About this journal

Welcome to BPJ 22, our second journal focused on Māori Health

E aku iti, e aku rahi, rau rangatira mā, koutou ngā manukura, ngā manutaki o te hauora o te iwi tēnā koutou.

Koutou mā kua timu i te tai, koutou mā kua rere atu i te Pū-nui-o-tonga, koutou mā kua haere ki tua o Paerau. Moe mai, okioki mai.

Ka aro atu ēnei tuhinga ki te whakapakaritanga o te hauora o te Māori, ka aro pū tonu atu ki ngā ngāngara e ngau kino tonu ana ki te iwi taketake o ēnei whenua, a ka whai atu anō ki ētahi ngāngara anō e kīkini ana ki te tangata whenua, ko te oranga niho, te mate tākihi ukiuki me te aukatinga kai paipa.

Koutou mā te arero o te taiaha o tēnei pakanga hauora, nei te mihi kore mutu ki a koutou, werohia, werohia, werohia rā!

This edition focuses on three health issues for Māori where ethnic disparities are significant:

• Oral health
• Chronic kidney disease
• Smoking cessation

These are all areas where primary care has the potential and opportunity to make a significant contribution to improving Māori health.

One of the key contributors to disparities in health outcomes is the cost of accessing care. Financial barriers can be significant with over 56% of Māori located in the three most deprived socio-economic deciles. This journal includes information on the subsidies and other support that is available for individuals and whānau (see here). General practitioners, pharmacists and practice nurses can assist by becoming familiar with the financial support that is available and by ensuring all patients receive their full entitlements.

Successful services targeting Māori

To show what can be achieved with careful planning and effective targeting of services we have profiled three initiatives:

• One Heart Many Lives – cardiovascular risk assessment for Māori men in Hawke’s Bay
• Rural general practitioner clinics in Central Otago
• Mobile practice nurse services in Hamilton

While there are many successful services targeting Māori around the country, more can and should be done to ensure the momentum continues and improvements to Māori health are prioritised. Whānau ora – families supported to achieve their maximum health and wellbeing – remains an important aim.

He Ritenga Whakaaro

A recent survey about Māori experiences of health services showed that while most reported good experiences, 20% expressed concerns about their interactions with health professionals. Some Māori had such negative experiences of health services that they say they are less likely to access medical care when needed.

Although Māori have lower life expectancy (8.2 years for males and 8.8 years for females) and greater rates of illness or disability than non-Māori, they receive less consultation time with their GPs (13.7 minutes versus 15.1 minutes), less access to some health services, fewer referrals to specialists and fewer investigations. Four key themes emerged about barriers to healthcare:

1. Organisational Barriers
   • The distance to travel for care
   • The availability of appointments at suitable times
   • Waiting times
   • The (lack of) choice of provider
   • Inflexibility of healthcare systems
   • Poor experiences (e.g. lack of response to complaints, lengthy resolution times)
2. Cost Barriers
   • Direct costs (e.g. consultation costs, prescription charges)
   • Indirect costs (e.g. loss of wages due to time off work while obtaining care, expenses relating to travel or child care)
   • Participants also questioned whether a GP visit was value for money
3. Health Provider Barriers
   • Perceptions of negative or racist attitudes towards Māori
   • Perceptions of being patronised
   • Being treated disrespectfully by staff
4. Cultural Fit Barriers
   • Patients attitudes (e.g. whakama or shyness)
   • Reluctance to challenge authority
   • A wait and see attitude toward sickness or injury (often related to cost)
   • Prior bad experiences
   • A preference (often unfulfilled) for Māori clinicians and providers

He Ritenga Whakaaro suggests there is a growing trend among Māori to critique the health system. Te Wero (the challenge) for primary care services is to improve attitudes and behaviours, and deliver health care services that are appropriate, accessible and effective for Māori.