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Background: Disparities in cardiovascular outcomes between Māori and non-Māori persist despite technological advances in the treatment of cardiovascular disease and improved service provision. Little is known about how social determinants of health, such as income [in]security affect Māori men's access, treatment, and recovery from cardiovascular disease. This paper explores the contexts within which cardiovascular disease is experienced and healthcare becomes embedded. Methods: This study utilized a case-comparative narrative approach to document and make sense of the patient experiences of four male Māori patients who, in the previous 6 months, had come through cardiac investigation and treatment at Waikato Hospital, a large tertiary cardiac center in New Zealand. Participant accounts were elicited using a culturally patterned narrative approach to case development, informed by Kaupapa Māori Research practices. It involved three repeat 1–3-hour interviews recorded with participants (12 interviews); the first interviews took place 5–16 weeks after surgery/discharge. Results: Each of the four case studies firstly details a serious cardiac event(s) before describing the varying levels of financial worry they experienced. Major financial disruptions to their lives were at the forefront of the concerns of those facing financial insecurity—as opposed to their medical problems. Financial hardship within the context of an unresponsive welfare system impacted the access to care and access to funding contributed to psychological distress for several participants. Economic security and reciprocal relationships between employers and employees facilitated positive treatment experiences and recovery. Conclusion: Findings suggest that although multiple factors influence participant experiences and treatment outcomes, financial [in]security, and personal income is a key determinant. The heterogeneity in participant narratives suggests that although general inequities in health may exist for Māori as a population group, these inequities do not appear to be uniform. We postulate diverse mechanisms, by which financial insecurity may adversely affect outcomes from treatment and demonstrate financial security as a significant determinant in allowing patients to respond to and recover from cardiovascular disease more effectively. [ABSTRACT FROM AUTHOR]

This paper sets out to identify the values and approaches that underpin effective Māori leadership for iwi who are looking to secure prosperity in a post-Treaty of Waitangi settlement era. We conduct face- to -face interviews with seven leaders from Waikato and Ngāi Tahu who have served as Chairs, Deputy Chairs, or CEOs in governance boards within the first five years of post-Treaty settlement or within the last five years. Through our interviews, we identified three core themes that provide the foundation to the strategies employed by iwi leaders to promote prosperity for their people: poipoia, pāhekoheko, and pono. We argue that these themes are important in the future development of effective iwi leaders. In particular, Ngāti Maniapoto, who recently settled historic Treaty breaches, are now focused on future progress and development, and may leverage on the experiences and advice of other iwi leaders who have already embarked on their post-settlement journey. [ABSTRACT FROM AUTHOR]

Aim School-based interventions to tackle the rise in childhood overweight and obesity remain inconclusive and are often limited in their application to diverse populations. To inform and measure the effect of the implementation of a primary school-based longitudinal randomised controlled nutrition and activity intervention, Project Energize, baseline measures of body size and blood pressure were required. Methods This cross-sectional study stratified by age, sex, ethnicity, rurality and school socio-economic-status (school- SES) measured body mass index ( BMI), percentage body fat (% BF), waist and resting blood pressure from 2752 5- and 10-year-old children (62% European, 31% Māori) representative of the Waikato region of New Zealand. Result Waikato children have a high prevalence of overweight and obesity that is linked with hypertension. Cardiovascular risk factors including raised blood pressure and hypertension, waist and arm circumference and percentage body fat (% BF) were more prevalent in 10-year-olds, lower school- SES and to some extent, urban living. In European children, BMI and waist circumference were similarly predictive of % BF, but for Māori children, waist circumference predicted % BF better than BMI. Conclusions A variety of stratified, baseline measurements is important when designing school-based interventions. In particular, waist circumference measures may be a more accurate predictor of % BF than BMI when determining measurement protocols that consider different ethnic groups and environments among children. The effect of targeted improvements of the school physical activity and nutrition environment on the rate of increase of weight, fatness and blood pressure in children should be examined. [ABSTRACT FROM AUTHOR]