Quality Standards for Diabetes Care Toolkit

Specific relevance to Māori and Pacific people

The impact on Māori people

Māori have on average the poorest health statistics of any ethnic group in New Zealand, and the government has made it a key priority to reduce these inequalities (Ministry of Health 2014c). Harwood and Tipene-Leach (2007) suggest: ‘For no other disease are significant health inequalities more obvious than when we look at diabetes’ (p 162). Diabetes is almost three times more common in Māori than non-Māori. In addition, for Māori aged 45–64 years, death rates due to diabetes are nine times higher than for non-Māori New Zealanders of the same age. Māori are diagnosed younger and are more likely to develop diabetic complications, such as eye disease, kidney failure, strokes and heart disease.
Prevalence estimates for diabetes in New Zealand are complicated by the issue of undiagnosed diabetes mellitus in the community. Some commentators estimate that for every one person known to have diabetes, there is one undiagnosed. Incidence and mortality rates for type 2 diabetes are expected to significantly increase over the next 20 years (along with prediabetes, insulin resistance, and obesity), with the biggest impact being on Māori, Pacific people, and those living in deprived neighbourhoods. Additionally, there is a growing number of children and adolescents developing type 2 diabetes, and it is known there is increased morbidity and mortality in this age group (Constantino 2013).
New Zealand’s health context is unique in that our health inequalities between Māori and non-Māori can be held to redress in part by New Zealand’s founding document, the Treaty of Waitangi. As controversial as the Treaty is, part of its obligation is to provide equality. That means, within the health context, Māori should be able to enjoy the same health and wellbeing as non-Māori and Māori health interests are protected. Additionally, Māori should have equal access to appropriate health services (Kingi 2007). This also adheres to the HQSC of New Zealand’s Triple Aim Strategy.
In a study reported by the Ministry of Health (2013b), access to health care was found to be reduced for Māori. Cost prevented 23% of Māori adults and 8% of Māori children from visiting a GP when they needed to in the previous 12 months, whilst many Māori adults (18%) and children (12%) did not collect a prescription item in the previous 12 months due to the costs). Also of note, health literacy may be an issue, as shown in the recent Māori health literacy research into gestational diabetes (Ministry of Health 2014b). Poor health literacy is a barrier to understanding and managing gestational diabetes which is a precursor to type 2 diabetes.
Examples of government strategies intended to address health inequalities are the implementation of the He Korowai Oranga: Māori Health Strategy (Ministry of Health 2014c); the Māori Provider Development Scheme; Māori Hauora/health scholarships; promotion of Māori health models; DHB Māori Health Plans; Whānau Ora programmes and funding rongoā Māori in some areas.
The Ministry of Health website describes models of health for Māori, and these are helpful for understanding Māori Health perspectives. It can be accessed at: www.health.govt.nz/our-work/populations/Māori-health/Māori-health-models
Some helpful recommendations for providing care to Māori with diabetes can be found in the booklet prepared for the Medical Council of New Zealand by Mauri Ora Associates – Best health outcomes for Māori: Practice implications. It can be accessed at: www.mcnz.org.nz/assets/News-and-Publications/Statements/Best-health-outcomes-for-Maori.pdf