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Pacific children

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  1. Pacific children Improving Health and Healthcare for Pacific Children in New Zealand Dr Teuila Percival

  2. Pacific People Relationships Holistic health and spirituality Contribution and responsibility Correctness and respect Faith Dignity

  3. Pacific People’s challenges • High Mortality across the lifespan • High rates of non-communicable and infectious disease • Late presentation to healthcare& multiple • co-morbidities • Inequitable healthcare access • Upstream determinants - Poverty unemployment, environments • Lower formal education

  4. Pacific children • High infant & child mortality • Infectious diseases • Respiratory disease • Rheumatic Fever & RHD • Child Obesity • Lower Pre-school enrollment • Lower School achievement

  5. New Zealand Pacific Children

  6. Infectious diseases Admissions by deprivation and ethnicity Baker et al 2012

  7. Pacific infants • Pacific preterm rate 5.5 % • Low birth weight 5.4% • NICU admission rate 11% Hospitalization rate 1st year of life 27.3% Auckland Population 2009 - 2011

  8. Proportion of NZ Children(0-14yrs) living in Crowded Households by ethnicity and NZ Deprivation Index Decile, 2006 Census % of agegroup NZ Deprivation Index Decile NZ Child & Youth Epidemiology Service.

  9. Emergency Department Attendances, Auckland DHB’s 2011

  10. Specialist Outpatient Appointments FSA for Auckland DHB’s, 2011

  11. Accessing health careAge standardised mortality (1990-1992), CABG and PTCA intervention rates(1990-1999) per 100,000 population by ethnic group. New Zealand Males Tukuitonga C et al. NZMJ,2002 Per 100,000

  12. Outpatient Clinic DNA rate % DNA First Specialist Appt Auckland DHB’s, 2011

  13. Ethnic differences in Rx/intervention Upstream determinants death or cure Diagnosis Treatment Detection Co-morbidities Age

  14. The 6 Building Blocks of Health Systems • Service delivery • Health workforce • Information • Medical products • Vaccines & technology • Financing • Leadership and Governance Source: WHO

  15. Health Literacy • How to navigate and interact with the complex health system • What health information is relevant and how to find it • Developing knowledge and expectations about health and well-being • Evaluating and understanding health messages, nutrition information, instructions and medicine labels • Completing medical forms and responding to information requests • Confidence and ability to talk with health professionals and ask questions

  16. General practitioner Hospital Emergency Dept School nurse Practice nurse Local chemist Community health worker Delivery suite Well Child Nurse Hospital midwife teacher community midwife Public health nurse obstetrician Paediatrician Traditional healer outpatient clinic Community social worker Accident & Medical Clinic Next door neighbor Accessing healthcare ?

  17. BronchiolitisNorthern DHB Acute Hospitalisations 2000 - 2010

  18. Bacterial /non-viral PneumoniaNorthern DHB Admissions 2000-2010, 0-24yrs

  19. CMDHB Pacific Child Admissions for Acute medical conditions, 2000 - 2010 Admissions per 1000

  20. LRI in under 2 yr olds, CMDHB 2007Trenholme A. et al. • 394 children / 508 admissions • 56% Pacific, 30% Maori • 78% in Dep 9 & 10 • 65% smoke exposed • 27% use no household heating • Longer stay = young, preterm, Maori or Pacific

  21. Reducing respiratory disease • Second hand smoke • Housing and household crowding • Improved breastfeeding rates • Raise immunization rates • General infectious disease prevention

  22. Health solutions1. Determinants of Health & Health Promotion

  23. Respiratory illness, South Auckland initiatives • Healthy Housing • Snug Homes • Immunization – outreach, NIR • Pneumococcal vaccine coverage • Low cost Primary Care • Smoking Cessation • Pacific Churches

  24. Children fully immunized at age 2 yrs.New Zealand 2009 Source: IMAC

  25. Admissions for Asthma in Northern DHB’s, 2000 – 2010, Age 0-24 yrs

  26. Focus on Asthma • Second hand tobacco smoke • Self/Home based management of Asthma • Housing and household crowding • Increase immunization rates • Culturally specific Asthma programmes

  27. Health Solutions2. Improving Health Care

  28. “An evaluation of a pictorial asthma medication plan for Pacific children” Kristiansen et al, 2012

  29. “Primary Care for Pacific People”Barriers to seeking help • Transport • The cost of healthcare • Difficulty communicating and understanding • Language barriers • Difficulty making appointments • The expectation / experience “gap” • Sometimes insensitive and “racist” behaviour Southwick et al, 2012

  30. Healthcare was a positive experience… When the patient and family • Felt welcome • Felt respected • Valued • Listened to & understood Southwick et al, 2012

  31. Best Practice Maternity carePerinatal and Maternal Mortality Review Committee 2012, 6th Report “All Women should commence maternity care before10 weeks” • Screen for congenital abnormalities, STI, maternal mental health, underlying medical condition • Identify at risk (obesity, socio-economic) “LMC’s should be aware that teenage mothers are at increased risk of stillbirth and neonatal death”

  32. Responsive Health ServicesMaternal & Child Health in Primary Care pilotSouth Seas HealthCare, Otara • Point of access to care = +ve pregnancy test • Co-locate GP, midwife, Well-Child, Social worker • One shared medical record • Early social work assessment & intervention

  33. Child Pedestrian Injury Child hit by vehicle while crossing a road Traveling not playing 40% on school journey 75% within 1 km of home High traffic volume roads Traffic usually speeding Higher rates in Pacific & Maori children Lower socioeconomic communities

  34. Health Solutions3. Policy and infrastructure

  35. Walking school bus

  36. Policy • FREE health care for children • FREE education for children • Ethnicity and socio-economic status factored into funding of health programmes

  37. Health Solutions4.Community development & empowerment

  38. Promoting Healthy Church Environments “Health Eating Church Awards”

  39. Impact of Health Eating Awards on Health Village Action Zone ChurchesLiliani Momota Atiola, University of Auckland Gold AwardChurch characteristics • Strong & supportive Church leader • High engagement of congregation • Dedicated Health co-ordinator • Active Health Committee “We notice at church functions the presence of more vegetable and fruit salads and less food that is high in fat, salt and sugar. This is very exciting for us moving into the future.”

  40. Healthy eating Healthy activity Healthy weight Environmental change Individual behaviour change The environmental gradient is steep