Maori, the indigenous population of New Zealand make up approximately 15 percent of the New Zealand population, yet Maori have the poorest health of any New Zealand group. Maori see that the past shapes the present and guides the future. Maori have experienced the different phase of development of disability services in New Zealand, from are in the community supported by whanau, institutional or asylum care, the introduction of new psychotic drugs and treatment regimes and now care back in the community supported by mental health and related services and the support of kin friends.
Each change has had an impact on culture of Maori and often Maori have not been involved in the changes, but have had to adapt to whatever form of care is in vogue. Many Maori families are now faced with the challenge of providing support to kin who have been institutionalized often with little back up support, knowledge or resource to provide care. Deinstitutionalisation as a philosophy is consistent with Maori values, however, as past decisions have undermined Maori values, beliefs and Maori structures, such as the whanau, many families are now struggling to provide support.
Maori are still a population undergoing major culture changes and will likely continue this century and into the next millennium, with the impact of changing technology, new means of communication and New Zealand as part of a global world economy. Although the boundaries of Maori horizons have increased, Maori still have strong views of their uniqueness and the contribution they can make locally, nationally and internationally. In being part of a global economy, Maori see the need to establish strong links with Pacific and Asian nations and with other indigenous peoples who had similar experiences as their of the effects of colonalisation.
Recently published research concluded that the whanau is a secondary social and economic unit in the lives of Maori with disabilities. This is a significant departure from the commonly held belief that whanau is the primary unit for Maori and may reflect a previously invisible distinction for Maori with disabilities within a broader cultural context.
Identify a national situation is being discussed
This history of health care Maori covers the period from 1840 to 1940, a time span chosen to reflect the passage of a critical phase in the history of government policy.
In 1840 the Treaty of Waitangi,
The health benefits ushered in by the 1938 Social Act marked the end of the subsidized doctors who had served many Maori communities since the mid nineteenth century. This legislation also removed the financial impediments which had hindered the integration of hospital services for Maori and Europeans. This is more important watershed than 1900, the year which saw the inception of the Department of Public Health and the passage of the Maori Councils.
Missionary medicine was not part of official provision for Maori in the early years of European settlement. Yet the services provided by missionaries, in the absence of other medical assistance, helped shape the reaction of Maori to western medicine. . Few missionaries were fully trained in this discipline, but a number had a smattering of knowledge which enabled them to provide rudimentary care to family and colleagues in their isolated mission communities.
In February 1846 the Colonial Secretary informed the Chief Protector of Aborigines that Governor George Grey intended ‘altogether to remodel the Protecorate Department and to expend such portion as the Colony can afford of the larger sum that establishment has hitherto cost annually, upon schools hospitals and other institutions for the Natives’. As part of this reform the colony’s resident magistrates would oversee expenditure on Maori health.
In 1870 the government tabled a ‘Return of Expenditure Under Civil List Acts, for Five Years Ended 31 May 1870’. The ‘Second Division’ listed funds allocated to Native Purposes. The funding for Maori health was erratic in the 1860s, perhaps as a result of the dislocation and upheavals of war.
The provision of western medical service for Maori prior to 1846n was haphazard.
There was little incentive to erect hospitals in the colony. Nevertheless, some planners recognized the need to mark provision for illness.
Access to care or support for families were not available.
The special care required for kaumatua and kuia who have suffered strokes is well known to many whanau. Often such elders are more psychologically comfortable within their own homes but do not have the facilities for effective care. This is also true for some Maori with long term disabilities, many of whom stoically struggle to maintain their lifestyle under extremely trying conditions.
The Government requires that both purchasers and providers are to be guided by the following Crown objectives to meet the specific needs of Maori- "The Crown will seek to improve Maori health status so in future Maori will have the same opportunity to enjoy the same level of health as non- Maori".(Policy Guidines for Maori Health 1995/96, Ministry of Health )
Health gain priority areas have been indentify by the Government in Policy Guidelines for Regional Health Authorities(1994).
In its 1994 Report the Core Services Committee recommended four fundamental principles as the basis to guide the specification of health and disability support services which are to be publicly funded:
the treatment of services provides benefit
the treatment of services is value of money
the treatment of services is a fair use public funding
the treatment of services is consistent with communities’ value.
1991~1995 Funding for disability support transferred from the Social Welfare is to be ring –fenced.
People with disabilities have higher rates of health services utilization. In 1991 it was announced by Government that the health sector was to reformed. At the time, disability support services were largely purchased by the Department of Social Welfare. In 1992, the Core Services Committee was expanded to cover disability support services and renamed National Advisory Committee on Core health and Disability Support Services.
Maori requiring disability support services have access services that their special needs.
The Maori Health Plan gives direction to health providers about what they need to do to achieve the national plans. It recognises that health and well-being are affected by influences that historically were seen as outside the Healthcare and Disability Support arena. The Board is working with the Runanga to tackle these broader 'health determinants' with a range of health providers and agencies in other sectors such as housing.
Long-term health care refers to a broad set of paid and unpaid services for persons who need assistance because of a chronic illness or physical, mental or age-related disability. Policies that define the provision of long-term care to the disabled and elderly across member nations of the Organisation for Economic Cooperation and Development (OECD) vary according to what each nation values, what they can afford and what they are prepared to sacrifice by way of competing priorities. Up until the 1970’s many countries, like New Zealand, enjoyed a universal comprehensive welfare system that assured assistance for persons in need during all their lifespan
From government or some organizations to support services financial.
Over the past three decades mental health has moved from an institution-based service to a community-based one. The focus has shifted from containment to recovery, which supports full participation of tangata whaiora in society, protecting rights and helping to create supportive environments as well as more traditional clinical tasks of providing diagnosis and illness treatment services.
As noted earlier, a significant proportion of the excess mortality among Maoris stems from diseases for which effective health care is available, suggesting differences in access to health care. Health care need and health care quality have been developed into a framework for measuring disparities in access to care in the United States, a framework that includes broader environmental and societal factors (e.g., racism) that may affect access.
There is increasing evidence that Maoris and non-Maoris differ in terms of access to both primary and secondary health care services, that Maoris are less likely to be referred for surgical care and specialist services, and that, given the disparities in mortality, they receive lower than expected levels of quality hospital care than non-Maoris. One survey showed that 38% of Maori adults reported problems in obtaining necessary care in their local area, as compared with 16% of non-Maoris. Maoris were almost twice as likely as non-Maoris (34% vs 18%) to have gone without health care in the past year because of the cost of such care. This adds to previous evidence that cost is a significant barrier to Maoris’ access to health services.
A person with a disability is someone who has been assessed as having a physical,
psychiatric, intellectual, sensory or age related disability (or a combination of these)
which is likely to continue for minimum of six months and result in a reduction of
independent function to the extend that ongoing support is required; and is not as a result of personal injury by accident for which eligibility for cover and entitlement has been confirmed under the Accident Insurance Act.
If society disables then material changes to the social world will enable a less disabling social world. Thus the social model provides a framework for material change. This politics of identity which finds its expression in the social model of disability provides the philosophical basis underpinning current disability policy in New Zealand.
Identify attitudes, stereotypes and barriers
Attitudes have been identified, through consultation, as the major barrier that operates at all levels of daily life in the general population. Attitudes and ignorance make their presence felt as stigma, prejudice and discrimination.
Stigma, prejudice and discrimination affect our behaviours. Sometimes the combination of attitudes and behaviours can seem to create almost insurmountable barriers, for example, whole systems or organisations can become a barrier much in the way that institutionalised racism operates.
The Social Model views disability as a consequence of environmental, social and
attitudinal barriers that prevent people with impairments from maximum
participation in society. Disability is seen to stem from the failure of society to
adjust to meet the needs and aspirations of a disabled minority. This model implies that the removal of attitudinal, physical and institutional barriers will improve the lives of disabled people, giving them the same opportunities as others on an equitable basis.
The Religious Model views disability as a punishment inflicted upon an
individual or family by an external force. It can be due to misdemeanours
committed by the disabled person, someone in the family or community group, or