Maori Health Case Study


MaoriHealth Case Study

Accordingto Rashbrooke (2013), the inequality amid the Māoriand the non- Māori is evident and has been indicated as an enduringfeature in the New Zealand. Presently, the Māori are experiencinginequality in health outcomes compared to the non- Māori in respectto different measures. The population of the Māori is younger andincreasing faster on average compared to that of the non- Māorithis implies that the future of the New Zealand will be partlydetermined by the young Māori. Thus, reducing inequality in healthoutcomes will be an important consideration to the country. Animportant health issue that the Māori have that brings poor healthoutcome is health access. The inequality in access to primary healthamong the Māori has been identified by different researchers and itwould be critical for the government to use different strategies inresolving the inequality (Earp &amp Matheson, 2004). The purpose ofthis report will be to discuss the issue of inequality in access toprimary health among the Māori and reasons behind the inequality.Besides, the report will also discuss the Waitangi Treaty and how theprinciples of the treaty can be used in resolving the inequality inaccess to primary health among the Māori.

Accessto Primary Health Services

Itis believed that a strong primary health care system is important inthe maintenance and enhancing of health and wellbeing, as well as inhandling health inequalities. In Aotearoa, New Zealand, the access ofprimary health services among the Māori and non- Māori has beenindicated to depict inequalities. According to investigations done byDavis (1987), it was indicated that Māori utilization rates ofhealth services differed according to age and gender. The rates ofutilization of health services among the males were higher than thatof females, but the utilization rates for children were on average. Aresearch survey conducted by the New Zealand Health Surveys in2002/2003 indicated that Māori were less likely to visit GP services(Crengle et al., 2004). The National Primary Care Survey collectedinformation in 2002 and provided that the Māori were most likely tovisit GPs during urgency. Besides, GPs reported fewer tests beingordered for the case of Māori compared to non- Māori. This was anindication that there exists inequality in access to primary healthservices among the Māori and non- Māori.

Māorihave limited access to primary health services relative to the entirepopulation in New Zealand especially when proxies for need likehospital discharges and mortality are considered. Poor access toprimary health services for Māori can thus be considered a primaryfactor in higher rates of illness as well as hospitalizations amidthe Māori. Also, poor access to primary health services among theMāori can be perceived to be the reason for poorer health outcomesamid the Māori and a contributor to health inequality in Aotearoa(Crooks &amp Andrews, 2009).

Nationaland Local Access to Primary Health Service

InNew Zealand, access to primary health services has been noted to aproblem. This is because of the high cost. A survey conducted by NewZealand Health Survey in 2011 indicated that about 267,000 adults donot collect one or more prescription items due to cost. Besides,women that are aged 25-44 years are likely to experience unmet needs.However, about 73% of the individuals are capable of accessingprimary care when they need it. In the local communities, access toprimary health services seems to be a problem since communities likethe Māori and pacific adults have unmet needs. Generally,individuals that fall in the lower class experience inequality inaccessing primary health services (New Zealand Health Survey, 2012).

Reasonsfor the Poor Access to Primary Health Services

Thereare various reasons that have contributed to Māori experiencinginequalities in the access to primary health services. The followingparagraphs will discuss some of the probable reasons for theinequality in access to primary health services amid the Māoris.


Affordabilityis an exceedingly critical factor, when it comes to accessing ofhealth care services. It is usually difficult for individuals toaccess health care services when the cost of health care services istoo high. This is because it becomes difficult to afford the cost ofthe health services. One of the reasons that could contribute toinequality in access to primary health services among the Māori inAotearoa may be the cost of the health services. The Māori falls inthe lower social class, which implies that they are not in a capacityto afford high health services due to their economic power.Overpricing of primary health services make it difficult for theMāori to access the health services since they see it as a burdenpaying the high prices charged in health facilities (Croxson et al.,2009). However, the non- Māori fall in the middle and upper classeswhich is an indication that they have the capacity to afford payingfor the primary health services that they receive. Therefore, thiscreates inequality in the access to the primary health services.


Educationalso plays an important role in the access to primary healthservices. An individual that is well educated is usually wellinformed as to why he/she needs to attend a health care facilitythis is different from an individual that is not educated. The Māoricomprises of the indigenous people of the New Zealand as such, mostof them do not value education and perceive it as not important.Because of the lack of education amid the Māori, it is difficult tounderstand the importance of visiting a health facility. This hasresulted to only few individuals accessing health facilities toreceive primary health services. Besides, educated individuals hateignorance and are likely to ignore any health concern however, thisis different with an uneducated person. Because of lack of education,the Māori are likely to ignore some of the health issues that seemminor, but only attend health facilities for major health concerns.This may explain why there may be an inequality in access to primaryhealth services.

Attitudesand Behavior of Doctors and Health Services Staff

Themanner in which a doctor or health services staff provides theirservices may affect the way in which patients respond to theirservices in the future. When the initial encounter with a doctor orhealth service provider is satisfactory, it is likely that a patientwould like to have a future encounter with the doctor or the healthservice provider. Nevertheless, in case the first encounter with thehealth service provider was not satisfactory, it would be difficultfor a patient to have a future encounter with such a health serviceprovider. It has emerged that some health services providers arediscriminatory to the Māori, when providing health services (Jansen&amp Smith, 2006). This usually dissatisfies the Māori and may be acontributing factor to the Māori failing to visit health facilitiesfor primary care this may result in the inequality in the access toprimary health services.

CulturalResponsiveness to Health Services

Culturalresponsiveness to health services may be another contributing factorthat can be used in explaining inequality in access to primary healthservices. When a certain culture is not responsive to healthservices, it implies that it would be difficult for members of theculture to access health facilities for primary care. Most of theMāori only go to hospitals when they note that their case iswanting. This may offer an explanation to the existing inequality inaccess to primary health services.

TheTreaty of Waitangi

TheTreaty of Waitangi underpins a unique relationship amid the iwi andthe Crown. This treaty is usually guided by three principles thatwere obtained from the Royal Commission on Social Policy theseprinciples entail participation, partnership, and protection. Theprinciple of partnership focuses on working together with the Māori,iwi, hapü, and whänau in developing strategies for Māori healthbenefit and appropriate health services (Orange, 2004).Alternatively, the principle of participation focuses on engagingMāori at all levels of service, in planning, decision-making,delivery and development of services where it is deemed appropriate.On the other hand, the principle of protection focuses on working inensuring that Māori have at least acquired the same level of healthjust like non- Māori, as well as ensuring that the culturalconcepts, practices, and values of Māori are safeguarded. Accordingto the Treaty of Waitangi, all parties need to recognize these threeprinciples during the establishment and operation of PHO as well asthrough all elements of the national PHO agreement. From theprinciples of the treaty, it is evident that the treaty can be usedin coming up with strategies that eliminate disparities in the healthsystem (Orange, 2011).

Applicationof Waitangi’s Treaty in Resolving the Inequality in Access toPrimary Health

Fromthe three principles of Waitangi’s treaty, it is possible to comeup with strategies that focus on eliminating the inequality in accessto primary health services. One of the strategies that would becritical in eliminating the inequality should focus on the principleof protection. Under the principle of protection, the level of healthfor the Māori should be at least be made to be the same with thenon- Māori. In this case, affordability of primary care may be anissue that the government should focus on. Most of the Māori may notbe in a position to access the primary health service because theyare not in a position to afford the services. In this case, thegovernment should focus on funding primary health care instead ofproviding subsidies. In case the government funds the primary carerather than providing subsidies, it will be possible for the Māorito be in a position to access primary health services withoutproblems just like the non- Māori. This move would be necessary ineliminating inequality of access to primary health services among theMāori because they will not have a cost burden for primary healthservices.

Anotherstrategy that can be used in eliminating the inequality in accessingprimary health services among the Māori would focus on the principleof partnership. Under the treaty, partnership of the communities iscritical in resolving any disparities. In this case, focusing oneducation would be a critical idea. As it has been pointed above,education may be a probable cause for the inequality in the access toprimary health services since the uneducated Māori may notunderstand the need for seeking primary care. Also, as indicatedabove, due to lack of education Māori may ignore seeking primaryhealth services (Abel et al., 2005). Thus, the government shouldfocus on ensuring that the Māori community becomes educated. Theacquisition of education would aid the community in understanding theimportance of visiting health facilities for primary care.Furthermore, education would make the community not ignore primarycare, thus eliminating inequality in access to primary care.

Inaddition, emanating from the principle of participation, Māorishould be engaged at all levels of service, in planning,decision-making, delivery and development of services where it isdeemed appropriate. The issue of representation when formulatinghealth principles is exceedingly crucial as it can help in bringingin ideas of a community that may be hindering access to healthservices. Therefore, it would be necessary for the government toengage the Māori community in every aspect of health decision-makingconcerning the issue of inequality in accessing primary services.


Theissue of inequality in access to primary health services emerges as achief concern among the Māori community in New Zealand. Differentreasons have been speculated to have a contribution in creating theinequality, which in turn results in poor health outcomes. Cost hasbeen considered as one of the reasons, where Māori are deemed not tohave the capacity of paying for primary health services. Because ofaffordability problem, the Māori do not have access to primaryhealth services. Another reason that has been deemed as a probablereason leading to inequality in access to primary health servicesentails education. Education is perceived to play a role in making anindividual understand the importance of receiving primary care.Attitudes and behavior of health service staff are also indicated toplay a role in creating inequality in accessing primary healthservices among the Māori. Through focusing on the principles of theTreaty of Waitangi, it is possible to resolve the issue ofinequality.


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