health & science

Frustrations rising over Pasifika health inequities

Pasifika leaders are concerned at the state of poor health outcomes, and question whether there is enough focus from Government and DHBs, Laura Walters reports

Pacific people are facing some of the worst health outcomes in the country but feel like there is not enough focus and money going towards fixing the problems.

Last week, Newsroom reported allegations of a questionable tender process and conflicts of interest over the allocation of $1.3m of discretionary funding awarded by Capital & Coast DHB (CCDHB).

While $1.3m might not sound like a lot, Newsroom understands it is the only discretionary funding that’s been made available purely for Pacific health initiatives in the CCDHB area.

Those running a Pasifika practice in Porirua, an area with a high population of Pasifika people – similar to South Auckland – say that $1.3m could have made a real difference if it was put into an existing practice.

The criticisms over the funding allocation come as the country grapples with rising health inequities, particularly for Māori and Pasifika people.

While there has been a strong focus on Māori health, which is sorely needed, some in the Pasifika community feel they are being overlooked.

Pacific people in New Zealand die almost a decade younger than non-Pacific, non-Māori people. They develop type 2 diabetes younger and at a higher rate.

They have also been the ones to bear the brunt of the measles outbreak.

“We come from an obedient, feudal society where we very much rely on our chiefs; our ministers to do the talking. But they’re not doing the talking for us. In fact, they’re doing the opposite of what they should be doing. They’re saying: ‘let’s concentrate on our language and our culture’, meanwhile people are dying."

One person described it as being treated as the “poor cousin”. Of course tangata whenua should want better outcomes that what has resulted from colonisation. However, the same "deficit thinking", and Māori lens would not work for Pacific people, they said.

Meanwhile, there is frustration at the Government’s focus and funding on language and culture, over and above health and housing.

Millions has been dedicated to language and culture funds – Pacific Peoples Minister Aupito William Sio announced another fund this week - and millions more has gone to employment programmes based in regions with low Pasifika populations.

Those at the coalface said this was not enough.

John Fiso, a businessman of Samoan descent, has decided to speak up in an effort to get more funding and more action.

“We come from an obedient, feudal society where we very much rely on our chiefs; our ministers to do the talking. But they’re not doing the talking for us. In fact, they’re doing the opposite of what they should be doing.

“They’re saying: ‘let’s concentrate on our language and our culture’, meanwhile people are dying...

“Meanwhile, housing, education and everything else is going down the gurgler....

“I recognise a lot of our people can’t do the talking because they’re in jobs that they need.

“On the other hand, I’m not getting employed by the DHB, and to be honest I’m quite happy to be an advocate for things when they’re not quite right.”

Pacific Health Plus has a Pacific population of more than 80 percent, with more than 93 percent of patients being high-needs. Patients have complex needs and can't afford to pay their bills, but those who work and own the primary health organisation say this isn't recognised in their funding. Photo: Laura Walters

In 2018, Fiso purchased what’s now Pacific Health Plus in Cannons Creek, Porirua.

When he took over the clinic, which sits between a burnt-out pub and an earthquake-prone laundromat, there was a hole in the ceiling, caused by a leak. It was on the brink of bankruptcy.

A year on, he’s fighting for a shot at more funding, in order to respond to the health needs in his community, while also using innovative and collaborative ideas to educate Pacific people and change their lifestyles.

Of a total enrolled population of 2190 at the practice, 1775 are Pasifika (81 percent). The proportion of high-needs patients at the practice is 93.7 percent – the highest of all the high-needs, low-cost practices in the region.

Currently, Pacific Health Plus is funded at $280 per patient, which doesn’t recognise the resources that go into dealing with multiple, complex health needs.

While the Very Low Cost Access scheme and the capitation funding model was put in place to help practices like Pacific Health Plus and the local Porirua Union Community Health Service, they aren’t fit for purpose.

Those who spoke to Newsroom said this was contributing to widening inequities.

“We have a very sick population,” one person who works with Pacific people said to Newsroom – she did not want to be named.

“What we’re saying is our people are dying, for goodness’ sake.”

At CCDHB, life expectancy is estimated to be eight years lower than for non-Māori non-Pacific peoples (76 versus 84 years). This gap in life expectancy has not narrowed over the past 10 years.

Pacific people have high preventable hospital admission rates, and high rates of diabetes and metabolic disease.

The prevalence of type 2 diabetes is considerably higher in Porirua than in other areas in the Wellington Region. The number of young people with type 2 diabetes is also rising.

It’s a similar story in South Auckland. Within Counties Manukau DHB, diabetes prevalence was highest among Pacific people at 13.9 percent.

The New Zealand Health Survey showed life expectancy at birth was improving for Pasifika across the country, however, it remained significantly lower than for the general population: 78.7 years for Pacific females and 74.5 years for Pacific males, compared with 83.2 years for females and 79.5 years for males in the total New Zealand population.

At CCDHB which covers Fiso’s practice, life expectancy is estimated to be eight years lower than for non-Māori non-Pacific peoples (76 versus 84 years). This gap in life expectancy has not narrowed over the past 10 years.

CCDHB’s Pacific population health profile equity report from November said: “There are marked and long-standing inequities in health outcomes between Pacific and non-Māori non-Pacific peoples. These inequities are driven by a higher prevalence of risk factors and long-term conditions and poorer access to primary health care.”

Determinants of Pacific poor health are complex and numerous, including economic and socio-cultural factors, as well as education and employment status.

Risk factors include crowded homes, poor nutrition, lack of physical activity, hazardous drinking and smoking.

Pacific leaders say its children, like Anzac, who have to be front of mind when making decisions about Pasifika health. Photo: Laura Walters

In order to address the drivers of poor health outcomes, there needs to be better education and lifestyle changes.

Fiso, and other Pacific people who spoke to Newsroom, said this meant Pasifika creating solutions and programmes for Pasifika.

“I note that Pacific people’s culture and language has a huge influence on our worldviews and our choices in managing health and wellbeing. Maintaining Pacific languages contributes to improved health literacy and the ability of Pacific people to effectively navigate the health system.”

One of the Government’s five priorities for its inaugural Wellbeing Budget was a focus on delivering for Māori and Pasifika – again, the two were put into the same category.

Associate Minister of Health – responsible for Pasifika health – Jenny Salesa said the Government was delivering on its promise.

Salesa said the evidence showed Pacific health issues could be similar to those experienced by Māori, but the Ministry of Health addressed them separately through different strategies, policies and budget allocations.

The kinds of programmes developed and delivered were culturally appropriate, she said.

In response to the criticism by some that too much attention and money was being spent on language, rather than health and housing, Salesa said: “I note that Pacific people’s culture and language has a huge influence on our worldviews and our choices in managing health and wellbeing. Maintaining Pacific languages contributes to improved health literacy and the ability of Pacific people to effectively navigate the health system.”

Budget 2019 included $61 million for Pacific health over four years, with $25m for Pacific-specific mental health and addiction support, almost $10 million for the Pacific Community Health Fund, $12 million for Rheumatic Fever, another $10 million to grow the Pacific health workforce pipeline, and $4.3 million of new money for wraparound support services for Pacific nursing and midwifery undergraduates.

Associate Health Minister Jenny sales says the Government is delivering on its promises to Pacific people, at that includes when it comes to health. Photo: Lynn Grieveson

Salesa also pointed out the Ministry of Health had a dedicated Pacific health team to improve access and outcomes, and the new Pacific Action Plan was currently being finalised.

DHBs around the country have their own Pacific plans. Counties Manukau has its statement of intent from 2018-2022, which includes plans to reduce health inequities, and a Pacific Health Plan that expired in 2018.

CCDHB has a Pacific Action Plan out to 2020, and it is soon to announce a refresh of the plan that encompasses CCDHB and Hutt Valley DHB.

The DHB's executive director of strategy, innovation and performance Rachel Haggerty said prioritisation of new and existing funding in future years will have a greater focus in 2020/21 on improving equity for Māori, and also Pacific, as part of the implementing a pro-equity commissioning approach.

In 2019, CCDHB commissioned a Pacific population profile to better understand the specific health needs of the Pacific community in the region to better inform future prioritisation decisions.

And in 2020 it planned that all investment decisions would have a pro-equity approach.

“This starts with equity for Maori and includes Pasifika, those with disabilities, those with enduring illness and addiction, those who experience poverty, and the LGBTQI community,” Haggerty said.

* You can read Newsroom's coverage of concerns over conflicts with Pasifika health funding here.

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