SEPTEMBER 14 2019 LISTENER 21
R
educing inequities in heart health
for Māori and Pacific people is
a key goal of Manaaki Mānawa,
the University of Auckland’s new
Centre for Heart Research, which
will be launching in February. It has
partnered with Māori and Pacific advisers
and aims to have Māori participation and
leadership in heart research.
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 kaupapaMāori 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 10years’ 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.”
Researching social determinants of health is crucial
to helping Māori and Pacific people.
KE
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There for the mokopuna
Massive equity gaps: left,
Anna Rolleston; below,
Cassidy Moeke.
Māori can be made to
feel ashamed – whakamā
- or responsible for
their disease, when
they are not.