Ethnicity

Ethnicity is a construct that includes history, language, cultural orientation and behaviours, spiritual beliefs, religion, lifestyle and biology, all of which have an individual and combined effect on lifestyles, socioeconomic factors and access to health care for indigenous people (Pearce, Foliaki, Sporle & Cunningham, 2004). According to Durie (2005) ethnicity is a distinctive factor that can be explained by describing two major categories. The first includes the characteristics of the indigenous groups themselves such as ‘genetic predisposition, customary beliefs and cultural practices’ and the second relates to ‘explanations outside the ethnic groups such as discriminatory behavior in the provisions of services, access to economic opportunities, stereotypical preconceptions towards people of other cultures and rejection of ethnic and cultural values and aspirations, all of which influence social outcomes’ (Durie, 2005, p. 43).

There are some theories that cancer presents in a more aggressive phenotype amongst minority ethnic groups. Thus, “biologic differences could explain some of the associations between low SES and both stage and mortality” (Byers et al., 2008, p. 586). While this could explain some associations, Pearce et al., (2004) suggest that ethnic disparity could be more a result of environmental factors such as housing, employment and lifestyle behaviours that have a direct effect on health and increased

risk factors of cancer. Ibrahim, Thomas and Fine (2003) suggest that characteristics and practice of some health care professionals including racism, bias, discrimination, stereotyping and cultural incompetence is another explanation for disparities in health for minority ethnic groups through an inability to successfully engage and therefore treat ethnic minorities.

A further theory for explaining the larger racial disparities in cancer mortality in USA also came from Byers et al., (2008), who reported that medical care is ultimately dependent upon economic status. It was therefore hypothesised that the disparity was due to a larger proportion of minor racial groupings found in lower SES areas where people cannot afford the higher quality treatments. This has been supported by findings, that in an organised health setting such as Department of Defence and Veterans Administration where healthcare inequalities are smaller, racial minorities experience better outcomes (Jeffrey’s et al., 2009).

Overseas research indicates that indigenous cultures and displaced ethnic groups all over the world experience health disparities and poor health outcomes. People of indigenous cultures, particularly those that have been colonised, suffer poorer levels of health than those of the dominant culture (Aishing-Giwa, 2004; Boffa, 2008; Byers et al., 2008; Cancer Control Taskforce, 2005; Coory et al., 2008; Durie, 2005; Gill & Martin, 2002; Pearce et al., 2004). For instance, research in Australia suggests that the Aboriginal population have a lower cancer survival rate than non-Aboriginals, are less likely to be offered diagnostic or therapeutic procedures, or receive adequate cancer management (Boffa, 2008; Coory, Green, Stirling, Valery, 2008). In a large study of breast cancer survivors in USA including

that disparities in stage of diagnosis, survival, morbidity and mortality exist for ethnic minority women, many of whom are diagnosed at more advanced stages than other American women (Ashing-Giwa, 2004). Native American Indians and Alaskan Natives also experience less screening for cancer, higher degrees of late stage prognosis and higher mortality rates (Wiggins et al., 2008).

New Zealand is an ethnically diverse country of approximately four million people. According to Statistics New Zealand (2006), 14.6% of the population as Asian. The remaining 69.3%

consists of mostly European .

(people of the land) as affirmed by the Treaty of Waitangi and represent the indigenous/ethnic group of New Zealand. Statistics suggest that there are three main patterns of inequities for ; (a)

deprived neighbourhoods (deciles 8-10), (b) despite controls for deprivation and (c)

more seriously affected by socioeconomic status than other ethnic groups in New Zealand (Reid, Robson, & Jones, 2000). These disparities are displayed in Figure 1 below (Cormack et al., 2005, p. 17).

Other research indicates that “M ori have a poorer health status mentally and physically than non-M ori, regardless of their level of education, income or occupation” (Cancer Control Taskforce, 2005, p. 5; Durie, 2005), and approximately twice the cancer mortality rate of non-

Figure 1. -

Perceived social support is recognized as an important factor in Mental QOL. However the

reported lower levels of perceived social support than non-

levels reduced with age, socioeconomic status, income and levels of educational qualifications (Stephens & Noone, 2008).

Socioeconomic status may provide some explanation as to why are reported to be disproportionately represented in cancer statistics, with inequalities apparent in risk, incidence and outcomes (Cormack et al., 2005). However, research

always take advantage of healthcare offered, for reasons such as rurality, transport costs, and perceived cultural safety (Barnett & Kearns, 1996; Jeffrey’s et al., 2005; Pearce et al., 2004). Whether or not these are

224.6 120.1 218.8 136.3 181.9 59.0 199.4 74.2 0 50 100 150 200 250 Mäori non-Mäori

ri are medically underserved in New Zealand, (Cormack et al., 2005; Durie, 2005; Robson,

to the expected need (Jeffreys et al., 2005).

Another issue related to ethnicity and socioeconomic status is employment. According to the Labour Department (2009) are over-represented in lower skilled jobs within at-risk industries, which largely involve physical work. This could imply that for who develop cancer, the chance of returning to work following treatment is substantially reduced because of the nature of the employment and inability to continue to be employed in physical work. Furthermore leave entitlements and the flexibility of working hours could impact upon access to cancer services, time available for treatment plans particularly for those who may depend upon others for transport (Robson, 2004).

However, other research has found that in rural districts where local iwi based utilisation of health services is higher than that

improved cultural fit of services provided, or the availability of health services, however the fact remains that are still underserved. Whilst there is a strong -led healthcare and services, there is still a lack of qualified

continue until the status quo improves. Such disparities impact significantly on both QOL and cancer survivorship through failing to access adequate healthcare and lacking the support networks within and the knowledge of healthcare resources to gain assistance as required.