Understanding the determinants of health for Māori living with chronic disease in Aotearoa New Zealand.

Abstract

Introduction: Aotearoa New Zealand has wide disparities in health outcomes between indigenous and non-indigenous groups, which are strongly associated with inequitable access to determinants of health by ethnicity. Experiences of health determinants culminate in higher rates of diabetes, asthma, kidney disease and other chronic diseases and worse outcomes for Māori.

Aim: This paper explores the relationships between health determinants and chronic disease from the perspectives of Māori patients and healthcare providers.

Methods: Using a Kaupapa Māori methodology and qualitative methods, six semi-structured focus groups with 21 Māori living with chronic disease and semi-structured consultations with 130 healthcare providers across the Waikato region were undertaken between 2021 and 2023.

Results: Participants identified five key health determinants shaping the everyday experience and management of chronic disease, including employment, welfare support, income, access to information and racism. Access to economic resources had significant impacts. Those in situations of economic insecurity experienced significant complications to everyday disease management and had fewer resources to mediate their effects. Chronic disease also reduced access to economic resources through increased health costs, reduced earning power and the impacts of dealing with the welfare and health systems. Comparatively, stable access to economic resources, such as health insurance, enabled disease management.

Discussion: Everyday experiences of health determinants are shaped considerably by economic circumstances. Claiming welfare support continues to be difficult for eligible participants, and welfare payment inadequate. The health system needs to re-design healthcare delivery so people with poor access to economic resources are actively supported to access health determinants.