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Having recently moved from clinical practice into nursing education, I have had the opportunity to reflect on, and research a topic that has been on my mind for some time - the existence of ongoing Maori health inequities.
Despite the inclusion of cultural safety in nursing education 30 years ago,a the introduction of a competency framework that requires individual nurses to consider and provide evidence of culturally safe practice,2 and the addition of various nursing policies recognising the need to address Maori health inequities, poor Maori health outcomes continue.
Absence of discussion
Literature suggests the medical profession has spent recent years seriously researching and reflecting on their contribution to Maori health disparity.3,4 But from my perspective, there appears to be an absence of robust discussion about nursing's contribution to Maori health disparity, despite the fact nurses are the largest group of health professionals providing direct care to Māori.5 Which leads me to ask: "Are we oblivious to, or just ignoring, the very obvious elephant in the room?"
It has been well established that, in comparison to non-Maori, Maori experience poorer health outcomes and are over-represented in all disease categories. Maori experience higher morbidity and mortality in diabetes, rheumatic fever,6 cardiovascular disease7 and most cancers.6 Mortality rates suggest that, if you are Maori, you are more likely to die seven to eight years younger than someone who is non-Maori.6 You have a higher risk of taking your own life if you are Maori,6 and will be more likely to die from a preventable disease.6 But you are less likely to be referred for specialist care8 and less likely to receive elective surgical interventions.9,10 If you are Maori, you are also less likely to access primary health care11 and more likely to be referred to mental health services via the justice system.ļ2
Once in the health system, Maori experience high rates of racism and discrimination13 Maori are more likely to experience an adverse medical event, receive poor quality care and be in hospital for a shorter period of time for the same issue as a non-Maori, but are more likely to be readmitted.16 If entering...