Indigenous Perspectives on Health Outcome Measurement

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Indigenous Perspectives on Health Outcome
Measurement

• Te Kani Kingi
• Te Mata o te Tau
• Massey University
• Wellington

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Florence Nightingale 1800s

• Relieved
• Dead
• Discharged

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The Issue with Health Outcome Measurement

• The problem of defining health and health
  outcome has bedevilled attempts to set
  priorities based on effectiveness and outcomes,
  in New Zealand and elsewhere. They continue to
  do so today. A decades-long debate has
  surrounded the definition of health and has
  failed to provide consensus on this issue.i
• i Health Funding Authority, (1998), op cit.,
  p. 7.

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The Issue with Mental Health Outcome Measurement

• Sometimes difficult to decide what to measure
• when to measure is also an issue
• Clinical and consumer perspectives sometimes at
  odds with each other
• cure often an unrealistic outcome objective
• proxy measures used

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The Issue with Mental Health Outcome Measurement

• Evidence of outcome an issue schedules require
  interpretation
• The impact of environmental externalities
• Linking an outcome to an intervention
• process often confused for outcome

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Some Broad Questions to Consider

• What is health ?
• How to measure health ?
• How to ensure what is measured is relevant and
  valued?

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Indigenous Perspectives on Health

• Typically holistic
• Multiple domains
• Integrated
• Spiritual, mental, physical, environmental,
  community, land and ecological connections
• Well-ness orientated
• Often in conflict with western perspectives

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Indigenous Perspectives on Health

• To be effective health outcome measures must
  consider or measure what is important to the
  consumer
• This is likely to include the more usual domains
  or dimension
• Must also (to be relevant) reflect indigenous
  perspectives when used with an indigenous
  population

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Indigenous Perspectives on Health

• For example
• - has the intervention enhanced the individuals
  relationship with their family
• - has it enhanced their capacity to function as
  part of their community
• - has their spiritual beliefs been considered as
  part of the outcome assessment process.

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Indigenous Perspectives on Health

• - has the relationship between their physical
  health and mental well-being been considered
• - has the intervention considered their cultural
  needs
• - is it well-ness or illness orientated

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Indigenous Perspectives on Health

• Q 4
• As a result of the hip replacement are you now
  able to walk around the block
• A) Much better than before
• B) Better than before
• C) The same as before
• D) Worse than before
• E) Much worse than before

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Indigenous Perspectives on Health

• in American a popular saying is that a squeaky
  wheel gets the oil conversly a popular saying in
  many asians countries is the nail that protrudes
  will be pounded down. A well known Maori
  whakatauki that provides insight into the view of
  Maori society toward self promotion and
  individuality is kaore te kumara e korero mo
  tona reka which when translated states that the
  kumara does not proclaim its own sweetness (S
  Bennett Confirmation Report)

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Indigenous Perspectives on Health

• An elderly man who is overweight, breathless on
  exercision and prone to gout, may be seen by
  himself and his community as healthy because his
  whanau relationships are mutually rewarding and
  he maintains a sense of harmony with the wider
  environment

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Key Themes

• Mental health outcomes are particularly difficult
  to measure
• The conventional measures of mental health
  outcome are useful for indigenous populations
• They must, however, accommodate a broader range
  of outcome preferences and in order to be useful
  and relevant
• How can these perspectives be more widely
  recognised, and how can they be measured?

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Indigenous Perspectives on Health Outcome
Measurement

• Te Kani Kingi
• Te Mata o te Tau
• Massey University
• Wellington