Understanding the determinants of health for Māori living with chronic disease in Aotearoa New Zealand

Lynley Uerata; Nina Scott; Jade Tamatea; Amy Jones; Polly Atatoa Carr; Lynne Chepulis; Ryan Paul; Haylee Simon; Ross Lawrenson

doi:10.1071/HC25064

RESEARCH ARTICLE (Open Access)

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Understanding the determinants of health for Māori living with chronic disease in Aotearoa New Zealand

Lynley Uerata

¹ ^* , Nina Scott ² , Jade Tamatea ³ ⁴ , Amy Jones ¹ , Polly Atatoa Carr ⁵ ⁶ , Lynne Chepulis

⁷ , Ryan Paul ⁷ ⁸ , Haylee Simon ¹ , Ross Lawrenson

⁷

+ Author Affiliations

- Author Affiliations

¹ Māori Health, Te Whatu Ora Waikato Health NZ, Hockin Level 1, Waikato Hospital, Pembroke Street, Private Bag 3200, Hamilton 3240, New Zealand.

² Hauora Māori Services, Te Whatu Ora Health NZ, Hockin Level 1, Waikato Hospital, Pembroke Street, Private Bag 3200, Hamilton 3240, New Zealand.

³ Te Kupenga Hauora Māori, The University of Auckland, Auckland Central, Auckland 1010, New Zealand.

⁴ Te Whatu Ora Waikato Health NZ, Hockin Level 1, Waikato Hospital, Pembroke Street, Private Bag 3200, Hamilton 3240, New Zealand.

⁵ Te Ngira: Institute for Population Research, University of Waikato, Hillcrest Road, Hillcrest, Hamilton 3216, New Zealand.

⁶ Paediatrics, Te Whatu Ora Waikato Health NZ, Hockin Level 1, Waikato Hospital, Pembroke Street, Private Bag 3200, Hamilton 3240, New Zealand.

⁷ Waikato Medical Research Centre, University of Waikato, Hillcrest Road, Hillcrest, Hamilton 3216, New Zealand.

⁸ Te Whatu Ora Waikato Health NZ, Hague Road, Hamilton West, Private Bag 3200, Hamilton 3204, New Zealand.

^* Correspondence to: Lynley.uerata@tewhatuora.govt.nz

Handling Editor: Felicity Goodyear-Smith

Journal of Primary Health Care https://doi.org/10.1071/HC25064

Submitted: 11 April 2025 Accepted: 7 July 2025 Published: 31 July 2025

© 2025 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of The Royal New Zealand College of General Practitioners. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Introduction

Aotearoa New Zealand has wide disparities in health outcomes between indigenous and non-indigenous groups, which are strongly associated with inequitable access to determinants of health by ethnicity. Experiences of health determinants culminate in higher rates of diabetes, asthma, kidney disease and other chronic diseases and worse outcomes for Māori.

Aim

This paper explores the relationships between health determinants and chronic disease from the perspectives of Māori patients and healthcare providers.

Methods

Using a Kaupapa Māori methodology and qualitative methods, six semi-structured focus groups with 21 Māori living with chronic disease and semi-structured consultations with 130 healthcare providers across the Waikato region were undertaken between 2021 and 2023.

Results

Participants identified five key health determinants shaping the everyday experience and management of chronic disease, including employment, welfare support, income, access to information and racism. Access to economic resources had significant impacts. Those in situations of economic insecurity experienced significant complications to everyday disease management and had fewer resources to mediate their effects. Chronic disease also reduced access to economic resources through increased health costs, reduced earning power and the impacts of dealing with the welfare and health systems. Comparatively, stable access to economic resources, such as health insurance, enabled disease management.

Discussion

Everyday experiences of health determinants are shaped considerably by economic circumstances. Claiming welfare support continues to be difficult for eligible participants, and welfare payment inadequate. The health system needs to re-design healthcare delivery so people with poor access to economic resources are actively supported to access health determinants.

Keywords: Aotearoa New Zealand, chronic disease, chronic disease management, determinants of health, economic [in]security, health service redesign, Kaupapa Māori, Māori, qualitative methods.

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