1. Levels of
health intervention
Lessons from the Land
of the
Long White Cloud

2. The second topic I would like to address relating to Maori health is how to conceptualize possible levels of health intervention. When I first showed this picture to my husband, he couldn’t make out what I was trying to draw. He asked, “Is it a tree with a building underneath?” Who can guess what I am trying to represent here? Right, this is the ambulance at the bottom of the cliff! That is a metaphor we are familiar with, but I want to extend that metaphor to consider other possible levels of health intervention.
Here we have a trampoline or a net halfway down the cliff. This is intended to catch people after they have fallen but before they impact the bottom, to protect them from being hurt too badly. If this is a trampoline, you have the problem of people just bouncing up and down on it without being able to get back up to the top of the cliff. I suppose you also need to build a ladder back up. If this is a net, you have the problem of some people falling through the holes.
Here we have a strong fence built at the edge of the cliff. This is intended to prevent people from falling. Depending on the pressure against it, it might need to be very, very strong.
Here I have drawn some people to represent the community living at the cliff face. I would like to suggest that a fourth level of health intervention would be to move the center of the community away from the cliff face. This would reduce the pressure on a fence, and reduce the numbers coming close enough to the edge of the cliff to fall off.
Camara Phyllis Jones, MD, MPH, PhD

3. Levels of health intervention
Camara Phyllis Jones, MD, MPH, PhD

4. Camara Phyllis Jones, MD, MPH, PhD

5. Camara Phyllis Jones, MD, MPH, PhD

6. Camara Phyllis Jones, MD, MPH, PhD

7. Camara Phyllis Jones, MD, MPH, PhD

8. Camara Phyllis Jones, MD, MPH, PhD

9. Camara Phyllis Jones, MD, MPH, PhD

10. Camara Phyllis Jones, MD, MPH, PhD

11. Camara Phyllis Jones, MD, MPH, PhD

12. Camara Phyllis Jones, MD, MPH, PhD

13. Camara Phyllis Jones, MD, MPH, PhD

14. Camara Phyllis Jones, MD, MPH, PhD

15. Camara Phyllis Jones, MD, MPH, PhD

16. How do disparities arise?
Differences in the quality of care received within the health care delivery system
Differences in access to health care including preventive and curative services
Differences in life opportunities, exposures, and stresses resulting in differences in underlying health status
Camara Phyllis Jones, MD, MPH, PhD

17. Camara Phyllis Jones, MD, MPH, PhD

18. Camara Phyllis Jones, MD, MPH, PhD

19. Camara Phyllis Jones, MD, MPH, PhD

20. Camara Phyllis Jones, MD, MPH, PhD

21. Camara Phyllis Jones, MD, MPH, PhD

22. Camara Phyllis Jones, MD, MPH, PhD

23. Painting by Robyn Kahukiwa
Papatuanuku
Painting by Robyn Kahukiwa