Recent report details significant disparities regarding tamariki Maori health

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In June 2008 the initial findings for adults and children from the 2006/07 New Zealand Health Survey were released in the report, A Portrait of Health: Key results of the 2006/07 New Zealand Health Survey. The report which was released in late December 2009, focuses specifically on findings for Maori and Pacific children that were not explored in the initial report.

The following summarizes the key areas in which Maori children experience disparities in health indicators compared with non-Maori children. These key areas are

  • asthma
  • body size
  • nutrition and physical activity
  • oral health
  • oral health service use
  • primary health care use
  • family support

Asthma

AsthmaCThe most common health conditions among both Maori and non-Maori children were asthma and eczema, with both conditions significantly higher among Maori children. In particular, Maori were 55% more likely than non-Maori children to have asthma. In addition to having a higher prevalence, Maori were also more likely to have more severe (speech-limiting) episodes of asthma than non-Maori.

Risk factors for asthma can be endogenous (eg, genetic) and/or environmental. Examples of environmental risk factors include allergens, obesity, exposure to second-hand smoke, and duration of breastfeeding (Barnes 2008).

Although Maori children have had a good start to life, with the majority ever having been breastfed, they were twice as likely as non-Maori children to be given solids before four months of age (16.3% versus 8.7%). In addition, Maori children were more likely to be exposed to second-hand smoke in the home than non-Maori children (18.9% versus 6.9%). Exposure to second-hand smoke was significantly higher in the most deprived areas than in the least deprived areas for both ethnic groups. Although there were no significant ethnic differences in the least-deprived areas, Maori were significantly more likely than non-Maori children in the most deprived areas to be exposed to second-hand smoke. Maori children were also more likely to be obese than non-Maori (discussed below).

Children with poorly controlled asthma are more likely to have days off school (Diette et al 2000), which is likely to have long term implications into adulthood for these children. Good access to appropriate primary health care services, later introduction of solid food (ie after four months of age), and the promotion of supportive environments (eg, smoke-free homes) are essential for the treatment of asthma. Primary health care practitioners, in particular the Well Child providers, are well placed to provide support to mothers. For example, Well Child assessments at three and five months of age should continue to support parents and promote the later introduction of solids and smoke-free environments through encouragement and consistent advice.

With regard to reducing exposure to second-hand smoke, government policies on this important initiative should continue; for example, supporting smokers to quit and the smoke-free cars campaign, as well as a number of other initiatives.

Body size, nutrition and physical activity

ObesityCThe 2006/07 New Zealand Health Survey found that Maori children had a significantly higher prevalence of obesity than non-Maori children, and that this disparity was highest among 1014-year-olds, and increased with age. In contrast to non-Maori children, where obesity increased with deprivation, there was no significant difference in the prevalence of obesity for Maori children by deprivation. This suggests that factors independent of neighbourhood deprivation may be driving the higher prevalence of obesity among Maori.

Fizzy drink and fast food consumption and television watching are factors that are associated with an increased risk of obesity, and Maori children (in particular 1014-year-olds) were more likely to be exposed to these behaviours compared to non-Maori children. Maori children were more likely than non-Maori children to consume fizzy drinks (51.7% versus 43.7%) and fast food (74.5% versus 60.1%) in a typical week.

NutritionCThe consumption of fizzy drink and fast food was also significantly higher in the most deprived areas than the least deprived areas. There were no ethnic differences within deprivation quintiles, suggesting that the differential consumption of fizzy drink and fast food observed for Maori children may be attributed to factors associated with deprivation rather than ethnicity.

Insufficient physical activity and sedentary behaviour are associated with obesity. Active transport (eg, walking, biking or skating) to and from school provides an opportunity for children to undertake regular physical activity. In contrast, watching television is a very sedentary behaviour, which displaces other pursuits and has been shown to increase the risk of obesity (Scragg et al 2006; World Cancer Research Fund and American Institute for Cancer Research 2007).

There was no significant difference between Maori and non-Maori children in the use of active transport to and from school. However, among children aged 59 and 1014 years, Maori were significantly more likely than non-Maori to watch two or more hours of television a day. Although children living in the most deprived areas were significantly more likely to watch two or more hours a day than those in the least deprived areas, the difference observed between Maori and non-Maori remained, even when taking neighbourhood deprivation into account, suggesting that deprivation is not the only factor influencing the ethnic differences in television watching.

Oral health and oral health service use

OralHealthCThe findings from this survey confirm Maori children as a priority population in the Oral Health Strategy. Overall, Maori children were less likely to have never had a filling and more likely to have had one or more teeth removed due to decay, abscess or infection compared with non-Maori children.

Barriers to the utilisation of oral health care also need to be addressed. In New Zealand, children and young people are entitled to free basic dental care from birth to their 18th birthday. This care includes dental check-ups and fillings (Ministry of Health 2006). Maori and non-Maori children were equally likely to have seen an oral health care worker in the previous year (79.3% and 80.4% respectively). However, Maori were slightly more likely to experience unmet need for an oral health care worker than non-Maori children. The primary reason for unmet need noted for both ethnic groups was the inability to get an appointment at a suitable time. Maori were also less likely to have never had a filling and more likely to have had one or more teeth removed due to decay, abscess or infection than non-Maori children. This higher prevalence of poor oral health might suggest that Maori children do not have appropriate access to services relative to their level of need and that this need is not identified soon enough. As a result, teeth are required to be pulled rather than filled.

Investigation of and research into the use of alternative approaches to improving the use of oral health services for Maori is important for improving oral health among this ethnic group.

Primary health care use

PrimaryHealthCMany of the health outcomes reported in the 2006/07 New Zealand Health Survey were measured as doctor diagnosed or medicated health conditions. Monitoring health outcomes in this way means that the prevalence of a health outcome may be underestimated if access to the health service required for diagnosis is inadequate.

Although access to and use of primary health care was similar among Maori and non-Maori children, Maori children were more likely to experience unmet need for GP services than non-Maori children. The inability to get an appointment at an appropriate time, cost, and the need occurring after hours were the main reasons for unmet need among both ethnic groups. Although Maori were also significantly more likely to report lack of transport as a reason than non-Maori, they were less likely to report insufficient time. It is important to note that these ethnic differences in unmet need remain even though Maori were more likely not to be charged for their last visit than non-Maori children, suggesting that further work in improving access to primary health care for Maori may be required.

Utilisation of Well Child services in the past year was not as good as utilisation of GP services. Among both Maori and non-Maori children only half of children aged under five years had seen a Well Child nurse in the past year. This primary health care service is important for the health of Maori children. Well Child nurses are able to support Maori families with the key long-term health outcomes of concern: obesity, eczema and asthma. All of these conditions are common in Maori children aged under five years.

Whanau support

WhanauOraCFamily is an important social structure that is crucial to the health and wellbeing of individuals, especially children, who depend on their family for most of their needs for physical and emotional development (Ministry of Social Development 2004b). It is important to note that although we looked at family cohesion by ethnic group, the ethnic group analyses do not represent the family unit; that is, these analyses do not describe, for example, Maori families.

Parents of Maori children were significantly less likely to report their familys ability to get along with one another as excellent or very good than parents of non-Maori children. Family cohesion decreased with age for both groups, but there was no significant difference by neighbourhood deprivation. Risks to family cohesiveness and methods for improving it need to be explored further, with a particular focus on Maori families with school-aged children. This approach is consistent with the Ministrys commitment to working towards and promoting strengthened wh?nau capabilities (Ministry of Health 2009).

Discipline that excludes physical punishment has been found to be better for the parent-child relationship and is more effective when the methods used are consistent, supportive and authoritative (not authoritarian) (Smith et al 2004). The most common types of discipline used by primary caregivers of both Maori and non-Maori children were telling them off and explaining why they should not do something.

Physical punishment was the least used form of discipline in the previous four weeks for both ethnic groups, but primary caregivers of Maori children were more likely to utilise it than those of non-Maori children (14.0% versus 9.3%). Of the group of children who experienced physical punishment, the primary caregivers of Maori children were less likely to report it as an effective discipline strategy than their non-Maori counterparts. The recognition that physical punishment is not the most effective means of discipline, combined with the continued disparity observed between ethnic groups for the use of physical punishment, suggests that factors other than effectiveness may be driving this disparity. Further research to tease out these factors, combined with the promotion of effective alternatives, may be useful next steps.

The findings presented in this report confirm that there are disparities both in health outcomes and in the exposure to risk and health behaviours between Maori and non-Maori children and between Pacific and non-Pacific children. There are also differences in the access to and use of both primary health and oral health services. These findings support the ongoing prioritisation of these two groups of children in monitoring and policy development.

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