Opinion: For watchers of Aotearoa New Zealand’s health system, the past few years have brought a steady drumbeat of new reports to digest, new strategy documents to scrutinise and new organisational charts to pore over.
For those focused on the health of Aotearoa’s Asian populations, however, the overwhelming message over this time seems to have been far more continuity than change – and not for the better.
Te Pae Tata, the Interim New Zealand Health Plan, is intended to set the strategic direction for Te Whatu Ora-Health New Zealand and Te Aka Whai Ora-Māori Health Authority over the next two years – in effect, building the foundation for what our new health system will look like.
Almost immediately after its release, however, it was criticised by Asian health advocates for overlooking Aotearoa’s Asian populations. The word ‘Asian’ did not appear at all in the 100-page report, apart from a cursory mention of South Asian populations being among those at higher risk of death from cardiovascular disease.
This is, unfortunately, familiar territory for many working in the Asian health space. Amid the hundreds of pages of discussion about the health system released by the Government over the past few years, only a handful of references to ‘Asians’ – itself a crude, broad-brush classification – could be found. Even then, they were largely lumped in with the even broader classification of ‘ethnic’ communities.
On the surface, Aotearoa’s Asian populations appear to be relatively healthy. According to the 2021-22 New Zealand Health Survey, on almost every health measure, from self-rated health to the prevalence of psychological distress, they are at least on-par with, if not performing better than, the national average.
However, these rosy headline figures deserve a little more scrutiny than they tend to receive. For example, many of the prevalence figures in the survey rely on successful diagnoses. In other words, to be counted, they require that somebody has recognised signs and symptoms of illness, is willing to seek help, knows where to seek help and is able to do so in a timely and affordable fashion.
My PhD research, which has focused on ethnic Chinese populations’ experiences with, and opinions of, Aotearoa’s mental health system, has found that few of these factors can be taken for granted in Asian populations.
In a paper I published with my supervisors in the New Zealand Medical Journal earlier this year, health professionals found a myriad of obstacles facing ethnic Chinese seeking mental health support, from stigmatisation of mental health issues to isolation from support systems.
Even for those willing and able to seek help, language, cultural and affordability barriers remain an issue. The prospect of pouring your heart and soul out to a counsellor is often harrowing enough for most people, never mind doing it in your second language, or through a translator.
Overall, they told us ethnic Chinese tend to access mental health services far too little, and far too late. This corresponds to previous research, as well as New Zealand Health Survey data, showing lower use of primary health care more generally among Asian populations.
The consequences of waiting until a ‘breaking point’, when the effects of mental illness can no longer be ignored, can be severe. One DHB manager told us they are commonly asked by mental health professionals: ‘Why are Asian cases always dramatic’?
Thus far, a lack of a coordinated, government-wide strategy has meant the burden of mental health care has largely fallen on NGOs and individual health professionals. They act as ‘cultural brokers’, mediators who understand the context of Asian communities and the structures of Aotearoa’s wider health system, and must balance these in their everyday practice. It is a labour-intensive role, and one not sufficiently recognised or resourced currently.
The Government’s seemingly low awareness of the health needs facing Aotearoa’s Asian communities is not for a lack of trying. Mainstream media attention has increased in recent years, with coverage often being spearheaded by dedicated journalists, and outspoken NGOs and health professionals.
Despite the advocacy work, however, the continuing silence by the Government has led to cynicism among some health professionals. Another DHB manager told us of ‘a brain and heart problem’ in the Government: ‘They recognise [Asian populations’ health needs] in their brain … But their heart is still very cold and frozen, not willing to fund or allocate [appropriate services].’
This is not an issue that should be swept under the rug for any longer. The experience of Aotearoa’s Māori and Pacific Islander communities shows that, once embedded, health disparities can be stubborn. Despite the Government starting work on health equity for Māori and Pacific Islanders in the 1980s and 1990s, progress on overcoming disparities in health outcomes remains frustratingly slow, and implementation of pro-equity health policy remains insufficient. Work begun now will take years, if not decades, to translate into tangible health outcomes.
However, the pioneering example of Māori and Pacific Islanders also shows a potential path forward for Asian communities. The introduction of novel service models such as Whānau Ora show the potential for culturally sensitive models of care, led by the communities they are serving, to work within the context of a wider public health system.
The significant scrutiny it has received over the past few years has shown positive results, particularly in encouraging increased engagement among groups who have had low use of, and trust in, government health services.
A similar model, tailored to the cultural needs of our Asian populations, could be a good first step in encouraging further engagement with health services. The shared cultural values between Māori and Asian communities, including views of whānau, community and collectivism, could provide a foundation to build on the positive outcomes that have already emerged from Whānau Ora.