Collaboration will be the key to change New Zealand’s Pacific health inequities, according to the country’s largest network of healthcare professionals.
ProCare CEO Bindi Norwell has responded to the Health, Quality & Safety Commission’s report Bula Sautu by pledging continued support of cross-sector solutions to the dire health issues that plague our Pacific families throughout the entire life course. She cites the organisation’s Population Health Strategy as being its guiding force, central to every stream of work, and agrees with Bula Sautu’s number one step towards improving Pacific health: "Know your data".
"You can’t address what you can’t properly see or understand" says Norwell "Which is why we embarked on a comprehensive Health Needs Analysis (HNA) in 2018, which looked at the entire population we serve - around 760,000 across Tamaki Makaurau of which 100,000 are Pacific". The HNA guided a consultation process with Māori and Pacific community groups that led to the development of a Population Health Strategy which focuses particularly on our Māori and Pacific communities, identifying equity gaps to the health care they were receiving.
ProCare’s Associate Clinical Director Dr Sue Wells, who is leading the Strategy, says Bula Sautu made for harrowing but unsurprising reading. "We know that these inequities exist, and we are working incredibly hard to address the gaps that we see in five target areas: Early start to life - pregnancy and children aged 0-4, Youth Health, Wellbeing, People with Long Term Conditions and Quality of Life for Older People. Our data, gleaned from the HNA and updated continuously in real time, is allowing us to really support practices to understand the health needs of their unique Pacific populations and then to adjust the way care is provided. The data provides an opportunity for us to really tailor care."
As was highlighted in the Bula Sautu report, less than half of pregnant Pacific women are enrolled with a midwife for crucial screening and health care in their first trimester. Dr Justine Mesui, Associate Clinical Director for Pacific Health, sees this every day working as a GP in West Auckland and knows first-hand, the complications that can arise for Pacific women and their unborn babies. Access to pregnancy healthcare is a huge problem for many of our Pacific pregnant mothers for many reasons. Many do not understand how the health system works when they are pregnant, why they need to engage earlier on, what support services they are entitled to and how they can access them.
"We can do better as healthcare providers and have an obligation to support them better every step of the way" says Dr Mesui.
"We are developing a pregnancy road map which outlines at each step of their pregnancy what health services they can expect to receive and what other services are available. It covers both health and social supports. We have also installed an early pregnancy assessment tool (called Best Start Kōwae) in most of the ProCare practices which was developed by the National Hauora Coalition PHO. We have used this tool, as an in depth physical, psychosocial assessment to address the disparities in healthcare experienced by our high needs population such as Māori and Pacific expectant mothers".
With the influence of ProCare’s Māori and Pacific Advisory Committee (ProMa and ProPa) the drive to close the Pacific gaps led to an increase in Pacific workforce including nurses Lupe Helu and Judy Ikihele. Their focus includes support for the 170 ProCare General Practice’s with tools and cultural advice to help improve their responsiveness to the needs of our Pacific families.
In terms of tangible, on-the-ground solutions, Norwell says no single entity can claim to have all the answers - working together is the way forward. The Healthy Village Action Zone (HVAZ) programme and Diabetes Self-Management Education (DSME) that ProCare and other health providers offer are great examples. "These services complement the work of the GPs and Nurses in the community, providing Pacific churches and community groups with health education, screening, nutrition training and lifestyle change programmes.
Integrated services are available through partnerships with Pacific providers and services; they are a shining example of how sector partners can work together, addressing exactly the kind of issues that Bula Sautu has laid bare," says Norwell. "Our HVAZ work streams have been incredibly impactful. It is clear to me why this is so; we are speaking with these families, instead of at them, in an environment that is familiar and special to them, and we are bringing their leaders (such as church reverends) on the journey too. The staff who interact with our communities are all Pacific; they understand the culture and the language" says Masuisui Sam Partch, HVAZ Coordinator.
ProCare Pacific Strategy Advisor Viv Pole says there is good work being done to address Pacific health issues, but it is a drop in the bucket compared to the scale of the problem. Pole would like to have seen more emphasis on Pacific health in the recent Health & Disability System Review, considering Pacific suffer worse health outcomes than most other ethnicities in New Zealand. "We are concerned with the high prevalence of Pacific diabetes and the 30% (25-44 yrs) who have prediabetes, let alone the undiagnosed. It will be good to have dedicated funding to address the burden of the disease and protect the quarter of Pacific that are expected to have diabetes in 20 years".
In order to bring about widespread change, Norwell hopes that the Reforms will enable more targeted care for Pacific people, based on their need and delivered in their local community - close to home. "We need to work in collaboration and we need to listen to our communities. This is the opportunity of a lifetime for the sector to come together - to embrace what’s working, and to turn our backs on what’s not."