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Source: Health Quality and Safety Commission

A new report paints a stark picture of the health care challenges faced by Pacific peoples in New Zealand and calls for ambitious changes to the system to be made urgently.

Bula Sautu: A window on quality 2021: Pacific health in the year of COVID-19 was launched today in Parliament by Minister for Pacific Peoples Hon Aupito William Sio. The report is the latest in a series of ‘window’ publications from the Health Quality & Safety Commission (the Commission). It considers the health of Pacific peoples and provides a snapshot view of how the health system is working (or not working) for them.

The report is the product of a partnership and co-development process between the Commission and Drs Corina Grey, Api Talemaitoga, and Debbie Ryan. It includes contributions from many Pacific health and community leaders, clinicians and health workers. The Commission convened a consumer advisory group comprised of Pacific consumers on 27 May 2021 to respond to the findings of Bula Sautu. This group has developed a set of practical recommendations to further advance the report’s findings.

Bula Sautu highlights some of the worst health care inequities in New Zealand affecting Pacific peoples and the lack of discussion of these inequities in the ongoing health system reforms. The report also profiles providers, communities and individuals responding creatively and effectively within the constraints imposed upon them. This was particularly evident during the COVID-19 response, when innovation flourished.

Associate Professor of Public Health Collin Tukuitonga, Associate Dean Pacific at the University of Auckland and a Commission board member, says Pacific peoples who call Aotearoa New Zealand home have been denied their right to health and wellbeing for decades despite clear evidence that inequities exist in almost all health conditions reported.

‘Pacific peoples are expected to navigate through a health system that has not been designed with or for them. Many have to effectively look after themselves, as it is impossible for them to overcome the many barriers to accessing health care. These shortcomings reflect systematic bias and racism in the New Zealand health and disability system and the lack of diversity in the health workforce.

‘We need a health system that enables Pacific peoples to identify and design Pacific solutions. Leaders and decision-makers in our training establishments and professions must take decisive action to support and grow the Pacific workforce required at all levels of the system. And we need to turn around the unacceptable racism of our system; it drives inequitable health care processes and outcomes, and is enabled by the structure of the system.’

Dr Corina Grey, Pacific Health Data and Insights Lead at Auckland District Health Board, and co-author of the report, says within the health sector there are a number of key actions organisations and individual services can take, many of them within existing resources. These actions are presented in the report as a framework to improve Pacific health.

‘These key actions focus on knowing the data; delivering holistic and integrated care; improving access to health services; respectful and authentic engagement with Pacific consumers and communities; simple, clear communication; and support of the Pacific workforce,’ she says.

‘The strengths of Pacific providers and communities were highlighted during the response to COVID-19. Pacific health and social service providers worked together with church and other community leaders to rapidly set up testing services, tailor support for contact tracing, and deliver food packages and masks to communities, working collaboratively with community leaders and other agencies to provide holistic and integrated models of care.’

Dr Api Talemaitoga, a general practitioner, chair of the Pacific General Practitioners’ Network and co-author of the report, says initiatives such as this show change is possible.

‘However, improvements in Pacific health and a reduction in health inequities will not happen without an ambitious change and transformation agenda.

‘A strategy based on “business as usual” will not give us the change required.’

Pacific innovation

Below are snapshots of other innovative approaches showcased in this report.

Dr Maryann Heather – GP, South Seas Healthcare, Otara, Auckland; senior lecturer Pacific health, School of Population Health, University of Auckland

‘In terms of our high rates of immunisations for children, I give credit to our practice nurses because they’re the ones that make sure that all our kids get the immunisations. They do the recalls. They’ll call, they’ll send people around. That comes down to relationships. Our parents and our grandparents know the benefit of vaccinations. Often, a lot of the time when we ask them, we tell them why it’s important, and they really listen.’

Sinia Saafi, community health worker, Alliance Health Plus Primary Health Organisation

‘The key for me was working through the churches. You need that time for the health worker to go in there and work with the community from the inside out. People are hungry for personal connection, because the personal connection with a health worker gives them confidence.’

Dr Api Talemaitoga, GP, chair of the Pacific General Practitioners’ Network

‘Rates of vaccination for human papillomavirus (HPV) in Pacific peoples improved when the Ministry of Health and the Health Promotion Agency worked to ensure the messages were culturally appropriate.

‘A campaign tailored for Pacific peoples was developed with pictures of Pacific families. The message was reframed from appealing to the individual teenager to one about future protection and health of Pacific families.

“Messages were delivered in Samoan, Tongan and Fijian languages. Immunisation messaging focused on families worked.’

Manogi Eiao, pre-dialysis nurse specialist, renal services, Counties Manukau DHB

‘Money is a big problem. That’s what holds a lot of people back – they have no time off work, or they don’t have any sick leave. They need to go to work to get that money, to pay the bills, to feed the family and they “neglect” their health. They “neglect” their appointments.

‘We’re open 8:00am to 4:30pm, but if I recognise a family is struggling, I’ll go out and do a home visit at 6:00pm.

‘Our nurse practitioner does Saturday clinics. She’ll see a lot of patients who can’t make it during the week. It’s trying to work with our patients and fit in with their lives.’

Examples of inequities facing Pacific peoples

Pacific peoples live, on average, six fewer years than non-Māori non-Pacific.
Less than half (47 percent) of pregnant Pacific women were registered with a lead maternity carer (LMC) in 2018, compared with 81 percent of non-Māori, non-Pacific women.
Pacific women subsequently experience more complications during pregnancy, more intensive interventions during and after birth, and worse outcomes for both mother and baby than other ethnicities.
Only 59 percent of Pacific families of infants in their first year of life received all their Well Child/Tamariki Ora core contacts, compared with 81 percent of non-Māori, non-Pacific families.
Pacific children subsequently experience a higher incidence of a range of conditions, including asthma, dental problems, and ear and skin infections, than children from other ethnic groups. Only 36 percent of five-year-old Pacific children are free of caries (tooth decay) compared with 69 percent of non-Māori, non-Pacific children.
There is a lack of national data on the health of Pacific youth but survey data suggests rising rates of depressive symptoms and attempted suicide in Pacific youth, and barriers to accessing health care.
For Pacific peoples some aspects of preventative health care, like flu immunisations, seem to perform well, but Pacific peoples bear a disproportionate burden of long-term conditions including gout, cardiovascular disease, kidney disease, cancer and asthma, and, in particular, diabetes. Those with diabetes experience a trifecta of issues:

earlier onset leading to earlier and worse complications
inadequate management and control of diabetes
worse hospitalisation rates relative to other ethnic groups.

Pacific peoples are significantly under-represented across the entire health workforce.