Epidemiology Maori Mental Health Chris Gale For Otago Psychiatry Trainees. March 2011 Maori. ● Polynesian. Migrated NZ around 1200 – 1300. – Neolithic (no metals) – Tribal: simplified hierarchy compared with other polynesian cultures. ● Imported to NZ – Kumara (other crops such as Taro and Banana required higher temperatures). – Dogs (kiore) ● Combination of hunting, fishing, gathering & agriculture. Atua (Gods) Ethics. ● Tapu – Holy, sacred. – Only preists (tohunga) or chiefs can approach. ● Noa – Cursed. – Leads to shame (whakama) ● Utu. – Reciprocation or revenge. ● Northern iwi – Ngāi Takoto • Ngāpuhi • Ngāti Whātua • Ngāpuhi ki Whaingaroa • Ngāti Kahu • Ngāti Kurī • Ngāti Wai • Te Aupōuri • Te Kawerau • Te Rarawa • Te Roroa ● Waikato-Tainui iwi – Ngāi Tai (Ngāti Tai) • Ngāti Hako • Ngāti Haua • Ngāti Hei • Ngāti Huia • Ngāti Mahuta • Ngāti Maniapoto• Ngāti Maru •Ngāti Paoa • Ngāti Whānaunga • Ngāti Pūkenga ki Waiau • Patukirikiri • Ngāti Rāhiri Tumutumu • Ngāti Tamaterā • Ngāti Tara Tokanui • Ngāti Te Ata • Waikato – Tauranga Moana tribes: Ngāi Te Rangi • Ngāti Pūkenga • Ngāti Ranginui ● West coast NI iwi – Ngā Rauru (Ngāti Rauru) • Ngā Ruahine • Tangahoe • Taranaki • Ngā Ruanui • Ngāti Hau • Ngāti Hauiti • Ngāti Mutunga • Ngāti Ruanui • Ngāti Tama‡ • Pakakohi • Ngāti Maru •Poutini • Te Āti Awa ● ● Te Arawa iwi – Ngāti Pikiao • Ngāti Rangiteaorere • Tuhourangi • Uenuku-Kopako • Ngāti Rangitihi • Ngāti Tūwharetoa• Tapuika • Tarawhai • Ngāti Rangiwewehi • Ngāti Tahu • Ngāti Whakaue ● Mataatua iwi – Ngāi Tūhoe • Ngāti Awa • Ngāti Manawa • Ngāti Whare • Te Whakatōhea ● East coast iwi – Ngāriki Kaiputahi (Ngā Ariki) • Ngāi Tāmanuhiri (Ngāti Tāmanuhiri) • Ngāti Porou • Ngāti Ruapani • Ngāti Tutekohe • Rongowhakaata • Te Āti Haunui-a-Paparangi • Ngāti Rongomaiwahine • Te Aitanga-a-Hauiti • Te Whānau-ā-Apanui • Te Aitanga- a-Mahaki ● Ngati Kahungunu – Ngāti Kahungunu ● Southern iwi – Muaūpoko • Ngāti Raukawa • Ngāti Toa (Ngāti Toarangatira) • Ngāti Apa • Rangitāne (Ngati Rangitane) ● South Island iwi – Ngāi Tahu (Kāi Tahu) • Kāti Mamoe • Waitaha • Ngāti Koata • Ngāti Kuia • Ngāti Rarua • Ngāti Tama‡ • Te Āti Awa ● Urban "pan-tribal" iwi – Ngāti Ākarana • Ngāti Poneke • Ngati Ranana Treaty of Waitangi. ● 1840. Negotiated at Waitangi with Northern Tribes. Multiple other tribes then signed. Written in Maori and English. Translation was poor and the two versions contradict. ● Tuhoe have never signed. ● Three clauses. – Ceding sovereignty to British Crown. – Tribes have possession of all their lands and assets. – Maori have rights of British Citizens. Short timeline contact. ● 1770s – European explorers (British, French) ● 1800s – Small settlements for whaling. ● 1810 – 1835. – Iwi (tribes) start trading flax and kauri for muskets. – Tribal wars ● 1835 – Confederation of tribes of Aoteoroa. – Declaration of Independence. Post treaty. ● 1854: First Parliament disavows treaty. ● 1860s – 1880s. Land Wars. – Waikato confiscated – Eastern Bay of Plenty confiscated. – Taranaki confiscated. ● 1890s – King movement – Tribal unity North Island, led Waikato. ● 1910 – 1930 – Young Maori Movement. ● Aparina Ngata ● Sir Peter Buck. Renaissance. ● 1930s. – Ratana Movement aligns with Labour Party. ● 1970s. – Revival Maori Language and culture. ● 1980s – Treaty settlement process. – Principles of treaty enshrined in law. – Development of Iwi based businesses esp. by Ngai Tahu. Kind of data needed for Polynesian groups: US black vs US white and olanzapine. Estimated change in PANSS total score in olanzapine-treated black and white patients over 24 weeks. Graph based on MMRM Model including fixed terms baseline PANSS total score, treatment week, protocol, investigator, race, and ethnic origin × treatment week. Race P-value = 0.93. BMC Psychiatry. 2010; 10: 89. Demographics NZ population ethnicity, NZMHS Metabolic Status Maori, Non Maori doi: 10.3945/ajcn.2010.29317​ Receiver operating characteristic curves for BMI, waist circumference, and waist- to-height ratio in relation to insulin resistance [homeostasis model assessment of insulin resistance (HOMA-IR)] and insulin sensitivity (McAuley score). Black solid lines, Māori men; black dashed lines, Māori women; gray solid lines, European men; and gray dashed lines, European women. Maori. Aust N Z J Psychiatry. 2009 Jul;43(7):659-65. Drug Alcohol Rev. 2009 Mar;28(2):166-74. Perceptions of SCZ: sample Broadbent. ANZJP in press doi: 10.3109/00048674.2010.561479 Maori perceive that they will unwell for a shorter time than Pakeha. Broadbent. ANZJP in press doi: 10.3109/00048674.2010.561479 12 month prevalence of disorders by prioritised ethnicity. Development ● Limited number Maori and Pacific MH workers. ● Limited training available workers. ● Balance effectiveness and clinician and effectiveness within culture ongoing challenge. ● Synergism between mainline services and Maori services necessary. ● Question as to if special status of any ethnic group helping development: In Malaysia it has reduced health status..