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Exposure to stressful life events (SLE) around the time of pregnancy is associated with adverse health outcomes for mothers and children. Previous New Zealand research found Indigenous Māori women are more likely to be exposed to SLE than non-Māori, and are exposed to a higher number of SLE. The consequences of this for ethnic inequities in child health outcomes are unknown. This paper examines the relationship between patterns of maternal SLE exposure with child health and development outcomes at age 3 years, for Indigenous and non-Indigenous children. We found most children had a stressful early life environment at least sometimes, but more than a quarter of Māori children had a mother experiencing multiple SLE on all occasions measured. We found a clear association between maternal experiences of SLE and disordered child sleep and development concerns. While not able to fully assess the contribution of maternal SLE to ethnic inequities in child health outcomes, we did clearly demonstrate that more Māori children have mothers exposed to multiple SLE, and that these maternal SLE are associated with poorer child outcomes. The impacts of chronic SLE exposure need to be better understood, especially given the large ethnic disparity in chronic SLE exposure.

Abstract Hikitia te Ora (Certificate in Health Sciences) is a 1 year Indigenous bridging foundation programme at the University of Auckland, Aotearoa New Zealand. The programme aims to increase Māori and Pacific health workforce representation. This qualitative study applied a Kaupapa Māori positioning to elucidate the strengths, challenges, and opportunities of the programme. Data were collected through two workshops and seven focus groups with a total of 67 participants who were students of Hikitia te Ora from past and present cohorts, or their family members. Using a general inductive thematic analysis, the primary themes identified were that programme successes encompassed whanaungatanga (process of establishing relationships), academic and pastoral support, programme structure and the teaching content. Challenges included social cliques and divisive social groupings, timetabling of courses and high workloads. The three areas that emerged for further development include extending Pacific content, increasing the number of students in the programme, and maintaining a programme-specific study space for students. Implementing the findings from this study into Hikitia te Ora is expected to improve educational outcomes for Māori and Pacific students and may have the potential to benefit other bridging foundation courses aiming to promote Indigenous health workforce development.

In Aotearoa/New Zealand (NZ), the Indigenous Māori population have been more severely impacted than non-Māori throughout the COVID-19 pandemic, and less well served by NZ’s COVID-19 response. This case-study describes an innovative Indigenous-led service delivery model, which was designed and implemented to improve the case and contact management of Māori with COVID-19 in Auckland. We outline the context in which the conventional public health case and contact management was failing Māori and the factors which enabled Indigenous innovation and leadership. We describe the details of the model and how the approach fundamentally differed to the conventional approach to care. Qualitative and quantitative data on impact of the model are shared, along with the key barriers and enablers in the implementation of the model. The Māori Regional Coordination Hub (MRCH) model offers a valuable alternative to the conventional public health case and contact management approach, and this case study highlights lessons which may be applicable to improving the design and delivery of public health services to other Indigenous and marginalized groups.

Abstract Examining the pathways and causes of ethnic inequities in health is integral to devising effective interventions. Explanations set the scope for solutions. Understandings of ethnic health inequities are often situated in victim blaming and cultural deficit explanations, rather than in the root causes. For Indigenous populations, colonisation and racism are fundemental determinants of health inequities. Using a conceptual framework can support understanding of the fundamental causes of Indigenous health inequities. This article presents an Indigenous adaptation of the ‘Williams model’ for understanding the causes of racial/ethnic disparities in health. The Te Kupenga Hauora Māori modified model foregrounds colonisation as a critical determinant of health inequities, underpinning all levels from basic to surface causes. The modified model also attempts to reflect the dynamic interplay between causes at different levels, rather than a simple unidirectional relationship. We include the influence of worldviews/positioning as a cause and emphasise that privilege alongside racism plays a causative role in Indigenous health inequities. We also critique some of the limitations of this framework in reflecting the complex pathways of causation for ethnic health inequities, and indicate areas for further strengthening.

Objectives Despite significant international interest in the economic impacts of health inequities, few studies have quantified the costs associated with unfair and preventable ethnic/racial health inequities. This Indigenous-led study is the first to investigate health inequities between Māori and non-Māori adults in New Zealand (NZ) and estimate the economic costs associated with these differences.Design Retrospective cohort analysis. Quantitative epidemiological methods and ‘cost-of-illness’ (COI) methodology were employed, within a Kaupapa Māori theoretical framework.Setting Data for 2003–2014 were obtained from national data collections held by NZ government agencies, including hospitalisations, mortality, outpatient and primary care consultations, laboratory and pharmaceutical usage and accident claims.Participants All adults in NZ aged 15 years and above who had engagement with the health system between 2003 and 2014 (deidentified).Primary and secondary outcome measures Rates of ‘potentially avoidable’ hospitalisations and mortality as well as ‘excess or underutilisation’ of healthcare were calculated, as the difference between actual rates for Māori and the rate expected if Māori had the same rates as non-Māori. These differences were then quantified using COI methodology to estimate the financial cost of ethnic inequities.Results In this conservative estimate, health inequities between Māori and non-Māori adults cost NZ$863.3 million per year. Direct costs of NZ$39.9 million per year included costs from ambulatory sensitive hospitalisations and outpatient care, with cost savings from underutilisation of primary care. Indirect costs of NZ$823.4 million per year came from years of life lost and lost wages.Conclusions Indigenous adult health inequities in NZ create significant direct and indirect costs. The ‘cost of doing nothing’ is predominantly borne by Indigenous communities and society. The net cost of adult health inequities to the government conceals substantial savings to the government from underutilisation of primary care and accident/injury care.

Abstract Background Eliminating indigenous and ethnic health inequities requires addressing the determinants of health inequities which includes institutionalised racism, and ensuring a health care system that delivers appropriate and equitable care. There is growing recognition of the importance of cultural competency and cultural safety at both individual health practitioner and organisational levels to achieve equitable health care. Some jurisdictions have included cultural competency in health professional licensing legislation, health professional accreditation standards, and pre-service and in-service training programmes. However, there are mixed definitions and understandings of cultural competency and cultural safety, and how best to achieve them. Methods A literature review of 59 international articles on the definitions of cultural competency and cultural safety was undertaken. Findings were contextualised to the cultural competency legislation, statements and initiatives present within Aotearoa New Zealand, a national Symposium on Cultural Competence and Māori Health, convened by the Medical Council of New Zealand and Te Ohu Rata o Aotearoa – Māori Medical Practitioners Association (Te ORA) and consultation with Māori medical practitioners via Te ORA. Results Health practitioners, healthcare organisations and health systems need to be engaged in working towards cultural safety and critical consciousness. To do this, they must be prepared to critique the ‘taken for granted’ power structures and be prepared to challenge their own culture and cultural systems rather than prioritise becoming ‘competent’ in the cultures of others. The objective of cultural safety activities also needs to be clearly linked to achieving health equity. Healthcare organisations and authorities need to be held accountable for providing culturally safe care, as defined by patients and their communities, and as measured through progress towards achieving health equity. Conclusions A move to cultural safety rather than cultural competency is recommended. We propose a definition for cultural safety that we believe to be more fit for purpose in achieving health equity, and clarify the essential principles and practical steps to operationalise this approach in healthcare organisations and workforce development. The unintended consequences of a narrow or limited understanding of cultural competency are discussed, along with recommendations for how a broader conceptualisation of these terms is important.