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Health is multi factorial and is the product of reciprocal interaction between individuals and their environment. Social determinants of health are the conditions in which people are born, grow, live, work and age, including the health system (World Health Organisation, 2008). As in most countries, health in New Zealand is also distributed unequally throughout the society. This reflects that there is an uneven allocation of social determinants of health such as income, education, occupation and access to health for certain groups compared with others. This essay will examine income as one of the social determinates of health and the effect of low economic status in Maori health. Further it will discuss how the nurses can care for Maori people with inequalities in health and the importance of the government strategy developed to address Maori health concerns. Finally this essay will analyse the psychological factors associated with smoking behaviours and its consequences.
Income, employment, education, housing, culture and social cohesion are the distinct social determinants which directly or indirectly influence health outcome of an individual. The people who are more vulnerable to ill heath mostly come under low income category. Income inequalities increased evidently in New Zealand between 1987 and 1991 due to unemployment. The growth in income inequalities is especially seen in Maori population (Davis & Dew, 2005). Income is one of the major determinants of health, which contribute to the poor health status of Maori. Indigenous Maori have the poorest health status among any other ethnic groups in New Zealand. The median annual income of Maori in 2006 was $20900 compared to $24400 of the total population in New Zealand (McMurray & Clendon, 2010). According to the New Zealand statistics 2005, the average weekly income of Maori was $471 compared to $637 of non-Maori (Robson & Harris, 2007). Income and wealth are the major modifiable determinants of health which affect the access to healthy environment, living condition, housing, education and timely effective health care. Level of home ownership, property ownership and income producing assets are lower among Maori than non-Maori population. In addition to these, lower equivalent income levels limit the availability of the Maori families to accumulate wealth out of current income (Dew & Mathewson, 2008). Compared to non-Maori, inequalities in health status and mortality are higher and increasing among Maori, with increased incidence of conditions such as coronary heart disease and higher fatality rates (McMurray & Clendon, 2010). The current economic situation of the Maori and non-Maori is profoundly linked to the history of colonization of New Zealand. Besides this, economic reforms also cause loss of income from changing nature of work arrangements for Maori (Broom, 2007). The income inequalities can be also explained in terms of lower educational qualification and under representation of Maori workers in high profile jobs. In New Zealand society Maori are the lowest salary earners and this leads to a low socio economic status (Robson & Harris, 2007). Besides this, income level can affect mental health, caring for children and family. People belonging to low economic status always struggle to care their life and childrenââ‚¬â„¢s health (Marmot & Wilkinson, 2001).
Being health professional, nurses have obligation to identify unfairness or inequalities in health. Nurses should work to address the underlying determinants of health and working towards to ensure equitable health and wellbeing of everyone in the society (McMurray & Clendon, 2010). In order to deliver proper health care nurses have to be aware about the needs and rights of Maori (Broom, 2007). Principles of Treaty act as a model for nurses to work with Maori. Nurses should respect the cultural beliefs and deliver health services in a culturally acceptable manner (Francis et al., 2008). Nurses should work in a manner to improve the access to health, especially to those who lacks financial resources. Approaches like selecting a central location and convenient time for health services can improve access of health facilities by the low income groups. Nurses should identify vulnerable groups with low income such as unemployed, single mothers and parents with more dependent children. In order to ensure unbiased health to low income group nurses have to educate them regarding the health facilities and their right to health irrespective of economic status. Increasing conventional services like employing of indigenous health workers and establishing indigenous programs is another nursing intervention for reorienting health service for Maori. (Mason & Durie, 2003) For instance Maori can be cared better by employing more Maori nurses as they will have enhanced understanding.
Improvements in Maori health status are critical, because Maori has the poorest health status among other New Zealanders. The New Zealand government identified the importance of prioritising the Maori health problems and the need to eradicate health inequalities which has a negative impact on Maori health. He Korowai Oranga is a health strategy set for Maori health development in the health and disability sector. This strategy acts as a basis for the health sector to deal with the health problems of Whanau. The focus of He Korowai Oranga is on Whanau or family wellbeing. The outcomes are mainly aimed at empowering Whanau with physical, social, mental and emotional health; enabling them to take control over their health, creating better quality of life and ensuring their active participation in New Zealand society (Francis et al., 2008). He Korowai Oranga stands on the principles such as partnership, participation and protection which are the core principles of Treaty of Waitangi. He Korowai Oranga tries to identify health inequalities among Maori people in terms of education, income, occupation and access to health health. This strategy aims at considering Maori approaches and models to health for improving Maori outcomes. Inequalities among health statuses of Maori are clearly documented in this. Nationwide population health priorities for Maoris are also enlisted in appendix 3 of this strategy. Besides this it also provide guidelines to district health board for effective assessment and monitoring of Maori health status. This strategy also has made provisions to improve Maori access to mainstream health services like public hospitals or primary health centres (Ministry of Health, 2002).
Risk taking behaviours are those which affect the physical and mental health of individuals. Risk taking behaviours may include smoking, alcoholism, unsafe sexual habits, gambling and participating in dangerous activities. Tobacco is the major cause of preventable death in New Zealand. Smoking kills around 4300 to 4700 people per year, among this almost 600 are Maori (Maori Affairs Committee, 2010). Some people consider smoking as a method of channelizing their stress or escape mechanism from their stressful situation or frustrated family life. Some consider smoking as a way to get peer pleasure and to kick out their boredom (Marks, Murray, Evans & Willig, 2001). Increased risk of smoking is usually seen in those who are divorced, separated or lone parents. 80-90% of smoking prevalence is seen among people who are under severe deprivation areas such as prisoners, homeless and poor (Marmot & Wilkinson, 2001). Young people consider smoking as a way of developing their identity, method of relaxing tension and making peers. Parents and role models can greatly influence smoking behaviour of adolescents (McMurray & Clendon, 2010). Media plays a great role in influencing people to smoke even though they advertise about the repercussions of smoking (Marks et al., 2001). The use of tobacco gives rise to many health hazards. Smoking contributes to the higher incidence of coronary artery disease, chronic obstructive pulmonary disease, pneumonia, reduced lung function, impaired lung growth in children and various cancers especially lung cancer. Smoking aggravates the symptoms of many other illnesses, for instance smoking can reduce fertility, increased cataract incidence, poor wound healing, and worsen peptic ulcer. Smoking during pregnancy can lead to birth complications, premature death, small gestational age and low birth weight. Passive smoking is another health risk associated with smoking. Non-smokers living with smokers have 30% increased chance of lung cancer (Maori Affairs Committee, 2010).
In brief social conditions are particularly important in determining health status of an individual. When a social environment is supportive, the person is more likely to be empowered in their health. There is a well-established evidence of relationship between income and Maori health status. Nurses can play an important role in reducing the inequalities in health. In addition to this smoking remains a major contributor to disparities in health status because this behaviour is strongly shaped by income deprivation, occupation and education.