Whānau Māori Voice

– South Island participant, Hui Whakaoranga, 2021

Local reports from within the Ngāi Tahu Takiwā shine a light on the barriers to accessing primary health care for whānau Māori. These include:

• Barriers around patient co-payments, consultation times, pharmacy open hours, and access to oral health care, including for tāngata whaikaha Māori (Māori with lived experience of disability) (Takiwā Poutini, 2023 and Christchurch Clinical Network, 2022)
• The selective closure of general practice books, especially for high-needs patients (Christchurch Clinical Network, 2022)
• Frustration at a lack of progress and cultural considerations for Māori well-being, including addressing racism (Christchurch Clinical Network, 2022)
• Impacts of discrimination and other barriers for some population groups (including Māori and Pasifika whānau, culturally and linguistically diverse groups, the LGBTQIA+ community, and rural populations (Christchurch Clinical Network, 2022).

Access to high quality antenatal care early in a pregnancy is an important part of ensuring the best possible outcomes for māmā and pēpi.

Between 2018 and 2022, just over three quarters of Māori women (75.9%) within the Ngāi Tahu Takiwā were enrolled with a Lead Maternity Carer (for example a midwife or private obstetrician) within their first trimester of pregnancy (that is within the first 14 weeks of pregnancy). In comparison, 85.1% of non-Māori women were enrolled with a Lead Maternity Carer in their first trimester.

There are several studies looking at pregnancy and birthing experiences for Māori. This includes the impact of māmā experiencing multiple stressful life events during pregnancy and in the first years of their child’s life, which is more common amongst Māori (Paine et al, 2023). There is also evidence that Wāhine Māori who give birth by emergency caesarean delivery value being included in the medical decision-making process around giving birth, even in emergency situations, and having whānau support, including those who can advocate for them. The ability for Māori whānau to have access to and observe tikanga/traditional practices is also seen as very important (Lawrie et al, 2024). The best possible outcomes for mama and pēpi can be bolstered through holistic models of care that include the immersion of hapū (pregnant) māmā in learning raranga (weaving) and result in strengthen social networks (Te Huia et al, 2023).

One indicator of how well primary care and maternity systems are working is how early newborn babies are enrolled with a primary health care provider after their birth. In 2022, with the Ngāi Tahu Takiwā, 77.6% of pēpi Māori were enrolled in with a primary care provider by the time they were three months old. In the same year, non-Māori babies were more likely to be enrolled in primary health care at the same age (96.4%).

Oral health care is free in New Zealand for tamariki and rangatahi up to 18 years of age, and all children should be enrolled with local community oral health as soon as possible after birth. In the Ngāi Tahu Takiwā, 81.8% of Māori children aged 0 to 4 years were enrolled with community oral health services compared with 93.4% of non-Māori children.

Looking at attendance at oral health services, only 56.3% of eligible Māori five-year-olds attended community oral health services in 2022 (and non-Māori five-year-olds attended at very similar rates). However, in that same year, tamariki Māori in year 8 (around 11 or 12 years old) were less likely than non-Māori students to attend community oral health services (66.0% for Māori compared with 77.9% for non-Māori).

Of the tamariki Māori who were seen by community oral health services in the Ngāi Tahu Takiwā in 2022, nearly half had decayed teeth and for both Māori five-year-olds and Māori Year 8 students the rate of decayed teeth was higher than for their non-Māori counterparts.

For more information on child oral health in the Ngāi Tahu Takiwā, including a break down by former DHB region, please see Te Tauraki Māori Health Profile Volume Two [insert link].

Māori in the Ngāi Tahu Takiwā are much more likely to have a missed first specialist appointment than non-Māori. In 2023, for example:

• 8.5% of first specialist medical appointments for Māori were missed, compared to 3.8% of appointments for non-Māori,
• 14% of first surgical appointments for Māori were missed, compared to 5.5% for non-Māori.
• The level of missed appointments varied with age and was highest for Māori aged 30 to 39 years (with 18.7% of appointments missed for Māori, compared to 8.2% for non-Māori).

Access to appropriate outpatient and hospital care has decreased across the country over the past four years. By November 2023, the number of people waiting more than 4 months for a first specialist assessment was five times the number waiting in February 2020. For example, in November 2023, nearly a quarter of Māori said they couldn’t get health care because wait times were too long. For more information on the national picture of access to health care, you can refer to Window on Quality 2024 on the website of Te Tahu Hauora (the Health Quality and Safety Commission).

Between 2020 and 2023 there were an average of 20,762 hospital admissions each year, 1.1 times the rate of hospitalisation for non-Māori. Māori females had the highest rates of hospitalisation amongst all groups.

Internationally, Indigenous peoples consistently report a lack of engagement and connection when accessing hospital services, and it is the same in New Zealand. A recent New Zealand study (Komene et al, 2023) looked at the experiences of thirteen whānau and patients and identified that those who felt understood by their care teams (holistically, culturally and ethnically) felt more engaged, and they emphasised the need for effective, two-way, communication that recognised the importance of whānau in decision-making. This study also noted that Māori and whānau spoke about the structural racism they encountered in hospital services.

There are two ways data can help us look at hospitalisations that could be prevented:

• Potentially avoidable hospitalisations, which are those which could have been prevented by primary health care, public health, or social policy intervention, or
• Ambulatory sensitive hospitalisations, which are those which could have potentially been avoided through interventions in primary care.

When it comes to potentially avoidable hospitalisations, Māori had slightly higher rates of hospitalisation than non-Māori. For example, for people within the Ngāi Tahu Takiwā aged 15 to 24 years old, Māori were 1.2 times more likely than non-Māori to be hospitalised for potentially avoidable causes between July 2022 and June 2023.

For Ambulatory sensitive hospitalisations Māori again had higher rates of hospitalisation. For example, for people within the Ngāi Tahu Takiwā aged 45 to 64 years, Māori aged 45 to 64 years had a rate of ambulatory sensitive hospitalisation that was 1.7 times that of non-Māori.

Research looking at trauma admissions for Māori at Christchurch Hospital has shown that for both the Māori and total populations, the incidence rate of major trauma
in Canterbury is higher than rates in the North Island. However, the incidence rate for Māori was slightly higher than for the total Canterbury population (Kandelaki et al, 2021).

For more information on hospitalisations and mental health refer to [link to mental health and hospitalisations section below].

A small group of long-term conditions are responsible for many of preventable deaths of Māori in the Ngāi Tahu Takiwā (outlined in the section on Potentially avoidable deaths above [insert link]). These include diabetes, cardiovascular disease, chronic respiratory disease, and stroke and are driven by a range of risk factors including tobacco, alcohol, and unhealthy diets.

This section looks at some key indicators connected to these long-term conditions. For more detailed information, please refer to Te Tauraki Māori Health Profile Volume Two.

Around 26.7% of Māori aged 15 years and over in the Ngāi Tahi Takiwā were regular (daily) smokers, according to the 2018 Census. The rate was slightly higher for Māori women than for Māori men and overall Māori were about twice as likely to be regular smokers as non-Māori in the Takiwā. New Zealand Health Survey Data shows that between 2017 and 2022 11.9% of Māori in the Takiwā were vaping on a daily basis, with the rates in the former West Coast DHB region and the former South Canterbury DHB region being higher than other parts of the Takiwā.

Around 12.6% of rangatahi Māori in the Takiwā aged 15 to 19 years were regular smokers, according to the 2018 Census. Male rangatahi Māori had a slightly higher smoking rate than female rangatahi Māori. Again, rangatahi Māori were around twice as likely to be regular smokers as non-Māori rangatahi.

Between 2020 and 2023, Māori in the Ngāi Tahu Takiwā were 1.5 times more likely than non-Māori to be hospitalised for circulatory system diseases (which includes hospitalisations from conditions such as rheumatic fever, high blood pressure, ischemic heart disease, stroke, and other forms of heart disease).

Māori in the Ngāi Tahu Takiwā were more than twice as likely as non-Māori to be hospitalised for heart failure. The rate of hospitalisation was highest for Māori males.

This is consistent with the pattern of Māori health inequities across the country. For example, evidence shows Māori experience stroke at a younger age and are at greater risk than New Zealanders of European ethnicity. Not only have these inequities persisted for decades but there is some evidence suggesting the gap is widening. Research evidence emphasises the importance of approaches that support Māori-led solutions (Ranta et al, 2023).

Based on data held in the Virtual Diabetes Register, roughly 4,385 Māori (2,201 women and 2,184 men) aged 25 years or older in the Ngāi Tahu Takiwā had diabetes in 2022 (an estimated 6.2% of Māori in the age group). After adjusting for differences in the population age structures, Māori in the Takiwā were 1.5 times more likely than non-Māori to have diabetes. Yet, Māori were also significantly less likely (0.9 times) than non-Māori with diabetes to be regularly receiving diabetes medicines. While not all people with diabetes require medication, those that do should take it regularly for optimum diabetes control. The presence of ethnic differences in medication receipt raises questions about the quality of care and access to appropriate treatment for Māori, especially when Māori with diabetes in the Takiwā have higher rates of preventable diabetes complications.

Between 2020 and 2023, asthma hospitalisations were highest for Māori children, with an average of 94 Māori children (aged 14 years and younger) per year in the Ngāi Tahu Takiwā hospitalised for asthma, a rate 1.7 times higher than for non-Māori.

Māori in the Takiwā aged 45 years and older were also 2.4 times more likely than non-Māori to be hospitalised for chronic obstructive pulmonary disease (COPD). Māori also had higher rates of hospitalisation from bronchiectasis across the Takiwā than non-Māori (a rate of 9.3 per 100,000 people for Māori compared with 7.8 per 100,000 for non-Māori), although small numbers make it hard to draw conclusions for all regions. On average, there were 15 premature Māori deaths each year from respiratory disease within the Takiwā between 2014 and 2018.

Gout is the most common form of inflammatory arthritis, and people with gout typically experience recurrent flare of severe joint inflammation which, if not properly treated, can lead to tophi, chronic arthritis, and joint damage.

Māori men in the Ngāi Tahu Takiwā were more likely to be affected by gout than any other population group with around 3,012 Māori males (or 7.5% of Māori males) aged 20 years or older affected in 2022. This data is based on those who were hospitalised with gout or prescribed gout medication and who are enrolled with a primary health organisation (PHO), so it may not capture everyone with gout in the Takiwā.

Gout is treated through long-term urate-lowering medications, such as allopurinol, but data shows that only 42.2% of Māori with gout in the Takiwā were receiving regular urate-lowering medication. This is roughly the same proportion as for non-Māori, but as Māori with gout have earlier onset and more severe disease, equitable care would require higher levels of medication prescribing (Health Quality and Safety Commission, 2024).

Cancer is a leading cause of illness and death for Māori across the country, making up 25% of amenable mortality for Māori females and 10% for Māori males (Ministry of Health, 2010).

Broad health system actions that impact multiple cancers, such as improving access for Māori to prevention, timely diagnosis and appropriate treatment (regardless of income or place of residence), increased Māori control in cancer decision making and Māori-led services are crucial to improving Māori outcomes in the area (Gurney, Robson et al. 2020).

Preventing the human papillomavirus (HPV) infection, which causes virtually all cervical cancers, through HPV immunisation is an important contribution to reducing the incidence of cancer. HPV vaccine is part of the routine NZ National Immunisation Schedule to be given to all 12-year-olds. However, the rate of HPV vaccination is lower for Māori in the Ngāi Tahu Takiwā at 14 years of age (55.8% as at June 2023) than non-Māori (68.4% as at June 2023).

Cancer screening is a way to find and treat cancer early, to support the best possible cancer outcomes for people. There are three national cancer screening programmes covering breast cancer, cervical cancer, and bowel cancer.

In 2023, Māori participation in all three cancer screening programmes within the Ngāi Tahu Takiwā was lower than for non-Māori:

• For breast cancer screening 68.7% of eligible Māori (aged 45 to 69 years) have been screened in the previous two-year period, compared to 72.8% of non-Māori.
• For cervical cancer screening, 63.8% of eligible Māori (aged 25 to 69 years) were up-to-date within their cervical screening, compared to 73.8% of non-Māori.
• For bowel cancer screening, 60.2% of the eligible Māori population has been screened compared to 64.8% of non-Māori.

Within the Ngāi Tahu Takiwā, the most common types of cancer diagnosed for Māori between 2016 and 2020 were lung cancer, breast cancer, prostate cancer, and colorectal (bowel) cancer. This is the same as the most common types of cancer diagnosed for Māori nationally. Notably, the rate of lung cancer in Māori was 2.92 times higher than for non-Māori in the Takiwā, with the rate being higher for Māori females (who were 3.26 times more likely to be diagnosed with lung cancer than non-Māori).

For Māori in the Ngāi Tahu Takiwā the most common causes of cancer deaths were lung cancer, colorectal (bowel) cancer, liver cancer and breast cancer. Māori were 1.3 times more likely than non-Māori to die from any type of cancer, including 2.4 times more likely to die from lung cancer and 3.6 times more likely to die from liver cancer.

Mental health and substance use conditions are considerable contributors to overall health loss for Māori (Ministry of Health 2016). Māori are more likely to experience
psychological distress and mental health and substance use conditions than non-Māori, but evidence shows Māori experience poorer mental health care. This includes being less likely to receive medicines in line with need (Metcalf et al, 2018), and being more likely to be placed in seclusion (McLeod et al, 2017). People with mental health conditions are also more likely to experience discrimination, even within health care services, with Māori with mental health and substance use conditions were less likely than non-Māori with mental health and substance use conditions to report being treated with respect and listened to and were more likely to report experiencing unfair treatment (Cunningham et al, 2024).

Mental health outcomes are influenced by many of the determinants of health discussed in (the determinants of health section).

Between 2017 and 2022, 17.6% of Māori in the Ngāi Tahu Takiwā aged 15 years and older experienced high or very high levels of psychological distress, compared to 11% of non-Māori. The rate was even higher for Māori women, 22.2% of whom experienced high or very high psychological distress. Measuring prevalence of mental health problems can be difficult and for more detailed technical notes please refer to Te Tauraki Māori Health Profile – Volume Two.

Between 2017 and 2022, 38.5% of Māori aged 15 years and older within the Ngāi Tahu Takiwā were found to have a hazardous drinking pattern, in the previous year, according to data collected through the New Zealand Health Survey. This is 1.6 times higher than the rate of hazardous drinking amongst non-Māori in the Takiwā.

Episodic, or ‘binge drinking’, is also associated with a higher risk of experiencing alcohol related harm and of developing chronic health conditions. As with hazardous drinking, Māori within the Ngāi Tahu Takiwā were more likely to binge drink at least monthly than non-Māori (36.4% for Māori compared to 26.4% for non-Māori). The rate of heavy episodic drinking was highest for Māori males (45.8%).

There is less data available on the hazardous use of drugs other than alcohol. There is, however, some data on cannabis use. Between 2017 and 202, 34% of Māori aged 15 years and older in the Ngāi Tahu Takiwā reported they had used cannabis in the past year, which was nearly twice the rate of non-Māori.

Between 2020 and 2023 Māori within the Ngāi Tahu Takiwā were 1.8 times more likely than non-Māori to be hospitalised for any type of mental health or substance use disorder. The highest hospitalisation rates for Māori compared to non-Māori are for schizophrenia (3.4 times higher for Māori), and substance/alcohol use (2 times higher for Māori). As with much of the. Mental health data these should be interpreted with caution as data tends to be more incomplete for mental health conditions than for other health conditions – so the data may be underestimated. For more discussion on the quality of the mental health data, please see Te Tauraki Māori Health Profile, volume two.

Between 2020 and 2023, Māori aged 15 to 44 years in the Ngāi Tahu Takiwā were 1.5 times more likely to be hospitalised for intentional self-harm than non-Māori at the same age. The rate is higher for Māori women than it is for any other group.

One measure of mental health care is the prescription of medication. Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressant medication. Despite evidence suggesting Māori have a higher prevalence of depression, and likely higher need for medication, Māori in the Ngāi Tahu Takiwā aged 15 years and older were less likely to have regular SSRI medication than non-Māori. Medication is not the only treatment for depression, but this large ethnic difference in the rate of receiving antidepressant medication raises questions about access to and receipt of appropriate depression treatment for Māori in the Takiwā.