Maori PH workforce development: the Aotearoa context
In New Zealand, there are health inequalities between socioeconomic groups, different ethnic groups, and males and females.
Maori health inequalities
The inequalities in health are not random. In countries such as New Zealand, indigenous peoples have poorer health even when socioeconomic position is considered.
The broader determinants of health that have been shown to have the greatest influence in promoting and protecting health (including Maori health) are:
- Income and employment
- Occupation, education and housing.
In the New Zealand health and disability sector, the focus is to:
- Remove barriers that affect access to community health and disability services by population groups in need
- Promote workforce development that will increase the capacity and capability of a more representative public health workforce for those higher-need population groups.
Effective distribution of health resources can best be achieved by working with other sectors such as employment, income, housing, education and justice to influence approaches that positively impact on the wider determinants of health.
Responsiveness to Maori health needs
Government agencies and community health groups have different strategic frameworks for how they work with and respond to Maori to address Maori health needs.
The key priority is to ensure that community health services are available, accessible and appropriate for Maori; and are of high quality.
Responsiveness to Maori health needs requires measures that reach the structure, strategies, systems, management, staff and culture of a health organisation.
These measures should be implemented in such a way that it will account for the needs and aspirations of Maori in all the health organisation’s activities; in particular, its core business.
The Whanau Ora Tool
The Whanau Ora Tool is a practical guide to developing health programmes where whanau, hapu, iwi and Maori communities play a leading role in achieving whanau ora. It places Maori at the centre of programme planning, implementation and evaluation. Its aim is for Maori families to be supported to achieve fullness of health and wellbeing, as defined by them, within te ao Maori and New Zealand society as a whole.
Maori health strategy and action plans
The guiding framework used in the health sector for responding to Maori health issues is outlined in He Korowai Oranga: Maori Health Strategy.
The He Korowai Oranga framework uses the concept of whānau ora (Maori families supported to achieve their maximum health and wellbeing).
Whakatātaka Tuarua: The Maori Health Action Plan 2006-2011 is also a vital document as it provides actions to implement He Korowai Oranga and gives rise to Raranga Tupuake: Maori Health Workforce Development Plan.
In addressing Maori public health workforce development, it is essential to recognise that Maori social structure is such that income, occupation and employment factors impact not only on individuals and their whānau, but also on hapü and iwi.
Raranga Tupuake: Maori Health Workforce Development Plan acknowledges the importance of using Maori concepts of hauora and whānau ora to address Maori disparities in employment, income and occupational status by developing a comprehensive public health workforce development plan.
The steps to achieve whānau ora are clearly set out in He Korowai Oranga: Maori Health Strategy. The concept of whānau ora within this strategy identifies four pathways to achieving better Maori health outcomes.
This is a valuable framework for addressing the spectrum of approaches required for Maori public health workforce development.
Maori health workforce development pathways
The four Maori health workforce development pathways are:
1. Whānau, hapü, iwi and community development
This pathway focuses on promoting wider community development and participation, led by Maori, to provide a strong base for Maori whānau.
Where whānau can manage their own health the whānau is strengthened, as is their ability to participate in their own communities.
The services of health organisations need to be organised around the needs of whānau rather than individuals, and physical, financial and cultural barriers need to be removed.
2. Maori participation
This pathway focuses on supporting Maori participation in all levels of the health and disability sector.
It is about effective partnerships with iwi and Maori communities, such as strengthening the capacity and scope of Maori health providers, and developing the Maori workforce with new types of service-worker training and accreditation.
Maori health providers and workers are uniquely placed to work with whānau and hapü in holistic ways.
3. Effective Maori health service delivery
This focuses on reducing inequalities for Maori in health by ensuring mainstream services accept increased responsibility for Maori health, and deliver services in ways that are culturally appropriate and of the highest quality.
Effective public health service delivery includes high quality health research and information to inform government and help whānau to determine and provide for their own needs.
4. Working across sectors
The final pathway focuses on government sectors working together to address the wider issues affecting Maori health, including occupational, economic, social and cultural aspects.
It is also about sharing a common interest, and achieving improved co-ordination and service integration. An intersectoral approach to workforce development is essential.