Notes from New Zealand: Taking on Disparities in Diabetes and Asthma in the Community

September 11, 2014

Above, an Olympics-style community event organized by local Maori health leaders in the Coromandel.

Tara Kennon served as HSC’s communications manager before moving to New Zealand’s Coromandel peninsula, where she is has focused on projects to promote travel in this region. Now, she’s reporting back to us on a few of her observations related to school wellness. Today, we’re sharing the second of two posts she’s written about community-based efforts to address health disparities. Read the first post.

Diabetes has become a major issue in Maori communities over the past few decades following society-wide changes in the food system and daily activity patterns.

“It really wasn’t out there forty years ago with our great-grandparents,” said Sue King, who works as a Kaitiaki (a Maori word for guardian, carer or protector) at Thames Hospital in the small town where I live.

Her colleagues Heather Makiri-Wi, who works as a Kaiawhina (helper or guide) for service coordination at Te Korowai Hauora o Hauraki, put it this way: “In the past two or three generations, we’ve been moving away from the garden.”

(For more about Sue and Heather’s roles in the community, see the first post in this series )

Sue addresses diabetes at an individual level in her work at the hospital. When she meets a patient who has been recently diagnosed or is suffering from complications, she starts a conversation about how lifestyle can either ease or exacerbate the symptoms. Her role and perspective mean it’s naturally a culturally relevant message that may resonate more than general dos and don’ts. She offers practical tips like how to trim the fat out of a traditional boil-up meal.

“A lot of people, they don’t like being told, ‘you can’t do this, you can’t do that,’” she said. “But I can say, ‘Well, my brother had diabetes and this is what happened to him.’ They hear that, and they realize. Then I can talk about moderation, about what they eat.”

Even with this approach, her advice isn’t always popular. “Sometimes the way they react, it’s like you’re swearing at them!” she said. But over time, the message gets through. Sue works with other leaders to gradually make healthy changes so community members can observe the benefits on their own time even if they initially “grump” about it.

For community gatherings, “we started to change the way we cooked meals,” she said. “We started making salads. We put out fresh fruit for lunch, and we cut it up to make it really beautiful.”

It doesn’t take long for people to enjoy the benefits, she said. For example, tradition calls for extended family to gather at the marae (community meeting house) for three days to sit with the body of a loved one before burial. Those three days were often marked by a heavy breakfast, lunch and dinner and an intermittent stream of visitors. When they began to make healthy changes to the food prepared at the marae, Sue said, community members remarked that they had more energy. “They told me, ‘Now I’m not so tired and I’m not going to go to sleep when the visitors come,” she said.

Over at Te Korowai, Heather shares copies of a cookbook featuring practical and low-cost healthy recipes contributed by home cooks in the community. In that way, she gets out messages about healthy eating and lifestyle changes without ever rattling off a list of don’ts.

With disparities in asthma, community solutions are equally key. “It’s the living conditions” that make asthma symptoms more severe and bring children to the hospital or clinic, Heather said. Insulation requirements became a small part of the building code in NZ in the late seventies and were just strengthened in the last decade. This means many older homes were built without any insulation and even relatively new ones may have only minimal insulation from the elements – so it’s not unusual for houses to be drafty, damp and cold. Sue explained this is especially the case for affordable rentals and subsidized Ministry of Housing homes. It’s also especially problematic if you have a limited budget for heat.

In this context, Sue and Heather follow up with the families of children suffering severe asthma symptoms and work to connect them with insulation retrofit grants. Community leaders have also been part of ongoing advocacy for the Ministry of Housing to take on the issue in homes it manages. The conversations around this issue can be as touchy as talking about food, in part because of the stress that surrounds housing costs. Upgrading the insulation in a rented house, for example, may mean a landlord can demand more rent.

Effectively navigating issues like this one at the root of health disparities requires both a nuanced approach and a seemingly endless knowledge of the programs available, from government insulation grants to Heart Foundation healthy-cooking classes.

Perhaps most important, it requires leaders like Sue and Heather who listen closely, make personal connections, hear the unspoken parts of every story and somehow make it look easy. As Heather said: “It’s just knowing the community, that’s all.”

Read all Notes from New Zealand posts.