Oranga kaumatua: perceptions of health in older Maori people.

• Author: Waldon, John

Abstract

This paper explores some of the opportunities for Maori health uncovered by recent developments in the measurement and analysis of health-related behaviours. It presents the findings of a survey incorporating Short Form 36[TM] (SF36[TM]) of more than 400 older Maori, many considered kaumatua (respected older Maori men and women). The findings identify important cross-links between health and other factors contributing to health, indicating that higher standards of health are strongly associated with active participation and cultural affiliation, home ownership and higher incomes. Low income appears to be generally associated with poorer health, and it seems that older Maori may have less opportunity to supplement their income compared with other New Zealanders in the same age groups. In this paper the risks and protective behaviour of the participants covered the breadth of the social policy sector, and underline the need for long-term policy planning. Provision for Maori retirement is a matter that iwi (tribe), hapu (sub-tribe or clan) and the state should consider. Older Maori will continue to rely heavily on state provision. High home ownership is less likely among the next generation of older Maori, and many will have known long periods of unemployment. Long hours of voluntary work are not atypical, and there may be a case for recognising those efforts. As dependency ratios change with a larger proportion of older people, policies should also be revised to assure that potential at both ends of the life cycle is fulfilled.

INTRODUCTION

Recent developments in the measurement and analysis of health-related behaviours have brought about new understandings regarding the application of health assessment tools such as SF36[TM2], and have provided public health professionals with new ways of considering people's health (Salmon et al. 1999, 2000, Scott et al. 2000, Silburn et al. 1996, Waters et al. 2000, Zubrick et al. 1995, Zubrick et al. 1997). These tools may also provide new ways to improve health (perhaps using the health determinants approach of social epidemiology) and monitor changes.

The implications for determining self-assessed health status and the notion of risk behaviours will be discussed in this paper and reviewed at the conclusion. The case study is a window through which we may observe and understand health-related behaviour, the notion of cultural norms and social values, and how health states may be interpreted.

WORLD VIEWS

Understanding and recognising different world views can help us do better social policy by understanding where our world views share the same perspective and where our perspectives diverge. Patton (1990) suggests that it is important to match world view and competencies to the context of the research. The context in which we understand research is also important, as theory located in the Maori world that seeks to meet Maori needs is entirely sensible to Maori (Royal 1998). This is especially consistent with contemporary Maori structures, and leads to the development of new approaches to health that make sense to Maori (Durie 1998).

This paper considers the health and wellbeing of a selected group of older Maori in a mixed-methods research project.

AIMS OF THE PAPER

This article uses a case study, Oranga Kaumatua, a study of Maori people aged 60 years and over undertaken by Te Pumanawa Hauora, to outline a range of issues relating to the risk and protective behaviours of older Maori. Its aims are to:

* discuss health-related behaviours

* consider cultural norms and social values for a group of Maori

* describe preferences for health states.

The health and wellbeing of older Maori have been considered by some public health professionals from a narrow perspective in which Maori are seen to be the same as other older people. From this conservative perspective, older Maori are, in fact, invisible. It could be argued that considering the needs of older Maori is a radical departure from a conservative public health world view.

The aims of this study were to:

* gauge the economic circumstances of older Maori

* ascertain their health status

* measure the level of minor and major disability for older Maori

* identify policy implications for Maori and the Government.

OLDER MAORI

The Maori population is youthful, with a median age 10 years younger than the New Zealand population as a whole (Statistics New Zealand 1998). Although youthful, the Maori population is also ageing, due to a combination of increasing life expectancy and decreasing birth rates. Therefore, both the proportion and the numbers of older Maori will increase significantly over the next 20 to 30 years. During this time, older Maori will be confronted by many changes, including changes to whanau structures, the provision of health care, and the way in which government agencies provide for all its older citizens. Assumptions about the traditional role of older Maori in Maori society, or in New Zealand society generally, will not fit for all Maori. Nevertheless, older Maori will be increasingly relied upon when traditional Maori resources are required. Accurate information about the range of actual situations of older Maori is essential for future health planning.

This paper recognises that older Maori do not live in isolation from other systems and developments. Policies and programmes emanating from government, iwi and the communities in which they live influence the circumstances of older Maori.

Oranga Kaumatua is, in part, an exploration of the interaction between older Maori and their whanau (family). Rather than presuming that illness, disability or hardship are the key determinants of wellbeing in old age, the underlying philosophy of the study is that older Maori are able to pursue fruitful lives and occupy valuable roles, largely because of their many years of experience (Te Puni Kokiri 1997). This approach is consistent with Government policy for Maori public health as outlined both in He Matariki (Public Health Commission Rangapu Hauora Tumatanui 1995) and, most recently, by He Korowai Oranga: The Maori Health Strategy (Minister of Health 2002), and takes a positive view towards ageing.

THE STUDY

Sampling

Kaumatua were recruited through iwi and Maori community networks. The sample selection was biased towards older Maori who were more likely to participate in traditional or customary Maori society. In the sense of statistical generalisability to all older Maori, this case study falls short of being "representative". Nevertheless, the sample size of 429 older Maori men and women makes the study one of the largest research projects involving older Maori: study participants account for nearly 1.7% of all Maori aged...