š Improving breast cancer treatment; vision health access; navigating the health system; 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. Hereās what Iāve learned this weekā¦
š¬ The Latest Research
How can people with cancer navigate the healthcare system to access diagnosis and treatment effectively?
Dew, K., Chamberlain, K., Egan, R., Broom, A., Dennett, E., & Cunningham, C. (2024). Accessing diagnosis and treatment: The experience of cancer as wrangling with the system. SSM - Qualitative Research in Health, 5, 100418. https://doi.org/10.1016/j.ssmqr.2024.100418
This article explores the experiences of people who have survived cancer in Aotearoa, highlighting their challenges in accessing diagnosis and treatment. The study interviewed 81 individuals who surpassed clinical expectations in surviving cancer, revealing their strategies for navigating institutional and structural constraints. The concept of "wrangling" emerged, illustrating the complex practices patients employed beyond clinical settings. Key findings highlight the importance of cultural health capital, whÄnau support, financial resources, and social support in accessing necessary care. The study highlights the significant capabilities and capacity that individuals needed in order to wrangle with the health system to meet some of their healthcare needs. The ability to do so is limited by socioeconomic status, discretionary time, education, whÄnau support, and social connections. By learning from individualsā experiences with these challenges, we can empower MÄori and others with cancer to effectively access the care they need.
Addressing Micronutrient Deficiencies: A Key to Optimising Bariatric Surgery ?
Jeram, M., Coomarasamy, C., & MacCormick, A. D. (2024). Prevalence of micronutrient deficiencies in preoperative bariatric patients in a New Zealand tertiary centre. Obesity Surgery. https://doi.org/10.1007/s11695-024-07170-z
Researchers in this study examined the micronutrient profiles of preoperative bariatric patients, uncovering disparities amongst different ethnic groups. Micronutrient deficiencies are a potential complication of bariatric surgery and any pre-exisiting deficits might be exacerbated by surgery. Vitamin D and iron deficiencies were common, with 32% of MÄori patients exhibiting vitamin D deficiency and 28% having iron deficiency. The odds ratio of deficiency for MÄori participants was 1.78 that of NZ/Other Europeans in the study. These findings underscore the necessity for targeted nutritional interventions, particularly as they pertain to the MÄori community. Health professionals are encouraged to consider preoperative micronutrient supplementation as a proactive measure to enhance the wellbeing of MÄori and other patients awaiting bariatric surgery. By doing so, they can potentially mitigate the risk of postoperative complications and contribute to more favourable health outcomes.
Enhancing Maternal Mental Health in Aotearoa: A WCTO Service Perspective
Clapham, B., Breheny, M., Reweti, A., Severinsen, C., & Ware, F. (2024). Missed Opportunities for Addressing Maternal Mental Health: A thematic analysis of Mothersā experiences of using the Well Child Tamariki Ora Service in Aotearoa NZ. Health & Social Care in the Community, 2024, 1ā10. https://doi.org/10.1155/2024/5890641
This study examined the experiences of mothers using the Well Child Tamariki Ora (WCTO) service, revealing important unmet maternal mental health needs. The research analysed 125 narratives collected via the online WÄhi KÅrero site. Key themes included 1) mothers' fear about not coping and apprehension about judgment, 2) a yearning for meaningful connections with WCTO nurses, and 3) a call for comprehensive support encompassing maternal mental well-being. These findings highlight opportunities to provide greater support to mothers, along with the benefits of culturally attuned care for MÄori and Pacific mothers. This study advocates for a reimagined WCTO service that places equal emphasis on the mental health of mothers as it does on child welfare, potentially improving the post-natal journey for mothers. In addition, those seeking feedback from health system users or those collecting whÄnau voice might consider the WÄhi KÅrero site for collecting feedback.
Differences in Breast Cancer Treatment: Results by Ethnicity
Boyle, L., Lawrenson, R., Nosa, V. et al. Ethnic inequities in use of breast conserving surgery and radiation therapy in Aotearoa/New Zealand: which factors contribute?. Breast Cancer Res Treat (2024). https://doi.org/10.1007/s10549-024-07289-8
This recent study examined ethnic disparities in breast cancer surgery and radiotherapy (RT) among women with early-stage breast cancer. The study found that over one-third of women eligible for breast-conserving surgery (BCS) instead underwent mastectomy. After adjustment for a range of factors, mastectomy was more likely among Asian women (OR 1.62), and MÄori women in the public system (OR 1.21) compared to New Zealand European (NZE) women. Pacific women were less likely to receive RT (OR 0.64) following BCS than NZE women, as were MÄori women in the private system (OR 0.62). The authors highlight the importance of standardising the treatment of early-stage breast cancer to promote fairness in surgical care, especially ensuring equal access to treatment in both public and private healthcare settings.
Vision Health Equity in Aotearoa: A Closer Look at Access for MÄori
Rogers, J. T., Black, J., Harwood, M., Wilkinson, B., Kandel, H., & Ramke, J. (2024). Vision impairment and differential access to eye health services in Aotearoa New Zealand: a scoping review. BMJ Public Health. https://doi.org/10.1136/bmjph-2023-000313
A recent scoping review has highlighted the disparities in vision impairment and access to eye health services for MÄori in Aotearoa. The study included published research up to October 2022, and quantified the differences in access and outcomes that MÄori and Pacific Peoples have for eye health, particularly for conditions like diabetic retinopathy, glaucoma, and cataracts (see Table 2 in the journal article). MÄori were under-represented in services provided for each of these conditions but this was not due to better preventative care or lower prevalence. MÄori presented with cataracts ten years earlier and with worse visual acuity; diabetic retinopathy was also more common and more likely to be moderate or severe. WHO has a goal of universal health coverage, but Aotearoa needs to improve access to eye health services to achieve this goal; this review summarised the evidence that might support these efforts along with opportunities to enhance the available evidence. These opportunities include addressing the lack of evidence on services for uncorrected refractive error, ensuring consistent reporting on priority outcomes, identifying barriers and facilitators of access to eye health services, and developing and assessing strategies to improve access to services and overall eye health. This information can be used by policymakers and providers to address eye health needs.
š Chart of the Week
š” Primary Care - Last week Te Whatu Ora published the quarterly performance report for October-December 2023. 81% of tamariki were fully immunised by 24 months of age, down from 83% last quarter. 65.1% of MÄori tamariki were fully immunised at 24 months. As mentioned in a past newsletter, from 1 April (yesterday) childrenās vaccinations can now be given in (participating) pharmacies.
ā In Brief
š¦ The Public Health Communication Centre published a briefing on Long Covid last week. The prevalence of Long Covid ranges from 4-14% and a wide spectrum of symptoms and severity are seen. Vaccination reduces the risk of Long Covid. Three key recommendations were provided by the authors.
š A South Auckland school-based vision testing project led by Auckland University provided extensive eye health checks and other services as part of a kaupapa MÄori-based health day. Glasses were prescribed for 8% of the school, vs 1% prior to the visit. The glasses were provided at no cost. Based on these results, planners, providers, and policymakers in other areas may wish to support vision checks and eye health for school students.
š Pharmac continues to support pharmacy students with scholarships. The scholarships have been available since 2008 and close in October for pharmacy students.
š Health travel subsidy funding has been provided to help patients and whÄnau travel for care, and the amounts provided will increase shortly. The support amounts have been unchanged since 2009, and the administration required to receive them has been challenging.
š½ļø Tomaiora held a webinar last week on the history and application of equity in health. if you missed it, you can view it here; my notes are available here.
š¬ End Notes
š Can you answer a quick question? Click this link and tell us: how likely are you to recommend this newsletter to a friend or colleague?