The Aotearoa context
Health inequalities for Māori
In New Zealand there are health inequalities between socioeconomic groups, different ethnic groups and males and females. The inequalities in health are not random. In countries like New Zealand, indigenous peoples have poorer health even when socioeconomic position is considered. The broader determinants that have been shown to have the greatest influence in promoting and protecting health are income, employment, occupation, education and housing. In the health and disability sector the focus is to:
- remove barriers that affect access to health and disability services by population groups in need
- promote workforce development that will increase the capacity and capability of a more representative workforce for those higher-need population groups.
Effective distribution of 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 Māori
Government agencies and community groups have different strategic frameworks for how they work with and respond to Māori to address Māori needs. The key priority is to ensure that services are available, accessible and appropriate for Māori, and are of high quality.
Responsiveness to Māori requires measures that reach the structure, strategies, systems, management, staff and culture of the organisation in such a way that it will account for the needs and aspirations of Māori in all its activities, in particular, its core business.
The guiding framework used in the health sector for responding to Māori health issues is outlined in He Korowai Oranga: Māori Health Strategy (Minister of Health and Associate Minister of Health 2002). The He Korowai Oranga framework uses the concept of whānau ora (Māori families supported to achieve their maximum health and wellbeing). Whakatātaka: Māori Health Action Plan (Ministry of Health and Associate Minister of Health 2002) is also a vital document as it provides actions to implement He Korowai Oranga and gives rise to Raranga Tupuake: Māori Health Workforce Development Plan (Ministry of Health 2006).
Whānau ora
In addressing Māori public health workforce development, it is essential to recognise that Māori 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 (Ministry of Health 2006), acknowledges the importance of using Māori concepts of hauora and whänau ora to address Māori 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. The concept of whānau ora within this strategy identifies four pathways to achieving better Māori health outcomes. This is a valuable framework for addressing the spectrum of approaches required for Māori workforce development. The four pathways are outlined below.
1. Whānau, hapü, iwi and community development
This pathway focuses on promoting wider community development and participation, led by Māori, to provide a strong base for Māori whānau. Where whānau can manage their own health the whānau is strengthened, as is their ability to participate in their own communities. Services need to be organised around the needs of whānau rather than individuals, and physical, financial and cultural barriers need to be removed.
2. Māori participation
This pathway focuses on supporting Māori participation in all levels of the health and disability sector. It is about effective partnerships with iwi and Māori communities, such as strengthening the capacity and scope of Māori providers, and developing the Māori workforce with new types of service-worker training and accreditation. Māori providers and workers are uniquely placed to work with whānau and hapü in holistic ways.
3. Effective service delivery
This focuses on reducing inequalities for Māori in health by ensuring mainstream services accept increased responsibility for Māori health, and deliver services in ways that are culturally appropriate and of the highest quality. Effective service delivery includes high quality 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 Māori 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.
It is also important that the frameworks and initiatives for public health – including the Māori public health workforce development approach – are aligned with the workforce development plan for the whole Māori health workforce: Raranga Tupuake (Ministry of Health 2006).