Shining a light on Pacific health outcomes

Grief is a room where the lights have gone out and you can’t see clearly what is in front of you. Grief is a room where lights like Fa’anānā Efeso Collins once shone as a beacons of hope for marginalised people. Grief is a room occupied by Pacific people in which Te Aka Whai Ora (the Māori Health Authority) offered the promise of a healthier future. For me, the final light to go out recently was the news a close family member had been diagnosed with an advanced (and preventable) cancer.

I do not know what caused Collins’ death, if it could have been prevented, or if it was (as death often is) random. However, I am sure our healthcare system should have prevented my family member being diagnosed with Stage 4 cancer. Why isn’t the targeted cancer screening offered to some Māori and Pasifika after 50 better at protecting them from advanced disease?

I write as an Afakasi Samoan doctor all too aware of the unfair life expectancy differences and the broader inequities across all the health statistics depending on ethnicity. I’ve witnessed the impact of these inequities first-hand in my personal life and in my professional life. Growing up, I hardly knew my Samoan grandparents, who emigrated to New Zealand when my father was very young, and who passed away while I was too young to make tangible memories. I’ve also experienced the loss of aunties, uncles and cousins who have passed on to the other side far too young.

These are personal losses, but I also grieve for my culture, having missed out on deepening my Samoan roots through Talanoa (conversations) with elders. Sadly, having the chance to celebrate the 90th birthday of a great-great aunt, as we did in 2019 in Samoa, is the exception not the rule.

What is clear from statistics over the years is the stark and consistent gaps in health and survival by ethnic group in New Zealand, 

We can get inured to statistics but they are powerful in that they represent human lives. For example, when compared with other ethnicities, Māori and Pacific males in New Zealand lose 10 years of life on average – with the reported average life expectancy for a Māori male being 73.4 years and Pacific males 75.4 years in 2021. That’s someone’s father, uncle, cousin or grandfather.My research aims to identify the root causes and contributors of differential health outcomes by ethnicity in New Zealand to inform solutions.

Although I don’t have all of the answers on how to cure health inequities that have existed for decades, I do have questions.

Why hasn’t modern medicine, with advanced clinical drug trials, precision medicine genetics, and assisted intelligence technologies, aided and advanced survival for Pacific populations?How could our health system service some ethnicities better? Could we screen more, educate better and intervene earlier to optimise the quality and length of life for all people?

How can we break down the barriers that inhibit some population groups from taking full advantage of the preventative medicines or screening measures that save people’s lives?

Historical data shows us that when we implement culturally informed solutions they work – for instance, culturally targeted policy reforms that were culturally sensitive and inclusive to marginalised groups have been shown to reduce Māori infant mortality from Sudden Unexpected Death in Infancy in New Zealand. The Māori health authority group, Te Aka Whai Ora, could have seen a reduction in preventable deaths by using culturally informed and sensitive solutions. We may never know the impact Te Aka Whai Ora could have had on health inequities in New Zealand.Ultimately research could be the vessel to shine a light on the needs of Māori and Pacific people living in New Zealand.

Qualitative research can amplify the voices of those most affected by ethnic inequities in health outcomes to inform culturally valid solutions to complicated health matters. We should no longer tolerate other researchers and policy makers assuming what is best for us when we know what is best. I believe this is one way out of the darkness I feel living with these inequitable health statistics.