Maori in NZ: Struggling With Structural Barriers to Health Access - Essay Sample

Introduction

Maori are Polynesians located in New Zealand. They represent 12% of New Zealand's population as a whole. The indigenous Maori in New Zealand faces structural barriers to access to health services, including geographic isolation, poverty, discrimination, racism and lack of understanding of their cultures. A gap between indigenous and non-indigenous is noted in life expectancy, health care, education, unemployment and access to basic services (Ellison-Loschmann, & Pearce, 2006). These barriers generate severe differences between the life expectancies of the native peoples with those of non-indigenous people of the same country. The indigenous Maori people have a higher chance of suffering from depression, substance abuse, and other mental disorders, compared to their non-indigenous counterparts. The health status of indigenous Maori people is severely affected by their living conditions, income levels and employment rates, access to drinking water, health and medical services, and their food availability. The Maori's are among the poorest people in New Zealand. The health and personal integrity of the Maori people is at risk throughout their lives: from childhood, when they face high mortality rates, as throughout their existence, when they experience a higher prevalence of diseases and premature death (Ellison-Loschmann & Pearce, 2006). There have been several health model initiatives (such as Te Whare Tapa Wha and Te Pae Mahutonga) that have been developed in response to the health needs among the Maori. These health promotion initiatives are meant to strengthen and enhance the identity of the Maori and enhance their general health and position in society.

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Health Needs Among the Maori

The existence of health disparities affecting the Maori of New Zealand has been recognized by the government, researchers, and advocates of the right to health. All have proposed different methods to eliminate these disparities but the rates of sickness rate are still high and access to health insurance services is still fraught with difficulty. Addressing health disparities requires careful consideration of the factors that continue to affect the access of the Maori to health care, based on their geographic location, whether isolated, urban or rural (Harris, Tobias, Jeffreys, Waldegrave, Karlsen, & Nazroo, 2006). Health professionals do not take an overview of patient care or potential harm caused by the social determinants of health. Endemic problems (housing shortages, infectious diseases, unemployment, consumption problems) that occur in areas where the population is confined to dilapidated institutions contribute to the disintegration of communities and accelerate the spread of disease.

Social disparities in health often reflect the inequality of per capita income and many factors closely related to income (level of education, employment, housing, lifestyle, attitudes, etc.). In New Zealand, regional variations are not particularly marked, but despite recent progress, large minorities, Maori and Pacific Islanders, have poorer health outcomes and are more exposed to at risk of contracting a chronic illness than New Zealanders of European or Asian origin (King, Smith, & Gracey, 2009). Due to socio-cultural barriers, members of ethnic minorities may be reluctant to use primary care services. Maori and Pacific Islanders have lower rates of private health insurance coverage. As a result, low-income members of the minority community are the main users of hospital emergency services, for which no participation is required and which operate continuously (Pihama, Smith, Te Nana, Cameron, Mataki, Skipper, & Southey, 2017). The lack of lasting relationships with a primary care physician is detrimental to the quality of care and it worsens the situation.

Te Whare Tapa Wha

The Where Tapa Wha model, which in the Maori language means "the four corners of the house" is a holistic health model where health is structured on four main pillars: Te taha wairua (the spirit; spirituality), Te taha hinengaro (the mind; psychological and emotional), Te taha tinana (the body; physical), and Te taha whanau (the family/community; collective/social). The model was developed y Te Rangimarie Pere (1982) and is exclusively Maori. The four dimensions of the model are as explained below (Staps, Crowe, & Lacey, 2009):

Psychological Health Focusing on Emotions (Taha hinegaro): Relates to balance, confidence and knowing how to deal with other people's own emotions. It is related to positive beliefs, self-control, self-esteem, and emotional intelligence.

Physical and Mental Health (Taha tinana): Body and mind care, considering stimulating activities and healthy eating programs. Neurons shrink over time, and a way to compensate, that is, to produce new neurons, stimulating the brain through exercise, activity, new experiences, and challenges. For this reason, it is so important at this stage to perform physical activities, balanced diet and manage emotions to stay motivated and energized.

Spiritual Health (Taha wairua): Issues that transcend the here and now, not necessarily linked to religion, but which make the individual find meaning in their existence. It deals with the capacity for faith and wider communication and is related to the unseen and unspoken energies. It is one of the most essential health requirements and provides a connection between the environment and the self.

Family Health (Taha whanau): Quality family relationships. Unresolved issues can create problems for all other health dimensions.

Te Pae Mahutonga

Te Pae Mahutonga health model, developed by Durie (1999), was derived from the name given to the Southern Cross star constellation by the Maori (Wharewera-Mika, Cooper, Wiki, Field, Haitana, Toko, & McKenna, 2016). According to the Maori, the star helps in the identification of the magnetic South Pole. There are four central stars in the constellation and they form a cross shape and there are two stars (referred to as the two pointers) that are in a straight line and point towards the cross. These four main starts are named Te Oranga, Mauriora, Toiora, and Waiora and they represent four main health promotional goals. The other two stars (the pointers) are referred to as Te Mana Whakahaere and Nga Manukura.

Mauriora acts as an access route to Te Ao Maori while Waiora relates to the protection of the environment. Toiora is related to healthy living habits while Te Oranga calls for the involvement of all stakeholders in society. Nga Manukura relates with leadership whereas Te Mana Whakahaere is related to people making the right choices and decisions (autonomy) (Durie, 1999). The Maori believed that cultural identity resulted in good health whereas one of the main causes of poor health was because of deculturation (McNeill, 2005). Acculturation (occurs when people acquire and assimilate the characteristics and elements of another culture different from their own) results in good health while deculturation (occurs when a community loses its cultural characteristics in the process of adapting to a different culture) perpetuates poor health. Waiora, which advocates for environmental protection, states that a poor interaction between people and the environment results in poor health and diseases (Durie, 1999). There is a need to take care of water, cosmic, and terrestrial environments surrounding the human being.

Toiora deals with maintaining a healthy lifestyle. Leading a healthy lifestyle is the key to preventing disease, as well as certain conditions that people often suffer. Eating a healthy diet, exercising, maintaining proper weight, resting properly, avoiding alcohol, drugs, and smoking, and eating fruits and vegetables are all healthy practices. Te Oranga advocates for participation of everyone in the society through empowering all citizens while Nga Manakura states that if local leadership is not incorporated in health promotion plans, it will not be successful (McNeill, 2009). Te Mana Whakahaere stipulates that the lack of community ownership derails any health promotional plans, the community should be allowed to make its decisions.

Differences and Similarities Between Te Whare Tapa Wha and Te Pae Mahutonga

One of the major similarities between the two models is the focus on the physical dimension of an individual. Toiora (maintaining a healthy lifestyle) in Te Pae Mahutonga advocates for individuals taking care of their bodies and avoiding drugs, drinking, smoking, poor diets, poor living practices, and reckless spending among others. Healthy lifestyles should be adopted and interventions to protect people from self-harm, injury, and diseases at personal and community levels are necessary for the success of any promotional health plan (Durie, 1999). The Taha tinana (physical health dimension in Te Whare Tapa Wha) advocates for the capacity for physical growth and development. It calls for body and mind care, exercising, and healthy eating programs. Another similarity is that both models focus on the protection of the environment (Kingi Te & Durie, 2000). The models advocate for the promotion of healthy activities that enhance the balance between environmental protection and health well-being. The model called for the conservation of the environment, reducing wastage and recycling of materials. Clean air, clean water, low noise levels, planting trees, and taking care of the environment all contribute to good health.

When it comes to differences, Te Pae Mahutonga is more complex (in the meaning of its six components and in structure) compared to Te Whare Tapa Wha (which has four main components and is not as detailed). Durie (1999) states that Te Pae Mahutonga is a health promotional model that not only applies to the Maori people but not all New Zealanders and the rest of the world. Te Pae Mahutonga is a universal health model influenced by Maori cultural features and characteristics whereas Te Whare Tapa Wha mostly applies to the Maori people (Johnson, Hodgetts, & Nikora, 2013). Although both health promotional models can be applied universally, Te Pae Mahutonga is more detailed and not just exclusively for the Maori people. The Te Oranga dimension (participation in the society) in Te Pae Mahutonga is lacking in the Te Whare Tapa Wha model. Te Oranga advocates for the participation in the economy sector, providing education opportunities for the Maori, providing employment opportunities to the Maori, participation in the knowledge society and in the decision-making process (Cram, Smith, & Johnstone, 2003). Te Pae Mahutonga addresses the issue of how a person's health promotion activities enhance inclusion in the wider society and how such activities encourage participation in the education, employment, and recreation fields. The housing and living conditions of the Maori people are also taken into account in the Te Pae Mahutonga model whereas, in the Te Whare Tapa Wha model, all these issues are not taken into consideration.

Another difference is that Te Pae Mahutonga adds the concept of participation in the society which is lacking in Te Whare Tapa. The concept stipulates that the community should be able to count on and have access to the goods and services of society. The community should be able to participate in the economy, education, be granted employment opportunities, health services, knowledge society, and decision making (Durie, 1999). The participation of the Maori in the society should be increased. This concept is lacking in the Te Whare Tapa model that only focuses on the spirituality of people, the emotional and psychological dimensions, the physical and the social dimensions.

Another difference between the two models is the amplification of the being concepts of the Maori. In the Te Whare Tapa model, the te ha (the...