This essay discusses the determinants of health in New Zealand with a focus on maternity care in rural areas. The main determinants of health in New Zealand are the social, cultural and economic factors such as genetics, income, education, poverty, culture, occupation and housing. The second part of this essay goes on to describe how objectives of the New Zealand Health Strategy (NZHS) can have a positive impact on health care in New Zealand.
Dew and Matheson (2008) state that the disciplines of epidemiology and social epidemiology have progressively given more descriptions of health inequalities. They also state that epidemiology mainly focuses on how and from where infectious diseases spread, whereas social epidemiology looks at the patterning of health outcomes involved with social characteristics such as gender, ethnicity and income in order to find the causes of differences between these groups. Key determinants of maternity care in rural areas are education, income, a sense of control over life circumstances and access to health care services (Ministry of Health [MoH], 2000).
Full maternity care comprises of prenatal care, early pregnancy care, antenatal care, postnatal care and also full obstetric care (Preston & Miller, 2012). Midwives are the main providers of maternity services in rural areas, who work as either Lead Maternity Carers (LMCs), who provide maternity care for women from early pregnancy up to six weeks postnatal, or are employed by rural maternity hospitals, providing maternity care when women are in the hospital (Kyle & Aileone, 2013). There is an increasing number of expectant mothers who experience difficulties in finding a suitable LMC, especially in rural areas, as there is a shortage of both midwives and obstetricians in some regions (Power, 2009; Preston & Miller, 2012). For women who are unable to access LMC services, the District Health Board (DHB) is funded to provide limited services (MoH, 2014).
According to Kyle and Hendry (2012), the distribution of the midwifery workforce is identified as a key problem of maternity care. Additionally, there are fewer rural facilities employing midwives as a number of them have chosen to become self-employed as LMCs are having to move further afield to gain a fuller caseload (Kyle & Aileone, 2013; Kyle & Hendry, 2012). This, in turn has put added pressure on DHBs to recruit more midwives, and in many cases registered nurses are engaged in this role (Kyle & Hendry, 2012).
Rural hospitals are in many ways disadvantaged in comparison to urban hospitals, which is seen to be the result of the differences in resources available to them (Adair, Coster & Adair, 2011). Information gathered by the National Health Committee (NHC) concludes that in order to enable better and more appropriate service delivery, more emphasis is needed on providing rural communities with comprehensive primary health care, visiting services and transport support, and also more flexible, sustainable...