Indigenous adolescent health in Aotearoa New Zealand: Trends, policy and advancing equity for rangatahi Maori, 2001-2019

Terryann C Clark; Jude Ball; John Fenaughty; Bradley Drayton; Theresa Terry Fleming; Claudia Rivera-Rodriguez; Jade Le Grice; Roshini Peiris-John; Lynda-Maree Bavin; Ariel Schwencke; Kylie Sutcliffe; Sonia Lewycka; Mathijs Lucassen; Anaru Waa; Lara M Greaves; Sue Crengle

doi:10.1016/j.lanwpc.2022.100554

Indigenous adolescent health in Aotearoa New Zealand: Trends, policy and advancing equity for rangatahi Maori, 2001-2019

Lancet Reg Health West Pac. 2022 Aug 12:28:100554. doi: 10.1016/j.lanwpc.2022.100554. eCollection 2022 Nov.

Authors

Terryann C Clark¹, Jude Ball², John Fenaughty³, Bradley Drayton⁴, Theresa Terry Fleming⁵, Claudia Rivera-Rodriguez⁴, Jade Le Grice⁶, Roshini Peiris-John⁷, Lynda-Maree Bavin⁷, Ariel Schwencke⁸, Kylie Sutcliffe⁵, Sonia Lewycka^{9

10}, Mathijs Lucassen¹¹, Anaru Waa¹², Lara M Greaves¹³, Sue Crengle¹⁴

Affiliations

¹ School of Nursing, Faculty of Medical Health Sciences, University of Auckland, Private Bag 92019 Auckland 1142, New Zealand.
² Department of Public Health, University of Otago, Wellington, PO Box 7343, Newtown, Wellington 6242, New Zealand.
³ School of Counselling, Human Services and Social Work, Faculty of Education and Social Work, University of Auckland, Private Bag 92019 Auckland 1142, New Zealand.
⁴ Department of Statistics, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
⁵ School of Health, Te Herenga Waka | Victoria University of Wellington, PO Box 600, Wellington 6140, New Zealand.
⁶ School of Psychology, Faculty of Science, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
⁷ Section of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
⁸ Faculty of Medical Health Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
⁹ Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, UK.
¹⁰ Oxford University Clinical Research Unit, Hanoi, Vietnam.
¹¹ School of Health, Wellbeing and Social Care, The Open University, Milton Keynes MK7 6AA, UK.
¹² Eru Pōmare Māori Health Research Unit, Department of Public Health, University of Otago, Wellington, PO Box 7343, Wellington 6242, New Zealand.
¹³ School of Social Sciences, Faculty of Arts, University of Auckland, Private Bag 92019 Auckland 1142, New Zealand.
¹⁴ Department of Preventative and Social Medicine, Otago Medical School, PO Box 56, Dunedin 9054, New Zealand.

Abstract

Background: Rangatahi Māori, the Indigenous adolescents of Aotearoa New Zealand (NZ), have poorer health outcomes than Pākehā (NZ European /other European/"White") adolescents. We explored the influence of policies for Indigenous youth by presenting health trends, inequities and contrasting policy case examples: tobacco control and healthcare access.

Methods: Cross-sectional representative surveys of NZ secondary school students were undertaken in 2001, 2007, 2012 and 2019. Health indicators are presented for Māori and Pākehā adolescents (relative risks with 95% CI, calculated using modified Poisson regression) between 2001-2019 and 2012-2019. Policy examples were examined utilising Critical Te Tiriti Analysis (CTA).

Findings: Rangatahi Māori reported significant health gains between 2001 and 2019, but an increase in depressive symptoms (13.8% in 2012 to 27.9% in 2019, RR 2.01 [1.65-2.46]). Compared to Pākehā youth there was a pattern of persistent Māori disadvantage, particularly for racism (RR 2.27 [2.08-2.47]), depressive symptoms (RR 1.42 [1.27-1.59]) and forgone healthcare (RR 1.63 [1.45-1.84]). Tobacco use inequities narrowed (RR 2.53 [2.12-3.02] in 2007 to RR 1.55 [1.25-1.93] in 2019). CTA reveals rangatahi Māori-specific policies, Māori leadership, and political support aligned with improved outcomes and narrowing inequities.

Interpretation: Age-appropriate Indigenous strategies are required to improve health outcomes and reduce inequities for rangatahi Māori. Characteristics of effective strategies include: (1) evidence-based, sustained, and comprehensive approaches including both universal levers and Indigenous youth-specific policies; (2) Indigenous and rangatahi leadership; (3) the political will to address Indigenous youth rights, preferences, priorities; and (4) a commitment to an anti-racist praxis and healthcare Indigenisation.

Funding: Two Health Research Council of New Zealand Project Grants: (a) Fleming T, Peiris-John R, Crengle S, Parry D. (2018). Integrating survey and intervention research for youth health gains. (HRC ref: 18/473); and (b) Clark TC, Le Grice J, Groot S, Shepherd M, Lewycka S. (2017) Harnessing the spark of life: Maximising whānau contributors to rangatahi wellbeing (HRC ref: 17/315).

Keywords: Adolescent; Effective strategies; Ethnicity; Indigenous; Inequity; Maori; Mental health; Policy; Poverty; Racism; Rangatahi; Substance use; Surveys; Tobacco; Trends; Youth.