The Ministry of Health’s top Māori executive John Whaanga says its research consistently shows Māori aren’t getting the same treatment or access to services resulting in different health outcomes. First published 2019.
A tikanga Māori approach to targeted health initiatives has helped to drive a drop in the number of tamariki needing hospital treatment in Te Tauihu (the top of the south island).
The number of Ambulatory Sensitive Hospitalisations (ASH) for Māori children aged 0 to 4 years old in Nelson Marlborough fell from 5925 in the year ended March 2020, to 3602 for the year ended March 2021, district health board figures show.
And, after a steady increase since 2017, dental ASH rates were the lowest recorded for four years.
Nelson Marlborough Health Māori health and vulnerable populations general manager Ditre Tamatea said the improvements could be attributed to targeted programmes, using a tikanga Māori approach to deliver health messages in a meaningful way.
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The aim was to make healthcare equitable by coming up with new ways to reach the Māori community, Tamatea said.
“Equity means that you have to do more, resource and fund more, and you have to innovate, be brave, do things differently, because doing the same old thing isn’t going to resonate.”
When it came to ASH rates for Māori children, the two main drivers were respiratory problems and oral health, he said.
For respiratory problems, the core problem was people living in damp, cold houses.
One initiative they had introduced was Whare Ora, which translated to healthy home, where they targeted families when children presented with respiratory problems, to help make their homes warmer and drier, Tamatea said.
Anyone aged 14 or under will never be able to legally buy tobacco for the rest of their lives when a new law takes effect under the Government’s smokefree plan.
Through the programme, they would assess houses and then provide things like dehumidifiers, curtains and blankets to help make the home healthier.
“We assess the home and the needs of the home, and then we ship the products for free to those whanau … we’re making the home warmer, drier,” he said.
“That’s starting to resonate in the work, we’re seeing respiratory issues in terms of ASH rates declining.”
They were also focusing on education about smoking and the importance of going outside if you couldn’t quit.
Oral health was the other key area, with a programme to apply fluoride to children’s teeth twice a year, and programmes to promote healthy eating, Tamatea said.
Kirsty Rance, community oral health service team leader, said they were taking a “preventative approach” to dental health, with a focus on at risk communities.
They were particularly having success with stainless steel crowns, which they were putting on children’s teeth at early signs of decay.
It helped to stop the tooth deteriorating to the point where hospitalisation was necessary for treatment, she said.
“That’s a less invasive way to keep a tooth for children … it helps the tooth to maintain its integrity.”
They were also working to actively educate parents about dental health from when children were 8 months old, with simple messages about drinking water, low sugar diets and good oral hygiene, Rance said.
However, the Covid-19 pandemic may have had an impact on the ASH rates, with fewer people coming forward with concerns, she added.
Tamatea said a further programme, Hauora Direct, was offering a 360 health assessment for whānau to try and help catch illnesses early – with key health factors such as smoking, diabetes, living conditions, and blood pressure among the items being checked.
It has “every single indicator that you can think of, and it covers every single age range”, he said.
They were also running a Pēpi First programme to help hapū mothers quit smoking, where they were educating the mothers while also offering incentives like vouchers, he said. “That’s having a 50 to 80 per cent success rate, and that’s never been heard of before.”
The combination of all the programmes was helping to lower the ASH rates for children, as it was taking a whole whānau approach and capitalising on strong partnerships with different agencies, he said.
“The drive towards Māori health equity is definitely everybody’s responsibility.”