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Government commitment to Pacific healthThe document ‘Ala Mo'ui Pathways to Pacific Health and Wellbeing 2010–2014 set out the government's priority outcomes and actions that would contribute towards achieving better health outcomes for Pacific people.1Recognition of the importance of prevention was mentioned, "[w]e know that for many of the health issues of greatest concern, downstream treatment costs can be reduced through effective prevention and protection" (p11); and it was promising to see children and families as being critical components of the equation.Urgent themes for achieving better health outcomes for Pacific peoples were both explicit (e.g. improving nutrition and increasing physical activity) and implied (e.g. reducing risk factors such as obesity). However the salient issue of maternal health was completely missing, despite the authors citing relevant literature.2 An omission of the importance of the health of mothers reveals a potentially crucial disconnect between the Pacific health strategy and its aims of supporting healthier children resulting in a healthier population overall.3The document states that elimination of poverty is desired for the Pacific region by way of international aid and this is admirable. For New Zealand, however, the message is less clear as the intentions are focussed on improving broader structural issues such as education, employment, income and housing. This is an ambitious approach, as it requires significant collaboration between government ministries. But is this level of collaboration achievable and realistic?Additionally, ‘Ala Mo'ui speaks very generally of intentions to improve health services and systems, but specifically how this is meant to be achieved is also unclear.Structural mechanisms and health for Pacific peoplesGiven the commitments of ‘Ala Mo'ui and that we are drawing close to the end of the strategy's timeline, what are the structural circumstances and how has the Pacific community fared over this time?Perhaps the most critical issue is the level of poverty experienced among the nation's children which is unacceptably high at around 21%, or over a-quarter of a million (approximately 270,000).4 About half (47%) of these children were either Māori or Pacific, equivalent to 34% of all Māori and Pacific children living in poverty by 2011.4The Salvation Army report on the state of Pasifika people in New Zealand also provides some insight into how conditions have tracked over time.5 (The terms Pasifika and Pacific are used interchangeably in the report).Evidence of escalating inequity is in the more than five-fold increase in Pasifika families approaching the Salvation Army for food parcels in 2012 compared to 2007 (p27). Participation in social food programmes is an indication of the high rate (70%) of food insecurity in Pacific homes,6 and both of these are indicators of relative poverty and financial hardship.7Citing Household Labour Force Survey data, the Salvation Army report highlights that, in spite of the country's relatively stable unemployment rate from December 2009 to December 2012 (from 6.5% to 6.9%), Pasifika unemployment remained consistently high, going from 14% to 16% in the same period. In terms of age, the highest rates of unemployment were seen in the youngest working age group 15-24 years with Pacific (29%) and Māori (28%) double that of European (14%).8Increasing income inequality for those in employment was evident in the growth of the income gap between Pacific and non-Pacific. For the average weekly income between the two groups in 2007, Pacific were already receiving $190 less than non-Pacific ($477 cf. $667 respectively). This income difference increased to $240 by 2012 ($479 cf. $721 respectively). The non-Pacific average weekly income increased by $54 whereas Pacific incomes increased by only $2.Lower incomes and poverty have been attributed to increased stress, poorer food (nutrition) availability,9 and obesity in women and children.10 This is in the context of nutrient-rich foods being more expensive than the nutrient-poor, energy-dense and more filling food options.10Lower incomes also have a negative effect on housing affordability, quality and home ownership, exacerbated by an ongoing decline in social housing.12 Current real estate data show that in South Auckland, where most Pacific people live, house prices have increased rapidly by around 30% since 2011.13Hargreaves cites a recent OECD report which found that of the 34 countries in the OECD, New Zealand was the second most expensive country to buy a home and the least affordable place to live in terms of price to income.14,15 Evidence of this is borne out in the 2013 Census where individual home ownership in the total population had fallen to just below half (49.9%), from 54.5% in 2006.16,17Pacific individuals were less likely to own a home with less than one-fifth (18.5%) reporting ownership, compared with over one-quarter for Māori (28.2%), over one-third for Asian (34.8%) and more than half of all Europeans (56.8%).18The outcomeThe culmination is that after four of the 5 years of ‘Ala Mo'ui's strategy period, the structural mechanisms that would help contribute to better health outcomes for Pacific people remain, in general, worse than that of non-Pacific.19 20Positive signs could be the recently reported achievements in the National Standards' assessments for mathematics, reading and writing among young Pasifika children.21 However, there are some apparent setbacks to the positive data. First, as children age, educational performance is declining.21 22 This means that the curriculum or the National Standards assessments are not preparing Pasifika children for secondary school and that modifications need to be made to meet the educational needs of children and families. Second, education leaders say the data are unreliable because of the potential for measures to be assessed subjectively by individual schools,23 24 calling into question the overall integrity of the data. Thirdly, and more pertinently, the education achievement disparities between Māori/Pacific and non-Māori/Pacific students remain high.For Pacific an approximately 20 percentage-point lower achievement difference existed for all three National Standards' subjects, reading (64.1% vs. 84.1%), mathematics (60.8% vs. 79.8%) and writing (57.6% vs. 76.3%) when compared with Pakeha/European school children (years 1 to 8).21Finally, there is a lack of evidence of better health and wellbeing outcomes as envisioned by ‘Ala Mo'ui. Current prevalence of type-2 diabetes mellitus among Pacific people is high compared to other ethnic groups and incidence in younger Pacific will continue to increase largely due to high rates of obesity.6 Our recent publication reported a 70% prevalence of overweight (including 50% obesity) at age 11 years in a birth cohort (n>1000) of Pacific children from South Auckland in 2009/2010, demonstrating rapid physical growth in this population.25Compared to European, Pacific babies have higher birth-weights which are directly related to maternal body weight.26 Given that the propensity for rapid weight gain is intergenerational, where a genetic predisposition is amplified in the prenatal period, early intervention is critical.We urge the government to act with haste to provide more supportive environments for Pacific mothers and children, improve housing and food security, and address widespread poverty. Preventing the upstream causes is the pathway to health and wellbeing for Pacific children in New Zealand.

Summary

Abstract

The governments 5-year strategy for improving Pacific peoples health and wellbeing, Ala Moui Pathways to Pacific Health and Wellbeing 2010-2014, emphasised disease prevention and improvements in health systems as priority outcomes. Actions that would contribute to disease prevention included reducing barriers to health in structural mechanisms (such as better access to healthy housing) and improving health service systems. However, after 4 years since its release, not only have important structural barriers remained but so have the poor health outcomes of Pacific peoples in New Zealand.

Aim

Method

Results

Conclusion

Author Information

Faasisila Savila, Research Officer, Pacific Islands Families Study, Centre for Pacific Health and Development Research, Faculty of Health and Environmental Sciences, Auckland University of Technology (AUT); Elaine Rush , Professor of Nutrition, Centre for Child Health, Faculty of Health and Environmental Sciences, AUT, Auckland

Acknowledgements

We express our gratitude to the participant families and the research team on the Pacific Islands Families study.

Correspondence

Faasisila Savila. Pacific Islands Families (PIF) Study, Faculty of Health & Environmental Sciences, AUT University, Private Bag 92006, Auckland 1142, New Zealand.

Correspondence Email

faasisila.savila@aut.ac.nz

Competing Interests

Nil.

1. Minister of Health and Minister of Pacific Island Affairs. 'Ala Mo'ui: Pathways to Pacific Health and Wellbeing 2010-2014. Wellington: Ministry of Health; 2010. http://www.health.govt.nz/publication/ala-moui-pathways-pacific-health-and-wellbeing-2010-2014 2. Paterson J, Cowley ET, Percival T, Williams M. Pregnancy planning by mothers of Pacific infants recently delivered at Middlemore Hospital. N Z Med J. 2004;117(1188):1-6. 3. Victora CG, Adair L, Fall C, et al. Maternal and child undernutrition: consequences for adult health and human capital. Lancet 2008;371(9609):340-57. DOI:10.1016/S0140-6736(07)61692-4. 4. Perry B. Household incomes in New Zealand: Trends in indicators of inequality and hardship 1982 to 2011. Wellington: Ministry of Social Development. 2012. 5. Tanielu R, Johnson A. More Than Churches, Rugby & Festivals. A report on the state of Pasifika people in New Zealand. Auckland: The Salvation Army Social Policy and Parliamentary Unit; 2013. 6. Ministry of Health. A Focus on Pacific Nutrition: Findings from the 2008/09 New Zealand Adult Nutrition Survey. Wellington: Ministry of Health; 2012. 7. Cook JT, Frank DA. Food Security, Poverty, and Human Development in the United States. Ann N Y Acad Sci. 2008;1136(1):193-209. 8. Statistics New Zealand. Introducing ethnic labour force statistics by age. http://www.stats.govt.nz/browse_for_stats/income-and-work/employment_and_unemployment/ethnic-labour-force-stats-by-age.aspx#ethnicemployment 9. Smith C, Parnell WR, Brown RC, Gray AR. Balancing the diet and the budget: Food purchasing practices of food-insecure families in New Zealand. Nutrition & Dietetics. 2013:n/a-n/a. 10. Black RE, Victora CG, Walker SP, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. The Lancet. 2013;382(9890):427-451. 11. Drewnowski A. Obesity, diets, and social inequalities. Nutr Rev. 2009;67:S36-S9. 12. Koloto & Associates Ltd / New Zealand Institute of Economic Research / Gray Matter Research Ltd. Pacific Housing Experiences: Developing Trends and Issues. Centre for Housing Research, Aotearoa New Zealand & The Ministry of Pacific Island Affairs. 2007. 13. Gibson A. Auckland's property values jump 33pc. New Zealand Herald 19 Aug 2014. http://www.nzherald.co.nz/business/news/article.cfm?c_id=3&objectid=11311080 14. Hargreaves D. Prime Minister hits back at OECD findings of NZ having most expensive housing in world relative to rents. interest.co.nz, 19 May 2014. http://www.interest.co.nz/node/69985/property 15. Organisation for Economic Co-operation and Development. Chap. 1, General assessment of the macroeconomic situation. OECD Economic Outlook. Volume 2014/1. 2014. 16. The Future of Home Ownership and the Role of the Private Rental Market in the Auckland Region. Centre for Housing Research Aotearoa New Zealand and Auckland Regional Council. 2007. accessible through http://www.chranz.co.nz/pdfs/future-of-home-ownership-and-the-role-of-the-private-rental-market-in-auckland.pdf 17. Statistics New Zealand. Home ownership: Home ownership continues to fall. 2013. http://www.stats.govt.nz/Census/2013-census/profile-and-summary-reports/quickstats-about-national-highlights/home-ownership.aspx 18. Statistics New Zealand. 2013 Census QuickStats about housing: Home ownership by individuals. http://www.stats.govt.nz/Census/2013-census/profile-and-summary-reports/quickstats-about-housing/home-ownership-individuals.aspx 19. Gaffaney C. Inequality in NZ worsens over decade. 21 Aug, 2014. New Zealand Herald. Accessed on 22 Aug 2014 http://www.nzherald.co.nz/education/news/article.cfm?c_id=35&objectid=11312322 20. Marriott L, Sim D. Indicators of inequality for Mori and Pacific people. Working papers in Public Finance, Working paper 09/2014, Victoria University of Wellington. Accessed 25 Aug 2014 http://www.victoria.ac.nz/sacl/about/cpf/publications/pdfs/2015/WP09_2014_Indicators-of-Inequality.pdf 21. Ministry of Education. 2013 National Standards Achievement Results. 2013: Available from: http://www.educationcounts.govt.nz/ 22. Education Ministry worried too many children failing standards http://www.radionz.co.nz/national/programmes/morningreport/audio/2562204/education-ministry-worried-too-many-children-failing-standards 23. Television New Zealand. Schools' national standards data 'useless'. 2013: Available from: http://www.3news.co.nz/Schools-national-standards-data-useless/tabid/1607/articleID/301125/Default.aspx 24. Television New Zealand. National Standards data shows increase but 'disparity still exists'. 2013. Available from: http://tvnz.co.nz/national-news/standards-data-shows-increase-but-disparity-still-exists-5461067 25. Rush E, Obolonkin VV, Savila F. Growth centiles of Pacific Children living in Auckland, New Zealand. Ann Hum Biol. 2013;40(5):406-412. doi:10.3109/03014460.2013.793391. 26. McCowan L, Stewart AW, Francis A, Gardosi J. A customised birthweight centile calculator developed for a New Zealand population. Aust N Z J Obstet Gynaecol. 2004;44(5):428-31.

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

Government commitment to Pacific healthThe document ‘Ala Mo'ui Pathways to Pacific Health and Wellbeing 2010–2014 set out the government's priority outcomes and actions that would contribute towards achieving better health outcomes for Pacific people.1Recognition of the importance of prevention was mentioned, "[w]e know that for many of the health issues of greatest concern, downstream treatment costs can be reduced through effective prevention and protection" (p11); and it was promising to see children and families as being critical components of the equation.Urgent themes for achieving better health outcomes for Pacific peoples were both explicit (e.g. improving nutrition and increasing physical activity) and implied (e.g. reducing risk factors such as obesity). However the salient issue of maternal health was completely missing, despite the authors citing relevant literature.2 An omission of the importance of the health of mothers reveals a potentially crucial disconnect between the Pacific health strategy and its aims of supporting healthier children resulting in a healthier population overall.3The document states that elimination of poverty is desired for the Pacific region by way of international aid and this is admirable. For New Zealand, however, the message is less clear as the intentions are focussed on improving broader structural issues such as education, employment, income and housing. This is an ambitious approach, as it requires significant collaboration between government ministries. But is this level of collaboration achievable and realistic?Additionally, ‘Ala Mo'ui speaks very generally of intentions to improve health services and systems, but specifically how this is meant to be achieved is also unclear.Structural mechanisms and health for Pacific peoplesGiven the commitments of ‘Ala Mo'ui and that we are drawing close to the end of the strategy's timeline, what are the structural circumstances and how has the Pacific community fared over this time?Perhaps the most critical issue is the level of poverty experienced among the nation's children which is unacceptably high at around 21%, or over a-quarter of a million (approximately 270,000).4 About half (47%) of these children were either Māori or Pacific, equivalent to 34% of all Māori and Pacific children living in poverty by 2011.4The Salvation Army report on the state of Pasifika people in New Zealand also provides some insight into how conditions have tracked over time.5 (The terms Pasifika and Pacific are used interchangeably in the report).Evidence of escalating inequity is in the more than five-fold increase in Pasifika families approaching the Salvation Army for food parcels in 2012 compared to 2007 (p27). Participation in social food programmes is an indication of the high rate (70%) of food insecurity in Pacific homes,6 and both of these are indicators of relative poverty and financial hardship.7Citing Household Labour Force Survey data, the Salvation Army report highlights that, in spite of the country's relatively stable unemployment rate from December 2009 to December 2012 (from 6.5% to 6.9%), Pasifika unemployment remained consistently high, going from 14% to 16% in the same period. In terms of age, the highest rates of unemployment were seen in the youngest working age group 15-24 years with Pacific (29%) and Māori (28%) double that of European (14%).8Increasing income inequality for those in employment was evident in the growth of the income gap between Pacific and non-Pacific. For the average weekly income between the two groups in 2007, Pacific were already receiving $190 less than non-Pacific ($477 cf. $667 respectively). This income difference increased to $240 by 2012 ($479 cf. $721 respectively). The non-Pacific average weekly income increased by $54 whereas Pacific incomes increased by only $2.Lower incomes and poverty have been attributed to increased stress, poorer food (nutrition) availability,9 and obesity in women and children.10 This is in the context of nutrient-rich foods being more expensive than the nutrient-poor, energy-dense and more filling food options.10Lower incomes also have a negative effect on housing affordability, quality and home ownership, exacerbated by an ongoing decline in social housing.12 Current real estate data show that in South Auckland, where most Pacific people live, house prices have increased rapidly by around 30% since 2011.13Hargreaves cites a recent OECD report which found that of the 34 countries in the OECD, New Zealand was the second most expensive country to buy a home and the least affordable place to live in terms of price to income.14,15 Evidence of this is borne out in the 2013 Census where individual home ownership in the total population had fallen to just below half (49.9%), from 54.5% in 2006.16,17Pacific individuals were less likely to own a home with less than one-fifth (18.5%) reporting ownership, compared with over one-quarter for Māori (28.2%), over one-third for Asian (34.8%) and more than half of all Europeans (56.8%).18The outcomeThe culmination is that after four of the 5 years of ‘Ala Mo'ui's strategy period, the structural mechanisms that would help contribute to better health outcomes for Pacific people remain, in general, worse than that of non-Pacific.19 20Positive signs could be the recently reported achievements in the National Standards' assessments for mathematics, reading and writing among young Pasifika children.21 However, there are some apparent setbacks to the positive data. First, as children age, educational performance is declining.21 22 This means that the curriculum or the National Standards assessments are not preparing Pasifika children for secondary school and that modifications need to be made to meet the educational needs of children and families. Second, education leaders say the data are unreliable because of the potential for measures to be assessed subjectively by individual schools,23 24 calling into question the overall integrity of the data. Thirdly, and more pertinently, the education achievement disparities between Māori/Pacific and non-Māori/Pacific students remain high.For Pacific an approximately 20 percentage-point lower achievement difference existed for all three National Standards' subjects, reading (64.1% vs. 84.1%), mathematics (60.8% vs. 79.8%) and writing (57.6% vs. 76.3%) when compared with Pakeha/European school children (years 1 to 8).21Finally, there is a lack of evidence of better health and wellbeing outcomes as envisioned by ‘Ala Mo'ui. Current prevalence of type-2 diabetes mellitus among Pacific people is high compared to other ethnic groups and incidence in younger Pacific will continue to increase largely due to high rates of obesity.6 Our recent publication reported a 70% prevalence of overweight (including 50% obesity) at age 11 years in a birth cohort (n>1000) of Pacific children from South Auckland in 2009/2010, demonstrating rapid physical growth in this population.25Compared to European, Pacific babies have higher birth-weights which are directly related to maternal body weight.26 Given that the propensity for rapid weight gain is intergenerational, where a genetic predisposition is amplified in the prenatal period, early intervention is critical.We urge the government to act with haste to provide more supportive environments for Pacific mothers and children, improve housing and food security, and address widespread poverty. Preventing the upstream causes is the pathway to health and wellbeing for Pacific children in New Zealand.

Summary

Abstract

The governments 5-year strategy for improving Pacific peoples health and wellbeing, Ala Moui Pathways to Pacific Health and Wellbeing 2010-2014, emphasised disease prevention and improvements in health systems as priority outcomes. Actions that would contribute to disease prevention included reducing barriers to health in structural mechanisms (such as better access to healthy housing) and improving health service systems. However, after 4 years since its release, not only have important structural barriers remained but so have the poor health outcomes of Pacific peoples in New Zealand.

Aim

Method

Results

Conclusion

Author Information

Faasisila Savila, Research Officer, Pacific Islands Families Study, Centre for Pacific Health and Development Research, Faculty of Health and Environmental Sciences, Auckland University of Technology (AUT); Elaine Rush , Professor of Nutrition, Centre for Child Health, Faculty of Health and Environmental Sciences, AUT, Auckland

Acknowledgements

We express our gratitude to the participant families and the research team on the Pacific Islands Families study.

Correspondence

Faasisila Savila. Pacific Islands Families (PIF) Study, Faculty of Health & Environmental Sciences, AUT University, Private Bag 92006, Auckland 1142, New Zealand.

Correspondence Email

faasisila.savila@aut.ac.nz

Competing Interests

Nil.

1. Minister of Health and Minister of Pacific Island Affairs. 'Ala Mo'ui: Pathways to Pacific Health and Wellbeing 2010-2014. Wellington: Ministry of Health; 2010. http://www.health.govt.nz/publication/ala-moui-pathways-pacific-health-and-wellbeing-2010-2014 2. Paterson J, Cowley ET, Percival T, Williams M. Pregnancy planning by mothers of Pacific infants recently delivered at Middlemore Hospital. N Z Med J. 2004;117(1188):1-6. 3. Victora CG, Adair L, Fall C, et al. Maternal and child undernutrition: consequences for adult health and human capital. Lancet 2008;371(9609):340-57. DOI:10.1016/S0140-6736(07)61692-4. 4. Perry B. Household incomes in New Zealand: Trends in indicators of inequality and hardship 1982 to 2011. Wellington: Ministry of Social Development. 2012. 5. Tanielu R, Johnson A. More Than Churches, Rugby & Festivals. A report on the state of Pasifika people in New Zealand. Auckland: The Salvation Army Social Policy and Parliamentary Unit; 2013. 6. Ministry of Health. A Focus on Pacific Nutrition: Findings from the 2008/09 New Zealand Adult Nutrition Survey. Wellington: Ministry of Health; 2012. 7. Cook JT, Frank DA. Food Security, Poverty, and Human Development in the United States. Ann N Y Acad Sci. 2008;1136(1):193-209. 8. Statistics New Zealand. Introducing ethnic labour force statistics by age. http://www.stats.govt.nz/browse_for_stats/income-and-work/employment_and_unemployment/ethnic-labour-force-stats-by-age.aspx#ethnicemployment 9. Smith C, Parnell WR, Brown RC, Gray AR. Balancing the diet and the budget: Food purchasing practices of food-insecure families in New Zealand. Nutrition & Dietetics. 2013:n/a-n/a. 10. Black RE, Victora CG, Walker SP, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. The Lancet. 2013;382(9890):427-451. 11. Drewnowski A. Obesity, diets, and social inequalities. Nutr Rev. 2009;67:S36-S9. 12. Koloto & Associates Ltd / New Zealand Institute of Economic Research / Gray Matter Research Ltd. Pacific Housing Experiences: Developing Trends and Issues. Centre for Housing Research, Aotearoa New Zealand & The Ministry of Pacific Island Affairs. 2007. 13. Gibson A. Auckland's property values jump 33pc. New Zealand Herald 19 Aug 2014. http://www.nzherald.co.nz/business/news/article.cfm?c_id=3&objectid=11311080 14. Hargreaves D. Prime Minister hits back at OECD findings of NZ having most expensive housing in world relative to rents. interest.co.nz, 19 May 2014. http://www.interest.co.nz/node/69985/property 15. Organisation for Economic Co-operation and Development. Chap. 1, General assessment of the macroeconomic situation. OECD Economic Outlook. Volume 2014/1. 2014. 16. The Future of Home Ownership and the Role of the Private Rental Market in the Auckland Region. Centre for Housing Research Aotearoa New Zealand and Auckland Regional Council. 2007. accessible through http://www.chranz.co.nz/pdfs/future-of-home-ownership-and-the-role-of-the-private-rental-market-in-auckland.pdf 17. Statistics New Zealand. Home ownership: Home ownership continues to fall. 2013. http://www.stats.govt.nz/Census/2013-census/profile-and-summary-reports/quickstats-about-national-highlights/home-ownership.aspx 18. Statistics New Zealand. 2013 Census QuickStats about housing: Home ownership by individuals. http://www.stats.govt.nz/Census/2013-census/profile-and-summary-reports/quickstats-about-housing/home-ownership-individuals.aspx 19. Gaffaney C. Inequality in NZ worsens over decade. 21 Aug, 2014. New Zealand Herald. Accessed on 22 Aug 2014 http://www.nzherald.co.nz/education/news/article.cfm?c_id=35&objectid=11312322 20. Marriott L, Sim D. Indicators of inequality for Mori and Pacific people. Working papers in Public Finance, Working paper 09/2014, Victoria University of Wellington. Accessed 25 Aug 2014 http://www.victoria.ac.nz/sacl/about/cpf/publications/pdfs/2015/WP09_2014_Indicators-of-Inequality.pdf 21. Ministry of Education. 2013 National Standards Achievement Results. 2013: Available from: http://www.educationcounts.govt.nz/ 22. Education Ministry worried too many children failing standards http://www.radionz.co.nz/national/programmes/morningreport/audio/2562204/education-ministry-worried-too-many-children-failing-standards 23. Television New Zealand. Schools' national standards data 'useless'. 2013: Available from: http://www.3news.co.nz/Schools-national-standards-data-useless/tabid/1607/articleID/301125/Default.aspx 24. Television New Zealand. National Standards data shows increase but 'disparity still exists'. 2013. Available from: http://tvnz.co.nz/national-news/standards-data-shows-increase-but-disparity-still-exists-5461067 25. Rush E, Obolonkin VV, Savila F. Growth centiles of Pacific Children living in Auckland, New Zealand. Ann Hum Biol. 2013;40(5):406-412. doi:10.3109/03014460.2013.793391. 26. McCowan L, Stewart AW, Francis A, Gardosi J. A customised birthweight centile calculator developed for a New Zealand population. Aust N Z J Obstet Gynaecol. 2004;44(5):428-31.

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

Government commitment to Pacific healthThe document ‘Ala Mo'ui Pathways to Pacific Health and Wellbeing 2010–2014 set out the government's priority outcomes and actions that would contribute towards achieving better health outcomes for Pacific people.1Recognition of the importance of prevention was mentioned, "[w]e know that for many of the health issues of greatest concern, downstream treatment costs can be reduced through effective prevention and protection" (p11); and it was promising to see children and families as being critical components of the equation.Urgent themes for achieving better health outcomes for Pacific peoples were both explicit (e.g. improving nutrition and increasing physical activity) and implied (e.g. reducing risk factors such as obesity). However the salient issue of maternal health was completely missing, despite the authors citing relevant literature.2 An omission of the importance of the health of mothers reveals a potentially crucial disconnect between the Pacific health strategy and its aims of supporting healthier children resulting in a healthier population overall.3The document states that elimination of poverty is desired for the Pacific region by way of international aid and this is admirable. For New Zealand, however, the message is less clear as the intentions are focussed on improving broader structural issues such as education, employment, income and housing. This is an ambitious approach, as it requires significant collaboration between government ministries. But is this level of collaboration achievable and realistic?Additionally, ‘Ala Mo'ui speaks very generally of intentions to improve health services and systems, but specifically how this is meant to be achieved is also unclear.Structural mechanisms and health for Pacific peoplesGiven the commitments of ‘Ala Mo'ui and that we are drawing close to the end of the strategy's timeline, what are the structural circumstances and how has the Pacific community fared over this time?Perhaps the most critical issue is the level of poverty experienced among the nation's children which is unacceptably high at around 21%, or over a-quarter of a million (approximately 270,000).4 About half (47%) of these children were either Māori or Pacific, equivalent to 34% of all Māori and Pacific children living in poverty by 2011.4The Salvation Army report on the state of Pasifika people in New Zealand also provides some insight into how conditions have tracked over time.5 (The terms Pasifika and Pacific are used interchangeably in the report).Evidence of escalating inequity is in the more than five-fold increase in Pasifika families approaching the Salvation Army for food parcels in 2012 compared to 2007 (p27). Participation in social food programmes is an indication of the high rate (70%) of food insecurity in Pacific homes,6 and both of these are indicators of relative poverty and financial hardship.7Citing Household Labour Force Survey data, the Salvation Army report highlights that, in spite of the country's relatively stable unemployment rate from December 2009 to December 2012 (from 6.5% to 6.9%), Pasifika unemployment remained consistently high, going from 14% to 16% in the same period. In terms of age, the highest rates of unemployment were seen in the youngest working age group 15-24 years with Pacific (29%) and Māori (28%) double that of European (14%).8Increasing income inequality for those in employment was evident in the growth of the income gap between Pacific and non-Pacific. For the average weekly income between the two groups in 2007, Pacific were already receiving $190 less than non-Pacific ($477 cf. $667 respectively). This income difference increased to $240 by 2012 ($479 cf. $721 respectively). The non-Pacific average weekly income increased by $54 whereas Pacific incomes increased by only $2.Lower incomes and poverty have been attributed to increased stress, poorer food (nutrition) availability,9 and obesity in women and children.10 This is in the context of nutrient-rich foods being more expensive than the nutrient-poor, energy-dense and more filling food options.10Lower incomes also have a negative effect on housing affordability, quality and home ownership, exacerbated by an ongoing decline in social housing.12 Current real estate data show that in South Auckland, where most Pacific people live, house prices have increased rapidly by around 30% since 2011.13Hargreaves cites a recent OECD report which found that of the 34 countries in the OECD, New Zealand was the second most expensive country to buy a home and the least affordable place to live in terms of price to income.14,15 Evidence of this is borne out in the 2013 Census where individual home ownership in the total population had fallen to just below half (49.9%), from 54.5% in 2006.16,17Pacific individuals were less likely to own a home with less than one-fifth (18.5%) reporting ownership, compared with over one-quarter for Māori (28.2%), over one-third for Asian (34.8%) and more than half of all Europeans (56.8%).18The outcomeThe culmination is that after four of the 5 years of ‘Ala Mo'ui's strategy period, the structural mechanisms that would help contribute to better health outcomes for Pacific people remain, in general, worse than that of non-Pacific.19 20Positive signs could be the recently reported achievements in the National Standards' assessments for mathematics, reading and writing among young Pasifika children.21 However, there are some apparent setbacks to the positive data. First, as children age, educational performance is declining.21 22 This means that the curriculum or the National Standards assessments are not preparing Pasifika children for secondary school and that modifications need to be made to meet the educational needs of children and families. Second, education leaders say the data are unreliable because of the potential for measures to be assessed subjectively by individual schools,23 24 calling into question the overall integrity of the data. Thirdly, and more pertinently, the education achievement disparities between Māori/Pacific and non-Māori/Pacific students remain high.For Pacific an approximately 20 percentage-point lower achievement difference existed for all three National Standards' subjects, reading (64.1% vs. 84.1%), mathematics (60.8% vs. 79.8%) and writing (57.6% vs. 76.3%) when compared with Pakeha/European school children (years 1 to 8).21Finally, there is a lack of evidence of better health and wellbeing outcomes as envisioned by ‘Ala Mo'ui. Current prevalence of type-2 diabetes mellitus among Pacific people is high compared to other ethnic groups and incidence in younger Pacific will continue to increase largely due to high rates of obesity.6 Our recent publication reported a 70% prevalence of overweight (including 50% obesity) at age 11 years in a birth cohort (n>1000) of Pacific children from South Auckland in 2009/2010, demonstrating rapid physical growth in this population.25Compared to European, Pacific babies have higher birth-weights which are directly related to maternal body weight.26 Given that the propensity for rapid weight gain is intergenerational, where a genetic predisposition is amplified in the prenatal period, early intervention is critical.We urge the government to act with haste to provide more supportive environments for Pacific mothers and children, improve housing and food security, and address widespread poverty. Preventing the upstream causes is the pathway to health and wellbeing for Pacific children in New Zealand.

Summary

Abstract

The governments 5-year strategy for improving Pacific peoples health and wellbeing, Ala Moui Pathways to Pacific Health and Wellbeing 2010-2014, emphasised disease prevention and improvements in health systems as priority outcomes. Actions that would contribute to disease prevention included reducing barriers to health in structural mechanisms (such as better access to healthy housing) and improving health service systems. However, after 4 years since its release, not only have important structural barriers remained but so have the poor health outcomes of Pacific peoples in New Zealand.

Aim

Method

Results

Conclusion

Author Information

Faasisila Savila, Research Officer, Pacific Islands Families Study, Centre for Pacific Health and Development Research, Faculty of Health and Environmental Sciences, Auckland University of Technology (AUT); Elaine Rush , Professor of Nutrition, Centre for Child Health, Faculty of Health and Environmental Sciences, AUT, Auckland

Acknowledgements

We express our gratitude to the participant families and the research team on the Pacific Islands Families study.

Correspondence

Faasisila Savila. Pacific Islands Families (PIF) Study, Faculty of Health & Environmental Sciences, AUT University, Private Bag 92006, Auckland 1142, New Zealand.

Correspondence Email

faasisila.savila@aut.ac.nz

Competing Interests

Nil.

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