Transforming a global order in New Zealand to reduce health inequities in service provision

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
E Rawson
Keyword(s):  
Public Health ◽  
New Zealand ◽  
Indigenous Knowledge ◽  
Best Practice ◽  
Indigenous Health ◽  
Indigenous Communities ◽  
Health Inequities ◽  
Medical Emergency ◽  
Major Work ◽  
Health Initiatives

Abstract St John has been providing service in New Zealand for nearly 140 years since its arrival. It has now close to 4000 staff and nearly 20000 Members and over 8500 volunteers. In New Zealand the major work of St John is its Ambulance service providing front line first responders to crash, medical emergency and other life-threatening situations. St John New Zealand also provides a number of 'Community Health' initiatives focused on strengthening communities and prevention. In recent years St John has recognised that they have not engaged well with Indigenous communities and that their organisation in New Zealand must become skilled and relevant in addressing the needs of the Indigenous people of New Zealand, as they suffer the greater burden of disease and illness than any other population in the country. St John NZ Community and Health Services are embarking on a process of transformation through re-orienting its culture and practice by adopting Public Health approaches and an equity lens over all its programmes. They also have committed to understanding and using Indigenous knowledge to support this re-orientation to most effectively engage and implement programmes that will reduce Indigenous health inequities. This presentation will describe the process by which they will be implementing their strategy for change and highlight best practice for working with Indigenous communities. Key messages Indigenous Knowledge is key to addressing Indigenous Health inequities. Mainstream Public Health can learn from Indigenous Public Health approaches.

scholarly journals Responding to health inequities: Indigenous health system innovations

2016 ◽  
Vol 1 ◽  
Author(s):  
J. G. Lavoie ◽  
D. Kornelsen ◽  
L. Wylie ◽  
J. Mignone ◽  
J. Dwyer ◽  
...  
Keyword(s):  
Health System ◽  
Indigenous Health ◽  
Indigenous Communities ◽  
Health Inequities ◽  
Healthcare Services ◽  
International Perspective ◽  
Full Potential ◽  
Community Members ◽  
Culturally Informed ◽  
The Usa

Over the past decades, Indigenous communities around the world have become more vocal and mobilized to address the health inequities they experience. Many Indigenous communities we work with in Canada, Australia, Latin America, the USA, New Zealand and to a lesser extent Scandinavia have developed their own culturally-informed services, focusing on the needs of their own community members. This paper discusses Indigenous healthcare innovations from an international perspective, and showcases Indigenous health system innovations that emerged in Canada (the First Nation Health Authority) and Colombia (Anas Wayúu). These case studies serve as examples of Indigenous-led innovations that might serve as models to other communities. The analysis we present suggests that when opportunities arise, Indigenous communities can and will mobilize to develop Indigenous-led primary healthcare services that are well managed and effective at addressing health inequities. Sustainable funding and supportive policy frameworks that are harmonized across international, national and local levels are required for these organizations to achieve their full potential. In conclusion, this paper demonstrates the value of supporting Indigenous health system innovations.

State Preventive Medicine: Public Health, Indian Removal, and the Growth of State Capacity, 1800–1840

2020 ◽  
Vol 34 (1) ◽  
pp. 24-43
Author(s):  
Ruth Bloch Rubin
Keyword(s):  
Public Health ◽  
Nineteenth Century ◽  
Local Governments ◽  
Indigenous Health ◽  
Active Role ◽  
Vaccination Program ◽  
Indian Removal ◽  
Administrative Capacity ◽  
War Department ◽  
Health Initiatives

Despite growing awareness of the American state's active role in the early nineteenth century, scholars have tended to ignore the early republic's public health apparatus. The few studies that do chronicle antebellum health initiatives confine themselves to programs intended to directly reward citizens—and particularly those who contributed politically or economically to the nation's founding and expansion. As this detailed study of the Indian Vaccination Act of 1832 makes clear, however, antebellum policymakers saw value in providing medical care to those outside their settler citizenry. Blending liberal, republican, and ascriptive ideas, the vaccination program joined two competing political logics: one emphasizing the humanity of indigenous people and the importance of providing for their welfare, and the other prioritizing the state's interest in an efficient “removal” process. Evidencing far more autonomy and administrative capacity than the average nineteenth-century bureaucracy, the War Department played a pivotal role in petitioning Congress for, and ultimately administering, the vaccination program. Unwilling to cede regulatory power over indigenous health to more proximate local governments or private parties, the War Department preferred its own military manpower—a decision that would profoundly shape the design and reception of subsequent Native health programs.

scholarly journals Factors Influencing Coaches’ Decisions about Concussion on the Sidelines of Youth Sports

Neurology ◽  
2019 ◽  
Vol 93 (14 Supplement 1) ◽  
pp. S23.3-S24
Author(s):  
Ann Guernon ◽  
Christina Papdimitriou
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Practice Guidelines ◽  
Best Practice ◽  
Youth Sports ◽  
Return To Play ◽  
Health Concern ◽  
Sports Organizations ◽  
Factors Influencing ◽  
Health Initiatives

ObjectiveIdentify coach reported factors influencing decisions about potential concussion in youth sports.BackgroundYouth concussion in sport is an established public health concern. Coaches are the primary stakeholders deciding about removal from play for suspected concussion on the sidelines of competition and practice in most youth sports organizations. Estimates indicate over 2 million adults coach youth sports. Legislation across the U.S. and guidance from the Centers for Disease Control and the Concussion in Sport Group recommend players with suspected concussion be removed from play and not return prior to medical clearance and a graduated return to play protocol be followed.Design/MethodsQualitative semi-structured 1:1 interviews with coaches of youth community or school sponsored athletic programs in Illinois. Interview data was analyzed according to a constructivist grounded theory methodology employing constant comparative methods with an inductive approach to theme emergence.ResultsSixteen coaches of recreational, competitive and scholastic athletic teams participated. Coaches were primarily white (94%) males (81%) with an average age of 47. Ten were volunteer coaches. Analytic themes related to decision making include: 1) personal experience drives decisions more than concussion training, 2) coaches fear the legal liability of missing a concussive event on the field, and 3) discomfort with the ambiguity of making decisions on the field. Coach perceived factors for improving comfort with decision making were: 1) availability of checklists or tools for use on the sidelines, 2) improve shared decision making with all stakeholders, and 3) access to medical professionals on the sidelines.ConclusionsThere is a possible misalignment between coaches’ actual practices on the field and best practice guidelines. Coaches report behaviors on the sidelines that are distinct from practice guidelines and public health initiatives related to removal from play and return to play when events on the field present the potential for concussion.

scholarly journals Promoting Resilience Within Public Health Approaches for Indigenous Communities

2021 ◽  
pp. 78-99
Author(s):  
Christopher Mushquash ◽  
Elaine Toombs ◽  
Kristy Kowatch ◽  
Jessie Lund ◽  
Lauren Dalicandro ◽  
...  
Keyword(s):  
Public Health ◽  
Best Practices ◽  
First Nations ◽  
Indigenous Health ◽  
Indigenous Communities ◽  
Careful Consideration ◽  
Health Interventions ◽  
Indigenous Populations ◽  
Process And Outcome ◽  
Mental Wellness

Resilience within public health is conceptualized to be fostered through individual, community, and systemic initiatives that promote capacity through interconnected primary, secondary, and tertiary health interventions. Within community public health settings, particularly for Canadian Indigenous communities, an emphasis on interconnected, multisystemic interventions that promote resilience can be particularly useful. Fostering resilience within Indigenous health seeks to prioritize unique needs of individuals and communities, through both process- and outcome-based measurement. Given that Indigenous individuals’ needs may differ from non-Indigenous populations in Canada, careful consideration of how to best conceptualize, measure, and promote resilience is required. Tools such as the Native Wellness Assessment and the First Nations Mental Wellness Continuum Framework can be helpful to both measure and conceptualize resilience, as they can provide insight on what is considered to be best practices to increasing wellness within Indigenous communities. Such tools continue to prioritize the multisystemic promotion of resilience.

Determinants of health

2021 ◽  
pp. 83-92
Author(s):  
Matthew Fisher ◽  
Belinda Townsend ◽  
Patrick Harris ◽  
Ashley Schram ◽  
Fran Baum
Keyword(s):  
Public Health ◽  
Public Policy ◽  
Indigenous Health ◽  
Health Inequities ◽  
Determinants Of Health ◽  
Environmental Determinants ◽  
Policy Action ◽  
Main Factors ◽  
And Gender ◽  
Public Health Literature

The determinants of health are the biological, psychological, behavioural, social, economic, and environmental factors that determine the health of individuals and populations. Socially or politically conditioned inequalities in the distribution of determinants lead to inequities in health within or between countries. The ways that determinants act on health are complex, involving interactions between factors and effects occurring over differing timespans. These complexities present challenges for research and public policy, to understand and take action on determinants, to improve population health, and/or to reduce health inequities. In this chapter we review the four main categories of biological, behavioural, social, and environmental determinants. We then discuss the topic of social determinants of health in more detail and review a number of the main factors identified in contemporary public health literature; from education, employment, and gender to determinants of Indigenous health, and commercial determinants of health. In a later section of the chapter (‘The complexity of determinants and their interactions’) we look at some of the challenges raised by the complex, multifactorial nature of determinants of health for research, health practice, and policy action. In the final section, we discuss two particular political challenges facing governments and international bodies seeking to take action on determinants of health and health equity.

scholarly journals Strategies to support culturally safe health and wellbeing evaluations in Indigenous settings in Australia and New Zealand: a concept mapping study

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Margaret Cargo ◽  
Gill Potaka-Osborne ◽  
Lynley Cvitanovic ◽  
Lisa Warner ◽  
Sharon Clarke ◽  
...  
Keyword(s):  
New Zealand ◽  
Concept Mapping ◽  
Concept Maps ◽  
Indigenous Health ◽  
Hierarchical Cluster ◽  
Indigenous Communities ◽  
Mapping Study ◽  
Financial Investment ◽  
Evaluation Practice ◽  
Cultural Integrity

Abstract Background In recent decades, financial investment has been made in health-related programs and services to overcome inequities and improve Indigenous people’s wellbeing in Australia and New Zealand. Despite policies aiming to ‘close the gap’, limited evaluation evidence has informed evidence-based policy and practice. Indigenous leaders have called for evaluation stakeholders to align their practices with Indigenous approaches. Methods This study aimed to strengthen culturally safe evaluation practice in Indigenous settings by engaging evaluation stakeholders, in both countries, in a participatory concept mapping study. Concept maps for each country were generated from multi-dimensional scaling and hierarchical cluster analysis. Results The 12-cluster Australia map identifies four cluster regions: An Evaluation Approach that Honours Community; Respect and Reciprocity; Core Heart of the Evaluation; and Cultural Integrity of the Evaluation. The 11-cluster New Zealand map identifies four cluster regions: Authentic Evaluation Practice; Building Māori Evaluation Expertise; Integrity in Māori Evaluation; and Putting Community First. Both maps highlight the importance of cultural integrity in evaluation. Differences include the distinctiveness of the ‘Respecting Language Protocols’ concept in the Australia map in contrast to language being embedded within the cluster of ‘Knowing Yourself as an Evaluator in a Māori Evaluation Context’ in the New Zealand map. Participant ratings highlight the importance of all clusters with some relatively more difficult to achieve, in practice. Notably, the ‘Funding Responsive to Community Needs and Priorities’ and ‘Translating Evaluation Findings to Benefit Community’ clusters were rated the least achievable, in Australia. The ‘Conduct of the Evaluation’ and the ‘Prioritising Māori Interests’ clusters were rated as least achievable in New Zealand. In both countries, clusters of strategies related to commissioning were deemed least achievable. Conclusions The results suggest that the commissioning of evaluation is crucial as it sets the stage for whether evaluations: reflect Indigenous interests, are planned in ways that align with Indigenous ways of working and are translated to benefit Indigenous communities Identified strategies align with health promotion principles and relational accountability values of Indigenous approaches to research. These findings may be relevant to the commissioning and conduct of Indigenous health program evaluations in developed nations.

scholarly journals Through a Critical Lens: Expertise in Epidemiology for and by Indigenous Peoples

2019 ◽  
Vol 45 (6) ◽  
pp. 1142-1167
Author(s):  
Erica Prussing
Keyword(s):  
Public Health ◽  
Public Policy ◽  
Indigenous Peoples ◽  
Science And Technology Studies ◽  
Indigenous Health ◽  
Indigenous Communities ◽  
Public Health Research ◽  
Ethnographic Study ◽  
Social Worlds ◽  
Aotearoa New Zealand

Epidemiology for and by Indigenous peoples uses quantitative and statistical methods to better document Indigenous health concerns, and is oriented around providing data for use in advocacy to promote Indigenous health equity. This advocacy-oriented, technoscientific work bridges the often distinct social worlds of Indigenous communities, professional public health research, and public policy-making. Using examples from a multisited ethnographic study in three settings (Aotearoa New Zealand, Hawai’i, and the continental United States), this paper examines the forms of expertise that researcher/practitioners enact as they conduct research that simultaneously harnesses epidemiology’s persuasive power in social worlds like public health and public policy, while also critically challenging legacies of colonialist erasures and misrepresentations of Indigenous health in population statistics. By demonstrating how these continual translations across multiple social worlds enact expertise, this analysis offers a new integration of discussions about both coloniality and expertise within science and technology studies (STS). By focusing on the experiences of technoscientific professionals themselves, this study’s findings also pose new questions for broader STS conversations about how activism is shaping the production of knowledge about health in the twenty-first century.

scholarly journals Acknowledging and Promoting Indigenous Knowledges, Paradigms, and Practices Within Health Literacy-Related Policy and Practice Documents Across Australia, Canada, and New Zealand

2019 ◽  
Vol 10 (3) ◽  
Author(s):  
Gordon Robert Boot ◽  
Anne Lowell
Keyword(s):  
New Zealand ◽  
Health Literacy ◽  
Health Services ◽  
Indigenous Health ◽  
Indigenous Communities ◽  
Policy And Practice ◽  
Indigenous Knowledges ◽  
Qualitative Research Design ◽  
Health Studies ◽  
Quality In Healthcare

Enhancing health literacy can empower individuals and communities to take control over their health as well as improve safety and quality in healthcare. However, Indigenous health studies have repeatedly suggested that conceptualisations of health literacy are confined to Western knowledge, paradigms, and practices. The exploratory qualitative research design selected for this study used an inductive content analysis approach and systematic iterative analysis. Publicly available health literacy-related policy and practice documents originating from Australia, Canada, and New Zealand were analysed to explore the extent to which and the ways in which Indigenous knowledges are recognised, acknowledged, and promoted. Findings suggest that active promotion of Indigenous-specific health knowledges and approaches is limited and guidance to support recognition of such knowledges in practice is rare. Given that health services play a pivotal role in enhancing health literacy, policies and guidelines need to ensure that health services appropriately address and increase awareness of the diverse strengths and needs of Indigenous Peoples. The provision of constructive support, resources, and training opportunities is essential for Indigenous knowledges to be recognised and promoted within health services. Ensuring that Indigenous communities have the opportunity to autonomously conceptualise health literacy policy and practice is critical to decolonising health care.

scholarly journals Development and Dissemination of a Strengths-Based Indigenous Children's Storybook: “Our Smallest Warriors, Our Strongest Medicine: Overcoming COVID-19”

2021 ◽  
Vol 6 ◽  
Author(s):  
Victoria M. O'Keefe ◽  
Tara L. Maudrie ◽  
Allison Ingalls ◽  
Crystal Kee ◽  
Kristin L. Masten ◽  
...  
Keyword(s):  
Public Health ◽  
Mental Health ◽  
Native American ◽  
American Indian ◽  
Home Visiting ◽  
Indigenous Health ◽  
Indigenous Communities ◽  
Shared Responsibility ◽  
Indian Health ◽  
American Indian Health

The traditions, strengths, and resilience of communities have carried Indigenous peoples for generations. However, collective traumatic memories of past infectious diseases and the current impact of the coronavirus disease 2019 (COVID-19) pandemic in many Indigenous communities point to the need for Indigenous strengths-based public health resources. Further, recent data suggest that COVID-19 is escalating mental health and psychosocial health inequities for Indigenous communities. To align with the intergenerational strengths of Indigenous communities in the face of the pandemic, we developed a strengths- and culturally-based public health education and mental health coping resource for Indigenous children and families. Using a community-engaged process, the Johns Hopkins Center for American Indian Health collaborated with 14 Indigenous and allied child development, mental health, health communications experts and public health professionals, as well as a Native American youth artist. Indigenous collaborators and Indigenous Johns Hopkins project team members collectively represented 12 tribes, and reservation-based, off-reservation, and urban geographies. This group shared responsibility for culturally adapting the children's book “My Hero is You: How Kids Can Fight COVID-19!” developed by the Inter-Agency Standing Committee Reference Group on Mental Health and Psychosocial Support in Emergency Settings and developing ancillary materials. Through an iterative process, we produced the storybook titled “Our Smallest Warriors, Our Strongest Medicine: Overcoming COVID-19” with content and illustrations representing Indigenous values, experiences with COVID-19, and strengths to persevere. In addition, parent resource materials, children's activities, and corresponding coloring pages were created. The book has been disseminated online for free, and 42,364 printed copies were distributed to early childhood home visiting and tribal head start programs, Indian Health Service units, tribal health departments, intertribal, and urban Indigenous health organizations, Johns Hopkins Center for American Indian Health project sites in partnering communities, schools, and libraries. The demand for and response to “Our Smallest Warriors, Our Strongest Medicine: Overcoming COVID-19” demonstrates the desire for Indigenous storytelling and the elevation of cultural strengths to maintain physical, mental, emotional, and spiritual health during the COVID-19 pandemic.

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