Individuals and organisations in the health and disability sector recognise that Pacific families’ experience of health care is influenced by Pacific world views, cultural beliefs and values (Taumoefolau 2012). Culture has been identified as ‘expressions of knowledge, beliefs, customs, morals, arts and personality’ (Ministry of Social Development 2012a). Moreover, as Nga Vaka o Kāiga Tapu (Ministry of Social Development 2012a) recognises, while Pacific ‘cultures’ share some similarities in principles and concepts, they each have specific and independent world views. Culture is reflected in the following terms: akono’ang Māori (Cook Islands), tovo vaka Viti (Fiji), aga fakaNiue (Niue), aganu’u Sāmoa (Samoa), tū ma aganuku o Tokelau (Tokelau), anga fakaTonga (Tonga), tu mo faifaiga faka Tuvalu (Tuvalu) (Ministry of Social Development 2012a).
Given the dynamic nature of the Pacific population in New Zealand, these cultural world views, beliefs and values are diverse and evolving. In general, Pacific peoples in New Zealand maintain strong links with the Pacific Islands through family, culture, history and language (Health Research Council of New Zealand 2012).
Workers in the health and disability sector are aware that, for most Pacific peoples, ’āiga, kāiga, magafaoa, kōpū tangata, vuvale, fāmili (family) is the centre of the community and way of life. Family provides identity, status, honour, prescribed roles, care and support (Tiatia and Foliaki 2005). Care for family members with disabilities or for older family members is often informally provided within the family (Huakau and Bray 2000). Pacific peoples have a holistic view of health and wellbeing (Ministry of Social Development 2012a, b).
Whānau ora is a holistic and strengths-based approach to developing and maintaining strong and vibrant families. The initiative supports Pacific families through the development of ‘navigators’, who facilitate increased access to existing systems and services.
Quality health care
The key dimensions of quality – access, equity, cultural competence, safety, effectiveness, efficiency and patient-centredness – are implicit in the delivery of health and disability services to Pacific peoples (Minister of Health 2003). Quality health care is delivered from a strengths-based approach and is apparent at individual, family, community, organisation and overall system levels.
Working together – integration
The health and disability sector works together to provide seamless and integrated quality care to Pacific peoples. The sector focuses on the social, environmental, economic and cultural factors that impact on Pacific health outcomes. The health and disability sector partners with education, housing and social development to prioritise and focus on Better Public Service targets.
The health and disability sector specifically focuses on the vulnerable children targets, which are:
1. increase participation in early childhood education
Two enablers in the health and disability sector are reflected in the new ’Ala Mo’ui outcomes framework.
1. Pacific workforce supply meets service demand.
2. Every dollar is spent in the best way to improve health outcomes.
Increased Pacific responsiveness of the general New Zealand health and disability workforce
If we are to improve and gain equitable health outcomes for all Pacific peoples in New Zealand, it is essential to not only build the capacity and capability of the Pacific health and disability workforce but to also increase the responsiveness of the non-Pacific health workforce to Pacific health needs.
The Public Health Workforce Development Plan 2007–2016 recognises this and has a two pronged approach to supporting this matter, which is to ‘strengthen the Pacific public health workforce and to increase the capability of the non-Pacific workforce to improve Pacific health and reduce inequalities’.
Cultural competence of the health workforce is a recognised component of health service quality. Pacific cultural competency may be defined as the ability to understand and appropriately apply cultural values and practices that underpin Pacific peoples’ world views and perspectives on health (Ministry of Health 2008). A greater appreciation of diversity and the differences between patient’s and providers world views and lived reality, will lead to improved communication, diagnosis and adherence to treatment regimes (Southwick et al 2012).
Increasing the responsiveness of the New Zealand health and disability workforce requires leadership at all levels of the health system. This is a fundamental requirement if we are to gain our aim of health equity for Pacific peoples in New Zealand.
One of the workforce priorities that fall out of the Health Workforce New Zealand’s regional service plan 2014/15 requires DHBs to work with their regional training hub to increase participation Pacific FTEs in the workforce through initiatives such as scholarship programmes and supporting high-school based programmes.
Each of these enablers is described opposite.
1. Pacific workforce supply meets service demand
Developing the Pacific health and disability workforce is a priority because ethnic and linguistic diversity among health professionals is associated with better access to and quality of care for disadvantaged populations (Barwick 2000; United States Department of Health and Human Services 2006). Pacific health and disability workers bring connections with Pacific communities, personal understanding of Pacific issues, and Pacific cultural and language skills (Pacific Perspectives 2012). The Pacific health workforce can positively influence Pacific equity in health outcomes by ‘integrating cultural practices, concepts and diverse world views into high-quality, evidence informed health services’ (Pacific Perspectives 2012).
Pacific health workers have made an important contribution to the care of New Zealanders, particularly as nurses (Zurn and Dumont 2008) and non-regulated workers, such as community health workers, health care assistants and caregivers (Samu et al 2009). Developing the Pacific health and disability workforce therefore also contributes to the health and wellbeing of the wider New Zealand public.
Workforce development (including job creation and skill development) also has economic benefits for Pacific individuals, families and communities. Increasing the size of the Pacific health and disability workforce will also improve community health literacy and the cultural competency of the health and disability sector. Health literacy, socioeconomic determinants, collective world views and cultural beliefs impact on inequities experienced by Pacific peoples. Inequities are indicative of poor system responsiveness and quality of care experience (Pacific Perspectives 2012).
We want to improve our ability to attract, train and retain Pacific health and disability workers in priority areas where there are shortages, such as primary health care, child health, mental health, disability, youth sexual health and oral health. We also want to do better at recruiting and retaining qualified Pacific workers for Pacific providers and Pacific-focused services in mainstream organisations.
The youthful, urbanised and growing Pacific working age population is and will continue to be an important resource for the New Zealand health workforce (Pacific Perspectives 2012). We want to make best use of this resource by providing opportunities and support for Pacific peoples to become health and disability workers.
To this end, we also need to focus on increasing the number of Pacific students enrolling in health-related subjects at secondary school. In 2013, there were low numbers of Pacific students fully engaged in key science subjects at secondary school (such as chemistry, biology and physics), which are critical requirements for entry into many health workforce training courses (New Zealand Qualifications Authority 2014).
Pacific Provider Workforce Development Fund and Pacific Innovation Fund
The Ministry of Health allocates funding to Pacific providers via the Pacific Provider Workforce Development Fund. The focus areas for this funding are described in further detail below.
a. Increase the Pacific health workforce
The focus is on increasing the Pacific health workforce through a pipeline approach, as outlined in Table 1 below.
Table 1: Funded activities to increase the Pacific health workforce
Increased number of Pacific students taking science subjects in years 11, 12 and 13
Health Science Academies in Auckland
Mentoring for students studying health-related subjects (ie, Pacific Orientation Programme at Otago (POPO) mentoring – University of Otago; mentoring – Auckland tertiary institutions)
Pacific Health and Disability Workforce Awards (scholarships)
Increased number of Pacific students enrolled in a health qualification at a tertiary institution
Increased number of Pacific workers in the health and disability workforce
Pacific nurses – Master of Nursing in Pacific health, master class seminar to Pacific nurses in postgraduate study
Auckland University of Technology – return to midwifery programme
Professional health organisation support for: Pasifika Medical Association; Aotearoa Tongan Health Workers Association; Cook Islands Health Network; Tongan Nurses Association of New Zealand; Samoan Nurses Association of New Zealand; Pasifikology; Fiji Nurses Association
Upskill and retain
Increased number of Pacific health professionals advancing in professional and/or clinical development
The Pacific Innovation Fund will invest in Pacific health initiatives that demonstrate innovation through the application of new strategies, models and methods of service delivery. The focus of the 2014–2018 funding will be strengths-based innovation projects that seek to prevent the causes of disease and injury to the Pacific population. Priorities within this focus include:
strengthening Pacific child and youth protective factors
reducing the prevalence of risk factors affecting Pacific health (eg, obesity and smoking).
Currently, there is a significant shortage of New Zealand health and disability workers with an understanding of Pacific health perspectives and Pacific culture in general (National Health Board 2010; Pacific Perspectives 2012). Although Pacific peoples make up 7.4 percent of the total New Zealand population (Statistics New Zealand 2013), the proportion in the health workforce is lower (1.8 percent). See appendix 1 for the breakdown of the percentages of the Pacific health workforce in different health professional roles.
2. Every dollar is spent in the best way to improve health outcomes
Getting the best health value for every dollar spent is critical. Population ageing will place increasing demands on the health and disability sector in the future. There will also be ever higher expectations that the system should deliver a wider range of services and treatments. In parallel, funding increases for health and disability services are likely to be more constrained than they have been over most of the past decade.
Pacific peoples have a high prevalence of non-communicable diseases such as diabetes, heart disease, cancer and chronic respiratory disease. These conditions are causing a significant negative impact on the economic and social wellbeing of our Pacific communities and are associated with a number of modifiable risk factors such as smoking, unhealthy diets and physical inactivity.
Preventing chronic conditions is important for the future sustainability of the health and disability sector, both in capacity requirements and in terms of overall costs. Care for Pacific peoples in Auckland city alone costs in excess of $93 million a year, of which $35 million relates to costs associated with higher diabetes prevalence (Health Partners Consulting Group 2012).
We require urgent and sustained preventive public health interventions at all stages of the life cycle, beginning at antenatal care and continuing through to elderly care and support. A more sustained focus on priorities such as immunisation and effective support and management of long-term conditions within primary care is necessary.