Addressing the health gaps between Maori and non-Maori: nurses--along with the rest of the community--have a responsibility to challenge the policies and practices that underpin health disparities.

FORUM GUEST speaker Bridget Robson, a researcher from the Eru Pomare Maori Health Research Centre at the Wellington School of Medicine, was invited to give a presentation on the context within which nurses and the Nursing Council did their work.

Her passion, she said, was researching the disparities in Maori health and identifying those factors that created and entrenched those disparities. Inequalities in mortality rates between Maori and non-Maori had been increasing since the 1980s. Most marked were the disparities in cardiovascular, cancer and accident death rates, which were continuing to increase. Deaths from cancer and cardiovascular disease were decreasing for non-Maori but increasing for Maori, despite the fact the rates of getting these diseases were similar. Suicide rates for 15-25-year-old males were increasing steadily for Maori but levelling off for non-Maori.

Robson believes the gaps could have closed in the 1970s, but a number of factors emerging during the 1980s prevented this possibility. A radical restructuring of the economy during those years saw 40,000 Maori lose their jobs, mainly from the manufacturing, freezing works and forestry sectors. "Maori were put out of work at three times the rate of non-Maori. Maori leaders warned the government at the time that Maori would be the shock absorbers of the new economy and this is exactly what happened. Market rentals were introduced, house prices went up and services in rural areas were reduced. Many jobs became temporary or casualised, with Maori being forced to pick up the more dangerous work. In 1991, there were tax cuts for the rich and benefit cuts for the poor, and the levels have still not been reinstated. For the first time, food banks appeared and the family benefit disappeared. Incomes for Maori dropped in the 1980s and 1990s, and have never returned to the early 1980s' level."

The health implications in the differences in living standards for Maori and non-Maori were very serious, said Robson. There were differences in disease incidence; differential access to health care and differences in the quality of care received. The majority of Maori babies were being born into risk conditions, with 40 percent of Maori children living in households dependent on benefits. While there was a lot of pressure to monitor the over-payment of benefits, there was little effort put into monitoring under-payment, with Maori receiving lower rates of special benefits than non-Maori.

Smoking rates only accounted for a quarter of the difference in mortality rates, said Robson. "It is also harder for people living in low income households to quit smoking and to stay quit. Maori contribute $200 million a year in tobacco tax compared to the $140 million-a-year budget for Maori health providers. Lifestyle factors cannot account for the widening gaps."

Robson discussed some of the difficulties Maori had accessing health care compared to non-Maori. "Cost prevents Maori from getting the care they need and there is often unequal treatment in areas of equal need. Pakeha, for example, receive far higher angioplasty procedures and bypass grafts than Maori."

Quoting United States health researcher Camara Jones, who spent some time in New Zealand in 1999 as an Ian Axford Fellow, Robson said socio-economic status should never be accepted as an "explanation" of Maori and non-Maori health disparities. It was not adequate to address the surface causes of the disparities; the root causes, which included racism, also needed to be addressed.

"We cannot carry on allowing these disparities to continue. We need to know how the disparities are maintained, and we need to challenge the policies and practices that underpin them, including our own. As individuals, professionals, whanau and communities, we need to mitigate, resist and undo these disparities. It will take effort and we need to work together to achieve results. As nursing educator Irihapeti Ramsden once said: 'What is there to fear in a healthy Maori population?'

Linking education and practice

The rest of the forum was dominated by an explanation of the HPCA by council chief executive Marion Clark, a discussion on the Council's competency assurance framework led by professional adviser Pam Doole, and a panel presentation and discussion on the interface between education and clinical practice. This was introduced by education adviser Angela Bradley. In accordance with the recommendations from the Strategic Review of Undergraduate Nursing Education, the Council was revising the curriculum framework and standards for undergraduate education, she said. Nursing literature also highlighted the need for greater linkages between education and health services through formal, collaborative and effective partnerships. "In some areas, good partnerships and good discussions are going on between clinicians and educators about curriculum development. This is what is needed everywhere. Nurse educators and experienced practitioners have a shared responsibility for the student learning experience," said Bradley.

Taking part in the panel discussion were programme manager for the bachelor of nursing programme at Otago Polytechnic's school of nursing Linda Kinniburgh, executive director of nursing and midwifery at the Auckland District Health Board Taima Campbell and manager of Access home health services in Northland, Mary Munn. Questions from the floor included several from members of NZNO's student unit, with others focusing on how clinical placements could be developed in the primary health sector.