Health Care System in Aotearoa, New Zealand

Introduction

The New Zealand healthcare system focuses on achieving equity and equality in service delivery to the citizens. The nation depicts historical elements of discrimination of the minority groups such as the Māori in health service access and attainability. Additionally, New Zealand adopts the Treaty of Waitangi to eliminate systemic racism and promote equitable health. The progression involves the empowerment of the nursing practice in service delivery. The treaty outlines the nursing obligations and cultural safety requirements for the Māori people. This paper focuses on the Aotearoa healthcare system based on equity and equality, impact of diversity in health outcomes, as well as the influence of power on registered nursing practice.

Equity about the Health Care System in Aotearoa, New Zealand

Health equality refers to the provision of similar opportunities to all patients in accessing healthcare services (PowerPoint Slides “Mana Turite…” [Ppt], 2021). For instance, a community healthcare center can offer low-cost or free check-up services to every citizen. On the other hand, health equity refers to the provision of healthcare services depending on the individual’s needs (Reid & Robson, 2000). A health centre can offer services to patients and charge them according to their ability to pay. This situation implicates that those who are unable to pay for medical services receive free services. Additionally, health equality implicates that all individuals receive similar standards while health equity ensures individualized care resulting in a levelled healthcare service.

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The New Zealand healthcare system depicts inequality and inequity in service attainment due to racial discrimination. There is a significant disparity in health realization for the Màori and non- Màori citizens due to differences in health determinants such as education, health literacy levels, income, employment, and housing. Additionally, the Màori individuals report high death rate cases than non- Màori due to transportation barriers limiting access to medical services at preventive and treatment levels, indicating healthcare inequality (Berghan et al., 2017). Also, the Màori are more likely to face denial for health service appointments compared to the non- Màori.

The Màori do not also receive equity in healthcare based on their need for individualized care concerning screening and treating heart diseases (Reid & Robson, 2007). The inequity progression results in the Māori’s high need for healthcare services.

The Treaty of Waitangi in New Zealand entails the obligations owed to the Màori ethnic community in the nation concerning health achievement. It focuses on ensuring equity and sustainability in the healthcare system. Similarly, it requires the nursing profession to comply with the stipulated role in ensuring wellness for the Māori community by practising healthcare equity (Berghan et al., 2017). The Māori community also advocates for self-determination and respect for its cultural progression. The treaty compels the nursing council to partner with the modern world and the Màori community in realizing equitable health outcomes and cultural protection. It also encompasses the health plan strategy for the ministry of health at the government level.

The ministry holds a significant role in the communication level with the government in information generation and duty execution. The ministry establishment holds functions at different groups such as the Màori partnerships, leadership, the health disability workforce, development sector, safety insight, evidence and the cross-section sectors. The various levels offer guidance and advice to the ministry of education and the nursing council (Ministry of Health Manatū Hauora, 2020). Several significant values guide the workplace culture including, integrity, collaboration, accountability, stakeholder partnership, equity, efficiency and effectiveness.

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The New Zealand healthcare system faces the inequality challenge that places the Màori on the suffering end. The reformation of current New Zealand health system strategies forges towards meeting the rights of the indigenous people and giving equitable health outcomes to Màori citizens by creating a Maori Health Authority (Department of the Prime Minister and the Cabinet [DPMC], 2021).

The monitoring plan and mechanism concerning human rights in adopting a new constitutional reform contribute to linking Màori people to equity in healthcare services acquisition. This current New Zealand operation involves caring for all people equally regarding treatment and value to ensure that all citizens receive medical attention. Through the tribunal achievement, the Màori people now have access to justice after colonization, enhancing their voice issues. The treaty provisions also contribute to the protection of the Màori in realizing individualized care, which achieves equity in health.

The Waitangi treaty presentation on institutional racism also impacts the Māori’s ability to attain equity in health. Institutional racism refers to the societal structures that prevent some members from acquiring essential resources and power that others can access (Berghan et al., 2017). The situation is a historical aspect that impacts the current progression creating a disparity between the whites and the indigenous people. In New Zealand, institutional racism disadvantages the Màori people by limiting their access to health services resulting in inequality. According to the ethnicity report, the treaty reformations indicate how racial aspects place the Màori in an underprivileged position due to their location and identification (Ppt “Mana Turite…” 2021).

For instance, a survey on the Màori ethnic community and views regarding the interaction with other persons depict that racism affects their relations at different levels (Cormack, 2021). The Màori are more comfortable at home than when at workplaces or learning institutions due to racism. The situation also limits their ability to seek health services as they dread differential treatment.

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The treaty aspirations enlighten all New Zealanders on racism and the needed steps to reduce its impact on health service acquisition. It promotes the rights of all the inhabitants of Aotearoa in New Zealand, particularly the Màori. All persons’ responsibilities towards equity generation include avoiding stereotype perspectives, examining their own bias and applying the inclusion model by showing compassion and respect for others. This progression will improve the Māori’s comfort level around other people and seek and access medical attention as the nursing association is also obliged to strengthen equity in service.

Diversity in Health Outcomes in Aotearoa New Zealand

Diversity refers to the multiplicity of identity groups with different cultures, genders, abilities, religions and ages (Ppt “Mana Turite…” 2021). It ensures the recognition of numerous dimensions, including socioeconomic status, ethnicity, language and disabilities. New Zealand depicts diversity in the race with over 200 districts and the projection of additional others based on the population growth (Ppt” Mana Turite…” 2021). Diversity also covers the disability individuals, refugees, immigrants, gender, age and religious aspects. The aspect gives an upper hand to the dominant group while disadvantaging the less empowered groups.

For instance, the nursing interaction with patients depicts differential treatment based on ethnicity (Nursing Council of New Zealand, 2011). The Māori are more likely to report discrimination in the healthcare sector than Pekeha, a dominant group in Aotearoa, New Zealand. Through embracing diversity, the Māori can access individualized care based on their need to improve the health status.

Diversity affects the health outcomes of the minority and underserved groups by depicting several results concerning the accessibility chances to proper care. The positive aspects of diversity result in improved healthcare outcomes. The situation involves incorporating minority groups in healthcare provision (Zimring et al., 2004). Reports indicate that individuals from underrepresented communities are more likely and willing to serve minority groups.

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The idea implementation results in better health outcomes that contribute to equity achievement as the minority health workers ensure specialized care and observe the cultural needs of the patients. Additionally, embracing diversity in the nursing profession bridges healthcare delivery as some minority communities may be underserved by relying on their qualified workforce (Cormack, 2021). For instance, the Pacific and Māori healthcare practitioners register underrepresentation based on the patient population. Workforce diversity is essential in solving the disparity issue and creating equity.

The diverse health outcomes are evident in the statistical representation of the community population progress. The Māori makes up a small percentage of the total New Zealand population yet experience inequity in healthcare services. For the Māori, life expectancy varies with age and depicts a widening disparity with the non- Māori (Baxter, 2000). While the non- Māori portrayed a steady increase in life expectancy from the 1980s to 1990s, the Māori had a slight improvement. For instance, the life expectancy for Māori males was 69.0, while the non-Māori depicted 77.2 years from 2000-2002 (Cormack, 2021).

The female Māori, on the other hand, had a 73.2 life expectancy at birth compared to the non- Māori’s 81.9 years (Cormack, 2021). The disparity in the healthcare outcome presents the Māori as the underprivileged minority that requires individualized care for equity realization.

A mental health survey in New Zealand indicated that half of the Māori people experienced mental illness in their lifetime (Baxter, 2000). The report revealed that 31% of the population experienced anxiety while 26.5% were related to substance illness and 24.3% were mood disorders (Baxter, 2000). The mental health illness for the Māori is most prevalent for the 16-44 ages, the low-income families and those residing in higher deprivation areas.

The Māori showed a more elevated and severe rate of mental health than the non- Māori population. Additionally, the Māori had low chances of medical attention to the mental disorder needs with schizophrenia and the preceding bipolar disorder as the principal reason for hospitalization. On the other hand, the non- Māori were more likely to seek medical attention for depression disorders, eating and mental personality issues (Baxter, 2000). The 2000-2004 report depicts that between the 15-44 ages, the Māori were more likely to commit suicide than the non- Māori (Baxter, 2000). The disparities in the statistical health outcomes reveal the need for strategy implementation to ensure equality and equity.

Inequality and inequity aspects in the healthcare sector emanate from systemic issues such as unconscious bias. This element limits the vulnerable individuals from attaining the optimum care resulting in outcome disparities (Reid & Robson, 2000). The inclusion of diverse groups ensures the elimination of varied health outcomes based on unconscious bias.

Power Impacts on Registered Nurses in New Zealand

Power refers to mobilizing resources and getting things done or effort utilization in meeting one’s goals (Manojlovich, 2007). In the health environment, power refers to the entire network of rules and practices that the nurses have to adhere to while executing their professional duties. Power can be positive when it ensures freedom from oppression, while it may also appear negative when it focuses on competition, dominion, and control (Wilson, & Butters, 2020). New Zealand provides power to the nurses by establishing and granting them obligations to ensure the indigenous people’s safety. Additionally, the reformation abilities focus on empowering nurses through the training requirements formation of the committee that works in collaboration with the ministry of health in the delivery of efficient services.

Cultural safety refers to the protection of individuals’ needs concerning their gender, ethnicity, religious values, beliefs and customs in the face of diversity (Nursing Council of New Zealand, 2011). The New Zealand government advocates for the preservation of the vulnerable communities’ culture. The Māori community, for instance, calls for equity in healthcare delivery and emphasizes culture protection based on value and philosophy preservation. The treaty also compels the nursing practice to realize professionalism while understanding the community’s needs based on gender, disability, religion and spiritual values.

Nursing power and empowerment are vital in influencing efficient service to the patient. Inadequate nursing empowerment realizes poor patient outcomes, which implicates risks in human lifesaving. The nursing power constitutes of several factors, including cultural, social and educational influence. Education is a positive attribute due to its contribution to the expertise abilities in the study area as well as service (Wilson, & Butters, 2020). Nursing empowerment also encompasses power cultivation through authority and interaction with other professionals. This progression enhances the nursing autonomy where the healthcare professional act upon their knowledge in duty execution.

Professional autonomy is essential because it ensures the proper judgment for the patient’s needs and promotes positive outcomes. Additionally, the nurses spend most of their time with the patients and can give the best healthcare needs through empowerment. The structural abilities and culture also contribute to nursing empowerment (Wilson & Butters, 2020). This aspect entails the working environment and social progression in relationship building, focusing on the patients’ cultural safety and preservation guides the nursing role in creating better outcomes for community members. Apart from nurses using their power for better patient care, they can also utilize it while interacting with fellow professionals. They do so when advocating for social and equity achievement.

Although empowerment in the nursing practice realizes positive outcomes and efficiency in the system, it also depicts negative implications such as implicit bias. Implicit bias entails negative attitudes towards the patients based on their gender, race, culture and colour. Studies indicate that some professionals may treat the patients differently after perceiving that the medical issues are due to the patients’ lifestyle (FitzGerald & Hurst, 2017). For instance, obese patients, drug addicts and those with injuries. Negative aspects of implicit bias result in poor patient and health outcomes. This situation limits the patients from seeking future healthcare assistance due to dissatisfaction in the previous interactions. Implicit bias is a significant contributing factor to the health care disparities in New Zealand.

Harmful elements of implicit bias in the mental health patients may involve associating certain groups with the medical condition, which affects the treatment values (FitzGerald, & Hurst, 2017). Reports show that the nursing student graduates possess a more positive implicit bias for mentally ill patients than the professional healthcare practitioners. This circumstance accounts for the high percentage of the Māori with mental disorder issues. The minority groups fail to seek medical services due to perceived discriminatory progression.

Conclusion

The Aotearoa, New Zealand healthcare system comprises of inequality issues concerning service delivery, where the minority groups fail to achieve equity in the outcomes. The national reformation entails the Treaty of Waitangi’s provisions in guiding the nurse progression and community requirements. Additionally, the treaty focuses on cultural safety and value preservation in healthcare equity achievement.

There is a significant disparity in healthcare achievement for the Māori community and non- Māori. The diversity in healthcare outcomes, particularly in mental health, depicts the Māori with higher levels of disorder in schizophrenia than the non- Māori. The nursing profession requires empowerment for autonomous performance and the promotion of cultural safety. However, in some cases, nurse empowerment creates implicit bias, which may negatively affect the patient outcome. Generally, power in the nursing practice results in efficient duty execution and a fight for social justice.

References

Baxter, J. (2000). Mental health: Psychiatric disorder and suicide. Hauora: Māori Standards of Health IV, 121-138.

Berghan, G., Came, H., Coupe, N., Doole, C., Fay, J., McCreanor, T., & Simpson, T. (2017). Te Tiriti o Waitangi-based practice in health promotion. Auckland, New Zealand: STIR: Stop Institutional Racism.

Department of the Prime Minister and Cabinet. (2021). The new health system reform. Web.

Cormack, D. (2021). The Màori population. The University of Otago. Web.

FitzGerald, C., & Hurst, S. (2017). Implicit bias in healthcare professionals: A systematic review. BMC medical ethics, 18(1), 1-18.

Manojlovich, M. (2007). Power and empowerment in nursing: Looking backward to inform the future. The Online Journal of Issues in Nursing, 12(1).

Ministry of Health Manatū Hauora (2020). Te Tiriti o Waitangi. Ministry of Health. Web.

Nursing Council of New Zealand (2011). Guidelines for cultural safety, the treaty of Waitangi and Maori health in nursing education and practice. Web.

PowerPoint Slides (2021). Mana Turite, Pātuitanga, Whakamarumarutia: Equity, partnership, and active protection.

Reid, P., & Robson, B. (2007). Hauora: Māori Standards of Health IV Colonisation and health inequalities. University of Otago.

Wilson, S., & Butters, K. (2020). Power and politics in the practice of nursing. Contexts of Nursing: An Introduction, 165. Elsevier Australia.

Zimring, C., Joseph, A., & Choudhary, R. (2004). The role of the physical environment in the hospital of the 21st century: A once-in-a-lifetime opportunity. Concord, CA: The Center for Health Design, 311. Web.

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