Health outcomes for young Māori are improving but "systematic discrimination and poverty" continue to drive stubborn inequities, researchers say.
A paper published today found despite general health improvements, young Māori continued to be exposed to disproportionately high levels of poverty, which carried "significant health burdens".
The paper, published in the Australian and New Zealand Journal of Public Health, was based on data from anonymous Youth2000 surveys in New Zealand high schools in 2001, 2007 and 2012, and included responses from more than 27,000 pupils aged between 12 and 19, including nearly 6000 Māori.
The study said exposure to poverty "stubbornly" remained as a major driver of inequities, particularly for areas such as mental health and suicide rates. Sexual health, obesity and poor access to healthcare were also highlighted as areas with comparatively little resourcing.
"Urgent attention is required to address these under-served areas of health acknowledging ongoing colonialism and interstices of racism, sexism, fat stigma, poverty and violence that threatens Māori youth wellbeing," the study said.
Corresponding author Dr Terryann Clark of the University of Auckland said overall there had been some "significant improvements" for young Māori between 2001 and 2012.
These included a more than 50 per cent reduction in smoking, and a nearly as large drop in binge drinking.
"Those are quite dramatic changes that we don't normally see in such a short space of time," said Clark, a senior lecturer in nursing.
"It shows that when policies and resources are targeted to address inequities, such as increasing tax on alcohol and tobacco, they can be effective."
There were also small improvements in regards to family circumstances, family connectedness, school connectedness, neighbourhoods, and bullying and violence.
Gaps between Māori and New Zealand/European students were narrowing on most indicators, except for parents worrying about not having enough money for food, and being bullied at school.
The "not so good news" were around sexual health, mental health and obesity issues, Clark said.
In 2012 young Māori were "significantly more likely" to have moved home two or more times in the previous year, reported witnessing family violence at home, experienced sexual abuse, or been in a serious physical fight. They were also more likely to rate their general health as fair or poor, and less likely to see a doctor.
However, when socioeconomics and poverty were factored into the data, those inequities decreased.
"It shows a lot of the differences in health and equity can be explained by extreme poverty many Māori whānau experience," Clark said.
Adding to this was more than 25 per cent of young Māori reporting experiencing discrimination through health providers.
Clark said this could deter young people from accessing the healthcare they needed.
"The healthcare system is not youth appropriate, nor culturally competent. It needs to make young Māori feel more comfortable.
"I have spoken to young people, who finally had the courage to speak to somebody about mental healthcare, and then had their names mispronounced and felt judged.
"If they don't feel respected, they don't go back."
Poverty and access issues made it even more difficult.
"Primary care costs. It is free for children, but not for teenagers, and we know that is creating a significant barrier."
Improving access to healthcare, with initiatives like increasing healthcare in schools and community nurses, and increasing the time spent with young patients to build up trust, were crucial, Clark said.
"A lot of services require people to go into a little room with someone they have never met for 15 minutes and talk about some of their most intimate issues, but what we know is working with young people takes time to build up trust.
"We need to redesign how young people can engage with health services, and make them easier to access."
The study also called for obligations under Te Tiriti o Waitangi to be respected, meaning the right to equity of health and social outcomes.
"Māori youth as Te Tiriti o Waitangi partners need better – and deserve better. This should be a major driver for action."