š Interactive Maps Highlight Need, AI Solutions in Asthma Care, Growing MÄori Medical Workforce, Rising Home Ownership, 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 to help improve outcomes for MÄori.
The topics covered this week include:
New maps show where health services need support
Census shows better housing quality across Aotearoa
MÄori doctor numbers continue steady growth
AI could help manage asthma attacks better
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š My dashboard has been updated with the new Q4 health system results.
š¬ The Latest Research
šŗļø Can Interactive Maps Help Us Understand MÄori Vaccination Rates?
tldr: Rural MÄori communities showed significant variation in COVID-19 vaccination uptake patterns.
Miller, R., Davie, G., Crengle, S., Liepins, T., Clay, L., Whitehead, J., Taafaki, J., de Graaf, B., & Nixon, G. (2024). Development of an Interactive Web App to Examine Rural-Urban Variation in COVID-19 Vaccination Rates and to Inform Case Study Site Selection. New Zealand Population Review, 50, 325-351.
Researchers developed an interactive web application to analyse COVID-19 vaccination patterns across Aotearoa, revealing significant variations in rural MÄori communities' vaccination rates. The study found that while some rural areas with high MÄori populations achieved strong vaccination rates, most lagged behind urban areas. For example, in neighbouring rural communities, vaccination rates varied from 80% to 60%. The Health Service User dataset undercounted MÄori by 9%, highlighting systemic data challenges. This research is especially relevant now; healthcare providers can use these tools to identify areas needing targeted support, as well as their clinic and pharmacy access, and develop locally appropriate vaccination strategies. This may help providers lift vaccination rates among tamariki. The findings emphasise the importance of empowering local health services and addressing barriers in rural healthcare delivery.
š„ Are MÄori Getting Equal Access to Sinus Surgery in Aotearoa?
tldr: Study reveals potential barriers for MÄori accessing endoscopic sinus surgery services.
Kumar, A. R., van der Werf, B., Chiang, A., Exeter, D. J., & Wood, A. J. (2024). Access to Endoscopic Sinus Surgery: Effects of Ethnicity and Deprivation Status in the Waikato Region, New Zealand. New Zealand Population Review, 50, 125-144.
This Waikato-based study examined equity in access to endoscopic sinus surgery (ESS) between 2017-2019. While MÄori comprised 24% of the Waikato population, they represented only 18% of ESS patients. The research found no significant differences in waiting times or travel distances between ethnicities once referred. However, the underrepresentation of MÄori patients suggests barriers may exist at the primary care level. Healthcare providers can improve outcomes by reviewing PHO enrolment in their area, referral patterns, ensuring culturally appropriate care pathways, and actively monitoring representation by ethnicity in surgical cases. The study also highlighted the need for further research into chronic rhinosinusitis prevalence and severity among MÄori populations.
š How Healthy Are The Environments Where Tamariki And Rangatahi Live?
tldr: MÄori youth have good access to greenspace but face significant deprivation challenges.
Wiki, J., Theodore, R., Marek, L., Hobbs, M., Ruhe, T., Kokaua, J., Boden, J., Thabrew, H., Hetrick, S., Milne, B., & Bowden, N. (2024). How healthy are the environments of tamariki and rangatahi MÄori in Aotearoa New Zealand? A nationwide cross-sectional geospatial study. New Zealand Population Review, 50, 71-98.
This nationwide geospatial study examined environmental influences on health outcomes for tamariki and rangatahi MÄori. The research found that while MÄori youth had better access to greenspace, bluespace, and fruit and vegetable stores than non-MÄori/non-Pacific youth, they faced significant socioeconomic challenges, with 53.27% living in the three most-deprived deciles. The study highlighted that access alone doesn't ensure positive health outcomes; quality, safety, and affordability also matter. Health professionals and policymakers should focus on improving the quality and usability of health-promoting environments while addressing broader socioeconomic inequities. Creating healthier communities requires consideration of both environmental access and social determinants of health.
š« Can AI improve asthma management for MÄori?
tldr: MÄori perspectives crucial for developing culturally sensitive AI in asthma care.
Jayamini, W. K. D., Mirza, F., Bidois-Putt, M. C., Naeem, M. A., & Chan, A. H. Y. (2024). Perceptions Toward Using Artificial Intelligence and Technology for Asthma Attack Risk Prediction: Qualitative Exploration of MÄori Views. JMIR Formative Research, 8, e59811. https://doi.org/10.2196/59811
This study explored MÄori perspectives on using artificial intelligence (AI) for asthma management in Aotearoa. Researchers interviewed 20 MÄori participants, identifying four key themes: concerns about AI use, interest in technology, desired AI system characteristics, and experiences with asthma management. Participants expressed trust issues and the need for face-to-face interactions but showed interest in technology's potential benefits. They emphasised the importance of simple, user-friendly systems. The study highlighted the need for more information about AI in MÄori communities and culturally sensitive healthcare. To improve outcomes, health professionals should prioritise clear communication about AI benefits, ensure culturally appropriate implementation, and involve MÄori in AI system design for asthma management.
āļø Letters
š¬ PSA testing concerns
tldr: PSA screening benefits for MÄori men likely overestimated due to ignored biases and overlooked risks.
McLeod, M., Loring, B. Letter to the editor for the article āThe impact of non-structured PSA testing on prostate cancer-specific mortality on New Zealand MÄori menā. World J Urol 42, 628 (2024). https://doi.org/10.1007/s00345-024-05327-0
āļø A follow-up letter was published in response to a past article that noted a survival benefit for MÄori men who had regular prostate-specific antigen (PSA) testing. The letter is paywalled, but the authors note that the original study ignored crucial 'lead time bias' (finding cancer earlier) and 'length bias' (detecting slower-growing cancers). They argue that these biases, rather than true benefits, explain why screened men appeared to have better survival rates. The research also failed to consider important downsides like complications from unnecessary biopsies and treatments. Promoting screening without accounting for these biases and harms could lead to misguided health policies.
š Chart of the Week
š Living costs rise 3.8% in Aotearoa households - Stats NZ reported that the average household in Aotearoa experienced a 3.8% increase in living costs for the year ending September 2024 (green line in the chart; lower is better). This figure is much lower than the high of 8.2% recorded in December 2022. Increased interest payments, insurance costs, and rent primarily drove the 3.8% rise. Different household groups, including MÄori, beneficiaries, and superannuitants, faced varying impacts, with the lowest-spending households seeing the highest increase at 4.3%.
š©ŗ Medical Workforce Growth Continues; MÄori Representation Slowly Improves - The Medical Councilās āWorkforce Report 2024ā reveals the total number of doctors has grown to 20,012, representing a 3.4% increase from the previous year. While MÄori doctor representation has increased to 5.1% (more than double since 2000, green line in the chart below), it remains significantly below the population proportion of 17.8%. The report also highlights a continuing trend toward gender balance, with female doctors expected to become the majority by 2025, currently comprising 48.9% of the workforce.
ā
In Brief
š· Research Shows Alcohol Increases Suicide Risk - This Public Health Communication Centre (PHCC) article summarises a range of studies that definitively show that alcohol use worsens mental health outcomes and significantly increases suicide risk, with evidence indicating that those who die by suicide are often acutely affected by alcohol at the time of death. This post strongly refutes a recent claim that alcohol has some protective benefits.
š§ Psychology Barriers Highlighted - A recent report revealed challenges for psychology trainees and practitioners. Respondents stated that monocultural practices can marginalise Indigenous knowledge and impact MÄori, Pacific, and Asian practitioners and students. The report calls for urgent reforms, including cultural competency training and changes within regulatory bodies.
š Home Ownership Rises as Housing Quality Improves - The 2023 Census revealed that home ownership increased to 66% of households, reversing a declining trend since the 1990s. The increase resulted from changes during the preceding several years to make home ownership more accessible and rental property ownership less appealing. Housing quality also improved, with fewer homes experiencing dampness and mould, while two-thirds of dwellings now have heat pumps installed, marking a significant increase from 2018.
š¦ Pandemic Cooperation with Australia - This PHCC article outlines how a pandemic cooperation agreement between Aotearoa and Australia could bolster regional preparedness and responsiveness. An agreement could include coordinated disease surveillance, shared quarantine facilities, and integrated manufacturing of critical supplies. By working together, Aotearoa and Australia can enhance their capacity to protect public health and reduce the costs of pandemic preparedness. The initiative also suggests extending cooperation to interested Pacific Island states.
š Aotearoa Tightens Vaping Laws to Protect Youth - Changes to Aotearoa's Smokefree laws will restrict vape store locations near childcare centres, increase penalties for selling to minors up to $100,000, and ban disposable vapes, with implementation beginning this month.
ā”ļø Lightning Quick
š¢ Hereās a quick dashboard I created that summarises the Q4 Health New Zealand - Te Whatu Ora performance report mentioned above. Results for the MÄori population are summarised and interpreted.
š¬ End Notes
š Could you please answer a quick question? Iād really like your feedback. Click this link and tell me: How likely are you to recommend this newsletter to a friend or colleague?