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Sorting the (healthy) wood from the trees
“To generate good health policy you need to ensure that the younger population doesn’t miss out.” THE FIRST STEP in fixing any health challenge is to understand what you most need to focus on, says Bridget Robson. For an epidemiologist this view may not seem surprising. But as Director of Te Rōpū Rangahau Hauora a Eru Pōmare (Eru Pōmare Māori Health Research Centre) at the Wellington School of Medicine & Health Sciences, the University of Otago, she has shown that the picture of New Zealand patient health can change quite markedly depending on the statistics you use.
In the late 1990s when Bridget looked at official national statistics (to World Health Organisation standards) they indicated that for Māori heart disease was apparently becoming a less important concern. Yet any hospital can tell you Māori patients die nearly twice as frequently as Pakeha following cardiac operations. The answer to the conundrum: “It depends on what population model you choose,” Bridget says. Heart disease mostly affects the elderly. But as most Māori die relatively young on a “standard population” model proportionally very few show up among total cardiac deaths. And a key health problem goes at risk of being overlooked.
By adjusting for a younger population model Bridget, who is from Ngāti Raukawa ki te Tonga, found the data and the real-world experience came back into line. “It was kind of an “aha!” moment,” she says. Along with a continued need to reduce heart disease, other key challenges like accident and suicide prevention emerged in sharper relief. “We weren’t aiming to compare Māori with non-Māori, but rather to analyse how resources are distributed and to make a contribution to policy for producing better outcomes. To generate good health policy you need to ensure that younger populations don’t miss out,” Bridget says.
The study, Kaupapa Māori Epidemiology in Health Research – Finding our own standards, with Dr Fiona Cram of Katoa Ltd, Gordon Purdie of the Department of Public Health and Shirley Simmonds at the Eru Pōmare centre, has been provided to the Ministry of Health and taken by Health Care Aotearoa in developing revised performance measures for Public Health Organisations. Bridget says the research would not have been done without Ngā Pae o te Māramatanga. It was outside the resources of local Māori health organisations – and in the health research community no one else is charged with providing a view from a Māori perspective. “By getting a more accurate picture we can focus on the greatest areas of need,” she says. And have a much clearer picture of the health challenges that need to be faced.