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Similar to Safekids Aotearoa Presentation at the New Zealand Child and Youth Epidemiology Services Workshop 13 May 2019
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Safekids Aotearoa Presentation at the New Zealand Child and Youth Epidemiology Services Workshop 13 May 2019
- 2. Our Mission: Reduce the incidence and severity of preventable injuries to Tamariki aged 0-14 years Vision: That Tamariki will be free to enjoy their childhood without being adversely affected by unintentional injuries
- 3. Childhood deaths by cause 0-14 Years 2012–16
- 4. Child Injury Intent Unintentional Injury: 95% Intentional Injury: 5% Non-fatal injuries Unintentional Injury: 82% Intentional Injury: 18% Fatal Injuries
- 5. NZ child injury fatalities 2005-2014 (0-14 & 1-14 Years)
- 6. Non-Fatal All NZ (0-14 Years) 2007-2016 6600 6800 7000 7200 7400 7600 7800 8000 8200 720 740 760 780 800 820 840 860 880 900 920 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Numberofdischarges Rateper100,000 Number of Discharges Rate / 100,000 people
- 7. All child fatal injuries by ethnic group 2005-2014 (0-14 Years) -5 0 5 10 15 20 25 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Rateper100,000 Asian Euro/Other Maori Pacific Linear (Asian ) Linear (Euro/Other) Linear (Maori) Linear (Pacific)
- 8. All child non-fatal injuries by ethnic group 2007-2016 (0-14 Years) 0 200 400 600 800 1000 1200 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Rateper100,000 Asian Euro/Other Maori Pacific Island Linear (Asian) Linear (Euro/Other) Linear (Maori) Linear (Pacific Island)
- 9. 54% of deaths 5 times more likely to die Maori Fatalities 0-14 Years
- 10. 44% of deaths 3 times more likely to die Maori Fatalities: 1-14 Years
- 11. 28% of hospitalisations 1.5 times more likely to be hospitalised Maori Hospitalisations 0-14 Years
- 12. Leading Causes of Unintentional Injury Tamariki Māori Fatal Injury (Maori, Aged 1-14 yrs) Non-fatal injury (Maori, Aged 0-14 yrs) 1. MVT Occupant – 5x Euro/Other 1. Falls (46%) - 1.4x Euro/Other 2. Drowning - 2.4x Euro/Other 2. Struck by or against – 1.5x Euro/Other 3. MVT Pedestrian – 5.4x Euro/Other 3. Cut/ Pierce - 2x Euro/Other 4. Pedestrian, Other – 4.2x Euro/Other 4. Natural/Environmental (dog bites) – 2.5x Euro/Other 5. Suffocation – 2.4x Euro/Other 5. Poisoning - 1.5x Euro/Other
- 13. 11% of deaths Twice as likely to die Pacific Fatalities 0-14 Years
- 14. 8% of deaths Pacific Fatalities 1-14 Years
- 15. 12% of hospitalisations 1.3 times more likely to be hospitalised Pacific Hospitalisations 1-14 Years
- 16. Leading causes of unintentional injury for Pacific children Fatal Injury (Pacific, Aged 1-14 yrs) Non-fatal injury (Pacific, Aged 0-14 yrs) 1. MVT Occupant – 0.9x Euro/Other 1. Falls - 1.2x Euro/Other 2. Fire/flame – 4.1x Euro/Other 2. Struck by or against – 1.4x Euro/Other 3. MVT Pedestrian – 1.6x Euro/Other 3. Cutting/ Pierce - 2.3x Euro/Other 4. Drowning - 0.5x Euro/Other 4. Hot object/ substances – 3.2x Euro/Other 5. Pedestrian, Other – 3.3x Euro/Other 5. Natural/Environmental (dog bites) - 1.5x Euro/Other
- 17. Non-fatal injury rate 2007-16 Pacific ethnic groups (total response) 0-14 Years 784 623 943 595 702 926 617 0 100 200 300 400 500 600 700 800 900 1,000 Samoan Cook Island Maori Tongan Niuean Tokelauan Fijian Other Pacific IslandRate per 100,000 Average for all Pacific Groups: 804
- 20. Tama tu tama ora, tama noho tama mate To stand is to live, to lie down is to die. Got the ball rolling... • Data, fairness, social justice, Te Tiriti o Waitangi • Made our Intention Explicit: created a role, adopted an overarching priority, prefaced our conversations.
- 21. Recruited a team For Māori, by Māori • GM Māori and GM Pacific Health: – new structure – position descriptions – reached out through personal networks – sat on interview panel – Committed to ongoing support and engagement • Short-listed candidates who were Māori and Pacific Peoples • Prioritised cultural knowledge, skills and experience • Emphasised values-base of organisation & individuals
- 22. Safekids team Equity Youtube link video https://www.youtube.com/watch?v=RP3lluMEgqU
- 23. “Universal strategies such as social marketing campaigns tend to work best with people who have access to a range of social and economic resources, and they are therefore more likely to decrease the prevalence of risk behaviour in high SES groups... They may also help to decrease the overall rate of a form of behaviour in a populations... However, there is also evidence that they tend to generate significantly less or little improvements with low SES or other disadvantaged groups... The overall effect, therefore, may be to entrench or exacerbate inequality in health behaviour and so in health outcomes.” Baum, F., Fisher, M., 2014 Interrogated our programmes, advice...
- 24. “It has been argued that in Aotearoa-New Zealand health promoters are better at promoting health amongst the well-off but are less effective amongst low income groups... many health promotion programmes may have benefited the population as a whole, but at the same time, have increased the health disparity between the rich and poor and between Māori and Pākeha.” Health Promotion Forum of New Zealand, 2002
- 26. Expanded our evidence base “To achieve equitable health and social outcomes, notions of evidence need to extend beyond Western bio-medical definitions to incorporate māturanga Māori understandings of what protects and threatens health. Best practice is a term widely used in the health sector and often refers to international frameworks as generated in the Northern hemisphere in studies that include no indigenous theorising or analysis.” Cane, H., McCreanor, T., Doole, C., Rawson, E. 2016
- 27. “Funding levels should reflect equity considerations. They should take into account both the greater health needs of Māori, and the community capacity building required to enable the same state of readiness to benefit from interventions as other New Zealand communities... Contracts should also be of sufficient duration to provide a reasonable degree of stability and therefore, the capacity for ongoing programme planning and the development and maintenance of relationships.” Ratima, M., Durie, M., Hond, R. 2015 Started to tackle funding models
- 28. “It’s a hard truth to admit and own. And this is certainly not the only time I’ve realized my access and my decisions make me complicit in perpetuating racist systems. We live in an affluent, predominately white community. I benefit from generational wealth. My life in many ways is an amalgamation and product of privilege...When these moments of self-realization bubble to the surface, my initial reaction is often to feel overwhelmed and experience shame. Both of these emotions shut me down.” Shannon Cofrin Gaggero writing on reconciling her anti-racist parenting with her child’s private school education. Got uncomfortable
- 29. Those of us who have been granted privileges based purely on who we are born …often feel that either we want to give our privileges back, which we can’t really do, or we want to use them to improve the experience of those who don’t have our access to power and resources. One of the most effective ways to use our privilege is to become the ally of those on the other side of the privilege seesaw. This type of alliance requires a great deal of self- examination on our part…” Frances Kendall, 2003 Become an ally
- 30. “I have no doubt that self-criticism must accompany white people’s antiracist work. Too often white progressives leave their own attitudes and behaviours unexamined while working against racism.” Margaret Anderson in Whitewashing Race: A critical perspective on whiteness Self-reflected
- 31. “Allies understand that emotional safety is not a realistic expectation if we take our alliance seriously. For those with privilege, the goal is to "become comfortable with the uncomfortable and uncomfortable with the too- comfortable" and to act to alter the too-comfortable.” Frances Kendall, 2003 Got more comfortable with being uncomfortable
- 32. Ko wai ahau?
- 34. 1. Equity is not a substitue for Te Tiriti o Waitangi 2. Māori the right to at least the same level of health and wellbeing as non-Māori 3. Prioritising Māori health equity in the system 4. Work with Māori to ensure our strategies are robust Te Tiriti o Waitangi Equity vs Te Tiriti
- 36. • Te Ture Te Reo Māori (2016) • Revitalisation Strategy – Te Maihi Karauna (2018) • Revitalisation Strategy – Te Maihi Māori (2017) • Language revitalisation in health • What are we doing? Language is Cultural Competency “Te reo Māori is healing” Glavish, 2019
- 37. 1. Māori leaders represent the collective voice of their whānau, hapū and iwi 2. Promotes and implements change 3. Values-driven 4. Building capability for Māori Māori Leadership in the workplace He waka eke noa
- 38. 1. Stigma around working for mainstream organisations 2. Lack of leadership support, peer support and whanaungatanga 3. Racism 4. Tokenism 5. Lack of shared culture, understanding, knowledge and communication . Recruiting Māori “we just aren’t generating interest from Māori to apply for this role”
- 39. • Wānanga workplace • Tension informs learnings that lead to transformational change • What it feels like? • What does it look like? Transitioning into a Non-Māori team From a Māori operated team
- 40. • Theory in practice: • Applying values not only to programmes but in-house • Funding: • Reflect the same level of value in funding streams and Māori streams (engagement, social media and programmes) Addressing Equity in Safekids The tensions and learnings
- 41. Prioritising and designing interventions “Whāia te mātauranga hei oranga mo tātou” • Enable us to be part of the conversation about determinant of childhood injury inequity, eg: linkages with Healthy Homes Initiatives, Child & Youth Wellbeing Strategy • Are located with a Mātauranga Māori – Māori knowledge and way of knowing • Reveal and work towards the achievement of wawata Māori – Māori aspirations • Retain and strengthen Māori identity – te reo Māori “ To address inequities...organisational practices, policies and systems must re-orient to and embed attitudes, practices and procedures that champion and neutralise a culture that is purposely designed to enact health equity.” Starfield, 2011.
Editor's Notes
- Safekids Aotearoa is a service of Starship Children's Health, established in the early 1990s by Starship Children’s Health Trauma Service to help reduce the high rates of preventable injury to children. We are also funded by the Ministry of Health and are a member of Safekids Worldwide which is a nonprofit organization working to help families and communities keep kids safe from injuries. Throughout the world, almost one million children die of an injury each year, and almost every one of these tragedies is preventable. Safekids Worldwide is based Washington D.C in the United States
- Data from the most recent CYMRC report shows in NZ between 2012-16, (high level perspective) unintentional injuries are the 3rd leading cause of death amongst children aged 0-14 years. Social gradient Average 63 deaths and 7300 hospitalisations annually
- When looking at injury intent, around 8 out of 10 fatal injuries are unintentional. In terms of Non-fatal injuries, the statistics are even higher for unintentional injuries with around 95% of injuries being unintentional in intent. This is particularly important when we think about Govt. funding and where priority of investment tends to focus on. It’s not to say that things such as assault and self-harm are not important, instead it also important to recognise the burden of unintentional injury has on children in Aotearoa, The frequency, severity, potential for death and disability, inequities and costs of unintentional injury make it a significant childhood health problem.
- The rate of injury related deaths shows a steady decline, both with the inclusion and exclusion of the under ones.
- Again we see the same thing with non-fatal unintentional injuries. 2007-16: 10% decrease
- When looking at fatal injuries by major ethnic groups we see most groups are trending downwards. And that downward trend is also continues when applying a simple linear forecast line, as shown by the dotted line. Maori followed by Pacific continue to have the highest rates of injury. The only one not showing a downward trend is the Pacific trend line which is slightly trending upwards.
- In terms of non-fatal injuries by major ethnic groups we also see most groups trending downwards. And that downward trend is also shown when applying a simple linear forecast line, as shown by the dotted line. Maori followed by Pacific continue to have the highest rates of injury. What is interesting is that the only one not showing a downward trend is the Asian trend line which is slightly trending upwards. Based on a simple linear forecasting trend line the Asian rate may exceed Euro rates in the near future.
- In terms of child injury fatalities, Maori account for 54% of deaths and are 5 times more likely to die from unintentional injuries than European children. The National Injury Query System: Injury Prevention Unit, University of Otago, http://ipru3.otago.ac.nz/niqs
- When we remove the under one’s (removing the infant and neo-natal related deaths) Maori decrease from 54% to 44% of deaths and are 3 times more likely to die from unintentional injuries than European children, instead of 5 as shown in the previous slide.
- For hospitalisations Māori account for 28% of all unintentional injuries and are 1.5 times more likely to be hospitalised than Euro kids.
- For fatal and non-fatal injuries Maori are higher than Euro. MVT Occupant & MVT Pedestrian – 5 & 5.5 times. Asian Euro/Other Maori Pacific Drowning 4 37 30 3 Fall 1 6 6 0 Fire/Hot object or substance Fire/Flame 2 7 9 5 Motor Vehicle Traffic Motorcyclist 0 3 1 0 Occupant 11 39 66 6 Pedal Cyclist 0 4 5 1 Pedestrian 1 11 20 3 Natural/Environmental 0 9 2 1 Other Land Transport 1 21 4 1 Other Transport 1 4 5 1 Pedal Cyclist, other 0 6 2 2 Pedestrian, other 1 14 20 8 Poisoning 0 2 9 0 Struck by or against 0 6 7 2 Suffocation 2 22 18 2 Total 24 200 211 40
- – For Pasifika children, Pasifika account for 11% of deaths and are two times more likely to die from unintentional injuries than European children.
- When we remove the under one’s Pacific deaths decrease from 11% to 8% of deaths and their rate is on par with the Euro rate.
- For hospitalisations Pasifika account for 12% of all unintentional injuries and are 1.3 times more likely to be hospitalised than Euro kids.
- For fatal and non-fatal injuries Pacific rates are higher than Euro. Fire/flame & Pedestrian, Other (driveways) – 4.1 & 3.3 times. Asian Euro/Other Maori Pacific Drowning 4 37 30 3 Fall 1 6 6 0 Fire/Hot object or substance Fire/Flame 2 7 9 5 Motor Vehicle Traffic Motorcyclist 0 3 1 0 Occupant 11 39 66 6 Pedal Cyclist 0 4 5 1 Pedestrian 1 11 20 3 Natural/Environmental 0 9 2 1 Other Land Transport 1 21 4 1 Other Transport 1 4 5 1 Pedal Cyclist, other 0 6 2 2 Pedestrian, other 1 14 20 8 Poisoning 0 2 9 0 Struck by or against 0 6 7 2 Suffocation 2 22 18 2 Total 24 200 211 40
- Pasifika is a collective term used to refer to people of Pacific heritage or ancestry who have migrated or been born in Aotearoa New Zealand. Pasifika people are not homogenous and Pasifika does not refer to a single ethnicity, nationality, gender, language or culture. 1. What “Pasifika” actually means Pasifika is a term that is unique to Aotearoa and is a term coined by government agencies to describe migrants from the Pacific region and their descendants, who now call Aotearoa home. 2. Pasifika peoples are not a homogenous nation 4. Not all people from Pasifika cultures can speak their heritage languages 5. Not all Pasifika peoples come from one Pasifika nation 6. Pasifika peoples like to congregate in group settings 7. Pronunciation of names 8. Establishing positive relationships with Pasifika peoples 9. Pasifika voice 10. Improve communication with Pasifika communities And that non-homogeneity is reflected in this graph where the burden of injury is higher in some Pacific ethnic groups more than others, namely the Tongans and Fijians.
- Ko wai ahau: Ko Mataatua me Tainui ngā waka Ko Toroa me Rangawhenua ngā rangatira Ko Ohinemataroa, Rangitaiki me Ongarue ngā awa Ko Pohatu, Pūtauāki me Hikurangi Ko Otenuku, Pūkeko me Te Koura Putaroa ngā marae Ko Ngāti Koura, Ngāti Pukeko, me Ngati Pahere ngā hapu Ko Ngāi Tūhoe, Ngāti Awa, me Ngāti Maniapoto ngā iwi
- This is my whānau I have 3 daughters and my husband is Samoan/German My children all attend Māori total immersion because Te Reo Māori me ōna tikanga are important to our culture. My husband is learning Māori from our girls and I learn Samoan from him and my in-laws.
- Basic facts: Equity focusses on closing the gaps, Te Tiriti o Waitangi inform Māori asipirations. Te Tiriti o Waitangi enables Māori through a number of policies the right of access to at least the same level of health and wellbeing as non-Māori and non-pacific. The NZ health and disability act, NZ health strategy - He korowai oranga (MOH). We prioritise Māori in our systems and way of thinking to ensure we focus not only on closing the gaps! But to be enablers for Māori aspirations. To ensure that our strategies are robust we partner and work with manawhenau, the Māori leadership team, our Māori teams, provider arms, and draw on whānau-centredness to inform our design, engagement, implementation and evaluations. Debunking equity we look at the degree of inequities in this graph. The equity lens focusses efforts on closing the gap. We employ a different lens informed by Pae Ora that looks not only at closing the gap but also through employing both our equity aspirations and Māori aspirations to achieve the best health and wellbeing outcomes that informed and inspired by the community that it impacts on the most.