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Dr Teuila Percival, a paediatrician at KidzFirst children’s hospital in Middlemore, spoke to Voyages about the child epidemiology study and what can be done to improve the health of Pacific children. She says the way forward is through education and addressing socio-economic disparity.

What are the challenges for someone working in the area of Pacific children’s health?
The big issue for Pacific children is the inequity of everything. Not just their health, but their educational outcomes and socio-economic situation.

What did the study show?
The study didn’t throw up anything surprising for me. The story of Pacific children is a sad story. They have higher rates of all the infectious diseases and now with the epidemic of obesity, we see our kids with the highest rates of obesity and those chronic diseases associated with it, like type 2 diabetes and hypertension. So that’s the next big issue for our kids.

The epidemiology study also looked at hospitalisation rates for Pacific kids and the reasons why they were admitted with the highest rates of pneumonia and respiratory infections in New Zealand. The more you look at why that is so, the more you come back to housing and over crowding and levels of household income. They’re important.

Dr Teuila Percival

Is it time for a radical re-think?
If the Pacific community is serious about improving the lot of the whole community, they need to focus on their children. It’s about getting children the best possible healthcare so they can take their opportunities in education, because the biggest thing for our children and our future is educational success. But you can’t achieve that unless you have healthy children.

Are there any initiatives underway that point the way forward?
There are lots of health programmes targeting particular things that will lead to some improvement. We’ve seen a lot of money recently to get more Pacific children into pre-school education, which is a great step. And the Government’s about to start a ready for school check, assessing kids when they’re four to make sure they’re ready for school. Health is part of that – making sure they can see and hear well and haven’t got behavioural problems. Those checks will be done by health nurses.

That’s a really important step because one of the things we tend to do in health is focus on things that are easy to do such as fund a certain number of grommet operations for kids in a space of time. If you have that approach that’s all you’ll get, but if you fund a programme that was designed to improve the hearing of children, you’ll have a different focus and much more holistic approach.

Is the health system responsive to Pacific needs?
I think both mainstream and Pacific providers are doing a good job but the need is just overwhelming. But we can’t fix children coming in here with repeated bouts of pneumonia until we fix their housing. So we’ve got a programme here at Middlemore called healthy housing which involves Housing NZ and our DHB. They’re working with families and changing their houses and adding an extra bedroom or putting in insulation to make it a healthier environment. That’s the type of intervention that really helps.

Are Pacific communities engaged with these issues?
For some things they are and for others they aren’t and that’s not necessarily the community’s fault. You can’t just rely on awareness raising to achieve change, you’ve got to create an environment where it’s possible for us to make those changes. If someone tells you to run to stay healthy, it’s all very well, but if you’re working 12 hours a day and you can’t run at night because it’s dark and there are dogs running round, it won’t happen. The environment has got to be suitable to make those changes.

I think our community has had lots of awareness raising but that has to happen in tandem with changes in environment and changes in policy.

What’s your vision for what’s possible in the future?
There are a few things I’d like to see in our health system and one of them would be free primary health care for children. That’s an important thing that needs to be done. It’s expensive, but it’s one of the key things.

I think the way the Primary Healthcare Strategy is geared to a multi-disciplinary framework and thinking about the community is really good. More of that thinking is needed.

Being realistic, the solution to all these problems in the long term lies outside the health sector. It’s about income and education. The biggest predictor of child health status is their educational status. For me, if we keep doing what we’re doing in the health sector that’s fine. We do a good job and improve things for people, but the bigger picture in turning around the health status of Pacific kids is really outside our sector.

If the Pacific community is serious about improving the lot of the whole community, they need to focus on their children.

How important is it to have Pacific paediatricians, doctors and nurses. Is that an important factor in treatment?
The evidence is that cultural competence makes a difference to health outcomes. If you can’t speak to someone in their language or don’t have an understanding of where they come from you’re going to make decisions that could be inappropriate. This is true of all cultures. Even working with interpreters it’s very hard to get at complex health problems.

In primary care, out in the community, it’s very important to have that long-term relationship and understanding with the community. That’s where we need more Pacific GPs and Tongan, Samoan and Cook Island PHOs.

What about the needs of NZ-born, Pacific young people. Are they different?
Half our young people are NZ born. What we find is that they tend to identify with the ethnic group in the environment they’re in. In the Tongan community, they’re Tongan, but if they’re at uni with their palangi mates, they’re different. They may not all feel comfortable with a Pacific provider-type environment, but I think the Pacific providers realise they need to cater more and more for young people, with mixed ethnicities. They’re trying to set up a Pacific one-stop-shop youth service in the community at present. It’ll be very interesting to see how that goes.

What do you see as the research priorities in this area?
A big area we need more research on is respiratory problems, lung disease, bronchitis and so on. We know most of this relates to repeated pneumonia, but we don’t know what happens to these kids. No one’s looked at the long-term effect of these diseases. We also need to evaluate our interventions more.

Why have you chosen to work in this area?
I got into paediatrics by default. I just preferred working with children rather than adults. It’s a positive area because one of the things about paediatrics is that usually your patients don’t die, they tend to get better. As an area of speciality you take a broader view of the patient. A much more holistic approach.

Are you optimistic about the future of Pacific children’s health?
Some things get better. The meningococcal epidemic has waned, for example. On the other hand, something else comes along – now we’ve got obesity-related diseases. And we still have the same problems of poor access and third world diseases like TB. We’re making gains in some areas, but in the long term educational success is the key.

For example, there are two schools near here. One draws kids from South Auckland and the kids have lots of health problems. Just down the road is another school that draws kids from Remuera and the kids are slim and healthy and they hop on the train and go home to their wonderful environments. It’s a snapshot. We need to turn that around.

Health Priorities for New Zealand

Health Minister Pete Hodgson has announced that his priorities for the upcoming financial year will focus on the changing needs of New Zealand families. The priorities for the 2006/07 financial year are:

• getting ahead of the chronic disease burden, including a major focus on obesity prevention
  
• improving the health of young New Zealanders with initiatives to strengthen a range of child health services
  
• further implementation and entrenchment of the Primary Health Care Strategy and the population approach to health care
  
• improving aged care with particular attention to the growing number of New Zealanders who wish to remain in their homes for longer
  
• increasing our strategic focus on the development of the health workforce
  
• improving patient care through more aggressive implementation of the Health Information Strategy
  
• providing more and better health services through increased cost-effectiveness in the sector.
  

Ministry of Health Pacific child and youth epidemiology project

The Ministry of Health’s Pacific Health Branch is undertaking a project in collaboration with the New Zealand Child and Youth Epidemiology Service to identify the health status and health determinants for Pacific children and youth. The outcomes of this work will be used to inform policy decisions, the health sector and the public regarding key areas of health need for our Pacific children and youth. A Steering Group of Pacific health and disability professionals, reflecting a range of competencies from the Pacific health and disability sector such as clinical, research, academic, nursing, mental health, disability and government backgrounds, has been established to oversee and provide advice on the project.

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