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EDITORIAL
Dr Denise Wilson
Whanau Ora: Rethinking the way in which health services are delivered to Maori
There can be no arguing that Maori experience differential access to determinants of health and health care, and disparities in the quality of services they receive, despite health being a right of all citizens. These factors are out of the immediate control of individual Maori and their whanau. From a social justice perspective, inequities inhealth care and health outcomes are both unfair and unjust, and Whitehead (1992) claims they are “unnecessary and avoidable”. The continuance of disparities in the determinants, access and use, and quality of health care for Maori compared to others are unacceptable and needs to be at the top of health professionals’ and nursing’s agenda. More specifically for nursing, the agenda should be about how nurses can contribute to improving service and quality in health care delivery for Maori.
New Zealand is a small country and as such there is limited capacity to continually ncrease funding of health services and for this reason there is a political sense of urgency and an mperative to use the health dollar wisely. Yet some of the publicly funded targeted initiatives in mainstream health services have fallen short of improving access and outcomes for Maori. This, together with the health status of Maori, signals a need to critically look at how health professionals engage and work with Maori users of health services and their whanau.
Gareth Morgan’s and Geoff Simmons’ (2009) candid critique of our public health system flag Maori health as being the “biggest concern”. While acknowledging the gains that have been made in Maori life expectancy, they state emphatically:
. . more effort is needed, both to understand and to address the discrepancy. Quite apart from the fact that this is a significant part of our nation we’re letting down, Maori and Pacific peoples are an increasing proportion of the population. Their lower life expectancy will become more and more visible in our national statistics in coming years. Logically, a focus on Maori and Pacific health would also be more cost-effective than other areas that might be targeted for spending. (p. 108)
A similar sentiment was expressed by Des Gorman, at a recent meeting of the Ministry of Health’s Maori Nursing and Midwifery Clinical Leadership Advisory Group, about how little of the public health spending actually reaches Maori. Improvement in health outcomes of Maori cannot be changed without health professionals undertaking a socio-political and historical analysis of contemporary Maori health and health services, and realising that the current provision of ‘one size fits all’ services does not necessarily meet the needs of Maori health care users. The whanau ora policy directions provide health professionals, including nursing and midwifery, an opportunity to unreservedly explore alternative ways to deliver nursing care to Maori whanau.
Whanau ora, the ultimate goal of He Korowai Oranga (the Maori health strategy), (Ministry of Health, 2002), is about whanau and its individual members experiencing optimal health and wellbeing. The implementation of the whanau ora initiative will Nursing Praxis in New Zealand Vol. 25 No. 3 2009 Page require health professionals to rethink the way in which they engage with whanau and its individual members. Paternalistic and nurse-determined approaches will need to be set aside in order to work with and encourage whanau to identify and build on their existing strengths, and focus on outcomes. Nurses are well positioned to support the development of whanau capacity to prevent problems or crises, and manage any that may arise. Whanau ora is grounded in cultural beliefs and practices, a collective orientation, and the holistic, eco-spiritual worldview of many Maori. The predominate individual focus of care delivery that currently exists will need to be replaced by one that places the collective whanau and its individual member(s) seeking health care at the centre of nurses’ care delivery, so that their needs can be identified and met. This opportunity requires nurses along with other health professionals to revisit the fundamental values of our practice (such as client-centred care, caring, empowerment, and advocacy) and how these can be transformed from its rhetoric into the everyday practice of all nurses. The whanau ora policy directions should be a point of discussion among health service providers, nurses, and their local iwi. The outcome of such dialogue will help construct new ways for many nurses to practice.
Nurses have the potential to positively contribute to the development of whanau and the individual members. However, whanau ora requires nursing and nurses to revisit the way in which they work with Maori in order to keep whanau of central concern in their practice, and to facilitate their identification of the strengths they possess, and their holistic health needs in order to develop their capability and resources to optimise whanau health and wellbeing.
Denise Wilson, RN PhD FCNA(NZ)
Acting Editor-in-Chief
References:
Ministry of Health. (2002). He Korowai Oranga: The Maori Health Strategy.
Wellington, NZ: Author
Morgan, G., & Simmons, G. (2009). Health cheque: The truth we should all know
about New Zealand’s public health system. Auckland, NZ: Public Interest
Publishing.
Whitehead, M. (1992). The concepts and principles of equity and health.
International Journal of Health Services, 22, 429-445.
This edition of Nursing Praxis marks an end of an era. We wish to pay tribute to Tina Smith who has made a remarkable contribution to sustaining the existence of Nursing Praxis in New Zealand over many years. She has made a significant contribution of time and energy, and we are all grateful to her for handing over the journal to a renewed editorial group, and to launching the next phase of this nursing journal. We thank her sincerely and wish her all the best in her future endeavours.
Dr Denise Wilson (Acting Editor-in-Chief)
Dr Stephen Neville (Management Board)
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