Papaarangi Reid

• University of Auckland

Eliminating Indigenous and ethnic health inequities requires culturally-competent and culturally-safe health workforces and systems. Health professional training institutions and regulatory bodies are increasingly including cultural competency and cultural safety in health professional accreditation standards, and pre-service and in-service trainin...

aims: Ethnicity is an important variable, and in Aotearoa New Zealand it is used to monitor population health needs, health services outcomes and to allocate resources. However, there is a history of undercounting Māori. The aim of this study was to compare national and primary care ethnicity data to self-reported ethnicity from a Kaupapa Māori res...

Background An optimally structured prehospital trauma care system can reduce the serious consequences of many injuries. Whether all major trauma patients should be directed to a trauma centre (TC), bypassing closer lower-level hospitals, is a contentious issue. In particular, it is unclear if direct transport reduces risk of death. Objective To ex...

Background There are many long-standing challenges in delivering equitable health care in Aotearoa-New Zealand’s healthcare system. Little is known about inequities in EMS delivered care and transport pathways to hospital-level care, and any overlapping disparities by location of injury incident and ethnicity. Objective This study examines the int...

Hikitia te Ora (Certificate in Health Sciences) is a 1 year Indigenous bridging foundation programme at the University of Auckland, Aotearoa New Zealand. The programme aims to increase Māori and Pacific health workforce representation. This qualitative study applied a Kaupapa Māori positioning to elucidate the strengths, challenges, and opportuniti...

Introduction The out-of-hospital emergency medical service (EMS) care responses and the transport pathways to hospital play a vital role in patient survival following injury and are the first component of a well-functioning, optimised system of trauma care. Despite longstanding challenges in delivering equitable healthcare services in the health sy...

"The study aims to serve as a culturally informed foundational framework for the implementation by United Nations entities and Member States of the 17 Sustainable Development Goals as they relate to the health of Indigenous Peoples. The aims of the study are to: (a) identify unique determinants of the health of Indigenous Peoples to assist the Unit...

Introduction The COVID-19 pandemic has had both direct and indirect impacts on the health of populations worldwide. While racial/ethnic health inequities in COVID-19 infection are now well known (and ongoing), knowledge about the impact of COVID-19 pandemic management on non-COVID-19-related outcomes for Indigenous peoples is less well understood....

Enabling patients to consent to or decline involvement of medical students in their care is an essential aspect of ethically sound, patient-centred, mana-enhancing healthcare. It is required by Aotearoa New Zealand law and Te Kaunihera Rata o Aotearoa Medical Council of New Zealand policy. This requirement was affirmed and explored in a 2015 Consen...

Examining the pathways and causes of ethnic inequities in health is integral to devising effective interventions. Explanations set the scope for solutions. Understandings of ethnic health inequities are often situated in victim blaming and cultural deficit explanations, rather than in the root causes. For Indigenous populations, colonisation and ra...

Indigenous Peoples tend to approach health as an equilibrium of spirituality, traditional medicine, biodiversity and the interconnectedness of all that exists. This leads to an understanding of humanity in a significantly different manner than non-Indigenous peoples. In 2015, United Nations Member States adopted the 2030 Agenda for Sustainable Deve...

Health literacy is our ability to manage our wellbeing at a particular point in time given the range of demands placed on us by the way the health system and health services are organised and delivered. These complex demands also include how access to health professionals is controlled and how health information is provided. It can be useful to thi...

Background The Inclusive Trauma System has a multidisciplinary team of trauma patients such as PT and rehabilitation teams to help reduce complications from injuries. Khon Kaen Hospital (Level A) is a center hospital linked to hospitals at level M1, M2, F1 and F2 in 26 districts, but there are limitations in linking the rehabilitation system in tra...

Background Most injury-related deaths occur in the first 24 hours following the event. Some of these patients could survive if identified and managed promptly and effectively. Aims To assess the survivability of prehospital injury deaths in New Zealand. Methods A cross-sectional review of prehospital injury death post-mortems (PM) during 2009–201...

Background Although reducing the time from injury to definitive care has been shown to achieve better outcomes for patients, the relationship between injury incident location and access to specialist care has been largely unexplored. Aims To determine the number and distribution of prehospital trauma deaths in New Zealand (NZ) without timely acces...

Aims: To compare the distribution of Māori and New Zealand (NZ) European populations in Aotearoa New Zealand by neighbourhood deprivation, for the five censuses between 1991 and 2013, and to identify changes in the distribution pattern over time. Methods: Geographical meshblock data from the 1991-2013 New Zealand censuses, by NZDep Index depriva...

Objectives Despite significant international interest in the economic impacts of health inequities, few studies have quantified the costs associated with unfair and preventable ethnic/racial health inequities. This Indigenous-led study is the first to investigate health inequities between Māori and non-Māori adults in New Zealand (NZ) and estimate...

Planetary health has an important role to play in guiding humanity towards a healthy, equitable, and sustainable future. However, given planetary health's dominant colonial and capitalist underpinning ideologies, it risks reinscribing the same exploitative power dynamics that are fundamental drivers of global ecological collapse. In this Personal V...

Aims: This study estimates of the cost of Indigenous child health inequities in New Zealand. Methods: Standard quantitative epidemiological and cost of illness methodologies were used within a Kaupapa Māori framework. Data for 2003-2014 on children under 15 years were obtained from government datasets. Rates of potentially avoidable hospitalisat...

Studies estimate that 84% of the USA and New Zealand’s (NZ) resident populations have timely access (within 60 min) to advanced-level hospital care. Our aim was to assess whether usual residence (ie, home address) is a suitable proxy for location of injury incidence. In this observational study, injury fatalities registered in NZ’s Mortality Collec...

In this chapter, the health needs and rights of Indigenous peoples are discussed. This discussion covers current challenges beginning with how indigeneity is defined. Within this context, current data on Indigenous health are described with a critique of how Indigenous health is framed. In an attempt to make sense of global patterns of the health o...

Objective There is increasing evidence that EDs may not operate equitably for all patients, with Indigenous and minoritised ethnicity patients experiencing longer wait times for assessment, differential pain management and less evaluation and treatment of acute conditions. Methods This retrospective observational study used a Kaupapa Māori framewo...

Background : Of the five million injury deaths that occur globally each year, an estimated 70% occur before the injured person reaches hospital. Although reducing the time from injury to definitive care has been shown to achieve better outcomes for patients, the relationship between injury incident location and access to specialist care has been la...

Addressing the underrepresentation of Māori in the health workforce is expected to improve Māori health status and contribute to a reduction in Māori health inequities. This research aimed to understand the strengths, challenges and opportunities of the Whakapiki Ake Project (WAP) – an Indigenous tertiary recruitment programme that engages with Māo...

Climate change mitigation policies can either facilitate or hinder progress towards health equity, and can have particular implications for Indigenous health. We sought to summarize current knowledge about the potential impacts (co-benefits and co-harms) of climate mitigation policies and interventions on Indigenous health. Using a Kaupapa Māori th...

Objective Internationally, Indigenous and minoritised ethnic groups experience longer wait times, differential pain management and less evaluation and treatment for acute conditions within emergency medicine care. Examining ED Inequities (EEDI) aims to investigate whether inequities between Māori and non‐Māori exist within EDs in Aotearoa New Zeala...

Despite Māori (Indigenous population of New Zealand, NZ) having high Emergency Department (ED) use, few studies have explored for ethnic inequities in ED within NZ. ED healthcare can be time-pressured, complex and demanding. Clinical decision-making in this context may facilitate provider prejudice, stereotyping and bias. The Examining Emergency De...

Despite dramatic improvements in survival, nutrition, and education over recent decades, today's children face an uncertain future. Climate change, ecological degradation, migrating populations, conflict, pervasive inequalities, and predatory commercial practices threaten the health and future of children in every country. In 2015, the world's coun...

Background Reported international incidence rates of thyrotoxicosis vary markedly, ranging from 6 – 93 cases per 100,000 per annum. Along with population demographics, exposures, and study design factors, ethnicity is increasingly being recognized as a potential factor influencing incidence. This study aimed to document the epidemiology and clinica...

Objective Mobile Health approaches show promise as a delivery mode for alcohol screening and brief intervention. The ‘YourCall’ trial evaluated the effect of a low-intensity mobile phone text message brief intervention compared with usual care on hazardous drinking and alcohol-related harms among injured adults. This paper extends our previously pu...

Background: Eliminating indigenous and ethnic health inequities requires addressing the determinants of health inequities which includes institutionalised racism, and ensuring a health care system that delivers appropriate and equitable care. There is growing recognition of the importance of cultural competency and cultural safety at both individu...

The philosophical assumptions that underpin the way in which health states are valued within economic measures of health are rarely made explicit and fail to capture the experiences of Indigenous peoples. Within a Kaupapa Māori theoretical paradigm, in-depth interviews were conducted with six Māori key informants who had cared for whānau (family) m...

Objective Rapid access to advanced emergency medical and trauma care has been shown to significantly reduce mortality and disability. This study aims to systematically examine geographical access to prehospital care provided by emergency medical services (EMS) and advanced-level hospital care, for the smallest geographical units used in New Zealand...

Background: Postoperative infection is a serious problem in New Zealand and internationally with considerable human and financial costs. Also, in New Zealand, certain factors that contribute to postoperative infection are more common in Māori and Pacific populations. To date, most efforts to reduce postoperative infection have focussed on surgical...

Precision oncology guided by genomic research has an increasingly important role in the care of people with cancer. However, substantial inequities remain in cancer outcomes of Indigenous peoples, including Indigenous Māori in Aotearoa New Zealand (New Zealand). These inequities will be perpetuated unless deliberate steps are taken to include Indig...

The health of Māori, the Indigenous peoples of Aotearoa, New Zealand, like that of almost all Indigenous peoples worldwide, is characterised by systematic inequities in health outcomes, differential exposure to the determinants of health, inequitable access to and through health and social systems, disproportionate marginalisation and inadequate re...

Objectives Ethnic inequities in health outcomes have been well documented with Indigenous peoples experiencing a high level of healthcare need, yet low access to, and through, high‐quality healthcare services. Despite Māori having a high ED use, few studies have explored the potential for ethnic inequities in emergency care within New Zealand (NZ)....

'Race'/ethnicity data have become increasingly institutionalised within research on Indigenous health. While these data are important to monitoring the differential distribution of health risks and benefits in racialised societies, their uncritical and undertheorised use can perpetuate harmful biologically deterministic and essentialist approaches...

Background Postoperative infection is a serious problem in New Zealand, and internationally with considerable human and financial costs. Also, in New Zealand, certain factors that contribute to postoperative infection are more common in Māori and Pacific populations. To date, most efforts to reduce postoperative infection have focused on surgical a...

Background Postoperative infection is a serious problem in New Zealand, and internationally with considerable human and financial costs. Also, in New Zealand, certain factors that contribute to postoperative infection are more common in Māori and Pacific populations. To date, most efforts to reduce postoperative infection have focused on surgical a...

Objective To capture and better understand patients’ experience during their healthcare journey from hospital admission to discharge, and to identify patient suggestions for improvement. Design Prospective, exploratory, qualitative study. Patients were asked to complete an unstructured written diary expressed in their own words, recording negative...

Background Postoperative infection is a serious problem in New Zealand, and internationally with considerable human and financial costs. Also, in New Zealand, certain factors that contribute to postoperative infection are more common in Māori and Pacific populations. To date, most efforts to reduce postoperative infection have focused on surgical a...

Background Although early detection and management of excess rates of gestational diabetes mellitus (GDM) among Indigenous women can substantially reduce maternal and offspring complications, current interventions seem ineffective for Indigenous women. While undertaking a qualitative study in a rural community in Northland, New Zealand about the co...

Background: Postoperative infection is a serious problem in New Zealand, and internationally with considerable human and financial costs. Also, in New Zealand, certain factors that contribute to postoperative infection are more common in Māori and Pacific populations. To date, most efforts to reduce postoperative infection have focused on surgical...

Pancreatic neuroendocrine tumors (pNETs) are uncommon cancers arising from pancreatic islet cells. Here we report the analysis of gene mutation, copy number, and RNA expression of 57 sporadic well-differentiated pNETs. pNET genomes are dominated by aneuploidy, leading to concordant changes in RNA expression at the level of whole chromosomes and chr...

Background Timely advanced hospital level care gives the injured patient the best chance of survival from time critical injury. Little is known about the coverage and accessibility of emergency ambulance services in New Zealand despite the fact that New Zealand’s long travel distances and dispersed population present many challenges to the delivery...

Background Trauma-related injuries are a common cause of mortality globally. There has been little examination of prehospital fatalities (deaths occurring either at the scene of the injury event or en route to hospital) and the identification of primary and secondary prevention opportunities in the prehospital setting to prevent trauma-related fata...

The determinants of health inequities between Indigenous and non-Indigenous populations include factors amenable to medical education’s influence—for example, the competence of the medical workforce to provide effective and equitable care to Indigenous populations. Medical education institutions have an important role to play in eliminating these i...

Aim: To investigate differences in survival after diagnosis with colorectal cancer (CRC) by rurality, ethnicity and deprivation. Methods: In this retrospective cohort study, clinical records and National Collections data were merged for all patients diagnosed with CRC in New Zealand in 2007-2008. Prioritised ethnicity was classified using New Ze...

Introduction There is significant international interest in the economic impacts of persistent inequities in morbidity and mortality. However, very few studies have quantified the costs associated with unfair and preventable ethnic/racial inequities in health. The proposed study will investigate inequities in health between the indigenous Māori and...

Screening and brief intervention for hazardous alcohol use in trauma care settings is known to reduce alcohol intake and injury recidivism, but is often not implemented due to resource constraints. Brief interventions delivered by mobile phone could overcome this challenge. This study aimed to evaluate the effect of a mobile phone text message inte...

A national health target for length of stay in emergency departments (ED) was introduced in 2009 to reduce crowding and improve quality of care. We aimed to determine whether the target was associated with changes in time to CT and appropriateness of CT imaging, as markers of care quality for suspected acute traumatic brain injury (TBI). We underto...

Excellent health research is essential for good health outcomes, services and systems. Health research should also build towards equity and in doing so ensure that no one is left behind. As recipients of government funding, researchers are increasingly required to demonstrate an understanding of their delegated responsibilities to undertake researc...

Pancreatic neuroendocrine tumors (pNETs) are uncommon cancers arising from pancreatic islet cells. Analysis of gene mutation, copy number and RNA expression of 57 sporadic pNETs showed that pNET genomes are dominated by aneuploidy. Remarkably, ~25% of pNETs had genomes characterized by recurrent loss of heterozygosity (LoH) of the same 10 chromosom...

Aims: The purpose of this study was to identify predictors of remediation in a medical programme and assess the underlying causes and the quality of remediation provided within the context of a recent curriculum change. Methods: A mixed methods study incorporating a retrospective cohort analysis of demographic predictors of remediation during 20...

Aim: To determine whether implementation of a national health target called Shorter Stays in Emergency Departments impacted on clinical markers of quality of care. Method: A retrospective pre- and post-intervention study from 2006 to 2012 examined quality of care metrics for five different indicators at different sites in relation to the impleme...

Aim: The impact of national targets for emergency department (ED) length of stay (LOS) on patient care is unclear. This study aimed to determine the effect of New Zealand's six-hour time target (95% of ED patients discharged or admitted to hospital within six hours) on a range of quality indicators. Methods: A nationwide observational study from...

Tertiary institutions internationally aim to increase student diversity, however are struggling to achieve equitable academic outcomes for indigenous and ethnic minority students and detailed exploration of factors that impact on success is required. This study explored the predictive effect of admission variables on academic outcomes for health pr...

Aim: Timely access to computerised tomography (CT) for acute traumatic brain injuries (TBIs) facilitates rapid diagnosis and surgical intervention. In 2009, New Zealand introduced a mandatory target for emergency department (ED) stay such that 95% of patients should leave ED within 6 h of arrival. This study investigated whether this target influe...

Background Behavioural brief interventions (BI) can support people to reduce harmful drinking but multiple barriers impede the delivery and equitable access to these. To address this challenge, we developed YourCall™, a novel short message service (SMS) text message intervention incorporating BI principles. This protocol describes a trial evaluatin...

Over the past decade, there has been increasing attention paid to the role of assessment in higher education learning. A core message of these discussions is that the most effective way of changing how and what students learn is to change the way they are assessed (Norton, 2013). This resource on assessment for Indigenous health education is the ou...

Background: Tertiary institutions are struggling to ensure equitable academic outcomes for indigenous and ethnic minority students in health professional study. This demonstrates disadvantaging of ethnic minority student groups (whereby Indigenous and ethnic minority students consistently achieve academic outcomes at a lower level when compared to...

Background Despite known benefits, brief interventions (BIs) for problem drinking are often not implemented in trauma care wards due to resource constraints. We evaluated a mobile phone text message intervention (YourCall) designed to overcome this challenge. Methods Of 1564 potentially eligible injured patients aged 16–69 years recruited from the...

Background Marijuana is one of most widely used illicit substances globally. The risks of injury experienced by marijuana users relative to non-users have been poorly quantified in prospective studies. We investigated the associations between marijuana use and fatal or hospitalised injury in the New Zealand Blood Donors’ Health Study. Methods At r...

Background Notwithstanding difficulties in ascertaining intent, aetiological studies on adult poisoning typically focus on intentional or unintentional events as distinct entities. This study investigated the predictors of hospital admissions or deaths for intentional and unintentional poisoning in adult New Zealanders. Methods The 22,389 particip...

Aim: Colorectal cancer is one of the most common cancers, and second-leading cause of cancer-related death, in New Zealand. The PIPER (Presentations, Investigations, Pathways, Evaluation, Rx [treatment]) project was undertaken to compare presentation, investigations, management and outcomes by rurality, ethnicity and deprivation. This paper report...

Objective Time targets for ED stays are used as a policy instrument to reduce ED crowding. There is debate whether such policies are helpful or harmful, as focus on a process target may divert attention from clinical care. The objective of this study is to investigate whether the Shorter Stays in Emergency Departments target in New Zealand was asso...

Objective: There is debate whether targets for ED length of stay introduced to reduce ED overcrowding are helpful or harmful, as focus on a process target may divert attention from clinical care. Our objective was to investigate the effect of a national ED target in Aotearoa New Zealand on the recommended care for acute asthma as this is known to...

Introduction Achieving health equity for indigenous and ethnic minority populations requires the development of an ethnically diverse health workforce. This study explores a tertiary admission programme targeting Māori and Pacific applicants to nursing, pharmacy and health sciences (a precursor to medicine) at the University of Auckland (UoA), Aote...

Background Universities should provide flexible and inclusive selection and admission policies to increase equity in access and outcomes for indigenous and ethnic minority students. This study investigates an equity-targeted admissions process, involving a Multiple Mini Interview and objective testing, advising Māori and Pacific students on their b...

Bridging/foundation programmes are often provided by tertiary institutions to increase equity in access and academic performance of students from under-served communities. Little empirical evidence exists to measure the effectiveness of these bridging/foundation programmes on undergraduate academic outcomes. This research identifies the predictive...

Background: Screening for alcohol misuse and brief interventions (BIs) for harm in trauma care settings are known to reduce alcohol intake and injury recidivism, but are rarely implemented. We created the content for a mobile phone text message BI service to reduce harmful drinking among patients admitted to hospital following an injury who screen...

Aim: Doctors must ensure they are fit to practise medicine. There is a relationship between unprofessional behaviour at medical school and in subsequent medical practice. This study describes one programme's Fitness to Practice (FtP) policy and outcomes since inception in 2005. Method: FtP notifications were classified into: health or personal;...

Objectives Compare the prevalence of self-reported abnormal sleep duration and excessive daytime sleepiness in pregnancy among Māori (indigenous New Zealanders) and non-Māori women versus the general population, and examine the influence of socio-demographic factors. Methods Self-reported total sleep time (TST) in 24-hrs, Epworth Sleepiness Scale...