Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

The Nurse's Role in Improving Health Disparities Experienced by the Indigenous Maori of New Zealand

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

The Nurse's Role in Improving Health Disparities Experienced by the Indigenous Maori of New Zealand

Article excerpt

Many countries across the globe experience disparities in health between their indigenous and non-indigenous people (Stephens, Porter, Nettleton, & Willis, 2006). In Aotearoa (New Zealand) Indigenous Ma ori are the most marginalized and deprived ethnic group with the poorest health status overall [Ministry of Health (MOH), 2008]. Colonialism and numerous factors at the levels of individual patients, healthcare processes and the health system contribute to poor Ma ori health outcomes (Robson, 2004). There are a number of factors to consider, however this essay focuses on a select few in order to explore the complexity involved in ethnic disparities. Te Tiriti o Waitangi (The Treaty of Waitangi) is the primary source through which Ma ori are able to contest health disparities, however contradicting interpretations give rise to dispute over enforcement of Oritetanga (British Citizenship Rights; Humpage & Fleras, 2001). Nurses have a large role to play in reducing the barriers that Ma ori experience toward health services and improving Ma ori Ora (Ma ori holistic health and wellbeing) overall (Wilson, 2006).

British colonization brought new disease and weapons of war that drastically increased the mortality rates of Ma ori. Furthermore, settlers dominated the economic and political stature through methods of land confiscation and colonization, resulting in Ma ori inferiority (Ellison-Loschmann & Pearce, 2006). The signing of Te Tiriti o Waitangi resulted in Ma ori submitting Kawanatanga (Article one) to the Crown in exchange for Oritetanga (Article three) and Rangatiratanga (Article two). Essentially, Kawanatanga allowed for the establishment of a constitutional government that to this day controls the development of the New Zealand health system (Broom et al., 2007). It is widely understood that the health system was originally designed by non-Ma ori for non-Ma ori in accordance with their own values, beliefs and objectives (Ellison-Loschmann & Pearce, 2006).

The ongoing crisis of Ma ori inferiority is reflected by the prevailing disparities in health outcomes and inadequate cultural representation within the healthcare system (Reid & Robson, 2006). The structural design of the system gives rise to institutional discrimination in the form of differential access to healthcare and receipt of quality services (Hill et al., 2010). Ma ori experience a greater number of barriers to access, including slower treatment processes, lengthy waiting lists and socioeconomic deprivation impacting on affordability and accessibility of services (i.e., transport costs or taking time offwork; Jansen, Bacal, & Crengle, 2008). Cormack, Purdie, and Robson (2007) identify that Ma ori are only 9% more likely to develop cancer but are 77% more like to die from it in comparison to non-Ma ori. This is a good example of the implications that result from differential access experienced by Maori.

Similarly institutional discrimination gives rise to differential quality of receipt of services provided. Hill et al. (2010) explains that Ma ori colon cancer patients were more likely to experience at least one month's delay between diagnosis and treatment, which suggests that their treatment pathway is slower than that of non-Ma ori. Hill et al. (2010) adds that patients were less likely to be treated with additional chemotherapy. Essentially this implies that these Ma ori patients were receiving a lower quality of treatment timeliness and thoroughness overall, contributing to differential health outcomes in comparison to non-Ma ori patients. Consequently differential access and receipt leads to differential disease incidence, with Ma ori experiencing the poorest health outcomes overall (Reid & Robson, 2006). It is evident that institutional discrimination derived from the health system design has impacted on Maori health outcomes. Jansen et al. (2008, p. 19) proposes that this may be a result of having a 'one service for all' system that does not appropriately accommodate for their cultural needs and unique perspectives of health. …

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