Quality Standards for Diabetes Care Toolkit

Māori and Pacific peoples

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 2014). 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.
According to the Ministry of Health, access to health care is reduced for Māori. Cost prevented 23% of Māori adults, and 8% of Māori children from visiting a GP when they needed to in the past 12 months whilst many Māori adults (18%) and children (12%) did not collect a prescription item in the past 12 months due to the costs (Ministry of Health 2013a). Health literacy may also be an issue as shown in the recent Māori health literacy research into gestational diabetes (Ministry of Health 2014) and it is a barrier to understanding and managing gestational diabetes which is a precursor to type 2 diabetes.
New Zealand’s health context is unique in that health inequalities between Māori and nonMāori 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 obligations is to provide equality. 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 fits with the Health Quality and Safety Commission (HQSC) of New Zealand’s Triple Aim Strategy.
Examples of government strategies that are trying to address health inequalities are the implementation of the He Korowai Oranga: Māori Health Strategy (Ministry of Health 2014); the Māori health provider development scheme, Māori hauora/health scholarships; promotion of Māori health models; District Health Board (DHB) Māori Health Plans; Whānau Ora programmes and funding rongoā Māori in some areas.
Some helpful recommendations for working with 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: https://www.mcnz.org.nz/assets/News-and-Publications/Statements/Best-health-outcomes-for-Maori.pdf.
According to Foliaki and Pearce (2003), diabetes prevalence has increased rapidly over time in the indigenous people of the Pacific region (Polynesian, Melanesian, Micronesian), both in the Pacific islands and in countries such as New Zealand, and Pacific people experience greater morbidity and more complications than people of European descent with diabetes. This was confirmed by Statistics New Zealand based on 2002–2004 data, which stated the incidence of cardiovascular disease, diabetes, and respiratory illness is significantly higher among Pacific peoples than other ethnic groups. In addition, type 2 diabetes occurs earlier in Pacific peoples, about 10 years before New Zealand Europeans (NZE), including a growing number of children and adolescents. Young people with type 2 diabetes are at greater risk of morbidity and mortality (Constantino 2013).
In the 2013 report on the Adult Nutrition Survey, Coppell et al found that diabetes was prevalent among Māori and Pacific peoples, and particularly high among Pacific peoples. One-third or more of Pacific peoples aged 45 years and over had diabetes. Age-specific rates of undiagnosed diabetes were highest among Pacific peoples, for whom the ratio of diagnosed to undiagnosed diabetes was 5:4 compared with 10:3 for Māori and 10:1 for NZE. The highest prevalence of diabetes was observed among Pacific peoples, with rates among Māori in between that observed for Pacific peoples and the NZE groups. Rates increased with age with the highest prevalence observed for those aged 75 years and over.
Some helpful recommendations for working with Pacific peoples with diabetes can be found in the booklet prepared for the Medical Council of New Zealand by Mauri Ora Associates – Best health outcomes for Pacific peoples: Practice implications. It can be accessed at: www.mcnz.org.nz/assets/News-and-Publications/Statements/Best-health-outcomes-for-Pacific-Peoples.pdf.
The report Primary care for Pacific people: A Pacific and health systems approach (Southwick et al 2012) presents evidence to support improvements in primary care delivery to Pacific peoples. The full document is available here: www.pacificperspectives.co.nz/primary-health-research.html or here: www.health.govt.nz/publication/primary-care-pacific-people-pacific-and-health-systems-approach.