Friday's first mass vaccination event initially suffered from poor communication with the intended communities. Dr Collin Tukuitonga says that is a problem repeated time and again for Pacific people, who continue to suffer poor health statistics
The initial take-up failure of south Auckland’s mass-Covid-19 vaccination event is a clear indication of what happens when Māori and Pacific voices aren’t heard in healthcare initiatives.
It could have been so different. All that was needed was input from Māori and Pacific health providers, and from the Māori and Pacific communities the event was targeting. Surely, it’s not that hard to gauge that working with people who can speak to their own communities is a sure pathway to a successful health initiative.
But then again, it really comes as no surprise. This failure to engage successfully with Pacific and Māori communities over health issues is repeated time and again. And particularly, I have to say, with regard to our large and ill-served Pacific communities which take the lead when it comes to healthcare inequity in Aotearoa New Zealand.
Inequity was underlined in a recent report by the Health Quality and Safety Commission (HQSC) called Bula Sautu – A Window on Quality 2021: Pacific health in the year of Covid-19. It follows a similar report on Māori health in 2019 as part of the commission’s ongoing work to improve health and disability support services. The commission’s vision is Quality Health for All, and its brief includes patient safety and reducing inequities in health.
Bula Sautu presents a sobering story of the health inequities that Pacific people experience, especially in relation to difficulties with access to health care and variable quality of care provided.
These inequities have persisted despite various Pacific policy statements and interventions. Examples of the inequities include the failure of half of all pregnant Pacific women to secure reliable midwifery care and 40 percent of Pacific children under the age of four missing out on Well Child checks. Diabetes is most common among Pacific adults but despite good attendance at clinics, they have high complication rates such as kidney failure needing dialysis.
In some cases, the inequities are worse than those reported among Māori. Many in the Pacific community have expressed their disappointment at the lack of progress and most are hopeful that Bula Sautu will lead to effective actions. Incremental change is inadequate and fundamental change in design and delivery of health services is needed. It is also essential Pacific people are intimately involved in the co-design of any new initiatives. This would include events such as the mass vaccination, and we have already seen what happens when this step is disregarded.
Bula Sautu was produced by independent Pacific clinicians and researchers with support from the staff of the commission during 2020. It is the first comprehensive report on the health status of Pacific people living here over the latest two decades. The last comprehensive report on the health of Pacific people living here was the Public Health Commission’s “The Health of Pacific Island People in New Zealand” report released in 1994. Several strategies and policies have been promoted by the Ministry of Health since then, but the Bula Sautu findings suggest there has been little improvement in the health and well-being of Pacific people despite these interventions.
Information for the report was sourced from existing data and supplemented by the experiences of several Pacific clinicians. The result is an excellent source of updated information collated into one report intended for policy makers, researchers, health workers and Pacific people. The expectation is that Bula Sautu will lead to effective actions, including major health system design changes that can be implemented as part of the Health and Disability System reform currently underway. Given the lack of impact in recent years, Bula Sautu is a much-needed call to action.
Priorities include the need to invest in the training of more Pacific health care workers. Existing affirmative actions in health professional training are insufficient, bolder actions are needed and more training places need to be made available for Pacific (and Māori) young people.
Furthermore, with less than 10 percent of Pacific patients being seen by a Pacific health care professional of their choice, expansion of the Pacific primary and community care sector is important. More specialists are needed in priority medical specialities and we need to see additional investment in midwifery, pharmacy and optometry training. In addition, funding for primary health care needs to be reviewed to reduce financial barriers to health care. Bula Sautu includes several other recommendations and the full report can be found here.
Despite let-downs of the past, hopes are high that we now have a framework on which to hang the much-needed changes that will make a difference to our Pacific communities. And maybe then, we will not see again the off-the-mark message delivery that very nearly marred the well-intentioned mass vaccination event.
*At 5.30 pm Friday night the Northern DHBs reported 3500 people had received vaccination jabs across the first day.
