RESUMO
Background: Rangatahi Maori, the Indigenous adolescents of Aotearoa New Zealand (NZ), have poorer health outcomes than Pakeha (NZ European /other European/"White") adolescents. We explored the influence of policies for Indigenous youth by presenting health trends, inequities and contrasting policy case examples: tobacco control and healthcare access. Methods: Cross-sectional representative surveys of NZ secondary school students were undertaken in 2001, 2007, 2012 and 2019. Health indicators are presented for Maori and Pakeha adolescents (relative risks with 95% CI, calculated using modified Poisson regression) between 2001-2019 and 2012-2019. Policy examples were examined utilising Critical Te Tiriti Analysis (CTA). Findings: Rangatahi Maori reported significant health gains between 2001 and 2019, but an increase in depressive symptoms (13.8% in 2012 to 27.9% in 2019, RR 2.01 [1.65-2.46]). Compared to Pakeha youth there was a pattern of persistent Maori disadvantage, particularly for racism (RR 2.27 [2.08-2.47]), depressive symptoms (RR 1.42 [1.27-1.59]) and forgone healthcare (RR 1.63 [1.45-1.84]). Tobacco use inequities narrowed (RR 2.53 [2.12-3.02] in 2007 to RR 1.55 [1.25-1.93] in 2019). CTA reveals rangatahi Maori-specific policies, Maori leadership, and political support aligned with improved outcomes and narrowing inequities. Interpretation: Age-appropriate Indigenous strategies are required to improve health outcomes and reduce inequities for rangatahi Maori. Characteristics of effective strategies include: (1) evidence-based, sustained, and comprehensive approaches including both universal levers and Indigenous youth-specific policies; (2) Indigenous and rangatahi leadership; (3) the political will to address Indigenous youth rights, preferences, priorities; and (4) a commitment to an anti-racist praxis and healthcare Indigenisation. Funding: Two Health Research Council of New Zealand Project Grants: (a) Fleming T, Peiris-John R, Crengle S, Parry D. (2018). Integrating survey and intervention research for youth health gains. (HRC ref: 18/473); and (b) Clark TC, Le Grice J, Groot S, Shepherd M, Lewycka S. (2017) Harnessing the spark of life: Maximising whanau contributors to rangatahi wellbeing (HRC ref: 17/315).
RESUMO
AIM: To determine the proportion of pregnant women vaccinated with the pertussis booster in the third trimester of their pregnancy, and explore factors influencing coverage. METHODS: A clinical audit was undertaken at Rotorua hospital using electronic databases to determine pertussis immunisation among women who birthed from 25 March to 25 April, 2017 (n=111). Lead maternity carers (LMCs) were surveyed to assess knowledge of the vaccine and explore suggestions to increase vaccination coverage. RESULTS: Only 44% (n=49) of women were vaccinated in 2017. Women 25 years and under, and women from Rotorua were less likely to be vaccinated. A woman not being recalled to the GP for vaccination was the biggest reason for not being vaccinated (n=27). Every woman in Taupo/Turangi was recalled in pregnancy, leading to greater vaccine uptake compared to women in Rotorua. CONCLUSION: Overall, the proportion of pregnant women vaccinated for pertussis continue to be low with coverage being disproportionally lower for younger women. The integrated healthcare approach in Taupo/Turangi has resulted in improved vaccine uptake. Interventions that allow general practitioners, LMCs and primary health organisations to work together can improve vaccination rates of pregnant mothers in New Zealand.