Many population-based surveys use biomedical paradigms that are mismatched with Indigenous worldviews. Consequently, NZ health and disability policies structurally discriminate against Māori. We developed an approach that would address a more contextually relevant understanding of the determinants of health inequities for Māori. Of particular interest to health professionals, is the impact of functional imitation (disability) on health access.
A large, co-designed, accessible and culturally grounded, survey of people of Māori descent was conducted. Analysis included a novel dual-weighting system to ensure generalisability of results to the national Māori population. Variables included Demographics, Connection to whānau (family), lineage and land, Cultural participation, use of Te reo (Māori language), Life satisfaction, Discrimination, and Functional limitation with the Washington Group Short Set (WG-SS) amongst others. Regression analysis controlling for key factors was used to explore health access for those with a functional limitation.
The 7230 respondents were comprised of 4387 (60.7%) female participants, 5644 participants between and including the ages of 18 and 64 years; and 940 (13%) participants who reported a functional limitation with one or more items rated either ‘a lot of difficulty’ or ‘cannot do at all’ on the WG-SS. Nearly a third (32%) of participants reported having an unmet health need; 32.6% cite the cost of accessing health as the reason. Māori with lived experience of disability have 1.71 (95% CI: 1.43, 2.05; p0.001) times the odds of reporting difficulty accessing a GP, nurse, or other health care worker at their usual medical centre. The adjusted odds rate is 1.43 (95% CI: 1.15,1.77; p0.001).
Māori with lived experience of disability have significantly increased odds of reporting access issues to health care. Our data demonstrates the multiplicative impact of intersectionality, as Māori already have recognised issues with accessing health care. Future work will explore the impact of ‘some difficulty’ versus ‘a lot of difficulty and cannot do at all’ with the WG-SS to provide a more nuanced understanding of those at risk of unmet health need and the potential invisibilisation of health access issues for those with less severe functional limitation.
In NZ, access to nationally funded physiotherapy, for non-accidental injuries, is primarily via GP referral. Our data shows, that those who potentially have the most need for physiotherapy for long term functional limitations, have significant issues accessing their GP, and consequently physiotherapy. To mitigate this health inequity, physiotherapy professional organisations have a social responsibility to advocate at the macro health system level for direct access to nationally funded primary care physiotherapy for non-accidental injuries. At the meso level, physiotherapists need to consider ways of making their organisation and services more accessible and more culturally responsive. At the micro or individual level, reflection on unconscious bias and who currently accesses services is required.
Indigenous health
Intersectionality
