Indigenous adolescent health in Aotearoa New Zealand: Trends, policy and advancing equity for rangatahi Maori, 2001–2019

Abstract

SummaryBackgroundRangatahi 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.MethodsCross-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).FindingsRangatahi 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.InterpretationAge-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.FundingTwo 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).