The headline on a recent press statement from Massey University showed what great things emerge from state-funded research, although it seemed to state the obvious: New research highlights the benefit of injury prevention measures in Māori households.
Was research really required to demonstrate the benefits of taking steps to prevent injuries in Maori households – or any household, come to think of it?
Introducing a few common-sense safeguards – you might think – would be as beneficial to the wellbeing of householders, regardless of race, as putting on warm clothing when the temperature drops or looking for oncoming traffic before crossing the road.
Ah – but now we know that relatively low-cost modifications in homes can prevent 31 per cent of fall injuries.
The cost of the study (if our researchers got it right) was $786,851.52 and the money came from the Health Research Council, which is funded by taxpayers.
The research paper noted that the costs of the modifications was around $500, and avoiding one night in hospital can save more than $1500 for the health system.
This implies that 1573 or so householders could have been provided with $500 of modifications for the same amount of money spent on the prevention measures, although without the researcher we would not know that 31 per cent of fall injuries would be prevented.
The Health Research Council of New Zealand (HRC), by the way, is the government’s principal funder of health research. It is
“… committed to building knowledge and evidence on issues that affect New Zealanders. We know that the quality of healthcare and healthcare delivery is largely dependent on the research evidence that underpins it.
But the Ardern government has commanded that some New Zealanders’ health be given greater attention.
Professor Sunny Collings, the chief executive, in the 2019/20 annual report says:
This year we have also ramped up our commitment to advancing Māori health and improving health equity – both key goals for the government under the New Zealand Health Research Prioritisation Framework and ones that underpin all that we do.
In August 2019, the council introduced new Māori Health Advancement criterion for research proposals
“… in recognition that all health research, to varying degrees, can tangibly improve Māori health and wellbeing and reduce inequities”
The new criterion was first introduced for the council’s 2020 Programme funding round and was to be rolled out for all HRC funding opportunities.
The consequences are recorded in the annual report:
Half of council-funded Programmes and Projects supported in the 2019-2020 financial year were classified as contributing to health equity (of any kind) and 48% as contributing to Māori and Pacific health equity
Twelve per cent of 2019 funding round investment – a total of $10.4 million – was ring-fenced for Māori-led research through a Māori research investment stream. Nearly one-third of all Projects in the 2019 funding round included, or were led by, Māori health researchers and had significant Māori participation.
Research grants amounted to $115.8 million in 2019/20 but the funding for the research into Maori housing, hazards and health was provided around 10 years ago.
The approved budget was $786,851.52 to look into injuries.
The summary says:
“Home hazards are a major cause of injury for Maori. This study will capitalise on an existing cohort of Maori houses, included in the Best Outcomes for Maori : Te Hoe Nuku Roa longitudinal study. Audits of 350 Maori houses (Manawatu, Wellington, Nelson) will be undertaken using the Health Housing Index developed by members of this research team. “Trained Maori auditors from building science backgrounds will undertake the audits. All houses will undergo remediation: half of the houses will be randomly assigned to an intervention group where remediation of selected hazards will be undertaken by professional builders, with the balance of the houses remediated at the end of the randomised-control-trial.
“Post-intervention audits will be carried out after the conclusion of this intervention study. We will also assess emergency preparedness for earthquakes, determining structural and behavioural risks for Maori.
“A Maori doctoral student will complete her training.”
The study was carried out between September 2013 and February 2017 but (according to the more recent Massey University press statement) it involved 251 Māori households in New Plymouth and Wellington.
Half the homes were randomised to be modified near the start of the trial and the other half were modified after a three-year wait.
The following modifications or repairs were made:
- handrails for steps and stairs
- grab rails for bathrooms and toilets
- adequate outside lighting
- high visibility, slip-resistant edging for outside steps
- slip-resistant surfacing for outside surfaces such as decks
- non-slip bathmats
- repairs to window catches
- fixing of lifted edges of carpets and mats
The press statement says the study was led by the Director of the Research Centre for Hauora & Health (RCHH), Professor Chris Cunningham, and has just been published in a leading international public health journal, Lancet Public Health.
It was undertaken in collaboration with He Kainga Oranga, the Housing and Health Research Programme at University of Otago.
The study analysed ACC injury claims made by occupants of all the houses over three years.
“This revealed there were 31 per cent fewer fall-related injuries in the modified households and in the general areas of the home modified there were 40 per cent fewer falls,” Professor Cunningham says.
Then we learn of a difference between Maori injury rates and injury rates among the rest of us:
Māori experience higher rates of injury-related ill health than non-Māori and have elevated rates for fall injuries.
“On average, there are more than 500 unintentional deaths due to falls each year, much higher than the annual road toll, and there are more than 24,000 hospitalisations. During the period between 2011-2018, there were an annual average of 658,000 falls requiring some form of medical treatment annually, of which more than half were at home.”
This study follows on from another New Zealand randomised controlled trial, the Home Injury Prevention Intervention trial (HIPI), that showed significant reductions of 26 per cent in fall injuries for the general population when their homes were modified.
“As many Māori live in homes which are of poorer quality and more heavily populated, we are at greater risk of injury but also experience more benefit from these interventions,” Professor Cunningham says.
“If one night in hospital can be avoided a saving of more that $1500 is made for the health system. The costs of the modifications was around $500, so paying for the intervention saves the health system money.”
But the paper published in The Lancet shows the researchers went beyond health inequities between Māori and non-Māori and ventured into the domain of politics and law. It says:
New Zealand has a constitutional obligation to address such inequities, as initially expressed in an 1840 agreement between the colonising English and Māori, Te Tiriti O Waitangi (The Treaty of Waitangi).
Science at that point made way for a highly contentious assertion about a document which is open to an array of interpretations.
A fellow called Matthew Palmer, now a High Court judge, a few years ago wrote a book titled “The Treaty of Waitangi in New Zealand’s Law and Constitution”,
In this, he says:.
The general meaning of the Treaty amounts to an explicit commitment to the health of the relationships between the Crown, Maori and other New Zealanders. However, the legal status of the Treaty is incoherent and its legal force inconsistent, and the constitutional place of the Treaty remains contested and political, reflecting the underlying tension between democratic majority rule and the protection of the indigenous rights of a minority, as well as uncertainty about the foundational legitimacy of New Zealand’s constitution.
Palmer is a legal and constitutional expert
But to be fair, the paper published in The Lancet Public Health has several authors – Michael D Keall, PhD, Hope Tupara, PhD, Nevil Pierse, PhD, Marg Wilkie, PhD, Professor Michael G Baker, MBChB, Professor Philippa Howden-Chapman, PhD, and Professor Chris Cunningham, PhD.
When they put all their brainpower together, they may well be able to lay claim to a better knowledge of the Treaty than Judge Palmer.
Source: University of Auckland