Module 3 (Lecture 24, 25 and 26)

Question 1

What is the current state of Maori heath inequities?

Answer 1

There are systemic inequities meaning inequities that arise in functioning of systems. –In health outcomes
– In exposure to the determinants of health
– In health system responsiveness
– In representation in the health workforce.
There are also ethnic inequities which can be prevented and eliminated.

Question 2

What Causes Health Inequities?

Answer 2

Health inequities are driven by the unfair distribution of health
risks and opportunities (social determinants of health)

Question 3

What is health promotion and what is the conventional way of presenting health promotion?

Answer 3

Health promotion refers to strategies improve the overall well-being of populations. The westernised way is the conventional way of promoting health promotion. This would include - Based on Western models
- Led and designed by (predominantly) non-Māori
- Universal formula (one size fits all) Often our health promotion is designed on population level, and apply the one side fits all, and wonder why it is not working for Maori.
- Often simply adapted for Māori, meaning systems are usually designed for white people and then adapted slights afterwards for Maori .
- Not grounded in Māori values and realities
- Superficial vs structural approach (Focusing on the surface-level problems) It’s about how we are tackling things such as lifestyle, and thinking abut the structural levels (poverty, low incomes)
- Has tended to benefit non-Māori to a greater extent than Māori.

Question 4

How many frameworks are there for health promotion and what are they called?

Answer 4

1. Ottawa Charter
2. Te Pay Mahutonga

Question 5

What is Maori health promotion?

Answer 5

Māori health promotion is the process of enabling Māori to
increase control over the determinants of health and
strengthen their identity as Māori, thus improving their health
and position in society.

Question 6

What is the rationale of Te Pae Mahutonga to improve population
health?

Answer 6

1. Māori health status / inequities
2. Rights as Indigenous peoples and Treaty partners. This means that Maori health promotion is a legal and ethical obligation.
3. ‘Mainstream’ health promotion interventions tend to be less
   effective for Māori than for non-Māori

Question 7

What is the Te Pae Mahutonga?

Answer 7

This is a Maori model of population health. It is based on the Southern Cross as a navigational aid. tHERE ARE
4 central stars (key tasks) and 2 pointers (pre-requisites)
* Fundamental components of health promotion from a Māori
world view –“but as they might also apply to other New
Zealanders”

Question 8

Name the 2 pre-requisites for Te Pae Mahutonga.

Answer 8

1. Ngā Manukura (leadership)
   This is about health professional and community relationship. What this means is community leaders,health professionals, and individuals who can drive health initiatives and ensure that Māori health perspectives are represented and respected. Working with communities, empowering communities.
2. Te Mana Whakahaere
   (autonomy). This is about the Maori can undergo self governance, having control and authority over their rights, and self-determination. This is also about community control & enabling
   political environment.

Question 9

What are the 4 key tasks for health promotion.

Answer 9

1. Mauriora
2. Waiora
3. Toiora
4. Te Oranga

Question 10

What does Mauriora refer to?

Answer 10

Access to Te Ao Maori . This is about access to Maori culture and identity, language, knowledge, knowledge about your people, land, heritage, cultural protocols and access to. Not just about getting healthy but getting healthy as Maori.

Question 11

What does Waiora mean?

Answer 11

Environmental protection, social and built environment are crucial for being healthy. Physical environment.

Question 12

What does Toiora mean?

Answer 12

Healthy lifestyle, how we are eating, physical activity, smoking…

Question 13

What does Te Oranga mean?

Answer 13

Participation in society, access to social determinants in health, employment, education, being able to live in housing, appropriate income.

Question 14

Give a real life example of Te Pae Mahutonga.

Answer 14

An example of this framework can be viewed in SIDs which was a disease of an unexplained death of an infant. Nz had the highest rates of SIDs in the world, and increased the gaps between Māori and non-Māori populations in terms of infant mortality rates. A campagin called national SIDS prevention campaign was to reduce it.

Question 15

How did the SIDs programme affect the key tasks of Maouri?

Answer 15

The sids programme helped it by development of the flax bassinet, also to help families share their beds with children. This allowed co-sleeping which is a Maouri key task example, as it impacts the Maori culture and identity.

Question 16

How did the SIDs programme affect the key tasks of Waiora?

Answer 16

Promoting smoke-free indoor environments / safe bed sharing

Question 17

How did the SIDs programme affect the key tasks of Toiora?

Answer 17

Smoking cessation programmes tailored for Māori, breastfeeding promotion

Question 18

How did the SIDs programme affect the key tasks of Te Oranga?

Answer 18

Advocated for better housing conditions
Helped whānau access benefits and services they were entitled to
Supported people to get better education and qualifications
Challenged policies that made it hard for Māori to be healthy

Question 19

What are the key principles for Te Oranga?

Answer 19

Led and designed by Māori, for Māori (for everyone?)
* Promotes self-determination and control
* Based on valid models, frameworks, concepts
* Works with Māori people, values, collectives
* Uses contemporary tools and methods
* Allows for diverse realities
* Focus on determinants of health
* Evidence-based

Question 20

How did the SIDS help with the two pointers ?

Answer 20

Ngā Manukura – leadership
– Māori professional and academic leadership
– Collaboration with leaders in communities
* Te Mana Whakahaere – autonomy
– Communities enabled to identify their own
aspirations and priorities, and to lead the design of
their own solutions

Question 21

Why do we need to prioritise healthcare services?

Answer 21

Because we don’t have enough money in the kitty (shared money) to address diseases, risk factors and to implement interventions. This is why we must prioritise which health outcomes must come first in terms of reducing health outcomes.

Question 22

What is the OECD and where does NZ fit?

Answer 22

OECD is a graph made up of many countries that work towards improving economic performance, improving, um social performance and sustainability. The graph shows US has a higher expenditure meaning more money is being spent on health care. But it doesn’t mean that there is better health outcomes in populations.

Question 23

What do we use when we are prioritising on disease, risk factors and interventions?

Answer 23

Evidence based measures. The evidence based measures should be descriptive which tells us more information on the data, explanatory evidence will tell us about the risks and protective factors the determinants of those diseases. Evaluative evidence will tell us about the interventions, how well the interventions are working or not within a population.

Question 24

What other factors do we have to consider when prioritising health?

Answer 24

Community expectations and values, AND the te Tiriti, human rights, social justice, medical ethics.

Question 25

What type of data can be presented in the descriptive data?

Answer 25

1.Table which show what is the disease distribution in a population/ who is most and least affected. Listing the leading causes of avoidable death and how much each contributes to the life expectancy gap in Maori populations. 2. Trend Data is significant as if there is a downwards trend in Major causes of mortality in NZ 1996-2021 in Maori and Non-maori, meaning we might want to proritise those populations. Things to look for: flattening of the curve or increasing / decreasing in trend Iines.

Question 26

What type of data can be presented in the explanatory (second block of the public health framework) data?

Answer 26

This now explains the determinants of health. Why are population health issues getting worse/better? Why are populations different? What are the determinants or risk factors? Not only this, we need to look through an equity lens: Does the risk factor disproportionately affect population subgroups? Why? - Te Tiriti o Waitangi

Question 27

What are the epidemiological measures used to prioritise health diseases, risk factors and interventions?

Answer 27

There are 3 key measures: Population Attributable Risk (PAR) – Age at death and premature mortality * Years of potential Life Lost to death (YLL) – Time lived with disability * Years Lived with a Disability (YLD)

Question 28

What is attributable risk and how do we calculate it?

Answer 28

Attribute risk is the risk different of EGO and CGO. We calculate this as EGO - CGO. How much disease the exposed group gets because they were exposed. (The amount of “extra” disease attributable to a particular risk factor in the exposed group ~ occurrence in exposed population (EGO)).

Question 29

What is population attributable risk?

Answer 29

This tells us how much extra disease is attributed towards the entire population, including both EGO and CGO. If the association between the risk factor and disease is casual (directly linked), then PAR would be the amount of disease we can prevent if we removed the risk factor from the population.

Question 30

Describe the difference between PAR and attributable risk.

Answer 30

PAR is the entire population, the denominator is the entire population. AR is the extra disease attributed in the exposed group.

Question 31

How do calculate PAR?

Answer 31

PGO - CGO. PGO is total number of people with disease / total population. CGO = number of ideas cases / comparison group. PAR = 90/1000 pregnant women in the population.

Question 32

When do we use PAR?

Answer 32

We use PAR when there is a population based stragetty because it shows how much disease is cause by a certain risk factor in the entire population, assuming the relationship is casual.

Question 33

Why does an increase of prevalence mean an increase of PAR?

Answer 33

This means Because PAR reflects how much disease in the total population is due to the exposure.More people are exposed to a harmful risk factor (e.g., smoking, obesity, alcohol), Even if the individual risk stays the same, More disease overall will be linked to that exposure. This means PAR goes up.

Question 34

Describe the evaluative evidence.

Answer 34

Evaluative evidence looks at how we choose the best possible intervenions. It is based off of two questions: What can improve health outcomes (and in whom)? - Is the intervention improving health outcomes?

Question 35

What are the types of evidence we look for in evaluative evidence?

Answer 35

- Target population – Expected number in population who will be reached – Evidence of effectiveness (based on known success rates) – Cost

Question 36

What is something to be mindful of when looking at the evaluative evidence?

Answer 36

Economic feasibility Does it make economic sense to address the problem? Are there economic consequences if not carried out?

Question 37

Before we implement a health strategy, what do we need to cover?

Answer 37

Acceptability - Will the community and/or target population accept the problem being addressed? - Competing interests. This is because even when the intervention is evidence based we still need to look at how the community will accept it?

Question 38

What does communities want in terms of

Answer 38

Ability to set their own priorities – Confidence in the health system – Access to necessary care – Fair treatment – Culturally appropriate – Good information about their options

Question 39

Now we have to explain why breast cancer in NZ is a health priority issue (explain it in terms of descriptive evidence)?

Answer 39

Descriptive evidence Define the problem * NZ has one of the highest breast cancer rates in the world (2009: 93 new cases/ 100,000 and 19.9 deaths/ 100,000) * Most common cancer among NZ women * 2nd leading cause of cancer death in NZ * Rates for Māori: 125 new cases/ 100,000 and (non- Māori 27.4 / 100,000) * Rates are also high for Pasifika women

Question 40

Explain why breast cancer in NZ is a health priority issue in terms of explanatory evidence.

Answer 40

Identify risk and protective factors Modifiable risks factors of breast cancer identified for NZ women

Question 41

Explain why breast cancer in NZ is a health priority issue in terms of evaluative evidence.

Answer 41

The effectiveness of interventions. E.g: healthy lifestyle recommendations could be important for reducing breast cancer risk in postmenopausal Maori women.

Question 42

How is breast screening helpful in community expectations ?

Answer 42

Building confidence of screening in population groups,

Question 43

What is the state referred to as?

Answer 43

The state is the government and government agencies that that have authority to make and enforce laws, provide public services, and protect citizens.

Question 44

What should the state do to promote population health?

Answer 44

The key thing the state should do to help protect us are evidence based and that are likely to be effective.

Question 45

Explain the concept of a right

Answer 45

An entitlement to do something or be in a certain state. Create claims and sometimes duties for others (either to provide me of something or to not to stop me). When you have a right, you are entitled to something. Either you are entitled to choose how you act, entitled to receive something or be in an assertion state.

Question 46

Explain the concept of liberty and liberty right.

Answer 46

Liberty is freedom. Liberty right is In this sphere of freedom, you get to choose what you do. A protected sphere in which one can decide how to act for oneself, without a risk of being coercion.

Question 47

What does coercion mean?

Answer 47

* Coercion: force or threats of force. When someone is pressured to do something they don't want to do.

Question 48

Define Autonomy

Answer 48

self-determination. The capacity to make decisions for oneself, according to one’s own values. To be able to govern yourself.

Question 49

Define respect for autonomy.

Answer 49

Someone else's recognition of the capacity and entitlement of others to make decisions concerning their own lives

Question 50

What is (necessity principle)?

Answer 50

There are two ways a government can protect people. One is by citizens agreeing to follow the rules and regulations so that the government can keep everyone safe. In return the state has a duty to protect others. However, there are sometimes where the government will need to restrict the liberty (covid-19). The government can only use this force if the cause is really necessary to protect public health.

Question 51

What is the Proportionality Principle?

Answer 51

This refers to the government taking proportionate, resonable and balanced action to protect the safety of others.

Question 52

What is the harm principle?

Answer 52

That the only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others. This means The only good reason to use power against someone’s will is to prevent harm to other people.”

Question 53

Define Kotahitanga and give and example.

Answer 53

This is a Maori concept of believing in unity, togetherness, collective action. It's about making health decisions with the wellbeing of everyone in mind. An example of this would be to get vaccinated as not just for your own protection, but to protect your whānau (family) and wider community.

Question 54

Define Solidarity and give an example.

Answer 54

A commitment to engage in mutual support. Example: wearing masks protects others from getting sick.