Professional Documents
Culture Documents
Being Mori
Influence of Social Determinants on the
Health of the Mori
CAMERON WOODRUFF
JINGHAN LI
NEELI DEVIREDDY
OBAIDULLA KHALID
SHARYN SHEPHARD
Terminology:
(Kerry-Nicholls, 1886) The name "Mori, means the local people. It is also the name of the language
spoken by the people and was officially recognized in 1987 by the Parliament of New Zealand.
The term Pakeha, refers to the European settlers that arrived in 1815.
Demographics:
According to the National statistical data, as of 2013, there were 682,200 Maori people which roughly
constitutes about 15.4 % of the total New Zealand population. The median age of the males is 22 and
the females is 24 years. Whereas it is 35.7 and 38.2 in respectively in the remaining New Zealand
population (Statistics New Zealand, 2012).
It is not just the median age that is alarming. According to data from 2010-12, the Mori life expectancy
at birth was 72.8 years for males and 76.5 years for females. This is comparable with 80.2 years for nonMori males and 83.7 years for non-Mori females. One could argue that the rates have steadily
improved over the past 10 years, however there is no significant change in the morbidity rates. Over the
last 7-10 years, the Maori have significantly urbanized and are wide spread along Auckland, Waikato and
Northland.
Despite the high level of importance given to literacy, the overall education rates in the Maori
population are considerably low. A mere 12.3 percent of Mori women and 7.4 percent of Mori men
have reported to hold a Bachelors degree or a diploma qualification, and a staggering 33 percent hold
no qualification at all, according to the 2013 census.
Furthermore, 52 percent of the men and 35 percent of the women over the age of 15 were employed.
But, the unemployment rate has risen from 11 percent in 2006 to 15.6 percent in 2013. However, trends
have been changing recently with the New Zealand government reporting the rate of unemployment
has slowed down as of 2016 (Ministry of Business, 2016).We need to acknowledge that education is a
key building block in determining the socio-economic and environmental situation of a person. These
factors further influence the health status of an individual.
Disquiet:
The problem does not halt there. A fall in employment rates and increased suicidal tendencies, denote
an unaddressed element of mental trauma. The families being joint and larger, have increased incidence
of domestic violence.
Alcohol and drug intoxication, rising crime rates, and unease in society has been observed. When
compared to the rest of the New Zealand population, the incarceration rates of the Maori are
significantly high. A few theorists (Hook, 2009)believe this is due to a Warrior gene hypothesis, a
defective Monoamine Oxidase gene expression. However, labeling groups as genetically impaired is
immoral, racist and should be promptly disregarded.
Since the 1900s, the Pakeha, (European settlers) have not been completely legitimate in aspects of
governance. Trade did exist between the groups consisting agriculture and tobacco products which later
on became a cause of depreciation of health in the Maori.
Treaties were broken and remade constantly. Most parts of the land were confiscated by the Pakeha in
this process. One could argue that, had the Maori been more educated and aware of the consequences
of trade at that time, perhaps there would have been a better today.
Determinants at large :
The algorithm begins with the lack of education and unemployment. With more stomachs to feed per
family, a depressed mind often seeks the transient pleasure of intoxicants and drifts further from the
reality of depreciating health. Consequent rage, crime and domestic violence have contributed to the
increased levels of incarceration among the Maori.
One observes inequalities across high level indicators ranging from life expectancy to infant mortality.
Cardiovascular disease, cancer and asthma are ailments expressed downstream as a result of these
inequities. The government has provided funding only for oral health of the children and primary health
care. However, as per a study (Jansen & Smith, 2006), the fact that the Maori are less likely to be
involved in treatment where partial or complete out of pocket expense is required, denotes the
presence of a burden.
In order to address a burden and propose reforms that induce recovery and augment the health status
of a population, we need to focus at levels that need attention. This article will take a look at the
following determinants of health in the Maori, evaluate the current trends, and propose reforms that
augment their health status.
Introduction
Children are largely dependent on others and are sometimes vulnerable; they are continually learning
and developing the skills to make responsible decisions in terms of looking after themselves and their
community. These children are citizens in their own rights and need to be given proper unbiased
representation. It is becoming increasingly evident that maternal health and wellbeing during pregnancy
and even before conception can affect foetal health. Early life influences later-life health through social
trajectories, such as educational opportunities, socioeconomic and health circumstances. Adverse
childhood circumstances are shown through lower birth weights, poor diet, infections and passive
smoking.
New Zealand has one of the highest levels of inequality in educational outcomes of all OECD countries
(OECD Publishing 2010). In 2012 the New Zealand government announced its slogan for address this
issue as Every Child Thrives, Belongs, Achieves in a paper for vulnerable children and includes a 10
year plan (Childrens Action Plan 2016). This report addresses this Mori health inequality of that
prevent children from thriving and belonging by critically analysing health care access, food insecurity
and home/cultural environments. Mori are overrepresented in New Zealands child poverty statistics. It
is evident that there is a need to address this as a source of inequality, with one in three Mori children
living in poverty.
According the Sustainable Development Goals (SDGs), early life influences relates directly to goals 3
healthy lives and well-being for all at all ages, 4 inclusive and equitable quality of education and
promote lifelong learning (WHO 2015). 28% New Zealand kids are living in poverty (Statistics New
Zealand, 2015). Children in poverty are living in cold, damp, over-crowded houses, they do not have
warm or rain-proof clothing, their shoes are worn, and many days they go hungry. Poverty can also
cause lasting damage. It can mean doing badly at school, not getting a good job, having poor health and
falling into a life of crime. Short term impacts are lesser health outcomes, social exclusion and live with
life-time scars, with reduced employment prospects, lower earnings, poorer health and higher rates of
criminal offending.
Early life influences are defined as the time from conception to early childhood at 12 years old when
children complete primary school (Figure 1). There are many significant life events during this time,
ranging from essential literacy, numeracy and motor skill development to general growth from a foetus
to the start of puberty. In 2015, 1 in 3 Mori are under 15 years of age and only 1 in 17 are over 65;
comparatively 1 in 6 non-Mori are aged under 15 and 1 in 6 are over 65 (Statistics New Zealand, 2015).
This highlights the disparity between Mori and non-Mori populations and the potential impacts poor
early-life experiences have on later life. A critical development stage is when children are under 5 as it
sets the basis for health behaviours that children will carry throughout their life course.
Figure 1 Life course history with early-life stages highlighted in (beige), middle life (green) and later life (blue)
At the individual level, education can make a huge difference. For example, an educated girl is likely to
increase her personal earnings potential, be more likely to delay marriage and pregnancy and be more
likely to access health support, leading to lower rates of maternal mortality (DFID 2012). Additionally,
this will increase outcomes for future generations with approximately 50% worldwide reduction in child
mortality is due to increased education of women at reproductive age (Gakidou., Cowling, Lozano &
Murray 2010).
This report will focus on solutions that take a whole-child approach to improve equality between Mori
and non-Mori populations. Three SDoH identified that can be improved to reduce health inequalities
are addressed, being the perinatal period (three weeks pre- and post-birth), lack of immunisation, and
poor nutrition.
Lack of immunisation
To show the importance of immunisation the Depart of health and Aging Australia estimates that if in a
childcare centre, including schools, of 500 children that had not been immunised for the Measles,
Mumps, Rubella (MMR) Vaccine the following would occur; (Department of Health and Ageing
Publications, 2012)
Comparatively, if every child was vaccinated with MMR the vaccine will cause 1 case every 2000 years.
This is great that departments are being transparent but facts like this are often changed by the antivaxer movement to just Vaccines causes encephalitis or the famous vaccines cause autism and
contain poisonous mercury. Such statements as these are incredibly damaging to population approach
provided in using vaccines and require further education or upstream policies to enforce immunisation.
This could be through access to subsidised healthcare, children must be vaccinated; this approach is
often met with comments of nanny-states interfering in home life.
Immunisation rates between infant Mori and non-Mori populations are generally lower particularly at
the key age of 6 months (fig. 2). At six months the conferred mothers immunity becomes less effective
if breastfeeding is stopped. Breastfeeding in Mori culture is socially important and is considered a
treasure or taonga and family support is strong with about 80% breastfeeding rates until 6 months
(Unicef NZ 2015). New Zealand Health that breastfeeding continues until at least one year when a
followed immunisation program will provide protection for infants.
The increase in immunisation rates after six months are likely due Health (Immunisation) Regulations
1995 this requiresearly childhood services to keep a record and for them to contact their doctor and
inform them of free immunisations for under two year old. This free immunisation program should be
extended for all ages for cruical immunisations such as MMR. This regulation does not provide the
power for exclusion of non-immunised children and as such these children can habour and allow the
proliferation of mutant
Figure 2. Immunisation coverage by Milestone Age and Ethnicity. (source (Simpson, 2016))
Poor Nutrition
Food insecurity is a global issue and is identified as Goal 2 (Zero Hunger) of the Sustainable development
goals (UN 2015). As New Zealand is an affluent nation and welfare support is available, food security is
often considered to not be a significant problem (Else 2000). Behavioural and cognitive research has
shown the need for children to have adequate nutrition. The issue of whether this responsibility is the
governments or parents debated vehemently; often polarising people.
Current policy aims to educate children on healthy food choices, reduce access to poor nutrition foods in
school tuckshops, such as pies and soft drink, and ensuring children take all uneaten food home so
parents can see what is being eaten (Breakfast, 2016). Yet, the quality and type of food in low socioeconomic families are often nutritional poor, being high in salt and sugar with low amounts of fresh
produce. It is evident that there is a need to address this as a source of inequality, with one in three
Mori children living in poverty and only one-in-ten lunchboxes meeting nutritional standards (Craig et
al. 2013). As more onuses are on parents, the more likely the perpetuation of inequality and
intergenerational poverty. This section will analyse the potential changes that could be adapted at the
institutional level.
In combating the nutritional inequalities of Mori children will also address other races, which are likely
to have the same problems and attending the same low decile schools. Currently, the kickstart breakfast
program exists that are sponsored by milk and cereal companies, Fonterra and Sanitarium, in
conjunction with the government to all schools (Kickstart Breakfast 2016). Whilst, it is great that all
schools are receiving funding for breakfast the usefulness of this in the schools above the 6th decile is
somewhat limited and it currently has a waiting list. With the limited funding that is available, a greater
result is likely to be achieved if the populations that are at risk are targeted.
This pragmatic approach does not adequately meet the needs of the lower decile schools and may
exasperate obesity problems associated with the developed world. Presently, 74% of lower decile
schools (1-4) are providing sandwiches or a light cooked meal for lunch at least sometimes (Carne and
Mancini 2012). This shows that the schools are willing and the demand is there for this project but the
current methods incorrectly address the issues by providing free breakfasts to all schools. A population
approach is ideal; however it is important to define what the population is rather than simply all schools
as parents in higher socio-economic schools may choose not to provide a lunch where they normally
would. A more ideal approach is to assist 1-4 decile schools. Approaching this problem on a wholeschool basis prevents stigmatism from other students and those requiring assistance are more likely to
use the service if it does not highlight who are the haves and the have nots. Parents will not feel
shame that they are not able to provide for their children. If parents feel embarrassed they may keep
their child home to avoid scrutiny, further exasperating intergenerational inequalities. Parents in low
decile schools that are able to provide lunch for their child(ren) will also benefit from this program as
they are likely to be poorer and the program will allow them to allocate funds elsewhere, resulting in
reduced stress and improved well-being.
Conclusion
The health inequalities that arise in childhood can cause life-long damage to the ability for people to
achieve their fullest potential. This damage is largely financially driven and the burden of this health
inequality suggests future widening in the gap as the capacity for primary health care is not matching
the needs of Mori populations, particularly those from a low socio-economic background. It is evident
that while the obvious answer to solving these problems is to reduce out of pocket expenses it does not
fully acknowledge the Treaty of Waitangi which requires consultation with Mori Whnau.
The major challenges in implementing the strategies outlined in this report are in dealing with the
ideological viewpoint that governments should not be interfering in home life. This could be the
government forcing people to help vaccinations, controlling what will be eaten. However, the
government has an international obligation to all New Zealand children through the Treaty of Waitangi
1840. Governments should move quickly to reprioritise investment towards achieving best practice in
the areas of: reproductive health; prenatal, natal, postnatal, and whole-of-life nutrition; maternity and
postnatal care; and health, early childhood education and social service interventions for the first three
years of life, with a focus on the vulnerable, particularly indigenous Mori and Pasifika children.
Incorporating Whnau into decision making with likely increase the use of native Mori language into
the school curriculum and the best methods of causing a cultural change in how Mori individuals will
assist those at risk, particularly pregnant women and children in achieving the best health outcomes.
The result would be more culturally specific shared understandings of acceptable behaviour, rather than
the universal program design by the government.
The universal recognition on the place effect offers some fundamental ground for looking into a
particular group of population. However, rather than there being one single, universal area effect on
health there appear to be some area effects on some health outcomes, in some population groups, and
in some types of areas.(Macintyre, Ellaway, & Cummins, 2002) Macintyre described the place effect
in such a way to express its nature of complication. It is almost impossible to provide a universal place
effect rule and it requires highly specific information on the group to explain how the place effects
have influence on the groups health. Therefore, it demands great focus on a particular group to have an
overview on the particular issue without applying wrong experiences, and ultimately produce a potential
solution to the problem.
The huge gap of health between Maori population and Caucasian population (link to intro) are caused
by varies factors including early childhood influence, gender, instrumental racism, housing issues, and in
general Socio-economic status. In this report, we are going to have a close look at the place effect on
Maori population in New Zealand, examine the causation of the huge gap of health between Maori
households and Caucasian households caused by the different housing issues, and trying to explore the
potential remedies to close the gap. The place effect is an enormous topic and has its influence on
almost all aspects of life. It also interacts with other health factors. For example, the housing effects on
parental behaviors has deep influence on early childhood mental and physical development. Therefore,
it is hard to cover all aspects of the place effect in this report. As a result, only few selected aspects,
which with good indication of the gap between Maori and Caucasian households including
overcrowding, tenure type, home quality and neighborhood deprivation, are presented in this work. The
place effect influence on health is also discussed according to Turrells population health model.
(Turrell & Mathers, 2000)
The traditional Maori Wharepuni create many health concerns which have been raised back in 1800s,
including the health problems caused by drinking water safety, lack of sewerage and hygiene
installations, overcrowded space without separation and ultimately inadequate house. The government
tried to address the Maori health problem (especially the diseases introduced by westerners) caused by
housing through introducing sanitation facilities including tap water and sewers system in 1880s which
decreased the bacterial infectious disease rate, and Whare Pakeha which the order instructed the
demolishment of 1,256 Wharepuni. 2,103 new cottages were constructed throughout New
Zealand(Lange, 1999). However, the vast majority of Maori population was still living in traditional
Wharepuni without ventilation and modern sanitation installations.
The 1918 influenza epidemic is a catastrophic event on local Maori population that made New Zealand
government realized the tremendous gap of health, in which the Maori death rate was 4.5 times that of
Europeans(Pool, 1973) and led to new initiatives (e.g. Native Housing Act 1935 etc.) to improve Maori
housing and public health. The Maori population started migrating towards city during the period, and
by 1926 there were only less than 20% of entire Maori population. The urban place effect on Maori
population including overcrowding and home quality started to became an issue for the Maori
household. However, the problems did not discourage the migration due to the job opportunities in the
cities. The number tremendously increased during the post-WWII period and reached 84% in 2013 and
one fourth of the urban Maori population live in Auckland.(Meredith, 2015).
Overcrowding
In 2006, there were 13% of Maori households living in overcrowded accommodations with about 23% of
Maori population. And 4% of Maori households are severely crowded. The overall trend of crowding
issue in Maori population indicates a decline; however the disparity between Maori and Europeans
remains huge. There is almost 6 times more Maori population as Caucasian population lived in
overcrowded accommodations(Flynn, Carne, & Soa-Lafoa'i, 2010). Studies suggest that both subjective
and objective experiences on Household crowding(Gove, Hughes, & Galle, 1983) has negative impact on
life quality and furthermore on the both mental and physical aspect of health(Gomez-Jacinto &
Hombrados-Mendieta, 2002)
Overcrowding can be interpreted as a mental environmental stressors caused by the unsatisfied need
for space. A person living in an overcrowded environment experiences the lack of privacy and over
exposure to other individuals behaviors which together lead to chronic mental concerns, including
frustration, depression and aggression which sometimes leads to violence. Along with the physiological
influence, study also suggests that household crowding influence peoples behavior, usually in a harmful
way. For instance, people tends to adopt social withdraw as a coping strategy as a respond to chronic
crowding. And social withdraw comes with a high price breakdown of socially supportive relationships
and in turn elevate psychological stress.(Evans, Rhee, Forbes, Allen, & Lepore, 2000) As a result, more
health damaging behaviors, including smoking, alcohol/drug abusing, domestic violence and etc.,
become more attempting for the people under crowding stress, and ultimately lead to chronic health
issues including high blood pressure, asthma, arthritis and etc..
Overcrowding is also one of the major factors that influence the spread of infectious diseases. Factors
including lack of space in the household and highly frequent interpersonal contact provide ground for
infectious disease, especially airborne and vector-borne ones. Tuberculosis is an important bacterial
infectious disease in New Zealand. It spreads through air when people cough (which is one of the major
symptoms), spit, speak, or sneeze. An overcrowded house cannot provide enough space for quarantine.
Therefore, if one of the family members caught TB, he/she will most likely infect the whole family. As a
result, the CAU level of TB associate with the crowding level in the household, and research suggests
that the TB incident can be reduced by reducing the overcrowding in the households. (Michael Baker,
Das, Venugopal, & Howden-Chapman, 2008). Another example of bacterial meningitis spreading among
overcrowded households is Meningococcal disease. Its not as contagious as common cold but can be
transmitted through saliva and prolonged general contact with infected person, and it caused more
severe health morbidity than TB. Research suggests that overcrowding issue is the major factor of
Meningococcal disease infection and it has highest incident rate in Maori children living
Auckland(Michael Baker et al., 2000).
Tenure Type:
Tenure
Owner-Occupied
Rented
European
1,903,000(75%)
634,000(25%)
Maori
196,000(47%)
217,000(53%)
Ethnicity
In 2008, 75% of EZ European household owns their accommodation meanwhile the number for Maori
household is 45%. The house ownership is under the influences of varies Social-Economic Status (SES)
factors including employment, income, education and etc.. The difference between two ethic groups on
housing ownership is a result of all the SES factors. Refers to SES section? Furthermore, house
ownership influences other housing factors, e.g. crowding, housing quality and etc., as well. For
example, the household with owner-occupied housing usually can affords a higher-quality residential
environment than rental housing(Megbolugbe & Linneman, 1993).
Tenure is a both a marker of household SES and a factor that influence health. Though tenure type is
only responsible for 5.4% of clinical health measure variance, it limits the health agencies for the
renters. Renters are more likely to be exposed to health damage factors including dump, noise, etc.
(which is linked to housing quality) and less likely to have health promoting features like gardens etc.
(which is linked to neighborhood quality)(Macintyre et al., 2003). As a result, the place effect on the
downstream of population health caused by different tenure types is hard to define considering the
variety of health damaging/promoting factors and their multitude impact on both physical and mental
aspect of health. Therefore, it is only fair to explain the tenure type influence on clinical level by general
health measurements, e.g. life expectancy, DAILY and etc..
Housing quality:
Major Problem(s) with Housing
Total
No Problems
Problems
Ethnicity
European
2,580,000(100%)
1,805,000(63%) 776,000(37%)
Maori
441,000(100%)
225,000(51%)
216,000(49%)
The housing problems cover cold, dampness, and need for repair. There are 45% of Maori household
have housing problems mentioned above, meanwhile the percentage of NZ European household having
problems is only 37%, though the absolute number is higher. Maori households are also most likely to
have problems relevant to a need for immediate or extensive repairs on home.(NZ.Stat, 2016) The
house quality is identified as one of the major impact factors on health(HowdenChapman, Isaacs,
Crane, & Chapman, 1996).
Home quality has direct link to the physical aspect of health, as problematic houses can increase both
the chance and severity of home injuries. The most common cause of home injuries result in
hospitalization is fall, which usually caused by slips, trips, entrapments, collisions, poor lighting and poor
ergonomics.(Braubach, Jacobs, & Ormandy, 2011). The home injury can result in cuts, bruises, broken
bones etc. and sometimes with severe cases can result in paralysis, long-term physical constraints and
death, which contributes to both morbidity and mortality. Kool identifies Maori population with a
significantly higher portion in hospitalization caused by home injury in his study(Kool, Chelimo,
Robinson, & Ameratunga, 2011) and the result is largely due to the poor home quality among the vast
majority of Maori households.
Lower house quality also provides ground for respiratory morbidity (i.g. asthma and etc.) as well as
airborne infections (which is discussed in the previous section), especially the houses with dump and
mould issues. Dump is a significant health risk factor which causes not only respiratory morbidity but
also tiredness, headache and airborne infections(Bornehag et al., 2001). Mould is usually considered as a
mark of dump. However, it is also, most of the time accompanied with dump condition in the house,
leads to both allergic asthma caused by the fungus, and non-allergic asthma caused by the mycotoxin
produced by fungus(Zock et al., 2002).
Males
Females
Total
Males
Females
Total
194,241
202,266
396,507
11,457
11,385
22,842
193,155
202,428
395,583
14,346
14,424
28,770
186,231
195,495
381,726
16,047
15,957
32,004
178,188
187,359
365,547
18,345
18,825
37,170
173,019
182,469
355,488
22,002
22,704
44,706
166,347
176,040
342,387
25,911
26,937
52,848
159,444
170,121
329,565
30,252
31,575
61,827
150,816
161,703
312,519
36,840
39,594
76,434
139,296
148,344
287,640
47,565
53,163
100,728
10
114,051
118,725
232,776
65,712
75,177
140,889
NZDep 2013
NZDep 2013 is a set of decile system to evaluate the deprivation of a neighborhood. The higher NZDep
2013 score refers to a greater level of deprivation in the neighborhood(Atkinson, Salmond, & Crampton,
2014). The data indicates a larger total of Non-Maori ethnic group living in extreme deprived
neighborhood. However, the percentage of Maori population living in extreme deprived neighborhood
is larger. 23% of Maori population lives in extreme deprived neighborhood (NZDep2013: 10), and 72% in
deprived neighborhood (NZDep2013: 6-10). Meanwhile, the numbers for non-Maori population are 7%
(in extreme deprived neighborhood) and 44% (in deprived neighborhood).
Neighborhood influence population health with 4 major agencies, including Neighborhood institutions
and resources, physical stress, social stress and neighborhood based interpersonal dynamics. (Ellen,
Mijanovich, & Dillman, 2001). The four agencies, together, influence on health related behaviors and
mental health are both long term, with the weathering effect from accumulated stress, low
environmental quality, limited resources which make the household in deprived community more
vulnerable, and short term with its influence on health relevant behaviors, attitudes, and healthcare
utilization.
European/Other(M Baker, McDonald, Zhang, & Howden-Chapman, 2013). And Maori male elders is the
group which has been identified as the most vulnerable group against home injury (Kool, 2011).
There are few attempts to address the huge gap health between Maori population and Caucasian
population caused by housing issues, including Rural Housing Programme, Community Owned Rural
Rental Housing Loans, Special Housing Action Zones and etc. which target on Maori household and try
to improve Maori housing quality in general. However, it is such a problem that is difficult, if not
impossible, to solve due to its high resistant to resolution and the complexity to change the Maori
health behaviors in general, that it is can be identified as a Wicked Problem (Commission, 2012) and
therefore required interdisciplinary solutions (Brown, Harris, & Russell, 2010) more than policies only to
reach a sustainable result.
Most of the housing issues discussed above are the result of poor economic stands or in general the low
socio-economic status of Maori households, which is one of the most persistent social issues. Therefore,
it demands solutions that focus on mid-stream health determinants (e.g. behaviors and physiological
wellbeing) as well as in general improving Maori households socio-economic status. To tackling the
Wicked Problem of Maori health issues caused by housing problems, the following approaches are
recommended:
1. Establishing targeted marketing campaign on Maori household to promote health promoting
behaviors (e.g. healthier diet and etc.);
2. Establishing targeted education campaign on Maori household to reduce health damaging
behaviors (e.g. smoking, drug/alcohol abusing and etc.);
3. Providing subsidies for house repairing/maintaining services;
4. Supporting community level non-governmental organizations to promote Maori physiological
wellbeing;
5. Advertising the available public services to Maori household and encouraging their public
resource utilization;
6. Reduce the socio-economic status gap between Maori and Caucasian population through political
tools including tax and subsidies.
Background:
The caste system in India, apartheid in South Africa and the slavery seen in early American colonies are a
few examples where people in higher authorities, treated the minorities with disgust and discrimination.
However, things were a bit different when it came to the Maori population. Unlike indigenous
communities in different parts of the world who were succumbed to have poorer health outcomes, the
Maori population were not entirely crippled by the effects of colonization. Largely due to the Treaty of
Waitangi which played a major role in negotiating governmental policies between the Maori and the
Pakeha.
Nevertheless, (Robson & Harris, 2007) the Maori people have lower life expectancy rates and increasing
rates of morbidity even today. It is an understated notion, that racism is felt only at a personal level. The
history of colonization suggests that racism had been institutionalized and was expressed in discreet
forms of socio economic configurations. It had negative impacts on education, healthcare, employment
and pay grades. Land and various assets (Kokiri, 2000) were confiscated under the dogma of rapid
urbanization rendering more than half of the Maori (Kahukura, 2010) to live in more destitute
residential areas .
Racism (Bhopal, 1998; Williams, 1997) refers to a belief that a few races are superior to others. From the
discrimination of skin tone to ethnic prejudices, racism has many colors in itself. These practices trigger
and reinforce a system of oppression and inequality (Bhopal, 1998; Krieger, 2001).
Two main types of racism have been described: interpersonal and institutional by (Karlsen & Nazroo,
2002)
Interpersonal racism pertains to the discriminatory interactions that take place at an individual level.
These can be felt directly either physically or verbally. Institutional racism on the other hand, is invisible.
It refers to discriminatory policies which are ingrained within an organization (Karlsen & Nazroo, 2002;
Krieger & Berkman, 2000).
Micro-aggressions:
In public, there are often interactions and glances which may go unnoticed when lacking attention.
These convey impugnable messages to racial minority groups and are called as micro-aggressions (Sue &
Constantine, 2007).D Sue and her colleagues have described these micro-aggressions to occur in various
formats ranging from subtle derogatory looks and gestures to verbal assaults. These occur often
unconsciously, hurting the colored individual. She classified these into micro-assaults; which are readily
perceived by the victim, micro-insults; unintentional, rude actions which lack empathy and microinvalidations; when the people of the majority fail to accept the presence of such a phenomenon and its
consequences on minorities.
For deeper understanding of how these pathways determine health, it is important to understand the
upstream, mid-stream and downstream social determinants of health as proposed by (Turrell, 2006) in
relation to institutional and interpersonal racism.(Table R1 and R2)
Table R1 and R2 Influence of Racism on Social determinants of health. Adapted on the principles
proposed by Gavin Turell
1.Institutional racism
a)Employment :
This is one of the several reasons for a vast majority of Maori men and women to be
unemployed. Although the government and various private companies encourage graduates
with an indigenous origin to apply, and a significant number of people are attaining jobs, data
indicates that the unemployment rates for both men and women have increased steadily since
last year (Ministry of Business, 2016). An average of 12.2% Maori men and women population
are unemployed. With larger families to feed, and a racist notion, that the Maori are physically
fitter, they are given occupations which have hazardous effects on their health (Pearce et al.,
2004).
Table R3 The unemployment rates for both Maori men and women increased from March
2015 to March 2016
Adapted from Statistics New Zealand, Household Labor Force Survey, March 2016; MBIE
b)Education:
Schooling for children in the Maori has improved in the last five decades. However, there are
reports of Maori being looked upon in awe when they re-enter University after a semester
break.(Duff, 2015).This is due to a fact that only 25% of Maori who finish school, go to college.
This is 50% lower than the Non- Maori population (Marriott & Sim, 2015).Education and
employment are keys areas where the Maori have been termed as underachieving (Lock &
Gibson, 2008).Lesser the education, lesser the number of jobs or lower is the pay scale.
c)Housing:
In aspects of housing, systematic racism has pushed the Maori away from neighborhoods with
proper sanitation and hygiene. Policies in the housing markets are constructed in a way that
most cannot afford the same (Kahukura, 2010). Racial discrimination has led to introduction of
pepper potting policies aimed at concentrating the Maori in particular neighborhoods
(Waldegrave, King, Walker, & Fitzgerald). This causes much ill health both physically and
mentally.
d)Healthcare :
This section in racism deserves special importance because it can be perceived in an institutional
level and an interpersonal level by the medical staff themselves. Self-reported research on
racism which was conducted by (Harris et al., 2006)showed that the area where the Maori most
felt racial discriminated was in a medical setting. Identical discrepancies were found in a study in
Aotearoa, (Westbrooke, Baxter, & Hogan, 2001) which reported that less number of Maori
cardiac patients are likely to undergo surgical procedures when compared to Non-Maoris.
Similar is the case in caesarian section in pregnant Maori women (Harris et al., 2007).Although
people do acknowledge presence of such attitudes in the outer world, it is least expected from a
physician who has an ethical obligation towards his patient. This area has less research in New
Zealand, but a better example was seen in the hospitals of California, USA. Several women of
Arabic descent until 6 months after the 9/11 attacks, had pre term labour or gave birth to babies
with Low Birth Weight (LBW) whereas the outcomes of labour remained the same for rest of the
patients. (Lauderdale, 2006).
e)Criminal Justice:
Around 150 people per 100,000 are imprisoned in New Zealand every year. It has the highest
rate of incarceration per capita, only second to the United States (Department of Corrections,
2001). Despite being only 15% of the total population, they are over-represented in the prison
setting up to 6 times when compared to the European settlers(Workman, 2011). Up to 43% of
those convicted are Maori, 47% of violent offenders are Maori (Soboleva, Kazakova, & Chong,
2006) and a total of 51% of the total incarcerated are Maori (Doone & Unit, 2000; Workman,
2011).
Whether the criminal justice system is imparting longer sentences or whether the Maori are the
first to be suspects in case of any crime and hence convicted, requires further study. However,
these prisons often serve as a prison pool for various infectious diseases. Indulging in risky
behaviors (Patten & Gray, 1991) like sharing of needles and unprotected sexual intercourse
transmit infections like HIV, Hepatitis B and Tuberculosis. Upon release from the correctional
facility, these diseases are carried home. A more recent study (Stewart, Henderson, Hobbs,
Ridout, & Knuiman, 2004) also showed that all prisoners irrespective of their gender or ethnicity,
who were released from prison, died sooner. More so, when they had histories of risky
behaviors.
f)Urbanization:
The Maori are spiritual people. They value their land as Papatuanuku ; Mother Earth (Durie,
1997). As a result of massive urbanization, various parts of Maori land were consfisicated. This
not only led to loss of occupations with respect to cultivation, but also added to psychological
grief.
2.Interpersonal Racism
a)Physical assault:
Interpersonal racism is more visible when it occurs in the form of a physical attack. Direct
injuries to the victim may result in disability and death. This fact remains and understatement
given the associated mental factors during this racist transition.
Post assault instillation of fear, misery and a feeling of helplessness later convert into depression
and stress. A study (Paradies, 2007) showed that psychological stress, is expressed by adolescent
victims of racism in forms of violence, smoking, substance abuse or increased alcohol
consumption. Violence leads to jail while others only increase the existing burden of disease in
the society.
b)Sexual Assault:
In New Zealand, (Fanslow, Robinson, Crengle, & Perese, 2007) one in three teenagers under the
age of 16 are likely to be victim to sexual assault with approximately 70% of the cases involving
contact of genitals. Moreover, the likelihood for a Maori female to be a victim to sexual assault
is twice as high as a non-Maori (Mayhew & Reilly, 2007).
Literature suggests (Thomas, 1993) that rates of sexual assault on Aboriginal women by nonAboriginal men were higher in the past. However, evidence regarding the current traits is lesser.
Abuse of this kind has devastating effects on the mind, body and soul.
c)Verbal Assault:
Micro-aggressions in the form of involuntary degrading gestures do exist, however, it is when
the verbal abuse has targeted intent, the effects are mentally traumatizing. Subsequent
psychological stress often impedes vital decisions in their lives. A feeling of hostility warrants
unwantedness in social gatherings. These emotions later convert to depression which works in a
negative feedback mechanism, leading to isolation. Rage, stress and depression are emotions
which direct young Maori adults to adopt unhealthy behaviors like smoking and substance
abuse. History also suggests that when parents try to protect their children from being victim to
racism, by trying to impose restrictions, results have been calamitous with children turning to
suicide (Goldberg & Hodes, 1992).
The lack of appropriate education, increased poverty, longer periods of incarceration, psychosocial
factors, risky behaviors and decreased access to healthcare have added effects on the health of the
person. Products of risky health behaviors pathologically influence the human body via inflammation or
infection. Hypertension and hyperlipidemia increase the chances of cardiovascular disease whereas
immunosuppression leads to systemic and bronchopulmonary infections both of which add to the
morbidity and mortality of the population (Harris et al., 2006).
To combat Racism:
Given the fact that the element of racism exists since the time of the prophets, it is not easy to
tackle the situation with mere reforms and appeals to human right commissions. In the 1980s
an attempt was made to dethrone institutional racism, by introducing recommendations from
Puao te Ata Tu. (Table R4). These recommendations were accepted by the Minister of Social
Welfare and are till date the fundamental basis of anti-discrimination in all levels of public
services (Tennant, 2005). However, there still exist loop holes in the system. A targeted
approach to bring reform to the structure (institutional racism) and the agency (interpersonal
racism) is necessary.
1.Education :
Mass movements of intellectual resistance indeed existed in the history of the Maori which tried
to rebalance inequities. One such movement was the rejuvenation of Te Reo me ona tikanga by
developing educational institutions and universities for the Maori (Cram & Pipi, 2001).
Thus historically, it can be acknowledged that a good place to start reform, is to begin with
education. Education not only eliminates racist attitudes, but also teaches methodologies to
recognize its patterns and advocate against them. Educational programs initiate cultural
familiarization and understanding upon which relationships that thrive can be constructed
among societies.
Conclusion:
The Maori have been victim to political sabotage and continue to endure the subsequent effects of
racial discrimination till date. Deeply embedded within the structure of organizations, it has adversely
altered the thought process and existing dynamics of the Maori population, leading to disparities in
health. With historic origins so deep, abolishing racism may not be entirely feasible. However, a large
scale, multi-modal and vigilant system that can bring substantial change in the structure, transform the
agency; the perpetrators and develop bold leadership qualities in the oppressed, is mandated.
Life does not grant us options to choose family, intellect or skin tone for that matter. By dismantling
discrimination, we would be a step closer in redeeming ourselves.
References
(Breakfast, 2016; Carne, 2012; Commission on Social Determinants of Health (CSDH), 2008; Craig E, 2012; Craig, 2014; Dixon L, 2009; Elizabeth Craig, 2012; Else,
2000; Flenady V, 2011; Gakidou, Cowling, Lozano, & Murray, 2010; Governement, 1995; Hauora, 2015; Hikairo, 2013; Kylie Mason, 2012; Moewaka Barnes H., 2013;
Publications, 2012; Tipene-Leach D, 2010; UNICEF New Zealand, 2015; Woodward A, 2001)
Ahmed, I. (2012). Who Is Danny Brown - Growing Up Part-Filipino. Retrieved 19 May 2016
Atkinson, J., Salmond, C., & Crampton, P. (2014). NZDep2013 index of deprivation. Department of Public
Health, ed. University of Otago.
Baker, M., Das, D., Venugopal, K., & Howden-Chapman, P. (2008). Tuberculosis associated with
household crowding in a developed country. Journal of epidemiology and community health,
62(8), 715-721.
Baker, M., McDonald, A., Zhang, J., & Howden-Chapman, P. (2013). Infectious diseases attributable to
household crowding in New Zealand: A systematic review and burden of disease estimate (Vol.
1): Wellington: He Kainga Oranga/Housing and Health Research.
Baker, M., McNicholas, A., Garrett, N., Jones, N., Stewart, J., Koberstein, V., & Lennon, D. (2000).
Household crowding a major risk factor for epidemic meningococcal disease in Auckland
children. The Pediatric infectious disease journal, 19(10), 983-990.
Barker, D. J. (1990). The fetal and infant origins of adult disease. BMJ: British Medical Journal, 301(6761),
1111.
Bhopal, R. (1998). Spectre of racism in health and health care: lessons from history and the United
States. British Medical Journal, 316(7149), 1970.
Bornehag, C.-G., Blomquist, G., Gyntelberg, F., Jrvholm, B., Malmberg, P., Nordvall, L., . . . Sundell, J.
(2001). Dampness in buildings and health. Nordic interdisciplinary review of the scientific
evidence on associations between exposure to" dampness" in buildings and health effects
(NORDDAMP). Indoor air, 11(2), 72-86.
Bramley, D., Hebert, P., Tuzzio, L., & Chassin, M. (2005). Disparities in indigenous health: a cross-country
comparison between New Zealand and the United States. American journal of public health,
95(5), 844-850.
Braubach, M., Jacobs, D. E., & Ormandy, D. (2011). Environmental burden of disease associated with
inadequate housing. World Health Organization.
Breakfast, K. (2016). Goodness of Breakfast for Children. from https://kickstartbreakfast.co.nz/
Brown, V. A., Harris, J. A., & Russell, J. Y. (2010). Tackling wicked problems through the transdisciplinary
imagination: Earthscan.
Carne, S. a. A. M. (2012). Empty Food Baskets: Food Poverty in Whangarei. Whangarei, New Zealand:
Child Poverty Action Group.
Collins, C. A. (1999). Racism and health: segregation and causes of death amenable to medical
intervention in major US cities. Annals of the New York Academy of Sciences, 896(1), 396-398.
Collins Jr, J. W., David, R. J., Handler, A., Wall, S., & Andes, S. (2004). Very low birthweight in African
American infants: the role of maternal exposure to interpersonal racial discrimination. American
journal of public health, 94(12), 2132-2138.
Commission, A. P. S. (2012). Tackling wicked problems: A public policy perspective.
Commission on Social Determinants of Health (CSDH). (2008). Closing the gap in a generation: health
equity through action on the social determinants of health. Final Report of the Commission on
Social Determinants of Health. Geneva: World Health Organisation.
Craig E, A. J., Oben G, Reddington A, Wicken A and Simpson J (2012). Te Ohonga Ake The Health Status
of Mori Children and Young People in New Zealand. Dunedin: New Zealand Child and Youth
Epidemiology Service.
Craig, E. R., Anne; Adams, Judith; Dell, Rebecca; Jack, Susan; Oben, Glenda; Wicken, Andrew; Simpson,
Jean. (2014). Te Ohonga Ake The Health of Mori Children and Young People with Chronic
Conditions and Disabilities in New Zealand Series Two. Dunedin: New Zealand Child and Youth
Epidemiology Service Retrieved from http://hdl.handle.net/10523/6134.
Cram, F., & Pipi, K. (2001). Determinants of Maori provider success: provider interviews summary report
(Report No. 4). Wellington, New Zealand: Te Puni Kokiri.
Cubbin, C., Hadden, W. C., & Winkleby, M. A. (2000). Neighborhood context and cardiovascular disease
risk factors: the contribution of material deprivation. Ethnicity & disease, 11(4), 687-700.
Department of Corrections. (2001). About Time. In N. Z. Department of corrections (Ed.), Turning people
away from a life of crime and reducing re-offending.
Dixon L, A. P., Fletcher L, et al. (2009). Smoke free outcomes with midwife Lead Maternity Carers: An
analysis of smoking during pregnancy from the New Zealand College of Midwives database
2004-2007. New Zealand College of Midwives Journal, 1(40), 13-19.
Doone, P., & Unit, C. P. (2000). Report on combating and preventing Mori crime: Hei whakarurutanga
m te ao: Crime Prevention Unit, Department of the Prime Minister and Cabinet.
Duff, M. (2015). Racism at Aukland University tackled in project. Education. Retrieved 26 May, 2016,
from http://www.stuff.co.nz/national/education/67515796/racism-at-auckland-universitytackled-in-project
Durie, M. (1997). Identity, Nationhood and Implications. New Zealand Journal of Psychology, 26(2), 33.
Elizabeth Craig, G. M., Judith Adams, Anne Reddington, Glenda Oben, Jean Simpson and Andrew
Wicken. (2012). Te Ohonga Ake The Health of Mori Children and Young People with Chronic
Conditions and Disabilities in New Zealand. Dunedin: New Zealand Child and Youth
Epidemiology Service, University of Otago Retrieved from http://hdl.handle.net/10523/6133.
Ellen, I. G., Mijanovich, T., & Dillman, K. N. (2001). Neighborhood effects on health: exploring the links
and assessing the evidence. Journal of Urban Affairs, 23(34), 391-408.
Else. (2000). Hidden Hunger: Food and Low Income in New Zealand. Wellington: New Zealand Network
Against Food Poverty.
Evans, G. W., Rhee, E., Forbes, C., Allen, K. M., & Lepore, S. J. (2000). The meaning and efficacy of social
withdrawal as a strategy for coping with chronic residential crowding. Journal of Environmental
Psychology, 20(4), 335-342.
Evans, G. W., Wells, N. M., & Moch, A. (2003). Housing and mental health: A review of the evidence and
a methodological and conceptual critique. Journal of Social Issues, 59(3), 475-500.
Fanslow, J. L., Robinson, E. M., Crengle, S., & Perese, L. (2007). Prevalence of child sexual abuse reported
by a cross-sectional sample of New Zealand women. Child Abuse & Neglect, 31(9), 935-945.
Flenady V, K. L., Middleton P, et al. . (2011). Major risk factors for stillbirth in high-income countries: a
systematic review and meta-analysis. The Lancet, 377(97741), 1331-1340.
Flynn, M., Carne, S., & Soa-Lafoa'i, M. a. (2010). Maori Housing Trends 2010.
http://www.hnzc.co.nz/our-publications/maori-housing-trends/2010-maori-housing-trendsreport/2010-maori-housing-trends-report.pdf: Housing New Zealand Corporation.
Gakidou, E., Cowling, K., Lozano, R., & Murray, C. J. (2010). Increased educational attainment and its
effect on child mortality in 175 countries between 1970 and 2009: a systematic analysis. Lancet,
376(9745), 959-974. doi: 10.1016/s0140-6736(10)61257-3
Goldberg, D., & Hodes, M. (1992). The poison of racism and the selfpoisoning of adolescents. Journal of
Family Therapy, 14(1), 51-67.
Gomez-Jacinto, L., & Hombrados-Mendieta, I. (2002). Multiple effects of community and household
crowding. Journal of Environmental Psychology, 22(3), 233-246.
Gove, W. R., Hughes, M., & Galle, O. R. (1983). Overcrowding in the household: An analysis of
determinants and effects.
Lock, K. J., & Gibson, J. K. (2008). Explaining Maori underachievement in standardised reading tests: The
role of social and individual characteristics. Kotuitui: New Zealand Journal of Social Sciences
Online, 3(1), 1-13.
Macintyre, S., & Ellaway, A. (2003). Neighborhoods and health: an overview. Neighborhoods and health,
20-42.
Macintyre, S., Ellaway, A., & Cummins, S. (2002). Place effects on health: how can we conceptualise,
operationalise and measure them? Social Science & Medicine, 55(1), 125-139.
Macintyre, S., Ellaway, A., Hiscock, R., Kearns, A., Der, G., & McKay, L. (2003). What features of the home
and the area might help to explain observed relationships between housing tenure and health?
Evidence from the west of Scotland. Health & place, 9(3), 207-218.
Marriott, L., & Sim, D. (2015). Indicators of inequality for Maori and pacific people.
Mayhew, P., & Reilly, J. (2007). The New Zealand Crime and Safety Survey 2006. Wellington: Ministry of
Justice.
McNeill, R. G., Canny, S. J., & McNeill, J. K. (2016). Managing Expectations for Ground Station
Development at Awarua, New Zealand. Paper presented at the 14th International Conference
on Space Operations.
Megbolugbe, I. F., & Linneman, P. D. (1993). Home ownership. Urban Studies, 30(4-5), 659-682.
Meredith, P. (2015). Urban Mori - Urbanisation, Te Ara - the Encyclopedia of New Zealand.
http://www.teara.govt.nz/en/urban-maori/page-1.
Ministry of Business, I. E. (2016). Maori in the labour market - Unemployment. Hikina Whakatutuki.
Retrieved May 20, 2016, from http://www.mbie.govt.nz/info-services/employmentskills/labour-market-reports/maori-labour-market/maori-in-the-labour-market-factsheets/maori-mar-2016/unemployment
Ministry of Justice. (2002). Racial Harassment. The non-discrimination standards for government and the
public sector guidelines on how to apply the standards and who is covered. Retrieved 27 May,
2016, from http://www.justice.govt.nz/publications/publications-archived/2002/the-nondiscrimination-standards-for-government-and-the-public-sector-guidelines-on-how-to-applythe-standards-and-who-is-covered-march-2002/racial-harassment
Moewaka Barnes H., M. B. A., Baxter J., Crengle S., Pihama L., Ratima M. and Robson B. (2013). Hap
Ora: Wellbeing in the Early Stages of Life. Auckland: Whriki Research Group Retrieved from
http://www.health.govt.nz/publication/hapu-ora-wellbeing-early-stages-life.
New Zealand History. (2016). Treaty of Waitangi. Retrieved May 20, 2016, from
http://www.nzhistory.net.nz/politics/treaty-of-waitangi
NZ.Stat. (2012). Housing problems, Housing Satisfaction and Tenure by Ethnicity. Available from NZGSS
http://nzdotstat.stats.govt.nz/wbos/Index.aspx?DataSetCode=TABLECODE2465#
NZ.Stat. (2016). Perceptions of housing quality in 2014/15. from
http://www.stats.govt.nz/browse_for_stats/people_and_communities/housing/perceptionshousing-quality-2014-15.aspx
Oliver, W. H. (1981). The Oxford History of New Zealand: Oxford University Press, USA.
Pack, S., Tuffin, K., & Lyons, A. (2015). Resisting racism: Maori experiences of interpersonal racism in
Aotearoa New Zealand. AlterNative: An International Journal of Indigenous Peoples, 11(3), 269.
Paradies, Y. (2007). Exploring the health effects of racism for Indigenous people. Paper presented at the
RHRC 2007: Proceedings of the 2007 Rural Health Research Colloquium.
Pascoe, E. A., & Smart Richman, L. (2009). Perceived discrimination and health: a meta-analytic review.
Psychological bulletin, 135(4), 531.
Patten, D., & Gray, A. (1991). HIV/AIDS and Prisons: A Study of Knowledge, Attitudes, and Risk
Behaviours (Vol. 16): Department of Health, Health Research Services.
Pearce, N., Dryson, E., Feyer, A. M., Gander, P., McCracken, S., & Wagstaffe, M. (2004). Burden of
occupational disease and injury in New Zealand: report to the Associate Minister of Labour
Burden of occupational disease and injury in New Zealand: report to the Associate Minister of
Labour: National Occupational Health and Safety Advisory Committee.
Pool, D. (1973). The effects of the 1918 pandemic of influenza on the Maori population of New Zealand.
Bulletin of the History of Medicine, 47(3), 273.
Publications, D. o. H. a. A. (2012). The Australian Immunisation Handbook Canberra: National Health and
Medical Research Council.
Robson, B., & Harris, R. (2007). Hauora: Maori standards of health IV: a study of the years 2000-2005: Te
Ropu Rangahau Hauora a Eru Pomare Wellington, New Zealand.
Simpson, J., Adams, J., Oben, G., Wicken, A., & Duncanson, M. (2016). Te Ohonga Ake The Determinants
of Health for Mori Children and Young People in New Zealand Series Two. Dunedin: New
Zealand Child and Youth Epidemiology Service Retrieved from
http://hdl.handle.net/10523/6135.
Sissons, J. (2010). Building a house society: the reorganization of Maori communities around meeting
houses. Journal of the Royal Anthropological Institute, 16(2), 372-386.
Soboleva, N., Kazakova, N., & Chong, J. (2006). Conviction and sentencing of offenders in New Zealand:
1996 to 2005. Wellington: Ministry of Justice.
Statistics New Zealand. (2012). Mori population grows and more live longer.
Stewart, L. M., Henderson, C. J., Hobbs, M. S. T., Ridout, S. C., & Knuiman, M. W. (2004). Risk of death in
prisoners after release from jail. Australian and New Zealand Journal of Public Health, 28(1), 3236. doi: 10.1111/j.1467-842X.2004.tb00629.x
Sue, D. W., & Constantine, M. G. (2007). Racial microaggressions as instigators of difficult dialogues on
race: Implications for student affairs educators and students. College Student Affairs Journal,
26(2), 136.
Tennant, M. (2005). Welfare interactions: Maori, government and the voluntary sector in New
Zealand.[Article drawn from the Australasian Welfare History Workshop (2005: Melbourne).].
History Australia, 2(3), 80.
Thomas, C. (1993). Sexual assault: Issues for Aboriginal women. Without consent: Confronting adult
sexual violence, 139-148.
Tipene-Leach D, H. L., Tangiora A, et al. (2010). SIDS-related knowledge and infant care practices among
Mori mothers. The New Zealand Medical Journal, 123(1326), 88-96.
Turrell, G. (2006). Health inequalities in Australia: morbidity, health behaviours, risk factors and health
service use. Brisbane, QLD: School of Public Health, Queensland University of Technology.
Turrell, G., & Mathers, C. D. (2000). Socioeconomic status and health in Australia. The Medical Journal of
Australia, 172(9), 434-438.
UNICEF New Zealand. (2015). Child Poverty in New Zealand. from https://www.unicef.org.nz/learn/ourwork-in-new-zealand/Child-Poverty-in-New-Zealand
Waldegrave, C., King, P., Walker, T., & Fitzgerald, E. Mori Housing Experiences: Emerging Trends and
Issues. Wellington: The Family Centre Social Policy Research Unit/Research Centre for Mori
Health and Development, Massey University, 2006.
Westbrooke, I., Baxter, J., & Hogan, J. (2001). Are Maori under-served for cardiac interventions? The
New Zealand Medical Journal, 114(1143), 484-487.
Williams, D. R. (1997). Race and health: basic questions, emerging directions. Annals of epidemiology,
7(5), 322-333.
Woodward A, L. M. (2001). Morbidity attributable to second hand cigarette smoke in New Zealand.
Wellington: Ministry of Health Retrieved from
http://www.health.govt.nz/publication/morbidity-attributable-second-hand-cigarettesmokenew-zealand.
Workman, K. (2011). Mori over-representation in the criminal justice system does structural
discrimination have anything to do with it. Rethinking Crime and Punishment.
Zock, J.-P., Jarvis, D., Luczynska, C., Sunyer, J., Burney, P., & Survey, E. C. R. H. (2002). Housing
characteristics, reported mold exposure, and asthma in the European Community Respiratory
Health Survey. Journal of Allergy and Clinical Immunology, 110(2), 285-292.