新西兰奥特亚罗瓦的原住民青少年健康：2001年至2019年的趋势、政策与促进毛利青少年的公平性
Indigenous adolescent health in Aotearoa New Zealand: Trends, policy and advancing equity for rangatahi Maori, 2001-2019.
作者信息
Clark Terryann C, Ball Jude, Fenaughty John, Drayton Bradley, Fleming Theresa Terry, Rivera-Rodriguez Claudia, Le Grice Jade, Peiris-John Roshini, Bavin Lynda-Maree, Schwencke Ariel, Sutcliffe Kylie, Lewycka Sonia, Lucassen Mathijs, Waa Anaru, Greaves Lara M, Crengle Sue
机构信息
School of Nursing, Faculty of Medical Health Sciences, University of Auckland, Private Bag 92019 Auckland 1142, New Zealand.
Department of Public Health, University of Otago, Wellington, PO Box 7343, Newtown, Wellington 6242, New Zealand.
出版信息
Lancet Reg Health West Pac. 2022 Aug 12;28:100554. doi: 10.1016/j.lanwpc.2022.100554. eCollection 2022 Nov.
BACKGROUND
Rangatahi Māori, the Indigenous adolescents of Aotearoa New Zealand (NZ), have poorer health outcomes than Pākehā (NZ European /other European/"White") adolescents. We explored the influence of policies for Indigenous youth by presenting health trends, inequities and contrasting policy case examples: tobacco control and healthcare access.
METHODS
Cross-sectional representative surveys of NZ secondary school students were undertaken in 2001, 2007, 2012 and 2019. Health indicators are presented for Māori and Pākehā adolescents (relative risks with 95% CI, calculated using modified Poisson regression) between 2001-2019 and 2012-2019. Policy examples were examined utilising Critical Te Tiriti Analysis (CTA).
FINDINGS
Rangatahi Māori reported significant health gains between 2001 and 2019, but an increase in depressive symptoms (13.8% in 2012 to 27.9% in 2019, RR 2.01 [1.65-2.46]). Compared to Pākehā youth there was a pattern of persistent Māori disadvantage, particularly for racism (RR 2.27 [2.08-2.47]), depressive symptoms (RR 1.42 [1.27-1.59]) and forgone healthcare (RR 1.63 [1.45-1.84]). Tobacco use inequities narrowed (RR 2.53 [2.12-3.02] in 2007 to RR 1.55 [1.25-1.93] in 2019). CTA reveals rangatahi Māori-specific policies, Māori leadership, and political support aligned with improved outcomes and narrowing inequities.
INTERPRETATION
Age-appropriate Indigenous strategies are required to improve health outcomes and reduce inequities for rangatahi Māori. Characteristics of effective strategies include: (1) evidence-based, sustained, and comprehensive approaches including both universal levers and Indigenous youth-specific policies; (2) Indigenous and rangatahi leadership; (3) the political will to address Indigenous youth rights, preferences, priorities; and (4) a commitment to an anti-racist praxis and healthcare Indigenisation.
FUNDING
Two Health Research Council of New Zealand Project Grants: (a) Fleming T, Peiris-John R, Crengle S, Parry D. (2018). Integrating survey and intervention research for youth health gains. (HRC ref: 18/473); and (b) Clark TC, Le Grice J, Groot S, Shepherd M, Lewycka S. (2017) Harnessing the spark of life: Maximising whānau contributors to rangatahi wellbeing (HRC ref: 17/315).
背景
新西兰原住民毛利族青少年（rangatahi Māori）的健康状况比新西兰欧洲裔/其他欧洲裔/“白人”青少年（Pākehā）更差。我们通过展示健康趋势、不平等现象以及对比政策案例（烟草控制和医疗保健可及性）来探讨针对原住民青年的政策影响。
方法
在2001年、2007年、2012年和2019年对新西兰中学生进行了横断面代表性调查。呈现了2001 - 2019年以及2012 - 2019年毛利族和欧洲裔青少年的健康指标（使用修正泊松回归计算的相对风险及95%置信区间）。利用批判性《怀唐伊条约》分析（CTA）对政策案例进行了研究。
结果
毛利族青少年在2001年至2019年间健康状况有显著改善，但抑郁症状有所增加（从2012年的13.8%增至2019年的27.9%，相对风险2.01 [1.65 - 2.46]）。与欧洲裔青年相比，毛利族存在持续的劣势模式，尤其是在种族主义方面（相对风险2.27 [2.08 - 2.47]）、抑郁症状方面（相对风险1.42 [1.27 - 1.59]）以及放弃医疗保健方面（相对风险1.63 [1.45 - 1.84]）。烟草使用方面的不平等有所缩小（从2007年的相对风险2.53 [2.12 - 3.02]降至2019年的相对风险1.55 [1.25 - 1.93]）。CTA显示，针对毛利族青少年的特定政策、毛利族领导力以及政治支持与改善结果和缩小不平等现象相关。
解读
需要制定适合年龄的原住民策略来改善毛利族青少年的健康状况并减少不平等。有效策略的特点包括：（1）基于证据、持续且全面综合的方法，包括通用手段和针对原住民青年的特定政策；（2）原住民和青少年领导力；（3）解决原住民青年权利、偏好和优先事项的政治意愿；（4）致力于反种族主义实践和医疗保健本土化。
资金来源
两项新西兰健康研究委员会项目资助：（a）弗莱明T、佩里斯 - 约翰R、克伦格尔S、帕里D。（2018年）。整合调查与干预研究以促进青年健康改善。（健康研究委员会编号：18/473）；以及（b）克拉克TC、勒·格里斯J、格鲁特S、谢泼德M、列维茨卡S。（2017年）利用生活的火花：最大化家庭对青少年福祉的贡献（健康研究委员会编号：17/315）。
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