š $9/hour nurses, mental wellness, diabetes management, lower inflation, and more
MÄori health research highlights from the past week
šš½ Kia ora, Iām George Gray, a public health physician doing my best to keep up with the latest health research that can help improve outcomes for MÄori.
This edition explores:
the need for better education about diabetes,
how AI agents might meet that need,
a prevention framework for better mental health outcomes,
improving our approach to alcohol policy and,
lower inflation.
š¬ The Latest Research
Can Better Education Empower WhÄnau to Tackle Type 2 Diabetes?
Crosswell, R., Norman, K., Cassim, S., Papa, V., Keenan, R., Paul, R., & Chepulis, L. (2024). Are patients with type 2 diabetes in the Waikato District provided with adequate education and support in primary care to self-manage their condition? A qualitative study. Journal of Primary Health Care, 16(1), 61ā69. https://doi.org/10.1071/hc23141
āI really needed to be talked through it. Itās alright reading pamphlets. But then you take them home, and you put them away, which is exactly what I did! Also, if someone had given me a DVD, or something like that, I would have come home and watched it on the TV so then I would have been able to go from there - because Iām visual, audio you know?ā
This recent study in the Waikato found that patients newly diagnosed with type 2 diabetes felt overwhelmed and under-informed, signalling a crucial need for enhanced patient education and support at diagnosis. The research recruited participants from MÄori providers and identified themes of ineffective resource provision, inadequate communication from healthcare professionals, and systemic barriers within the health service as significant challenges. Patients found the current primary care system inadequate when it comes to appointment scheduling, patient education, and communication. They preferred educational methods that were graphic, conversational, or imagery-based over traditional pamphlets. Tailored written information that considers individual and cultural contexts is necessary. The authors advocate for adopting culturally relevant resources, empathetic and patient-centred care, and minimising health system barriers. These solutions can help patients and their whÄnau to manage diabetes more effectively. This is especially relevant in type 2 diabetes, where early aggressive management may reverse the condition.
Better Mental Health for Rangatahi: An Equity Framework for Prevention
Fleming, T., Crengle, S., PeirisāJohn, R., Ball, J., Fortune, S., Yao, E. S., Latimer, C. L., Veukiso-Ulugia, A., & Clark, T. (2024). Priority actions for improving population youth mental health: An equity framework for Aotearoa New Zealand. Mental Health & Prevention, 200340. https://doi.org/10.1016/j.mhp.2024.200340
This article discusses the increasing prevalence of mental health issues among young people in Aotearoa, particularly focusing on disparities faced by MÄori, Pacific, and other populations. It highlights the rapid increase in mental health needs since 2012 - the figure above shows the trend in depressive symptoms for rangatahi in Aotearoa. MÄori youth have elevated exposure to the risk factors for compromised mental health; accordingly, the authors emphasise the need for addressing the social determinants of health, inequities in access to care, and the limitations of treatment in reducing population rates of distress. The authors reiterate that a disproportionate focus on better treatment (tertiary prevention) has little impact on prevalence at a population level. The article proposes a framework (Te Mauri) for improving youth mental health through prevention efforts based on global prevention models and emphasises the importance of equity and inclusion. View the infographic abstract here.
Can Policy Reforms Bridge the Gap in Alcohol Harm for MÄori?
Darrah, T., Herbert, S., & Chambers, T. L. (2024). A thematic analysis of alcohol and alcohol-related harm across health and social policy in Aotearoa New Zealand. Australian and New Zealand Journal of Public Health, 48(2), 100143. https://doi.org/10.1016/j.anzjph.2024.100143
This article explores the framing of alcohol and alcohol-related harm in health and social policy documents in Aotearoa, pointing out the impact on the MÄori population. It highlights the persistent high rates of alcohol harm, the failure to address systemic drivers of alcohol consumption, and the lack of alignment with the WHO SAFER framework in policy recommendations. The SAFER framework encompasses: tightening regulations on alcohol availability; promoting and enforcing measures against drink driving; improving access to screening, brief intervention, and treatment; implementing bans or extensive restrictions on alcohol marketing, sponsorship, and promotion; and increasing alcohol prices through excise taxes and pricing policies. In this framework, price, availability, and marketing are considered the most cost-effective policies, known as 'best buys'. The authors note that misalignment of domestic alcohol policy with the SAFER framework may be due in part to the lack of a current national alcohol strategy (NAS). A revised NAS should incorporate partnership with MÄori in its design, and should designate accountable organisations, establish a structured monitoring and evaluation system, and adhere to the WHO SAFER framework. The last Aotearoa NAS was published in 2003.
Unlocking Better Mental Health Outcomes for MÄori Rangatahi: Are We Doing Enough?
Sutcliffe K, Wilson M, Clark TC, Crengle S, Fleming T (Theresa). Distinct profiles of mental health need and high need overall among New Zealand adolescents ā Cluster analysis of population survey data. Australian & New Zealand Journal of Psychiatry. 2024;0(0). doi:10.1177/00048674241243262
This analysis of data from the Youth19 Rangatahi Survey has unveiled useful insights into the mental health landscape of Aotearoa's young people, with implications for MÄori rangatahi. The study retrospectively analysed self-reported data from 7,721 individuals aged 13-18 years, revealing five distinct mental health clusters, including healthy (40%), anxious (28%), stressed and hurting (9%), distressed and ideating (16%), and the severe cluster (6%). The research highlighted a disproportionate representation of MÄori in higher severity clusters, suggesting a pressing need for affordable, accessible health services and culturally centred, holistic health models for these rangatahi. The study advocates for immediate, scalable mental health services tailored to the unique needs of MÄori youth, emphasising the integration of traditional practices and community support.
Can Equitable Surgical Care Reach MÄori Communities in Aotearoa?
Koea, J., Chao, P., Srinivasa, S., & Gurney, J. (2024). Upper gastrointestinal and hepatopancreaticobiliary surgery in New Zealand: Balancing the volumeāoutcome relationship with accessibility in a surgically low volume country. World Journal of Surgery. https://doi.org/10.1002/wjs.12174
This study examined the provision of complex upper gastrointestinal and hepatopancreaticobiliary (HPB) surgical care in Aotearoa, revealing a pattern of treatment that often sees MÄori patients accessing services outside major cancer centres. MÄori are more likely to live in rural areas compared with the New Zealand European population; this introduces challenges to access HPB surgery, which is mainly provided in main centres. The authors point out that regional facilities may be less well-resourced and perform HPB surgery less frequently, potentially influencing postoperative outcomes. The findings prompt the need to consider integrating more complex surgical services into regional centres, enhancing local healthcare capabilities, and ensuring equitable access to high-quality care across Aotearoa's diverse communities.
How Can Transport Accessibility Improve Health and Wellbeing?
Russell, E., McKerchar, C., Berghan, J., Curl, A., & Fitt, H. (2024). Considering the importance of transport to the wellbeing of MÄori social housing residents. Journal of Transport & Health, 36, 101809. https://doi.org/10.1016/j.jth.2024.101809
In this recent study conducted in Åtautahi/Christchurch, researchers unearthed the important role of transport in the lives of MÄori social housing residents, underscoring it as a lifeline to essential services, whÄnau, and cultural roots. The investigation revealed that inadequate transport options significantly hinder the residents' ability to maintain social connections and access health services, which are vital for their wellbeing. The study advocates for transport systems co-designed with MÄori, ensuring solutions are accessible and equitable. Health professionals and policymakers are asked to consider these findings, recognising that facilitating better transport access is integral to improving health outcomes.
Can Institutional Pathways Transform Psychosis Outcomes for MÄori?
Manuel, J., Crengle, S., Crowe, M., Lacey, C., Cunningham, R., Clark, M. T. R., Deen, F. S. P. D., Richard, J., & Pitama, S. (2024). Institutional pathways to psychosis for Indigenous MÄori: A qualitative exploration of experiences. SSM. Qualitative Research in Health, 100435. https://doi.org/10.1016/j.ssmqr.2024.100435
āI understand that that place is pretty much just slaps a band aid on you, get in, here you go, in you come, boom, hereās some meds, but donāt figure out how to use them.ā
This recent qualitative study explored the institutional experiences of 23 MÄori young people after a first episode of psychosis (FEP), unearthing key systemic barriers within health, social, and justice systems. The research incorporated perspectives from affected youth, their whÄnau, and health professionals and pinpointed critical junctures where intervention could be optimised. A standout finding was the pressing need for family-centric approaches, aligning with the MÄori value of whanaungatanga, to mitigate disparities in psychosis outcomes. Participants frequently felt they were processed rapidly through the health system based on threat or risk rather than having their clinical and social needs identified and addressed. The study advocates for a shift towards holistic, family-oriented models of care, and integrated cross-sector social-support responses.
š Chart of the Week
š° Annual inflation slowed to 4% for the 12-months ending March 2024. This represents a continuing decline since a peak of 7.3% in June 2022. The Reserve Bank has a target range of 1-3% inflation. Overall, the lower inflation rate is positive for whÄnau because it is associated with lower increases in costs for food, transport, and other items.
StatsNZ summarised inflation in selected comparison nations:
However, despite the decrease in overall inflation, rent prices are increasing at a rapid rate. Rental prices increased 4.7% for the year ending March 2024 - this is the highest rate since recording began in 1999.
ā In Brief
š”ļø The Ministry of Health published its greenhouse gas emissions report and inventory for the 22/23 financial year. The leading contributor to emissions at the organisation is air travel (pg 13), but this trend is down compared with past years.
šØ Greenhouse gas emissions fell at a national for the third year in a row to calendar year 2022, reaching the lowest of any year since 2000. For an easy win, if you havenāt already, switch your electricity retailer to a provider that uses 100% renewable sources. Iām with Mercury.
š® Gaming health targets can be prevented - now that Health Targets will return in July, itās a good time to reflect on unintended consequences and how these can be avoided so that tangible performance is sustained. This article from 2020 outlines how gaming emerged with Emergency Department attendance and how it can be avoided in future. An earlier article from 2011 described target gaming too.
š„ Waikato University graduates first cohort of nurses - The first cohort of Waikato Universityās nursing program graduated recently. The program started during the pandemic and forms part of the solution to the nursing shortage.
š Global Burden of Disease Project released its update to 2021, emphasising that populations are living longer but not necessarily in good health due to the rise of non-communicable diseases. Compared to men, women are more likely to be impacted by Long Covid and the mental health consequences of the pandemic.
š» Nurse AI assistants have been developed by Hippocratic AI and NVIDIA - the agents have been built on a medical large language model called Polaris. Evaluation by human nurses and doctors found the agents equivalent or better than humans on some tasks. The agents cost USD$9 per hour (or less) and have been built to perform administrative tasks such as explaining lab results, or how to take new medications. The agents are not suitable for diagnostic tasks. These tools have the potential to address nursing workforce shortages, provide the diabetes education that was highlighted in the first article of this newsletter, increase accessibility, and free up human nurses to perform tasks higher on the Porter value chain. The agent marketplace can be viewed here. The video below demonstrates an agent interacting with a client.
š§ Deciding whether to use AI in healthcare - Yeah or Nah? Using the agents described in the previous point is a challenging decision. The two perspectives are explored in the latest Journal of Primary Health Care. Reasons we should are described here, while Luke Braford explains why primary care clinicians should not use these tools.
š¬ End Notes
š Could you please answer a quick question? Iād really appreciate your feedback. Click this link and tell us: how likely are you to recommend this newsletter to a friend or colleague?