues of the Maori health before colonization, during colonization, and after colonization. I had used the different methods of research to analyze the data for the issues of Maori health. The research methods used are complete online research method text, course resources and reading and analyzing data from different books as literary review. A systematic review of the literature was undertaken to locate relevant information on Maori health. The review formed the body of work on which this essay was based. The literature search was limited to work published between 1900 and 2010 in six subject areas: Maori health in early 1900 till present day, Maori concepts and models, Maori health models, Maori and disability, Treaty of Waitangi and Maori health. The databases searched included all of the New Zealand university library catalogues, the City Library and Google Scholar. Sources that appeared to be relevant were entered into the Reference.

In 1769 James Cook concluded that Maori were healthy race .Prior to settlement by Europeans, Maori had been protected from many illnesses because of New Zealand’s Isolation from the large population centers of the world. Now a day’s Maori are recognized as being over represented statistically in poor health issues. Health statistics reveal that Maori have higher rates of cardio vascular disease, obesity, smoking, cancer, asthma mortality, mental illness, suicide, and mortality than non Maori (Blakely, Fawcett, Atkinson, Tobias & Cheung, 2005).
Recent research shows that since the mid 1980s disparities between Maori and non-Maori have increased significantly as measured by a number of key health indicators: life expectancy, cancer mortality and cardiovascular rates. The difference in life expectancy between Maori and non-Maori has grown to a gap of ten years. Research also shows some disturbing trends in the provision of health services, e.g., despite the high mortality from heart disease among Maori and Pacific peoples, cardiac interventions were most frequently received by non-Maori.
The impact of colonial settlement on Maori health is well established. Disease, conflict and dispossession led to a decline in the Maori population by one third or more during the late 19th century. The 20th century witnessed a regeneration of the Maori population and a rapid narrowing of the life-expectancy gap between Maori and non-Maori during the three decades after World War II (Pool 1991; Pömare et al 1995).
From the mid 1980s on however, recent research shows a new and significant widening of the disparities in Maori and non-Maori life expectancy (Ajwani et al 2003). Non-Maori life expectancy at birth increased at the fastest rate since World War II during the last two decades, while the increase for Maori has been minimal (figure 1).
Figure 1: Maori and non-Maori life expectancy by gender, 1950-2000. (Source Ajwani etal 2003)
Mortality rates declined for non-Maori across all age groups, while remaining relatively static for Maori. Thus mortality gaps widened in both sexes and in each age group.

Maori health issues in early 1900
Prior to colonization the overall health of Maori was significantly better than it is today. While life expectancy was relatively low by modern western standards, Maori did not live by the current socio-economic standards that rule present society in New Zealand. High fat, high sugar diets, inactivity, tobacco, alcohol, substandard housing and overcrowding were not health risks for Maori in pre-European New Zealand as these factors did not exist. Anthropological studies show that old age was reached by pre-European Maori around the age of forty, and few lived past their fifties (Rice, 1992). Oral history and archaeological studies have revealed that most women had an average of three children in their lifetime, and infant mortality was generally around 15- 30% (Durie, 1998; Rice, 1992). This led to smaller and healthier populations, living in close-knit and largely self-sufficient communities, and by sheer virtue of their numbers the issue of overcrowding, which so adversely affects Maori health today, was not a problem. Furthermore, traditional housing was located on hill sites, a choice that provided excellent drainage, significant protection from pests and rodents and houses freely exposed to the elements. This also provided a drying influence that minimized dampness, mould and exposure to infectious agent. Traditional Maori spiritual beliefs also contributed to the health of the community. Durie (1998) describes the concepts of tapu and noa with regard to these communities, and the protective influence this had on health. While tapu was largely a spiritual concept, it also had practical applications. For example, tapu ensured the sick and the dying were separated from the general population, reducing risk of contagion. It protected resources such as harvested food, the sea, nesting bird and water sources, preventing contamination, and preserving resources through conservation. Tapu and noa effectively protected the lifestyles and wellbeing of the population while preserving the natural world and an incidence of illness was seen as a result of a breach of tapu (Durie, 1998). It is not surprising therefore, that illness was a rare occurrence among pre-European Maori. Infectious disease was particularly rare. This is believed to be due both to the relative scarcity of contagious diseases prior to European settlement and to the careful management and protection of the community resources and populace by pre-European Maori (Rice, 1992).Lifestyle diseases that are so prevalent among Maori today were all but absent among pre- European Maori. On the other hand significant historical events that have affected Maori health include the musket wars of the 1820s, which saw tribe against tribe, and the introduction of European diseases. These diseases included measles, whooping cough, tuberculosis and influenza and caused the Maori population to decline from 120,000 in the early 1800s to 62,000 in the 1850s and 44,000 in the 1890s. By the early 1900s Maori had also lost possession of most of their land. The Maori population started to recover through intermingling with settlers which caused them to embrace the European culture and become more urbanized. However, urbanization led to Maori living in large family groups in inadequate housing conditions (Wikipedia, 2005).
Keene (1989) states that because of poor living conditions, which still included huts and shacks, the government in the 1930’s strove to improve Maori housing. It was believed that sixty percent of the Maori population was living in overcrowded situations with sometimes up to twelve people living in houses with unsanitary conditions, causing ill health. Although there was legislation put in place to fund housing for Maori, they remained at sublevel standards. After World War Two housing development provided better living conditions for Maori and this started to improve Maori health significantly. Nevertheless, the health of Maori was still not up to the standard of non-Maori and the gaps between these groups still remains to this day. These gaps will close, however, when Maori receive care that is unique to their needs. These issues could be addressed in many ways through the introduction of the Treaty of Waitangi and Cultural Safety principles in health care provision.

The impact of the Treaty of Waitangi

The Treaty of Waitangi was introduced by William Hobson in 1840 in response to systematic colonization. Many believe that the treaty was misinterpreted by both Maori and crown officials. However, it is widely recognized as the founding document of New Zealand (States Services Commission, 2004). Problems began when chiefs signed without being certain of what the document contained. Maori were more inclined to value the spoken word and it is thought that Hobson may not have translated the document’s content and context in a way that Maori could fully understand. One of the main areas of debate is the concept of ‘rangatiratanga’. This centre around the belief that Hobson failed to explain the full effects of British sovereignty on rangatiratanga (authority, chieftainship) of the land which was promised to Maori in article 2 of the Maori version of the Treaty. Between the 1890s and 1970s Maori were starting to lose faith in what they felt were the principles of the Treaty and although some of these issues were addressed, the crown was committed to the amalgamation of Maori into colonial society.
While the young Maori party in the early 1900s helped to address historical Maori grievances in regard to land claims, this was not formally recognized until the 1975 introduction of The Treaty of Waitangi Act. This has remained an important part of New Zealand’s health issues involving Maori. The Treaty includes three basic principles on which the partnership between the crown and Maori are based when delivering health care for Maori. These principles are partnership, participation and protection (King & Turia, 2002).
The partnership principle involves the government working together with iwi, hapu, whanau and Maori communities to develop schemes to improve Maori health and suitable health and disability services.
The participation principle of the treaty involves Maori at all levels of the health spectrum in making choices, planning, improving and delivering health and disability services. Services are offered through Maori providers such as ‘Ki a Ora Ngatiwai’ situated in the Northland area. This organisation offers health promotion services and aims to reduce health disparities amongst people within their tribal boundaries.
The protection principle is the process of working to ensure Maori have the same level of health as non-Maori. This aims to protect Maori cultural concepts, values and traditions. The principles of cultural safety, introduced at all levels of healthcare delivery, would ensure that Maori receive the appropriate care in relation to their needs. The aim is to close the gaps and gain equity within the health system. This, however, can be achieved only if health professionals recognize the distinctive way that Maori respond to certain issues (King & Turia, 2002).

Maori health issues in present day

Maori life expectancy improved dramatically between 1955 and 2007. A newborn Maori girl, born between 1955 and 1957 could expect to live 59 years. In comparison a Maori girl born between 2005 and 2007, ca n expects to live to 75 years. A newborn Maori boy, born between 1955 and 1957 could expect to live 57 years. In comparison a Maori boy born between 2005 and 2007, can expect to live 70 years. Over the last fifty years the difference in life expectancy between Maori and non-Maori has decreased. In 1955-1957 the life expectancy at birth for non- Maori exceeded that of Maori by 10.8 years for males and by 14.3 years for females. However, between 2005 and 2007, the life expectancy at birth for non- Maori exceeded that of Maori by only 8.6 years for males and by 7.9 years for females.

Graph 1: Maori Life expectancy, 1955-57 and 2005-2007

Source: Statistics New Zealand (2008). New Zealand Period Life Tables 2005-2007.

In the explanations for the current status of Maori ill-health, views ranged from the examination of what individuals put into their bodies on a daily basis (e.g., drugs, overeating) to more social (e.g., stress and poverty), and corporate (e.g., tobacco company advertising) explanations. These explanations fell into three interrelated categories: individual, whanau and societal. Individual explanations included the things people did that had an impact on their own health and/or the health of others – for example, smoking and drinking. Whanau explanations included occurrences and circumstances that undermined the foundations of the whanau. The whanau was described as being under stress, with people therefore missing out on whanau life. Societal explanations examined the health system as well as the wider social system and its impact on Maori health. There are multiple, interrelated layers within each explanation for contemporary Maori health status, and found that it was sometimes difficult to establish the root cause of a problem or illness. For example, smoking might be ‘caused’ by stress but what, in turn, has caused that stress? Sometimes, however, clear that the root cause of Maori ill-health was the disruption of whanau and hapu structures within the historical and contemporary setting of colonization in this country.
Smoking is one of the most prevalent causes of many diseases in Maoris’. The causes of smoking are adoption of new lifestyle and urbanization for Maori people. Tobacco smoking is a well-recognized risk factor for many cancers and for respiratory and cardiovascular diseases. Smoking is the main cause of lung cancer and other pulmonary disease. While 38 percent of Maori adults were current smokers in 2006/07, this represents a significant decrease in the proportion of smokers from 2003. These figures equate to a decrease of 8.4 percent for the Maori population since 1997 when close to half of all Maori adults (46 percent) smoked. However, it is important to note that Maori women were more than twice as likely to be current smokers as women in the total population in 2006/07. Similarly, Maori men were 1.5 times more likely to be current smokers than men in the total population

Graph 2: Proportion of adult daily smokers, 1996/97, 2002/03 and 2006/07

rap

Source: Ministry of Health, 2008. Data Source: New Zealand Health Information Service.
However, adoption of new life style, lack of exercise, urbanization, stress, imbalance diet and bad eating habits, smoking, excessive alcohol drinking and consuming narcotic drugs leads to major health issues in Maori population like obesity, Diabetes, and Cardiovascular diseases.
Obesity is defined as having an excessively high amount of body fat in relation to lean body mass and is measured by a Body Mass Index (BMI) score of 30 or more. Lifestyle factors such as poor nutrition and lack of exercise, can directly contribute to serious health problems, such as obesity and diabetes. Obesity is associated with a long list of health conditions, including high blood pressure, stroke, various types of cancer, Type 2 diabetes and kidney disease. Obese people also have a higher likelihood of experiencing personal, social and employment difficulties. Maori men and women were 1.7 times more likely to be obese than men and women in the total population in 2006/07.

Graph 3: Prevalence of obesity, 2006/07 819 6299 www.tpk.govtGraph 4

Source: Ministry of Health (2008). Ministry of Health: 2006/07 New Zealand Health Survey. Note: Age-standardized prevalence for total adults.

The percentage of obese adults in the Maori population has also increased slightly from 42.1 percent in 2002/03 to 43.2 percent in 2006/07.
Diabetes is a condition in which the body is unable to keep blood glucose (sugar) levels in the normal range. Diabetes can lead to cardiovascular disease, blindness, kidney disease and vascular problems. There is no cure for diabetes at present but it can be controlled to enable a person to live a full and active life. Although, Maori adults are more likely than adults in the total population to be diagnosed with diabetes in the course of their lifetime (seven percent compared to 4.3). The overall number of Maori adults to have ever been diagnosed with diabetes has slightly decreased from eight percent in 2002/03 to seven percent in 2006/07.

Graph 4: Prevalence of Diabetes, 2002/03 – 2006/07

819 6299 www.tpk.govt.nz
Source: Ministry of Health (2008). Ministry of Health: 2006/07 New Zealand Health Survey. Note: Age-standardized prevalence for total adults. Graph
Cardiovascular diseases are diseases affecting the heart and circulatory system. Of the cardiovascular diseases, coronary heart disease (CHD), also known as ischemic heart disease (IHD), is the major cause of cardiovascular deaths, followed by stroke, which is the greatest cause of disability in older people. IHD is the narrowing or blocking of the coronary arteries that supply blood and oxygen to the heart. IHD can cause angina and heart attack and lead to heart failure. Cardiovascular mortality decreased for both Maori and non-Maori, but to a lesser extent for Maori. Maori males aged 45–64 years had a rate of death from ischemic heart disease that was 3 times that of non-Maori males during 2000–2004. More males aged 65years and over had a death rate 1.63 times that of non-Maori. Maori females aged 45–64 years had a rate of death that was 4.39 times that of non-Maori females from 2000–2004. Maori females aged 65 years and over had a death rate 1.92 times that of non-Maori.
Graph 5: Ischemic heart disease mortality 2000–04

Conclusion

As the years have passed Maori health issues have slowly but progressively started to improve. According to the Maori Health Strategy (King & Turia, 2002) the aim of the strategy is to provide a framework for the public sector to support attainment of Maori health. This will include policies that promote better education, better employment opportunities, improved housing and general whanau well-being. For this to be initiated the Treaty principles of partnership, participation and protection must be recognized. Addressing all of these principles and including a multidisciplinary approach are imperative for the best results.

Another significant aspect of oranga (Maori wellbeing) may be the application of a Maori health model structured specifically in a way that Maori will understand. One such model is Te Whare Tapa Wha, a well known model developed by Mason Durie (1998). The components of this model are looked at as four walls of a whare (house). If one wall is weak or fails the house will fall, meaning ill health.

The wall of spiritual health is Te taha wairua. Maori are very spiritual and some believe that ill health has spiritual significance. Te taha tinana is the wall of physical health. Te taha hinengaro is mental health. These two walls signify the importance of mind and body, indivisible for good health. The last wall is Te taha whanau which signifies the importance of whanau involvement as an aspect of care for Mäori. It is believed that by using these models to guide the delivery of health care for Mäori, this population group will receive the health care that it is entitled to. Mäori culture is unique and, as professionals, nurses, caregivers, and healthcare professionals need to have an understanding of what culture is to be able to give appropriate standards of care for Maori consumers of health (Ministry of Health, 2003). It is of significance that the land acquisitions in the 1800s directly affected Mäori health. To this day the health gaps are apparent between Maori and non Maori in Aotearoa. However, improvement in the health sector is indicated by government legislation and policies. The Treaty of Waitangi, known as the founding document of New Zealand, as well as cultural safety and models of health, play a very important role in the health of Maori. Although it is the responsibility of health providers to ensure adequate services, it is also important for Maori themselves to realize the role they have in their health. To receive this care enables Maori to obtain a good level of oranga for whanau in the present and for generations to come.

REFERENCES
Ajwani S, Blakely T, Robson B, Tobias M, Bonne M. 2003. Decades of Disparity: Ethnic mortality trends in New Zealand 1980-1999. Wellington: Ministry of Health and University of Otago.
Blakely T, Fawcett J, Atkinson J, Tobias M, Cheung J. Decades of Disparity II: Socioeconomic mortality trends in New Zealand, 1981-1999. Wellington: Ministry of Health and University of Otago, 2005.
Durie, M. (1998). Whaiora Mäori health development. (2nd ed.) Auckland: Oxford University Press
Fiona Cram, Linda Smith and Wayne Johnstone. Mapping the themes of Maori talk about health. Journal of the New Zealand Medical Association, 14-March-2003, Vol. 116 No 1170
Huora Maori Health. June 2009. Te Puni Kökiri (Ministry of Mäori Development). www.tpk.govt.nz
Keene, L. (1989). A slow recovery. Kai Tiaki: New Zealand Nursing Journal, 82 (6) 24-25.
King, A., & Turia, T. (2002). He korowai oranga. Mäori Health Strategy Retrieved Oct 03, 2005,from http://www.moh.govt.nz/publications
Ministry of Health. (2003). Mäori public health action plan 2003-2004. Wellington: Ministry of Health.
Pömare E, Keefe-Ormsby V, Ormsby C, Pearce N, Reid P, Robson B, Wätene-Haydon N. 1995. Hauora: Mäori standards of health. A Study of the Years 1970-1991. Wellington: Te Röpü Rangahau Hauora a Eru Pömare.
Pool I. 1991. Te Iwi Mäori: A New Zealand population past, resent and projected. Auckland: Auckland University Press.
Rice, R.W. (ed) (1992). The oxford history of New Zealand. (2nd Ed). Auckland: Oxford UniversityPress
State Services Commission (2004) Treaty of Waitangi timeline. Retrieved Oct. 03, 2005: http://www.ssc.govt.nz/display/home.asp
Wikipedia (2002).History of New Zealand. Retrieved Oct. 03, 2005, from Answers.com Web site: http://www.answers.com…...

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