Transcript Pacific children - Asthma Foundation New Zealand

PACIFIC CHILDREN
Improving Health and Healthcare for
Pacific Children in New Zealand
Dr Teuila Percival
Pacific People
• Relationships
• Holistic health and spirituality
• Contribution and responsibility
• Correctness and respect
• Faith
• Dignity
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
Pacific children
• High infant & child
mortality
• Infectious diseases
• Respiratory disease
• Rheumatic Fever & RHD
• Child Obesity
• Lower Pre-school
enrollment
• Lower School
achievement
New Zealand Pacific Children
Infectious diseases Admissions by deprivation and
ethnicity
Baker et al 2012
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
% of age group
Proportion of NZ Children(0-14yrs) living in Crowded
Households by ethnicity and
NZ Deprivation Index Decile, 2006 Census
NZ Deprivation Index Decile
NZ Child & Youth Epidemiology Service.
Emergency Department Attendances,
Auckland DHB’s 2011
Specialist Outpatient Appointments
FSA for Auckland DHB’s, 2011
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
250
Tukuitonga C et al. NZMJ,2002
200
Per 100,000
150
Maori
Pacific
other
100
50
0
mortality
CABG
PTCA
Outpatient Clinic DNA rate %
DNA First Specialist Appt Auckland
DHB’s, 2011
Paediatric
Diabetes
Renal
Gynae
All FSA OP clinics
Pacific NMNP
18
9
19
9
14
5
16
6
11
3
Ethnic differences in Rx/intervention
Upstream
determinants
Detection
death
Diagnosis
Treatment
or
cure
Co-morbidities
Age
The 6 Building Blocks of Health Systems
1. Service delivery
2. Health workforce
3. Information
4. Medical products
5. Vaccines & technology
6. Financing
7. Leadership and Governance
Source: WHO
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
General practitioner
Hospital Emergency Dept
Practice nurse
Community
health worker
Well Child Nurse
teacher
Public health nurse
Paediatrician
outpatient clinic
Accident & Medical Clinic
School nurse
Local chemist
Delivery suite
Hospital midwife
community midwife
obstetrician
Traditional healer
Community social worker
Next door neighbor
Accessing healthcare ?
Bronchiolitis
Northern DHB Acute Hospitalisations 2000 - 2010
Bacterial /non-viral Pneumonia
Northern DHB Admissions 2000-2010, 0-24yrs
CMDHB Pacific Child Admissions for Acute
medical conditions, 2000 - 2010
25
Admissions per 1000
20
Acute Bronchiolitis
Acute Upper Respiratory
Infections Excl Croup
Asthma
15
Bacterial Meningitis
10
Bacterial/Non-Viral
Pneumonia
Linear (Bacterial/Non-Viral
Pneumonia)
5
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
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
Reducing respiratory disease
• Second hand smoke
• Housing and household crowding
• Improved breastfeeding rates
• Raise immunization rates
• General infectious disease
prevention
Health solutions
1. Determinants of Health
& Health Promotion
Respiratory illness,
South Auckland initiatives
• Healthy Housing
• Snug Homes
• Immunization – outreach, NIR
• Pneumococcal vaccine coverage
• Low cost Primary Care
• Smoking Cessation
• Pacific Churches
Children fully immunized at age 2 yrs.
New Zealand 2009
Source: IMAC
Admissions for Asthma in Northern DHB’s,
2000 – 2010, Age 0-24 yrs
Focus on Asthma
• Second hand tobacco smoke
• Self/Home based management of
Asthma
• Housing and household crowding
• Increase immunization rates
• Culturally specific Asthma
programmes
Health Solutions
2. Improving Health Care
“An evaluation of a pictorial asthma
medication plan for Pacific children”
Kristiansen et al, 2012
“Primary Care for Pacific People”
Barriers to seeking help
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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
Healthcare was a positive
experience…
When the patient and family
 Felt welcome
 Felt respected
 Valued
 Listened to & understood
Southwick et al, 2012
Best Practice Maternity care
Perinatal and Maternal Mortality Review Committee 2012, 6th 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”
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
Higher rates in
• Pacific & Maori
children
• Lower
socioeconomic
communities
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
Health Solutions
3. Policy and infrastructure
Policy
• FREE health care for children
• FREE education for children
• Ethnicity and socio-economic
status factored into funding
of health programmes
Health Solutions
4.Community development
& empowerment
Promoting Healthy Church Environments
“Health Eating Church Awards”
Impact of Health Eating Awards on Health Village
Action Zone Churches
Liliani Momota Atiola, University of Auckland
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.”
Environmental change
Healthy eating
Healthy activity
Healthy weight
Individual behaviour change
The environmental gradient is steep
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
The Southern Initiative
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