Health in a Global Society Padlet by Ciara Murphy https://padlet.com/ciaramurphy21/qi8k7227uu11rht0 Based on clinical experience I hope to compare health disparities from opposite corners of the world and exploring solutions to both. New Zealand is the antipode of Ireland en-us 2022-02-04 06:40:16 UTC 2026-03-06 20:02:54 UTC hello@padlet.com https://padlet-uploads.storage.googleapis.com/1566552980/137b27342639ec8fd660f6df58fe8c69/Social_Determinants_of_Health_Image.jpeg 3a. Working in the Irish Healthcare System ciaramurphy21 https://padlet.com/ciaramurphy21/qi8k7227uu11rht0/wish/2028945732 Since moving home New Zealand in August 2021, I have been working as a physiotherapist at the National Rehabilitation Hospital in Dublin, Ireland. I work as part of an Interdisciplinary Team helping people with Acquired and Traumatic Brain Injuries.

I feel having worked in New Zealand- a country colonised by Europeans, where inequity and inequality are clearly based on race and culture, I returned to Ireland with a heightened awareness of social injustice and its consequences of health and wellbeing.

It is very clear in my limited time working with people with complex disabilities that better outcomes are achieved by people who belong to a social system or class. 

"Health cannot be a question of income; it is a fundamental human right." Nelson Mandela]]> 2022-02-04 06:46:41 UTC https://padlet.com/ciaramurphy21/qi8k7227uu11rht0/wish/2028945732 Tackling Health Disparities with Inclusion ciaramurphy21 https://padlet.com/ciaramurphy21/qi8k7227uu11rht0/wish/2051565409 -Dr. Cliona Ní Cheallaigh and Nurse Ann Marie Lawlee have successfully introduced a 12-month Inclusion Health pilot project at St. James Hospital.
-Focus of the project is to recognise the complex medical and psychosocial needs and health inequalities experienced by the homeless, asylum seekers, prisoners and Travellers, for example (Cheallaigh et al., 2018).]]> 2022-02-16 18:26:09 UTC https://padlet.com/ciaramurphy21/qi8k7227uu11rht0/wish/2051565409 Concluding Notes: What is within my control? ciaramurphy21 https://padlet.com/ciaramurphy21/qi8k7227uu11rht0/wish/2079037997 - I may not be writing ground breaking policies but I can control my own actions.
-I think I, as a custodian of health have a responsibility to be accountable for my attitudes and always consider the patient's needs, preferences and motivators.
- As a therapists my patient's centred goals must be at the forefront of my care and treatment.
-I feel hospital environment can have a massive impact of recovery and overall outcome of disability and careful consideration for family, patient's needs and preferences will all play a factor in this going forward.

We need to stop treating healthcare as a one size fits all approach. People's beliefs, culture and background (social, economic and spiritual) will always need to be taken into consideration throughout the entire continuum of care.

"The burden of health care shouldn't be borne by the poorest families. We should have equity within health systems so that families are able to cope with serious illness and not be driven into poverty and relationship breakdown because they don't have access to health care."
Mary Robinson]]> 2022-03-05 09:42:42 UTC https://padlet.com/ciaramurphy21/qi8k7227uu11rht0/wish/2079037997 1. Background ciaramurphy21 https://padlet.com/ciaramurphy21/qi8k7227uu11rht0/wish/2111248757 Story Time: Hi my name is Ciara, I am a 2016 UCD physiotherapy graduate.  After graduating I worked for 2 years in Ireland in private practise and 1 year as a physiotherapist in the Irish Mental Health Services before emigrating to New Zealand in 2019.

While in New Zealand I predominantly worked in the community, helping older people, people with disabilities and people who had suffered life changing injuries.

New Zealand is a multi-ethnic society with 70.2% iden-
tifying as European, 16.5% indigenous Maori, 15.1%
Asian and 8.1% with Pacific Island backgrounds. Many
identify with more than one ethnic group and 27.4%
were not born in New Zealand (Stats NZ., 2019).

It became very clear to me while living in New Zealand that inequity in healthcare is very much NOT a thing of the past. Racial segregation and disparities in accessing or receiving appropriate healthcare are still issues that the Maori, the indigenous people of New Zealand, deal with everyday (Zambas & Wright, 2016). 

This multi-ethnic population requires assessment of ethnic differences in access to healthcare and the associations with outcomes.

As an emigrant seeking job opportunities as a healthcare practitioner in New Zealand it was mandatory that I was educated on Maori health and wellbeing. As part of my pre-registration with the physiotherapy board in NZ, I was required to take a course on Maori cultural competency and write and assignment on the pillars of Maori health and wellbeing. 

]]> 2022-03-24 06:35:23 UTC https://padlet.com/ciaramurphy21/qi8k7227uu11rht0/wish/2111248757 2b. Health Inequity Wāhine Māori ciaramurphy21 https://padlet.com/ciaramurphy21/qi8k7227uu11rht0/wish/2111288862 Wāhine Māori (Māori Woman) are 4 times more likely to die from a diagnosis of cervical cancer than their (European) counterparts.
Women diagnosed with stage 3 cervical cancer has a 40% chance of survival. As a Wāhine Māori you have a 13.3% cervical.
Māori women living in New Zealand are a third less likely to attend cervical cancer screening and more than twice as likely to be diagnosed with, and die from, cervical cancer than their counterparts of European ancestry (The Lancet Oncology, 2021).]]> 2022-03-24 07:11:36 UTC https://padlet.com/ciaramurphy21/qi8k7227uu11rht0/wish/2111288862 2a. Pillars of Maori Health and Wellbeing ciaramurphy21 https://padlet.com/ciaramurphy21/qi8k7227uu11rht0/wish/2112554530
With its strong foundations and four equal sides, the symbol of the wharenui illustrates the four dimensions of Māori well-being.

Taha tinana (physical health)
The capacity for physical growth and development. For Māori the physical dimension cannot be separated from the aspect of mind, spirit and family.
Taha wairua (spiritual health)
The capacity for faith and wider communication.
Health is related to unseen and unspoken energies. The spiritual essence of a person is their life force. This determines us as individuals and as a collective, who and what we are, where we have come from and where we are going.
Taha whānau (family health)
The capacity to belong, to care and to share where individuals are part of wider social systems. Whānau provides us with the strength to be who we are. This is the link to our ancestors, our ties with the past, the present and the future.
Taha hinengaro (mental health)
The capacity to communicate, to think and to feel mind and body are inseparable. Thoughts, feelings and emotions are integral components of the body and soul. This is about how we see ourselves in this universe, our interaction with that which is uniquely Māori and the perception that others have of us.

Should one of the four dimensions be missing or in some way damaged, a person, or a collective may become ‘unbalanced’ and subsequently unwell.
]]> 2022-03-24 19:44:31 UTC https://padlet.com/ciaramurphy21/qi8k7227uu11rht0/wish/2112554530 Solutions: People Changing the Narrative for Maori ciaramurphy21 https://padlet.com/ciaramurphy21/qi8k7227uu11rht0/wish/2114403659 The scarcity of tangible reductions in inequity between  Māori and non-Māori populations raises questions about the  effectiveness of policies to date (Fawcett et al., 2006).

To address health inequity, New Zealand might need to revisit deep-rooted historical, cultural, and systemic issues.

Māori and Pacific people experience the most significant inequities in exposure to Cardiovascular Disease risk factors compared with other ethnic groups (Selak et al., 2020).

Maori and Pacific peoples experience strokes at a younger age and have worse outcomes after stroke with a higher one-year mortality prevalence. The differences in occurrence have been largely attributed to a greater incidence of stroke risk factors, including hypertension, diabetes, and smoking. Māori have poorer access to key stroke interventions and experience poorer outcomes (Thompson et al., 2022). 

Dr. Matire Harwood is considered a leader in improving health outcomes for the Māori and Pacifika people. The success of her work was published widely and led to changes in treatment guidelines and clinical practise. ]]> 2022-03-25 20:05:18 UTC https://padlet.com/ciaramurphy21/qi8k7227uu11rht0/wish/2114403659 3b. Social Determinants of Health In Ireland ciaramurphy21 https://padlet.com/ciaramurphy21/qi8k7227uu11rht0/wish/2122218775 10 minute informative podcast on how social justice or lack there of affects health.

Key Take Away Points:
- Male Life Expectancy in deprived areas 74.4 years v 81.6 in the most affluent (Carson, Blakley, et al., 2021).

- Female Life Expectancy in deprived areas 79.6 years v 84.5 in the most affluent (Carson, Blakley, et al., 2021).

- Ireland has the lowest ranking in the EU when it comes to accessibility of healthcare. We are the only EU country who does not offer Universal Healthcare (Björnberg and Phang, 2018).

- Our complex two tier healthcare system has resulted in over 600,000 people on outpatient appointment waiting lists; 1/5 of which are waiting over 18 months to be seen (Björnberg & Phang, 2018).


Those in the lower socio-economic groups experience poorer health and shorter lives than those in the higher socio-economic groups. Such poor health is most evident amongst the Traveller population and the street homeless in Ireland.

"Social injustice is killing people on a grand scale." (WHO, 2008)
]]> 2022-03-30 19:54:11 UTC https://padlet.com/ciaramurphy21/qi8k7227uu11rht0/wish/2122218775 Solutions: Using Digital Health to increase Accessibility? ciaramurphy21 https://padlet.com/ciaramurphy21/qi8k7227uu11rht0/wish/2122226841 Covid-19 forced the entire world to take a deep plunge into the world of tele-medicine. A once considered unimaginable experience, civilians were able to access first hand health advice from the comfort of their own home. With adequate reinforcement, telemedicine has the potential to act as the “safety-net” of our public health response to an outbreak. (Eugenio Tozzi et al., 2019)]]> 2022-03-30 20:00:39 UTC https://padlet.com/ciaramurphy21/qi8k7227uu11rht0/wish/2122226841 2c. New Zealand Covid-19 Response ciaramurphy21 https://padlet.com/ciaramurphy21/qi8k7227uu11rht0/wish/2123988477 New Zealand (NZ)  was widely celebrated internationally for its initial response to COVID-19, and how its strict border control and measures protected its most vulnerable people.

Research from Te Pūnaha Matatini (the New Zealand Centre of Research Excellence for Complex Systems), published in the New Zealand Medical Journal, showed Māori are 2.5 times more likely to be admitted to hospital than non-Māori and 50% more likely to die (Steyn et al., 2021).

New Zealand Ministry of Health Released a Māori specific Vaccine Rollout Strategy which improved education and accessibility to the Māori and Pacific Islander Population. Vaccines were made available at Mahi (Work), Marae (Sacred Place) and via mobile units (Busifika Vax COVID-19 Vaccination Bus) as well as hospitals, GPs and pharmacies.

One of the main factors that improved vaccination uptake within the Māori and Pasifika community was to vaccinated irrespective of age bands. Māori do things as a whānau (family/ community) (NZ Hearld, 2021).
 
]]> 2022-03-31 16:48:16 UTC https://padlet.com/ciaramurphy21/qi8k7227uu11rht0/wish/2123988477 3c. Impact of Covid-19 in Deprived Areas ciaramurphy21 https://padlet.com/ciaramurphy21/qi8k7227uu11rht0/wish/2124325362 Being able to socially distance is a privilege.
Unskilled front lined workers from lower socio-economic areas can be more exposed to infection. They do not have the luxury of teleworking or can often live in close proximity.

Most fatalities will be amongst those with underlying illnesses such as high blood pressure, diabetes and heart or respiratory disease. The more socially and economically disadvantaged a person is, the more likely they are to suffer from these diseases.

 "Where you live and what you work at has an impact on your health. If you work at an unskilled job and live in a deprived area, you are more likely to die earlier than a professional worker living in an affluent area" (Burke & Pentony, 2011).]]> 2022-03-31 20:39:06 UTC https://padlet.com/ciaramurphy21/qi8k7227uu11rht0/wish/2124325362 Solutions: Implications of Education on Health ciaramurphy21 https://padlet.com/ciaramurphy21/qi8k7227uu11rht0/wish/2124384886 The health effects of education are at the grass roots-creating better overall self-awareness on personal health and making healthcare more accessible (Raghupathi & Raghupathi, 2020).

- Education is a pivotal in eradicating health inequity. 
- More transfer of knowledge ensures more informed health decisions. 
- Education can help assist with better job opportunities and help reduce the incidence of poverty. 
- Education promotes gender equality and helps empower girls and women.]]> 2022-03-31 21:42:53 UTC https://padlet.com/ciaramurphy21/qi8k7227uu11rht0/wish/2124384886 Reference ciaramurphy21 https://padlet.com/ciaramurphy21/qi8k7227uu11rht0/wish/2125501916 1. Björnberg, A. and Phang, A.Y. (2018) Health Consumer Powerhouse. Health Consumer Powerhouse.
2. Burke, S. and Pentony, S. (2011) Eliminating Health Inequalities. A Matter of Life and Death. TASC.
3. Carson, Philip., Blakley, Hannah. and Laverty, Caolan. (2021) Health Inequalities A product of the NI Health and Social Care Inequalities Monitoring System. [Online] Available from: www.nisra.gov.uk [Accessed 31/03/2022].
4. Cheallaigh, C.N. et al. (2018) The Development of an Inclusion Health Integrated Care Programme for Homeless Adults in. International Journal of Integrated Care, 18(S2), pp. 1–8.
5. Eugenio Tozzi, A. et al. (2019) Telemedicine Across the Globe-Position Paper From the COVID-19 Pandemic Health System Resilience PROGRAM (REPROGRAM) International Consortium (Part 1). 8, p. 556720.
6. Fawcett, J. et al. (2006) Decades of Disparity III. Public Health Intelligence, 31, [Online] Available from: http://www.wnmeds.ac.nz/nzcms-info.html [Accessed 30/03/2022].
7. Neilson, M. (2021) The 90% Project: How an iwi-led Covid-19 vaccination programme has achieved some of the country’s highest rates. [Online] NZ Hearld. Available from : https://www.nzherald.co.nz/nz/the-90-project-how-an-iwi-led-covid-19-vaccination-programme-has-achieved-some-of-the-countrys-highest-rates/MD3KWVZXINQOUNA6R7YV6Z2IGA/ [Accessed 01/04/22].
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9. Raghupathi, V. and Raghupathi, W. (2020) The influence of education on health: an empirical assessment of OECD countries for the period 1995-2015. [Online] Available from: doi.org/10.1186/s13690-020-00402-5 [Accessed 31/03/2022].
10. Selak, V. et al. (2020) Ethnic differences in cardiovascular risk profiles among 475,241 adults in primary care in Aotearoa, New Zealand. New Zealand medical journal, 133(1521), [Online] Available from: https://pubmed.ncbi.nlm.nih.gov/32994634/ [Accessed 01/04/2022].
11. Steyn, N. et al. (2021) Māori and Pacific People in New Zealand have higher risk of hospitalisation for COVID-19. medRxiv, p. 2020.12.25.20248427.
12. The Lancet Oncology (2021) Cervical cancer screening and New Zealand’s uncomfortable truths. The Lancet Oncology, 22, [Online] Available from: doi.org/10.1016/S1470-2045(21)00206-0 [Accessed 30/03/2022].
13. Thompson, S.G. et al. (2022) The impact of ethnicity on stroke care access and patient outcomes: a New Zealand nationwide observational study. The Lancet Regional Health - Western Pacific, 20, [Online] Available from: doi.org/10.1016/J.LANWPC.2021.100358 [Accessed 31/03/2022].
14. WHO (2008) Closing the gap in a generation Health equity through action on the social determinants of health.
15. Zambas, S.I. and Wright, J. (2016) Contemporary Nurse Impact of colonialism on Māori and Aboriginal healthcare access: a discussion paper. [Online] Available from: doi.org/10.1080/10376178.2016.1195238 [Accessed 30/03/2022].

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