Universal healthcare for all? Maori health inequalities in Aotearoa New Zealand, 1975-2000.

Despite establishing a so-called universal, taxpayer funded health system from 1938, New Zealand's health system has never delivered equitable health outcomes for its indigenous population, the Maori people. This article, using a case study approach focusing on Maori, documents these historic inequalities and discusses policy attempts to address them from the 1970s when the principles of the Treaty of Waitangi were first introduced in legislation. This period is one of increasing self-determination for Maori, but notwithstanding this, Maori continued to have significantly shorter life expectancy than the population as a whole and suffered poor health at much higher rates. Neo-liberal policies were introduced and expanded during the 1980s and 1990s in New Zealand, including in healthcare from the early 1990s. The introduction of the purchaser-provider split in health services and the focus on devolving responsibility to communities provided an opportunity for Maori health providers to be established. However, the neo-liberal economic and social welfare policies implemented during this time also worked against Maori and adversely affected their health. By analysing attempts to reduce inequity in health outcomes for Maori, we explore why these collective attempts, including by Maori themselves, did not result in overall improved health and increased life expectancy for Maori. There was often a significant gap between government rhetoric and action, and we suggest that a predominantly universal healthcare system did not accommodate cultural and ethnic differences, and this is a potential explanation for the failure to reduce inequities. While this is true for all minority ethnic groups it is even more crucial for Maori as New Zealand's tangata whenua (first people) who had been progressively disadvantaged under colonialism. However, the seeds of ideas around Maori-led healthcare were planted in this period and have become part of the current Labour Government's policy on health reform.

Mobilising Mothers: The 1917 National Baby Week.

This article focuses on Britain's 1917 National Baby Week and specifically how it played out in London. Pageantry and celebration were an important part of the event, and possibly a welcome distraction from the trials and horrors of war, and they were embraced by women of all social classes. But there was much more to it, as women who led the event seized the opportunity for political purposes, in what appeared to be an unthreatening environment of celebrating motherhood. Their goal was to promote the material wellbeing of, and state support for, women and children, and in this they were remarkably successful. Baby Week was also seized upon as an opportunity to showcase other welfare systems as a model for Britain, focusing in particular on New Zealand, with its free and comprehensive health service for infants. Rather than reflecting the eugenic and pronatalist concerns of the establishment, the event should be seen as a moment of politicisation of women arguing for cross-class social reform targeted at mothers.

Partnerships for health: decimating tuberculosis in the Cook Islands, 1920-1975.

How did the Cook Islands manage to achieve a significant reduction in tuberculosis from a high rate in the early 20th century to low rates by 1975? With the mid-century invention of effective drug therapy there was a widespread belief around the Western world that TB could be eradicated. The Cook Islands was one place which almost reached this goal. Based on primary and secondary historical and anthropological research, we argue that the geo-political emplacement of the Cook Islands and development of multi-scale partnerships were crucial to success. Our research indicates the value of understanding and engaging with local community networks and culturally appropriate partnerships in dealing with health issues.

From breast to bottle: a history of modern infant feeding.

In the early twentieth century, mothers began to turn towards scientific infant-feeding formulae as an alternative to breastfeeding their babies. This is strange because the benefits of breastfeeding were widely recognised. The extraordinary rise of the formula feed therefore demands a special explanation, one that includes an appreciation of key changes in public health, the emergence of paediatrics as a profession, commercial interests and advances in the sciences of bacteriology and nutrition. All these factors conspired to propel the formula feed to the fore.

Gender and class tensions between psychiatric nurses and the general nursing profession in mid-twentieth century New Zealand.

Abstract Histories of twentieth century nursing usually present 'general nursing' as the norm and make the assumption that nursing was a female-dominated profession in which men were a marginalised minority. In this article, we argue that in New Zealand, psychiatric nursing had developed a distinct culture from general nursing, was more an occupation than a profession, and was one in which men held a central and powerful position. We explore the tensions that developed between male psychiatric nurses (attendants) and professional nursing leaders when general nursing began to gain authority over mental hospital nursing in the period 1939 to 1959. We argue that rather than being marginalised, the male nurses used their strength as unionised, working-class men to resist the incremental control by general nursing, a profession underpinned by middle-class values. Some battles were lost, but overall the men retained a powerful position in the mental health system during this period.

Discourses of disease: representations of tuberculosis within New Zealand newspapers 2002-2004.

This paper critically examines the ways that tuberculosis (TB) has been represented in the print media in New Zealand over recent years (2002-2004). Our broad contention is that, notwithstanding its biomedical reality, TB is socially constructed by, and through, human experience. Further, public health practitioners depend, to a large extent, on the media to alert the public to threats of disease and opportunities for protection. However, the messages conveyed are sometimes neither helpful nor accurate. In our analysis of TB coverage in three major daily newspapers in New Zealand, we enumerate and classify references to the disease, as well as undertake a discursive analysis of the revealed themes. Of the 366 texts we retrieved in the database search, we selected 120 for in-depth analysis. Our examination indicated the importance of bovine TB within the national consciousness, the stigmatised character of TB and the association between TB and immigrants. We observe that newspaper 'stories' in general, and commentaries by public health officials in particular, are invariably offered on a 'case by case' basis. We conclude that this specificity in time and place avoids more challenging discourses linking TB with deeply embedded determinants of health such as the strong link between TB and poverty.