New research on heart health care in New Zealand showed there are many longstanding barriers that continue to affect Pacific and Māori people with heart related conditions, hence a call to action to increase the Pacific and Māori health workforce.

There are about 7000 Pasifika and more than 20,000 Māori living with heart disease, and for these groups there is a higher risk at a younger age.

The study used kaupapa Māori (Māori approach) and Pacific research methods, to look into how the risk of heart conditions are assessed and managed, and what can be done to reduce delays and improve access to hospital care for these groups.

Over the past three years, Senior research fellow and Co-Director of Pūtahi Manawa Dr. Karen Brewer led a major piece of work in the study of qualitative interviews with Pacific and Māori people about their experiences of heart health care.

It showed many barriers are longstanding and continue to affect Māori and Pacific peoples with heart related conditions. Despite a strong desire to take charge of their health, the same challenges stifled better outcomes.

“It’s the same old, same old. It’s almost new, that it’s not new,” said Dr. Brewer.

She said the need for education, especially among health professionals, with an emphasis on cultural safety aspects was demonstrated in the research findings.

Need for a representative workforce

"There was a call to action to increase the Māori and Pacific health workforce", Dr. Brewer said, emphasising the vital role of the MAPAS programme (Māori and Pacific Admission Scheme) at the University of Auckland and Te Kauae Parāoa at Otago University.

"Nurturing children and introducing health career pathways from as early as primary school could help the next generation of Māori and Pacific communities see themselves as future health professionals and researchers."

Researcher and former nurse, Dr. Tua Taueetia-Su’a said the study showed the importance of developing the workforce, from building the number of Pacific and Māori health professionals as well as training all providers in cultural safety.

Study participants said it could be as simple as having family members present when receiving care and for health professionals to engage with all family, and not just the patient.

Higher risk at a younger age

Cardiovascular or heart checks are regularly carried out through the testing of bloods, cholesterol, and blood pressure. For people who are not Pacific, Māori, or South Asian, and have no known risk factors, this means testing men from age 45 and women 55, but for Pacific and Māori, the ages are lower, testing men from 30 and women from 40.

Dr. Brewer said this is reflective of having a higher risk at a younger age.

The study confirmed that the social determinants of health played an important role in increased risk for Pacific and Maori people: housing, education, access to good nutrition and poverty etc.

However, differences in access to and quality of health treatment were also experienced by the participants and so having clarity around this was important to address the identified gaps.

“We value relationships, reciprocity and communication, there is a lot that doesn’t work for Māori and Pacific because the health system is not a Māori and Pacific system.”

These communities were not seeing themselves in the health care professionals they engaged with, Dr. Brewer said, continuity in care, which no longer seemed to be valued by the health system, made a marked difference to the treatment received.

“There is a difference in regularly seeing your GP and if possible, the same GP.”

People who had regular care were able to get an earlier diagnosis, and people receiving regular care were more likely to engage with the treatment, as well as take charge of their care.

These things are more likely to occur when there was a positive relationship between patient and provider.

Senior research fellow and Co-Director of Pūtahi Manawa Dr. Karen Brewer (Whakatōhea, Ngaiterangi) said the research programme Manawataki Fatu Fatu for ACCESS (Māori and Pacific hearts in unison for Achieving Cardiovascular Care in Equity StudieS) aims to identify evidence-practice gaps along the healthcare continuum, and address and improve heart health outcomes for Māori and Pacific people in Aotearoa, New Zealand.

The four-year programme, led by Senior Research Fellow Dr. Corina Grey (Alafua, Tafitoala, Vailima, Safune and Gataivai - Sāmoa) and Associate Professor Matire Harwood KSM (Ngāpuhi, Ngāti Rangi, Te Mahurehure and Ngāti Hine) was funded by the Heart Foundation and Healthier Lives National Science Challenge.