Health researchers measure the benefits of taking precautions – but they stumble when they bring the Treaty into considerations

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 find it’s a good thing to take 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 good for the wellbeing of householders, regardless of race, in much the same way as we all would benefit from putting on warm clothing when the temperature drops or from looking for oncoming traffic before crossing the road.

Ah – but the research gives us a number:  relatively low-cost modifications in homes can prevent 31 per cent of fall injuries in Maori households.

The cost of the study (if our researchers have tracked down the relevant information) was $786,851.52, a sum which was provided by the Health Research Council of New Zealand (HRC), the government’s principal funder of health research.

The council says on its website 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 building knowledge and evidence on issues that affect some New Zealanders – decided on a race basis – should be given greater attention.

Professor Sunny Collings, the chief executive, says in the 2019/20 annual report:

“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 2019/20 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 $786,851.52 funding for the research into Maori housing, hazards and health was approved around 10 years ago.

The research 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.  Nelson was eliminated from the exercise.

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.

Māori experience higher rates of injury-related ill health than non-Māori and have elevated rates for fall injuries, Cunningham says.

“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.  That’s when it faltered by saying:    

“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).”

And so health research findings 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.

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 their heads together, they may well be able to claim a better knowledge of the Treaty than Judge Palmer.

But claiming something and having it is not necessarily the same thing.

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