Social Determinants of Health in NZ

This assignment delves into the social determinants of health in New Zealand, specifically examining the period between 1981 and 2006. It utilizes a range of sources including academic articles, government reports, and Treaty of Waitangi principles to analyze the factors influencing health outcomes for various populations within New Zealand.

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Running head: HEALTH INEQUALITY IN NEW ZEALAND
Health Inequality in New Zealand
Name of the Student
Name of the University
Author’s note

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Table of Contents
Part One......................................................................................................................................1
Health Inequalities that Exist in New Zealand.......................................................................2
Principal Health Determinants...............................................................................................2
Social Determinants...........................................................................................................2
Economical Determinants......................................................................................................3
Cultural Determinants............................................................................................................3
Historical Determinants.........................................................................................................4
Impact of Ethnic Identity.......................................................................................................4
Māori..................................................................................................................................4
Pacific.....................................................................................................................................5
Asian..................................................................................................................................5
Healthcare Services Required by These Populations.............................................................5
Conclusion..............................................................................................................................7
Part Two.....................................................................................................................................8
Introduction............................................................................................................................9
Te Tiriti o Waitangi................................................................................................................9
Maori health Model (Hauora)................................................................................................9
Taha tinana (physical health)...........................................................................................10
Taha wairua (spiritual health)..........................................................................................11

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Taha whānau (family health)...........................................................................................11
Taha hinengaro (mental health).......................................................................................12
Applications of the principles of the of te Tiriti o Waitangi to health promotion strategies
in NZ....................................................................................................................................12
Relation to three articles of te Tiriti in health promotion of the Maori................................13
Article One: Kawanatanga – Governance........................................................................13
Article Two: Tino Rangatiratanga – Mäori control and self determination.....................14
Ko te Tuatoru – Article Three – Oritetanga.....................................................................14
Conclusion............................................................................................................................14
References................................................................................................................................15

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Part One
Environmental and sociological impacts on health outcomes for the Aotearoa New Zealand
population

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Health Inequalities that Exist in New Zealand
In New Zealand, the term ‘inequalities in health’ denotes connotations of socially
generated disparities, which are unfair. The inequalities in health are mostly reflected via
ethnic inequalities. However, recent polls in New Zealand suggest that imbalance between
wealth or a huge financial gap between the rich and the poor are increasing the concern of
health inequality (Rashbrooke,2013). The gap between the life expectancy as compared
between the most affluent and deprive population in New Zealand is 7 years for females and
9 years for male(Mitrou et al., 2014). The three major ethnic groups in New Zealand exhibit
socio-economic gradient in health. This gradient is steep of Māori and European ethnic
categories and shallow for Asian and Pacific peoples (Tobias &Yeh, 2006). Apart from
socio economic gradient other factors contributing towards inequitable access to health are
cultural gap, historical background. This health inequality leads to the generation of fiscal
costs thereby increasing crime and health expenditure. Thus, inequality in health must be
addressed urgently for numerous reasons. Equality in health helps to create a fair society
where the residing individuals receive equal opportunity to spot specific domains, which
demands improvements. Equality in health is also important for stable economic growth,
social cohesion (Cabinet Social Development Committee, 2004a).
Principal Health Determinants
Social Determinants
Socially isolated people tend to have poor health condition that that of the people who
have a strong family, communal and cultural ties. There is high level of connectivity access
in New Zealand in terms of telephone and motor vehicles but poor or the indigenous people
get limited access to the same, generating a dearth of social cohesion. Other features in New
Zealand society that are responsible for the reduction of social connectedness are, frequent

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change of residence, unemployment, lack of proper education and single parents. The average
length of stay in the secondary school of New Zealand is high. Moreover the majority of the
Pacific and Maori student are either school dropouts or lack basic education. These poor
literacy skills have widened the social barrier in health, generating inequality(Smith, 2012;
Sheridan, Kenealy, Schmidt-Busby & Rea, 2015).
Economical Determinants
The main factor of economic determinant is employment. Employment enhances the
financial status, boosts the self-esteemand increases the quality of social life via promoting
participation in the community life activity. In New Zealand, Māori and Pacific people have
much higher rate of unemployment than that of the average general population. Though
employment is an important determinant for good health, some occupations are associated
with certain health risk such as injury. Māori and Pacific people have low literacy level, they
fail to secure a job that demands intellect and land on to jobs which demands strenuous
physical activity, increasing the chances of health related complications. Moreover, due to the
lack of proper financial support they fail in availing adequate health service, promoting health
inequality.
Cultural Determinants
Cultural factors cast both negative and positive impact on health. In New Zealand,
ethnicity is associated with socioeconomic status. It is however; still unclear regarding how
cultural and ethnic factors contribute to the health inequalities in population. The Asian
indigenous people who have immigrated to New Zealand from Afghanistan has strict cultural
boundaries for the female members for their ladies. The male members forbid female
members to step outside the house and greet other unknown males of the society. The same
cultural though is nurture when it comes to health and meeting up doctors and hence leading
to health inequality in spite of having proper access to health avenues. Moreover, Maori,

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Pacific, Asian are the principal victims of racism further escalating the health inequality
(Harris, Cormack, Tobias, Yeh, Talamaivao, Minster & Timutimu, 2012).
Historical Determinants
Historical warfare and political turmoil are the two most important factors lying
behind the historical determinants of health. The Pacific people who have migrated during the
Second World War suffer from high health inequalities. The massive migration during the
world war have led to the increase in the number of new born death and transmission of
infectious disease creating health inequalities(Baker et al., 2012).
Impact of Ethnic Identity
Māori
Māori, a group of indigenous people in New Zealand have worse health status across
almost all health indicators. There is nine year gap of life expectancy between non-Māori
women and Māori women and a gap of eight years between Māori and non-Māori men
(Ajwani, Blakely, Robson, Tobias & Bonne, 2003).The huge gap in life expectancy is due to
poor quality of life, poor access of health care services, poor care received via health system
and negative disease outcome (Bécares, Cormack & Harris, 2013). All these poor access to
health avenues is attributed to socio-economic disparities. The majority of the Māori groups
are over-represented in low socio-economic groups (Salmond & Crampton, 2012). Moreover,
there exists a higher rate of smoking among the Māori than that of the non-Māori, creating
10% of the mortality gap(Barnett, Pearce & Moon, 2005). The racial discrimination
experienced in both outside and insidethe health sector along with poor access to quality of
health services are postulated as other driving factors behind the discriminationof life
expectancy gap (Harris, Tobias, Jeffreys, Waldegrave, Karlsen & Nazroo, 2006)

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Pacific
The people and their descendants who have migrated from the islands of the Pacific to
New Zealand during Second World War comprise the Pacific group. This indigenous people,
also exhibits a striking gap in life expectancy (Tukuitonga, 2013). The gap of life expectancy
is about five years. The reason behind this, worst socio-economic status experienced by the
Pacific peoples. Their socio-economic status is worse than any other major ethnic populations
in New Zealand, including Māori (Tukuitonga, 2013).
Asian
People who have migrated from the southern part of Asia like from Afghanistan to
New Zealand comprise the Asian group of indigenous people. They comprise of about one-
tenth of the total New Zealand’s population (Harris, Cormack, Tobias, Yeh, Talamaivao,
Minster & Timutimu, 2012). However, the scenario of health among Asian people is
comparatively better and the reason is attributed to ‘healthy migrant’ phenomenon 12. Asain
people express similar life expectancy in comparison to the European New Zealanders.
However, they fail to enjoy similar health access and accounts for about high rate of
occurrence of cardiovascular disease and diabetes (Chan et al., 2008).
Healthcare Services Required by These Populations
Health promotion programmes are required to be undertaken for improving the health of the
population along with associated health inequalities. High rate of teenage pregnancy exists in
New Zealand in comparison to other developed countries. Good antenatal care is the only
way out to improve the health of mother and child. However, access of antenatal care is less
among the low socio economic group. In order to spread the effectiveness of antenatal care,
several cultural factors which are leading to health inequalities must need to be considered.
Maternal smoking promotes neonatal death or late foetal complications. There are also
evidence, which suggest that maternal smoking reduces the average birth weight of the new

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born (Bickerstaff, Beckmann, Gibbons & Flenady, 2012). Program must be designed to
support “quit smoking” among pregnant women to reduce complications during pregnancy
and thereby assisting decrease in socioeconomic inequalities in health. Such programs must
be specifically directed towards the women of Maori population as they have highest rate of
smoking during pregnancy (The Social, Cultural and Economic Determinants of Health in
New Zealand: Action to Improve Health, 2017). At school level, Māori children have greater
reported cases of filled or missing teeth than non-Māori children. The scenario was common
in both non-fluoridated and fluoridated water supplies. Moreover, Māori adults also lack
awareness in dental care and are less like to visit dental care clinics. Regular dental
checkups are extremely important for detecting dental decay and treating the signs of the oral
malfunction early in order to prevent teeth loss (New Zealand Government Ministry of
Health, 2017).
There exists an ethnic difference in the form of financial barriers to obtain an
optimised access to prescription medication in New Zealand. According to Researched
Medicines Industry Association (RMI), New Zealand is far lagging behind the sweeping
reforms undertaken by Australia to fund its pharmaceuticals. In comparison to NZ Europeans,
Pacific and Maori people experience greater odds of deferring medication purchase. They
have higher unmet medical needs because of escalating cost. In order to curb this, primary
healthcare policies targeting Maori and Pacific people are required. Such health care policies
must address the concern like, inability to pay out-of-pocket costs for medication due to
lower access to resources. Moreover, Maori and Pacific people are in an urgent need for
special healthcare services because they have high health needs (Jatrana, Crampton & Norris,
2010).
The first point of contact in case of medical help which is not an emergency is GP -
general practitioner. In New Zealand, GPs work in groups in medical centre and are known

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as practice. They are fully trained medical doctor who provide proper medical advice and
specialist treatment. Maori and Pacific people are either not aware or have poor access to GPs
leading to health inequalities. In order to curb health inequalities, GPs must be made
available for the indigenous people. Awareness program must such that in case of medical
emergency, they must visit local hospital in order to avail medical help from the GPs for
serious injuries and illness (New Zealand Immigration, 2017).
Conclusion
In summary, it can be stated that there is detailed evidence behind the existence of
health inequalities in New Zealand. The principal determinants of health inequalities are
cultural background, history and economic status. The majority of health inequalities are
expressed in terms of ethnicity and socio-economic status are mostly prominent in Māori,
Pacific and Asian immigrants. Proper awareness in the ground of maternity health and
optimised access to dental care, general practitioners and prescribed medicines will help to
improve the overall scenario of health inequality.

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Part Two
The health strategies underpinning the Aotearoa New Zealand's health system, and how
TeTiriti o Waitangi is implicated in this health strategy

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Introduction
TeTiriti o Waitangi
The Treaty of Waitangi (Māori: TeTiriti o Waitangi) was first signed in the year 1840
by British Crown under the presence of Māori chiefs residing in the North Island of New
Zealand. The treaty deals with the official declaration of British sovereignty over New
Zealand by Lieutenant Governor William Hobson. The treaty recognised the ownership of
forest, lands other properties of Māori and provided then the rights of British subjects. As a
result of this treaty, the Queen of England, Queen Victoria gained the sole right to purchase
these lands. The major treaty principals are the partners of the treaty have a duty to in act in a
reasonable way along with proper faith. It also claims that Crown has the sole freedom to
govern them and has the sole duty to protect the interest of Māori interests and to provide
remedy to the past breaches. The Crown can never avoid its obligations under this treaty and
needs to consult with Māori before taking any significant step. According to treaty, Māori
retains rangatiratanga over their resources taonga will enjoy all the privileges and rights of
citizenships According to Māori culture, Tinorangatiratanga includes proper management of
resources and other associated taonga. What most interesting is, the Māori and the English
version of the treaty are significantly different and hence there is lack of consensus regarding
what exactly was covered or agreed under this signed treaty(Principles of the Treaty of
Waitangi – ngāmātāpono o tetiriti – TeAraEncyclopedia of New Zealand, 2017).
Maori health Model (Hauora)
The philosophy of Māori in the domain of health is based on a wellness. It promotes a
holistic health model. The concept of ‘tewhare tapa whā’ showcasing the four cornerstones of
Māori health is the principal model for understanding Māori health. The symbol of wharenu
illustrates four different dimensions of Māori well-being. All these four signs are interrelated.

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Any damage to a single sign indicates unbalanced health. At present, the majority of the
Māori modern health lacks the proper interpretation of the concept of tahawairua (the
spiritual dimension). As per the belief of the traditional Māori approach, proper inclusion of
wairua, significant role of whānau (family) and maintenance of proper balance of
hinengaro(mind) are determining physical factors of illness (Māori health models – TeWhare
Tapa Whā, 2017).
Source: Māori health models – TeWhare Tapa Whā, 2017
Tahatinana (physical health)
According to this concept, proper physical health is an important requirement for the
maintenance of optimal development. The physical wellbeing of a person is support by the
essence and shelter that he or she receives from the external environment. According to the
Māori believe the physical dimension is only one determining aspect of health and wellbeing

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and can never be isolated from the spirit, mind and family(Māori health models – TeWhare
Tapa Whā, 2017).
Tahawairua (spiritual health)
According to this concept, health has a direct connection with unspoken and unseen
energies. It believes that the spiritual aroma of an individual is like a life force, which
determines a person as an individual. According to the traditional Māori analysis, the
physical manifestation of illness is focused over the spirit of the individual (wairua)(Māori
health models – TeWhare Tapa Whā, 2017).
Tahawhānau (family health)
It deals with the caring and sharing with the associated individuals who are the part of
the wider social system. Whānau bestows the person with strength and provides link for the
ancestors. Proper understanding of Whānau is important factor contirbutin towards health and
illness and family is the fundamental framework of Māori culture(Māori health models –
TeWhare Tapa Whā, 2017).

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Tahahinengaro (mental health)
Mental health is another determining feature of the health and wellbeing of an
individual and this mental health is the principal concept behind the Tahahinengaro.
Hinengaro claims that though and emotions are the intergral component of soul and
body(Māori health models – TeWhare Tapa Whā, 2017).
Applications of the principles of the of teTiriti o Waitangi to health promotion
strategies in NZ
The Treaty of Waitangi is the key to health promotion in New Zealand. It has been
identified as the principal document for Aotearoa. It is partly framed and signed to promote
the health concerns which are common among the Maori people. The treaty thus can be
recognised as the principal document which provides proper framework control the health
and well-beingof the Maori and non-Maori population in New Zealand. The three main
principals of treaty that are designed in favour of health provisions are partnerships,
participations and active protection(The Treaty of Waitangi and Health Promotion, 2017).
Partnership: According to the treaty, partnership refers to the on-going relationships
that exist between the Maori population and the Crown or Queen. One of the prominent
examples that can be cited in this ground is the drink-drive programme that has been
collaboratively designed by the Maori and a mainstream organisation running under the
banner of crown(The Treaty of Waitangi and Health Promotion, 2017).
.

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Participation: According to the treaty, the participation means proper emphasises on
the Maori and their active involvement in all aspects of society especially within the
Aotearoa. Within the health promotion, in order to generate active participation there must
remain proper planning, monitoring and delivery of the programs that are actually relevant
for the Maori people and their culture(The Treaty of Waitangi and Health Promotion, 2017)..
Active Protection: As per the treaty, active protection recognises that the Crown
needs to be pro-active in the domain of optimised health promotion. It must also take
responsibility for the proper development of preventative strategies in the area of health and
wellbeing. In order to attain success in this ground, the Crown may need to deliver or appoint
additional resources. Such resources will enable the Maori population to enjoy equitable
health status along with their non-Maori neighbours(The Treaty of Waitangi and Health
Promotion, 2017).
Thus these three principles in unison have an active role in proper understanding
health and wellbeing of the Maori population in New Zealand. They also promote active
developments of standard health policies and timely delivery of the healthcare service(The
Treaty of Waitangi and Health Promotion, 2017).
Relation to three articles of teTiriti in health promotion of the Maori
Article One: Kawanatanga – Governance
The article one outlines the obligations and responsibilities of the Crown to protect
and govern the interest of the Mäori people. Here health comes as an important interest for
Mäori people. It imparts the sole right to the Crown to design new laws that are directed
towards the health and the wellbeing of the Mäori people in accordance with constitutional
rules and regulations. Such accordance with rules are regulations further ensures optimised
provision of service in all sectors of livings with a special mention to health. The sole power

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towards the Crown has been imparted by the Mäori in exchange of their lands and hence they
are obliged to receive optimised health support from the government which will contribute to
and enhance the health and wellbeing(TUHA–NZ a Treaty Understanding of Hauora in
Aotearoa-New Zealand, 2017).
Article Two: TinoRangatiratanga – Mäori control and self determination
As per article two, the Queen of England provides consents to chieftainship
(rangatiratanga) to all the people of New Zealand includingChiefs, hapu. She also agrees to
provide comprehensive protection to their villages and other possessions (taonga: everything
that is held precious). Article two of the treaty enables Mäori to exercise their sole
tinorangatiratanga, control. It also give them full authority and utmost responsibility over all
their existing affairs with a special mention to health. Article Two also guarantees the
Mäoripopulation to enjoy comprehensive the control over their existing resources and taonga.
These rights have paved to the development and generation of Mäori health funders and
subsequent providers(TUHA–NZ a Treaty Understanding of Hauora in Aotearoa-New
Zealand, 2017).
KoteTuatoru – Article Three – Oritetanga
According to the third article of the treaty, the Queen of England will provide full
benefit and equal rights to the Mäori of New Zealand like any other citizens in England. This
article is further helpful in curbing the health inequalities as it negates the chances of racism
and social discrimination, one of the principal driving forces behind health
inequalities(TUHA–NZ a Treaty Understanding of Hauora in Aotearoa-New Zealand, 2017).
Conclusion
Thus from the above discussion it can be concluded that the TeTiriti o Waitangi
signed with the Queen of England as a direct imact in framing the health plocies and

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promotion of health and wellbeing among the indegenious people in New Zealand with the
special mention to Mäori. Moreover, the Mäori health Model (Hauora) critically examines the
spiritual basis of the health and its associated factors on the well-being of the Mäori people.

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