GPs failing Maori, report finds

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While Maori in Nelson and Marlborough enjoy good access to health services, they are being placed at risk by the poor quality of care being provided by their family doctors.

This is one implication of a report examining the lifestyles of Maori in 150 Nelson and Marlborough households, carried out by Massey University's Research Centre for Maori Health & Development. The study was funded by the Nelson Marlborough District Health Board's Nutrition and Physical Activity Programme.

The research, involving 187 Maori adults and 135 children, was carried out towards the end of last year.

Three-quarters of adult Maori were overweight and at risk of cardiovascular and other diseases, report co-author Professor Chris Cunningham of Massey University told a meeting of the board's community and public health advisory committee in Blenheim this month.

The Ministry of Health's 2006/07 New Zealand Health Survey found one in three New Zealand adults were overweight and one in four were obese.

While more than 80 per cent of Maori adults had visited a GP in the year leading up to the survey, only 15 per cent were aware that the cholesterol level in their blood was high. Yet when tested for the study, 80 per cent had above recommended levels of total and LDL cholesterol with 13 per cent in a high-risk range, said Professor Cunningham.

Between 33 per cent and 49 per cent of adult Maori tested (depending on the method used) were insulin-resistant, indicating a risk of diabetes.

Half the adults smoked, including two thirds of mothers, half of these during the first year of their child's life or during pregnancy.

"The large number of people being diagnosed high cholesterol in a population which does have good contact with the health system is a major concern," he said.

Board planning and funding general manager Sharon Kletchko said it was "startling" general practices were not alert to these problems. This could be because of the very short time GPs spent with individual patients or to consultations being restricted to the health problem the patient presented with, she suggested.

Committee members said that when overweight patients walked through their door, GPs should as a matter of course look into cholesterol levels and insulin resistance.

"You don't want to discover when someone's taken to A&E with a heart attack that they've been at risk for 10 years," Prof Cunningham said.

Committee member Lorraine McMath of Blenheim said a NMDHB-funded cardiovascular screening programme focused on Maori and Pacific Island males should get off the ground in Marlborough within a month and had been operating in Nelson for a year. Run by GP practices, the programme should identify at-risk Maori much earlier.

Board chairman John Moore said he saw the report's findings on Maori health as a challenge both to the health service and to Maori.

At an individual level, the report highlighted that at times some Maori households could not afford to heat their homes adequately, buy quality food, visit the doctor or pick up prescriptions. Yet there was money available to pay for cigarettes, said Mr Moore.

"Is there a way of connecting people who are becoming very unwell with the consequences of what they do?" he asked.

Committee member Thomas Maniapoto said: "We have to hold the [medical] system as to some degree responsible because the engagement rate is high but the quality received is low."

The survey also covered culture, education, employment and living standards. Prof Cunningham said Maori who were connected with their culture, by speaking te reo for example, tended to have better health outcomes.

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