Researching social determinants of health is crucial to helping Māori and Pacific people, says University of Auckland senior research fellow Anna Rolleston.
Two scientists helping to frame the centre’s priorities are senior research fellow Anna Rolleston, who runs a 12-week lifestyle management/cardiovascular risk-reduction programme with a kaupapa Māori focus in Tauranga, and University of Otago postdoctoral fellow Cassidy Moeke, who is researching the link between inflammation and atherosclerosis and gout. “We have a world-class health system and the best of the best in heart health,” says Rolleston. “We have some great researchers in clinical science and physiology, but we have still got these massive equity gaps, disparities that haven’t changed in decades. It’s about changing the way we do research, collecting evidence in a different way and implementing it in a different way.
“For Māori, a lot of the reasons for the disparity are social determinants of health, things that are wider than physical health, and if we don’t address that and continue to do research that’s just around physical health, nothing is going to change. In the system, we think you should eat better and do more exercise and take your medication, and if you do those things you will be well. But that is our point of view – our perspective on someone else’s life. People aren’t going to eat better, exercise and take their medication if they are worried about putting food on the table. A much better way of doing it is to ask people what is important to them for their health and well-being, and help them with that. “They say things like, ‘I haven’t walked up Mauao [Mt Maunganui] for 20 years,’ or ‘I want to play with my grandchildren.’ It has nothing to do with hypertension management now … but, eventually, it will.”
Rolleston says researchers have to step outside their “business as usual” response. “There is some fantastic, amazing research, but if it continues to be what it’s always been, we will still be having this conversation about disparities in 10 years’ time.”
Moeke says earlier detection and better treatments are vital. “Māori sometimes may not take their medication because they don’t think it’s working. We need research and outcomes that work.” Part of that will depend on a better understanding of the differences in biological makeup between Māori and Pacific and other people.
Māori can be made to feel ashamed – whakamā – or responsible for their disease, when they are not. “Giving up smoking is one of the most difficult things to do. Lifestyle issues are major, not trivial, so we need to figure out how to make people make these changes. If we fail them, we’ve failed.”
Professor of translational physiology Julian Paton says the partnership with Māori advisers such as Rolleston and Moeke at the Centre for Heart Research will be crucial in changing the approaches that have led to the disparities in outcomes.
“This is an unprecedented opportunity to address equity and improve heart health for all in Aotearoa-New Zealand.”
This article was first published in the September 14, 2019 issue of the New Zealand Listener.