Case study 1 improving health and raising equality in the Bay of Plenty – Toi Ora Māori Health Planning and Funding Unit General Manager Janet McLean (left) with Rūnanga Chair Punohu McCausland. The...

Case study 1


improving health and raising equality in the Bay of Plenty – Toi Ora


Māori Health Planning and Funding Unit General Manager Janet McLean (left) with Rūnanga Chair Punohu McCausland.
The Māori population is spread across the whole Bay of Plenty and encompasses 18 iwi (an iwi is a Māori tribe). This is the highest number of iwi compared with any other District Health Board (DHB). Māori represent approximately 26% of the Bay of Plenty population; the national average is 15%. There are a number of health-related inequalities between Māori and non-Māori in the Bay of Plenty. The Toi Ora initiative aims for optimum health and wellbeing for Māori, and has been a strategic priority for the Bay of Plenty District Health Board since 2001.
This initiative has adopted approaches based on Māori culture and there has been a more ready acceptance of the health messages and input into the wellbeing of Māori communities. However, use of culturally based approaches has been challenging; this is because Māori initiatives are often seen as separatism. To address this, the emphasis in Toi Ora has been about working closely with the sector as a whole and emphasising how reducing inequalities for Māori is good for the whole population. McLean (pictured above) talks about how focusing solely on the most disadvantaged will not reduce health inequalities. Rather, actions need to be taken on a scale and intensity proportionate to the level of need. She gives the example of immunisation; while the majority of children will be immunised by their general practice staff or in the hospital environment, some children and families may need additional support or targeted interventions such as outreach immunisation. The target for 8-month-old child immunisation is set at 95% as this is the level required to stop outbreaks of disease. So far, additional support and targeted interventions have been successful; in July 2014, 83% of Māori 8-month-olds in the Bay of Plenty were immunised. By December 2014, this rate had risen to 89% compared with 88% of non-Maori. This means that more Māori children have been immunised and, importantly, this has closed the inequality gap.
Another significant challenge was ensuring Māori were not operating in isolation but connected and working closely with general practitioners, community nurses and local pharmacies. Essential to addressing this challenge is to remember the importance of a sense of autonomy, self-determination and self-management in a Māori community.
The Toi Ora team is not resting on its laurels and wants to continue reducing health inequalities more quickly. For example, the national cervical screening target is 80%. Non-Māori in the Bay of Plenty currently have a cervical screening rate of 84% compared with 63% for Māori. Over the past two years, there has been a 4% improvement, and McLean states, ‘We want to accelerate that.’ McLean also talks about placing more emphasis on approaches driven by Māori cultural values and working across agencies to bring about change. The current priorities include rheumatic fever, respiratory conditions and skin infections. As some of these concerns are linked to poor housing conditions including lack of insulation, there will be a drive to get the health sector to work more closely with other agencies in the community.
(adapted from Ombler, 2013)