Signs of hope in grim Maori health stats

Melanoma - it's the only area of health Associate Professor Tony Blakely can think of in which Maori don't fare worse.

The director of Otago University's health inequalities research programme said even in areas where 20 years ago European New Zealanders suffered the worst statistics - such as breast and colon cancer - Maori had caught up or were doing worse.

And although figures showed the gap in life expectancy appeared to be closing, Maori still died on average eight to nine years earlier.

It is a dismal reality. Maori are more likely to smoke, be overweight, have a heart attack or suffer diabetes than their European counterparts.

Maori health experts say social inequalities such as income, education and housing - coupled with a health system targeted at mainstream New Zealand - will continue to see Maori overrepresented in the statistics.

They say there is little evidence of significant improvement in Maori health under the Labour Government but are optimistic the biggest difference is yet to come through its primary health strategy.

Any dramatic change will be through programmes led by Maori and targeted at Maori, but they say in the present climate that is not a politically palatable approach.

Dr Rhys Jones, senior lecturer in Maori health at Auckland University, said if he had to choose the "big ticket items" with the biggest disparities they would be cardiovascular disease and diabetes. Ministry of Health figures show Maori men comprise 13.6 per cent and Maori women 10 per cent of those diagnosed with heart disease compared with total population figures of 9.6 per cent for males and 8.4 per cent for females.

Twice as many Maori have been diagnosed with diabetes and the ministry expects the numbers to double again by 2020.

Dr Jones said the problems started from birth, with greater numbers of pre-term and low birthweight Maori babies.

Older children were more likely to suffer dental and hearing problems, which could impact on other areas of their life. Such conditions did not cost millions to treat but greater focus was needed on them given the disproportionate number of Maori in younger age groups.

Dr Jones said it was easy to say Maori were overrepresented in cardiovascular disease statistics because of "surface" factors such as higher smoking rates and being overweight.

But that did not take into account "deeper" factors such as lower income levels and poorer housing.

Researchers say those in higher income groups tend to know about lifestyle changes needed to reduce their risk factors and are more likely to access screening programmes and receive better treatment. Dr Jones said there was increasing evidence Maori did not have as good access to health services.

Research he had done showed that although Maori had higher rates of cardiovascular disease, they were getting fewer operations.

Maori patients found the health system a "very complex beast".

Many were not aware of what they were eligible for and they were less likely to complain if they didn't get it.

"I think often because the service is delivered in a 'one size fits all' way, if you don't fit that you tend to have more difficulty navigating the system."

Professor Blakely said research published this year showed Maori were a third less likely to survive cancer. The difference could be partly attributed to how advanced and aggressive the cancer was but not altogether.

 

"It really does point to something happening in the health system that is not working as well for Maori."

Professor Blakely said both National and Labour had worked to improve Maori health outcomes - figures showed the number of Maori health providers had grown from about 20 in 1992 to 240 last year - and he was "cautiously optimistic" the present Labour-led Government was making a difference.

Tobacco control initiatives were starting to have an impact.

But, he said, the primary healthcare strategy must continue to be used to address inequalities.

Dr Guy Naden, clinical director of the Tamaki primary health organisation, said the system created better opportunities and it was vital to "keep things rolling".

Access PHOs, which get maximum state funding, worked with patients who tended to be sicker, did not get better quickly and had difficulty making lifestyle changes.

"We have only just started down this road. It's a good philosophy, it makes sense and we don't want it changed."