1. PACIFIC CHILDREN Improving Health and Healthcare for Pacific Children in New Zealand Dr Teuila Percival

9. Pacific People Relationships Holistic health and spirituality Contribution and responsibility Correctness and respect Faith Dignity

10. Pacific People’s challenges High Mortality across the lifespan High rates of non-communicable and infectious disease Late presentation to healthcare& multiple co-morbidities Inequitable healthcare access Upstream determinants - Poverty unemployment, environments Lower formal education

11. Pacific children High infant & child mortality Infectious diseases Respiratory disease Rheumatic Fever & RHD Child Obesity Lower Pre-school enrollment Lower School achievement

12. New Zealand Pacific Children

13. Infectious diseases Admissions by deprivation and ethnicity Baker et al 2012

14. Pacific infants Pacific preterm rate 5.5 % Low birth weight 5.4% NICU admission rate 11% Hospitalization rate 1st year of life 27.3% Auckland Population 2009 - 2011

15. Proportion of NZ Children(0-14yrs) living in Crowded Households by ethnicity and NZ Deprivation Index Decile, 2006 Census % of age group NZ Deprivation Index Decile NZ Child & Youth Epidemiology Service.

16. Emergency Department Attendances, Auckland DHB’s 2011

17. Specialist Outpatient Appointments FSA for Auckland DHB’s, 2011

18. Accessing health care Age standardised mortality (1990-1992), CABG and PTCA intervention rates(1990-1999) per 100,000 population by ethnic group. New Zealand Males Tukuitonga C et al. NZMJ,2002 Per 100,000

19. Outpatient Clinic DNA rate % DNA First Specialist Appt Auckland DHB’s, 2011 PacificNMNP Paediatric189 Diabetes199 Renal145 Gynae166 All FSA OP clinics113

20. Ethnic differences in Rx/intervention Detection DiagnosisTreatment death or cure Age Co-morbidities Upstream determinants

21. 1. Service delivery 2. Health workforce 3. Information 4. Medical products 5. Vaccines & technology 6. Financing 7. Leadership and Governance The 6 Building Blocks of Health Systems Source: WHO

22. Health Literacy How to navigate and interact with the complex health system What health information is relevant and how to find it Developing knowledge and expectations about health and well-being Evaluating and understanding health messages, nutrition information, instructions and medicine labels Completing medical forms and responding to information requests Confidence and ability to talk with health professionals and ask questions

23. School nurse Public health nurse General practitioner Practice nurse Community health worker community midwife obstetrician outpatient clinic Hospital midwife Delivery suite Accident & Medical Clinic Hospital Emergency Dept Well Child Nurse Community social worker Paediatrician Local chemist Next door neighbor Accessing healthcare ? teacher Traditional healer

25. Bronchiolitis Northern DHB Acute Hospitalisations 2000 - 2010

26. Bacterial /non-viral Pneumonia Northern DHB Admissions 2000-2010, 0-24yrs

27. CMDHB Pacific Child Admissions for Acute medical conditions, 2000 - 2010 Admissions per 1000

28. LRI in under 2 yr olds, CMDHB 2007 Trenholme A. et al. 394 children / 508 admissions 56% Pacific, 30% Maori 78% in Dep 9 & 10 65% smoke exposed 27% use no household heating Longer stay = young, preterm, Maori or Pacific

29. Reducing respiratory disease Second hand smoke Housing and household crowding Improved breastfeeding rates Raise immunization rates General infectious disease prevention

30. 1. Determinants of Health & Health Promotion Health solutions 1. Determinants of Health & Health Promotion

31. Respiratory illness, South Auckland initiatives Healthy Housing Snug Homes Immunization – outreach, NIR Pneumococcal vaccine coverage Low cost Primary Care Smoking Cessation Pacific Churches

32. Children fully immunized at age 2 yrs. New Zealand 2009 Source: IMAC

33. Admissions for Asthma in Northern DHB’s, 2000 – 2010, Age 0-24 yrs

34. Focus on Asthma Second hand tobacco smoke Self/Home based management of Asthma Housing and household crowding Increase immunization rates Culturally specific Asthma programmes

35. 2. Improving Health Care Health Solutions 2. Improving Health Care

36. “An evaluation of a pictorial asthma medication plan for Pacific children” Kristiansen et al, 2012

37. “Primary Care for Pacific People” Barriers to seeking help Transport The cost of healthcare Difficulty communicating and understanding Language barriers Difficulty making appointments The expectation / experience “gap” Sometimes insensitive and “racist” behaviour Southwick et al, 2012

38. Healthcare was a positive experience… When the patient and family  Felt welcome  Felt respected  Valued  Listened to & understood Southwick et al, 2012

39. Best Practice Maternity care Perinatal and Maternal Mortality Review Committee 2012, 6 th Report “All Women should commence maternity care before10 weeks” Screen for congenital abnormalities, STI, maternal mental health, underlying medical condition Identify at risk (obesity, socio-economic) “LMC’s should be aware that teenage mothers are at increased risk of stillbirth and neonatal death”

40. Responsive Health Services Maternal & Child Health in Primary Care pilot South Seas HealthCare, Otara Point of access to care = +ve pregnancy test Co-locate GP, midwife, Well-Child, Social worker One shared medical record Early social work assessment & intervention

42. Child hit by vehicle while crossing a road  Traveling not playing  40% on school journey  75% within 1 km of home  High traffic volume roads  Traffic usually speeding Higher rates in Pacific & Maori children Pacific & Maori children Lower socioeconomic communities Lower socioeconomic communities

43. 3. Policy and infrastructure Health Solutions 3. Policy and infrastructure

46. Policy FREE health care for children FREE education for children Ethnicity and socio-economic status factored into funding of health programmes

47. 4.Community development & empowerment Health Solutions 4.Community development & empowerment

48. Promoting Healthy Church Environments “Health Eating Church Awards”

49. Impact of Health Eating Awards on Health Village Action Zone Churches Impact of Health Eating Awards on Health Village Action Zone Churches Liliani Momota Atiola, University of Auckland Gold Award Gold Award Church characteristics  Strong & supportive Church leader  High engagement of congregation  Dedicated Health co-ordinator  Active Health Committee “We notice at church functions the presence of more vegetable and fruit salads and less food that is high in fat, salt and sugar. This is very exciting for us moving into the future.”

50. Healthy eating Healthy activity Healthy weight Individual behaviour cha nge The environmental gradient is steep Environmental change

52. The greatest opportunities to promote health will address : Poverty & low income Educational disparities Isolation & increase social cohesion Unsafe neighbourhoods Community built environment Commercial / retail environment

53. The Southern Initiative

54. Children are nurtured in Body, Mind and Spirit Environments invite learning and leisure People work and age with dignity Ecological balance is a source of pride and, The Ocean that surrounds us is protected for future generations Adapted from the 1995 Yanuca declaration