Mortality after release from incarceration in New Zealand by gender: A national record linkage study.

Background: People who enter and leave places of incarceration experience considerable health inequities and are at increased risk of premature death compared to the general population. Causes of premature death in this population vary markedly between countries and so country-specific information is needed. Additionally, there is a lack of large population-based studies which can disaggregate mortality risk based on person and incarceration factors. This study is the first examination of mortality in the period following release from incarceration in New Zealand. Methods: We linked deidentified administrative data on incarceration and release between 1 January 1998 and 31 December 2016 with national mortality data for the same period to examine mortality after release in those who had been incarcerated for at least 1 day. Age standardised mortality rates and mortality ratios compared to the general New Zealand population were calculated separately for men and women, for releases from remand compared with prison, and by cause of death and time since release. Results: 90,195 individuals (13% women, 49% Maori) were followed up for 9.4 years after release from incarceration, with 4,764 deaths over the follow-up period. The overall standardised mortality ratio was 3.3 (95% CI 3.2, 3.4) compared to the general population, and higher for women (3.8) than men (2.7). The most common causes of death were cardiovascular disease, cancer and suicide. Rates of death were similar following release from remand versus prison, however suicide rates were highest following release from remand. Regardless of the type of incarceration, mortality was highest in the first month after release. Conclusion: Experience of incarceration in New Zealand is associated with high rates of mortality from both chronic conditions and external causes. There are urgent policy imperatives to recognise and actively address the increased health and mortality risks faced by people released from New Zealand prisons.

A kia ora, a wave and a smile: an urban marae-led response to COVID-19, a case study in manaakitanga.

BACKGROUND: When COVID-19 emerged, there were well-founded fears that Maori (indigenous peoples of Aotearoa (New Zealand)) would be disproportionately affected, both in terms of morbidity and mortality from COVID-19 itself and through the impact of lock-down measures. A key way in which Kokiri (a Maori health provider) responded was through the establishment of a pataka kai (foodbank) that also provided a gateway to assess need and deliver other support services to whanau (in this case, client). Maori values were integral to this approach, with manaakitanga (kindness or providing care for others) at the heart of Kokiri's actions. We sought to identify how Kokiri operated under the mantle of manaakitanga, during Aotearoa's 2020 nationwide COVID-19 lockdown and to assess the impact of their contributions on Maori whanau. METHODS: We used qualitative methods underpinned by Maori research methodology. Twenty-six whanau interviews and two focus groups were held, one with eight kaimahi (workers) and the other with seven rangatahi (youth) kaimahi. Data was gathered between June and October 2020 (soon after the 2020 lockdown restrictions were lifted), thematically analysed and interpreted using a Maori worldview. RESULTS: Three key themes were identified that aligned to the values framework that forms the practice model that Kokiri kaimahi work within. Kaitiakitanga, whanau and manaakitanga are also long-standing Maori world values. We identified that kaitiakitanga (protecting) and manaakitanga (with kindness) - with whanau at the centre of all decisions and service delivery - worked as a protective mechanism to provide much needed support within the community Kokiri serves. CONCLUSIONS: Maori health providers are well placed to respond effectively in a public-health crisis when resourced appropriately and trusted to deliver. We propose a number of recommendations based on the insights generated from the researchers, kaimahi, and whanau. These are that: Maori be included in pandemic planning and decision-making, Maori-led initiatives and organisations be valued and adequately resourced, and strong communities with strong networks be built during non-crisis times.

Telehealth as a tool for equity: pros, cons and recommendations

Before the start of the second school term, and within a few weeks of our move to Alert Level 4, the New Zealand Government began distributing more than 17,000 digital devices to school students around the country1 In addition, thousands of modems were circulated to households without current internet access-all in an effort to bridge the digital divide and enable online learning amid the COVID-19 shutdown.2 In the context of health, clinical consultations that do not require in-person contact have moved to phone calls and video-conferences. The factors that drive poor healthcare access for Māori and Pacific peoples are multifactorial, but ultimately these factors reflect a disproportionate exposure to the multiple determinants of poor health (including health systems and social determinants such as socioeconomic deprivation and institutionalised racism).89 These are the social determinants that manifest as barriers to healthcare access for Māori and Pacific people: transportation barriers that prevent access to in-person appointments;financial barriers that prevent paying for general practitioner (GP) visits or medication;and cultural barriers that prevent access to a service that was not necessarily designed to align with Māori and Pacific worldviews of health-with the understanding that access is not solely premised by availability and affordability, but also acceptability of services for Māori and Pacific people. Opportunities Telehealth can reduce barriers to care. Since telehealth reduces or removes the requirement for patients to travel to receive care, it follows that telehealth can improve access to care among those who have transport barriers.1012 By removing the necessity to travel for care, telehealth also reduces the time commitment required by patients and their whanau, further improving access to care. Technical barriers to the equitable provision of telehealth for Māori and Pacific people include (but are not limited to): the availability of telephone or internet connection;device availability (including telephones and other communication devices);digital literacy/education regarding device usage;infrastructure, education and resourcing within Māori and Pacific health providers to provide telehealth to their communities;and attitudinal barriers to telehealth uptake among some health professionals.