Health Inequality in New Zealand: Determinants, Impact, and Strategies

This report provides a comprehensive analysis of health inequality in New Zealand, exploring various determinants such as social, economic, cultural, and historical factors. It highlights the disparities faced by Māori, Pacific, and Asian populations, examining the impact of ethnic identity on health outcomes. The report delves into the principal health determinants, including social and economic factors, and discusses the role of cultural and historical contexts. It also examines the application of Te Tiriti o Waitangi principles to health promotion strategies, including governance, Māori control, and equal opportunity. Furthermore, the report addresses healthcare services required by these populations, focusing on antenatal care, dental care, access to prescription medications, and the importance of general practitioners. The report concludes by emphasizing the need for awareness and optimized access to healthcare services to improve the overall health inequality scenario in 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.