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Māori are protected from communicable diseases across the life-course
The insights from this priority show that immunisation rates continue to stall for the Māori population, despite the immunisation rates for the general population increasing. This is putting pressure on hospitals, with the number of hospitalisations due to vaccine preventable diseases for Māori continuing to rise.
The Komiti believes that there is scope for a stronger social investment approach to support closing the gap in childhood immunisation rates between Māori and non-Māori. There are opportunities to improve value for investment in the way services are targeted and tailored for whānau, including with stronger integration of immunisations as part of continuous healthcare in the early years.
The Komiti emphasised the need to increase Māori immunisation rates significantly to achieve the national 24-month immunisation health target. They noted that evaluations from previous immunisation programmes targeting Māori show services designed and delivered by Māori health providers are a key factor in the success of these programmes.
To improve immunisation rates, especially for tamariki Māori, the Komiti stresses the need for a combination of improving whānau engagement with health services in early childhood, having services in places and at times that work for whānau, and building trust and confidence through addressing misinformation. The Komiti would especially like all Well Child Tamariki Ora (WCTO) providers, many of whom are Māori health providers, to be supported to provide childhood immunisations to tamariki under 5.
Previous reports
Māmā and pēpi receive consistent, quality care during pregnancy and into the early years
The insights from this priority show that while progress has been made, particularly in workforce and early enrolment policy adjustments, structural inequities in access to services persist. Māori continue to enrol later with a Lead Maternity Carer (LMC) compared to non-Māori non-Pacific peoples, often in the third trimester compared to the recommended first trimester. This has an impact on the health of māmā during pregnancy as well as their engagement with healthcare post birth. The Komiti would like the refresh of Kahu Taurima to be harnessed to engage hapu māmā earlier, including enrolling with an LMC at the earliest opportunity.
The extension of GP pre-enrolment timeframes appears to have supported earlier enrolment of pēpi Māori, suggesting that policy flexibility can improve access at key transition points. However, persistent enrolment gaps at 12 months indicate that early gains may not be sustained. The Komiti will continue to monitor trends in this area.
Declining WCTO referral and contact rates, alongside a higher proportion of tamariki Māori with no recorded contact, point to risks in continuity of early years support. The Komiti thinks that increasing the number of WCTO Māori providers and their connection into the first 2,000 days pathway could address this disparity and improve the contact rate.
The Komiti has noted a lack of data on the postnatal mental wellbeing of new mothers. They think that this area needs further exploration, including exploration of opportunities to better collect data.
Previous reports
Early prevention of long-term illnesses for tamariki and rangatahi
The Komiti notes the persistent inequities in health outcomes for tamariki Māori highlighted by this report. Tamariki Māori experience disproportionately higher rates of respiratory illness, poorer oral health, and barriers to accessing primary care. These disproportions can contribute to long-term health challenges for Māori. Addressing this health need through preventative measures and early, targeted interventions can improve lifelong wellbeing and reduce the burden and cost on the health system.
Dental health is an area the Komiti would like to specifically highlight. Māori tamariki continue to have more decayed, missing and filled teeth than European children. Engagement with child dental services dropped for all tamariki over the COVID-19 period. While the annual attendance rates for European children have since improved, rates for tamariki Māori have stayed low. The Komiti would like Health New Zealand to focus on improving access to dental health services for tamariki Māori.
In the context of overall health for tamariki, and considering that it is an important health target, the Komiti would like to stress the importance of prioritising investment in childhood immunisation approaches that are proven effective for Māori. In particular, tailored services that focus on reaching the most reluctant whānau and supporting greater understanding of the benefits of vaccination.
Rangatahi experience stronger mental health and resilience
The Komiti appreciates that this is a sensitive issue for many people. The Komiti have taken a strengths-based approach that looks at the protective factors for positive mental wellbeing among our young people. Many of the measures for rangatahi Māori | Māori young people are encouraging yet more work is required to improve the poor mental health and addiction outcomes and will likely benefit all. For example, recent research in the Lancet highlighted the impact of discrimination as a key factor in the mental health of young indigenous people.
The Komiti acknowledge the growth in community mental health services, including kaupapa Māori mental health services, recently reported on by the Te Hiringa Mahara | Mental Health and Wellbeing Commission. These services address access and choice issues, which are critical to addressing mild to moderate mental health issues before they become severe.
One area that the Komiti thinks warrants investigation and development is the link between emergency departments and community based mental health and addiction services. In the data we see higher rates of rangatahi Māori presenting to emergency departments with mental health and / or addiction-related conditions and higher rates of repeat visits. The Komiti note this is where the system is particularly stretched. There is an opportunity to build links between emergency departments and community based mental health and addiction services to better address these needs.
Although access to and care through mental health services are priorities, the Komiti also acknowledge the wider factors which impact on the mental wellbeing of rangatahi including education, income and housing as well as alcohol and drug addiction. Work to address these will align with the social investment aspirations of the government.
Rangatahi are engaging in healthy behaviours and are surrounded by protective social factors
For this priority, the Komiti looked at a range of behavioural factors for rangatahi. It’s positive to see rangatahi Māori engaging in physical activity and dental hygiene at similar levels to their non-Māori peers. Māori high school students, years 9 to 13, also tended to rate their relationships with whānau and friends positively. This was similar to the European high school population. Strong social relationships are an important protective factor for rangatahi for both physical and mental health. Building healthy and resilient young people is the core of a social investment approach. The Komiti are interested to see what the health sector and Social Investment Agency progresses in this area.
There is significant room for improvement in certain behaviours regarding healthy eating, smoking, vaping, alcohol, drug use, and sexual health. While the rate of smoking has decreased for rangatahi Māori, the rate of vaping has risen sharply. The Komiti sees a need to continue public health efforts to instil healthy behaviours in young people, including messages tailored to rangatahi Māori. The controls Government are putting in place to curb unhealthy behaviours also need to reflect that the suppliers of unhealthy products target poorer communities. There were seven times more vape stores in the most socio-economically deprived neighbourhoods compared to the least in 2023. This should be a concern for all key decision makers and stakeholders to address such inequities.
Identification and treatment pathways for cancers are faster, timely, comprehensive and effective
The Komiti is very mindful that cancer remains the largest cause of premature death for Māori, and that lung cancer is the biggest killer. The Komiti is concerned about the long-standing low rates of cancer screening for Māori. The recent improvements in breast and prostate cancer treatment pathways in the Waikato have significant potential and could be scaled across the country. The Komiti also thinks there is value in investigating a screening programme for lung cancer which is being tested in research funded by the Health Research Council.
The Komiti would like to stress that Māori are more likely to live and work in places where they are exposed to cancer risk factors. Even those risk factors that have an element of personal choice, such as smoking or hazardous drinking, are impacted by the higher number of tobacco and alcohol outlets in communities where many Māori live. Creating healthier communities for our tamariki and rangatahi will be important to changing the long-term impact of cancer.
The Komiti supports the government’s focus on ensuring that people, including Māori, receive timely access to cancer care. The similar survival rates for prostate and breast cancer demonstrates that there is much we can do to treat cancer today. However, the higher rates of Māori with cancer being diagnosed in emergency departments, and therefore at a later stage of cancer, results in worse cancer outcomes for Māori. This is particularly noticeable for bowel and lung cancer.
In other reports the Komiti has highlighted how important improving access to primary care is for improving health outcomes for māmā and pēpi and pakeke with diabetes and cardiovascular disease. This also applies to Māori with cancer. The Komiti supports the government’s efforts to make primary care more accessible through a variety of service channels. The Komiti is aware that the Māori health provider sector will be keen to innovate and be a part of these new initiatives.
Pakeke are accessing primary and community healthcare early, with positive outcomes and experiences relating to diabetes and cardiovascular disease
The insights from this priority highlight the importance of ensuring pakeke Māori have timely access to quality primary care in order to prevent complications relating to diabetes and cardiovascular disease (CVD) later in life. A consistent finding in this priority is the sizeable gap in hospitalisation and mortality rates between pakeke Māori and their non-Māori non-Pacific counterparts. This has not improved over the last year and is putting increased pressure on hospitals, when pakeke could be treated and managed in the community.
The Komiti would like to stress the importance of targeted local interventions that address the risk factors that can lead to diabetes and CVD. Especially interventions that that focus on promoting healthy lifestyles and reduce smoking and obesity rates.
While barriers to accessing primary care such as wait times and cost are shared across population groups, the high number of closed books in some areas further exacerbates the issue of access – particularly in rural areas such as Hawkes Bay, Mid Central, Taranaki, South Canterbury, Northland, and also the Hutt Valley.
The Komiti is looking forward to the introduction of the access to primary care health target, and the information it will provide on waiting times for and access to primary care across the country.
Previous reports
Kaumātua are supported to live well through managing complex co-morbidities
The Komiti would like to start by acknowledging the increasing life expectancy for Māori and the difference between Māori and European life expectancy. The health system has a significant role to play in ensuring this trajectory continues. The population of kaumātua Māori is expected to increase markedly over the next 20 years. A focus on prevention and addressing the determinants of health will support kaumātua Māori to live longer, healthier lives.
The Komiti is pleased to see that almost all kaumātua Māori are enrolled with a general practice, with trust and confidence in their primary care provider. This is especially important when kaumātua Māori are managing more long-term health conditions earlier than their European counterparts. Government efforts to remove the barriers to accessing primary care have a vital role to play in ensuring this level of engagement continues. Recently announced improvements to primary care funding will help with this.
Quality of care in hospitals stood out to the Komiti as an area for improvement. The higher rate of hospital readmissions and pressure injuries for kaumātua Māori is a concern. The Komiti recommends that the Health Quality and Safety Commission continues to work with Health NZ to discover why this is the case and where evidence shows better care is taking place for kaumātua Māori.
