PACIFIC CHILDRENImproving Health and Healthcare for Pacific Children in New Zealand

Dr Teuila Percival

Pacific PeoplePacific People

• Relationships• Holistic health and spirituality• Contribution and responsibility• Correctness and respect• Faith• Dignity

Pacific People’s challengesPacific People’s challenges• High Mortality across the lifespan• High rates of non-communicable and

infectious disease• Late presentation to healthcare&

multiple co-morbidities

• Inequitable healthcare access• Upstream determinants - Poverty

unemployment, environments• Lower formal education

Pacific childrenPacific children• High infant & child mortality

• Infectious diseases• Respiratory disease• Rheumatic Fever & RHD• Child Obesity• Lower Pre-school enrollment

• Lower School achievement

New Zealand Pacific Children

Infectious diseases Admissions by deprivation and ethnicity

Baker et al 2012

Pacific infantsPacific infants•Pacific preterm rate 5.5 %•Low birth weight 5.4%•NICU admission rate 11%

Hospitalization rate

1st year of life 27.3%

Auckland Population 2009 - 2011

Proportion of NZ Children(0-14yrs) living in Crowded Households by ethnicity and NZ Deprivation Index Decile, 2006 Census

% o

f ag

e gr

oup

NZ Deprivation Index DecileNZ Child & Youth Epidemiology Service.

Emergency Department Attendances, Auckland DHB’s 2011

Specialist Outpatient Appointments FSA for Auckland DHB’s, 2011

Accessing health care Age standardised mortality (1990-1992), CABG and PTCA intervention rates(1990-1999) per 100,000 population by ethnic group. New Zealand Males

0

50

100

150

200

250

mortality CABG PTCA

Maori

Pacific

other

Tukuitonga C et al. NZMJ,2002

Per

10

0,0

00

Outpatient Clinic DNA rate % DNA First Specialist Appt Auckland DHB’s, 2011

Pacific NMNP

Paediatric 18 9

Diabetes 19 9

Renal 14 5

Gynae 16 6

All FSA OP clinics 11 3

Ethnic differences in Rx/intervention

Detection Diagnosis Treatment

death

or

cure

Age

Co-morbidities

Upstream determinants

1. Service delivery

2. Health workforce

3. Information

4. Medical products

5. Vaccines & technology

6. Financing

7. Leadership and Governance

The 6 Building Blocks of Health The 6 Building Blocks of Health SystemsSystems

Source: WHO

Health LiteracyHealth Literacy• How to navigate and interact with the complex health system• What health information is relevant and how to find it• Developing knowledge and expectations about health and

well-being• Evaluating and understanding health messages, nutrition

information, instructions and medicine labels • Completing medical forms and responding to information

requests • Confidence and ability to talk with health professionals and

ask questions

School nurse

Public health nurse

General practitioner

Practice nurse

Community health worker

community midwife

obstetrician

outpatient clinic

Hospital midwife

Delivery suite

Accident & Medical Clinic

Hospital Emergency Dept

Well Child Nurse

Community social worker

Paediatrician

Local chemist

Next door neighbor

Accessing healthcare ?Accessing healthcare ?

teacher

Traditional healer

Bronchiolitis Northern DHB Acute Hospitalisations 2000 - 2010

Bacterial /non-viral Pneumonia Northern DHB Admissions 2000-2010, 0-24yrs

CMDHB Pacific Child Admissions for Acute medical conditions, 2000 - 2010

Adm

issi

ons

per

1000

LRI in under 2 yr olds, CMDHB 2007Trenholme A. et al.

•394 children / 508 admissions•56% Pacific, 30% Maori•78% in Dep 9 & 10•65% smoke exposed•27% use no household heating•Longer stay = young, preterm, Maori or Pacific

Reducing respiratory diseaseReducing respiratory disease

•Second hand smoke•Housing and household crowding•Improved breastfeeding rates•Raise immunization rates•General infectious disease prevention

Health solutions1. Determinants of Health 1. Determinants of Health & Health Promotion & Health Promotion

Respiratory illness, South Auckland initiatives

• Healthy Housing• Snug Homes• Immunization – outreach, NIR• Pneumococcal vaccine coverage• Low cost Primary Care• Smoking Cessation• Pacific Churches

Children fully immunized at age 2 yrs.New Zealand 2009

Source: IMAC

Admissions for Asthma in Northern DHB’s, 2000 – 2010, Age 0-24 yrs

Focus on Asthma•Second hand tobacco smoke•Self/Home based management of Asthma

•Housing and household crowding• Increase immunization rates•Culturally specific Asthma programmes

Health Solutions2. Improving Health Care2. Improving Health Care

“An evaluation of a pictorial asthma medication plan for Pacific children”Kristiansen et al, 2012

““Primary Care for Pacific People”Primary Care for Pacific People”

Barriers to seeking helpBarriers to seeking help

• Transport• The cost of healthcare• Difficulty communicating and understanding• Language barriers• Difficulty making appointments• The expectation / experience “gap”• Sometimes insensitive and “racist” behaviour

Southwick et al, 2012

Healthcare was a positive Healthcare was a positive experience…experience…

When the patient and familyWhen the patient and family Felt welcomeFelt welcome Felt respectedFelt respected ValuedValued Listened to & understoodListened to & understood

Southwick et al, 2012

Best Practice Maternity carePerinatal and Maternal Mortality Review Committee 2012, 6th Report

“All Women should commence maternity care

before10 weeks”

• Screen for congenital abnormalities, STI, maternal mental health, underlying medical condition

• Identify at risk (obesity, socio-economic)

“LMC’s should be aware that teenage mothers are at increased risk of stillbirth and neonatal death”

Responsive Health ServicesResponsive Health ServicesMaternal & Child Health in Primary Care pilotMaternal & Child Health in Primary Care pilotSouth Seas HealthCare, OtaraSouth Seas HealthCare, Otara

• Point of access to care = +ve pregnancy test

• Co-locate GP, midwife, Well-Child, Social worker

• One shared medical record• Early social work assessment &

intervention

Child hit by vehicle while crossing a road Traveling not playing 40% on school journey 75% within 1 km of

home High traffic volume roads Traffic usually speeding

Higher rates inHigher rates in• Pacific & Maori Pacific & Maori

childrenchildren• Lower Lower

socioeconomic socioeconomic communitiescommunities

Health Solutions3. Policy and infrastructure3. Policy and infrastructure

Policy• FREE health care for children• FREE education for children• Ethnicity and socio-economic status factored into funding of health programmes

Health Solutions4.Community development 4.Community development

& empowerment& empowerment

Promoting Healthy Church Environments

“Health Eating Church Awards”

Impact of Health Eating Awards on Health Impact of Health Eating Awards on Health Village Action Zone ChurchesVillage Action Zone Churches Liliani Momota Atiola, University of Auckland

Gold AwardGold Award Church characteristics Strong & supportive Church leader High engagement of congregation Dedicated Health co-ordinator Active Health Committee

“We notice at church functions the presence of more vegetable and fruit salads and less food that is high in fat, salt and sugar. This is very exciting for us moving into the future.”

Healthy eating

Healthy activity

Healthy weight

Individual behaviour change

The environmental gradient is steep

Env

ironm

enta

l cha

nge

The greatest opportunities to promote health will address :

Poverty & low income Educational disparities Isolation & increase social cohesion Unsafe neighbourhoods Community built environment Commercial / retail environment

The Southern InitiativeThe Southern Initiative

Children are nurtured Children are nurtured

in Body, Mind and Spiritin Body, Mind and Spirit

Environments invite learning and leisureEnvironments invite learning and leisure

People work and age with dignityPeople work and age with dignity

Ecological balance is a source of pride and,Ecological balance is a source of pride and,

The Ocean that surrounds us The Ocean that surrounds us

is protected for future generationsis protected for future generations

Adapted from the 1995 Yanuca declaration