Paul Callister

Measuring Ethnicity in New Zealand: Developing Tools for Health Outcomes Analysis

Objective. This study examines the development of new tools for analysing links between ethnicity and health outcomes. In a New Zealand context, it focuses on (1) how ethnicity is increasingly articulated as a social construct, (2) how individuals belonging to more than one ethnic group have been recorded and reported in research, and (3) health research and policy implications of the growing proportion of New Zealanders who claim multi-ethnic affiliations. Design. New Zealand provides a microcosm in which to consider ethnicity, indigeneity, migration and intermarriage, and their interacting effects on society, culture, identity and health outcomes. Against a backdrop of historical debates about the measurement of race, and then ethnicity, the paper explores recent changes in the recording and reporting of ethnicity in the five-yearly Census of Population and Dwellings, and in death registrations. These changes are then considered in relation to the study of ethnic health disparities and the development of policies to overcome them. Results. In the 2001 Census, of those who responded to the ethnicity question, at a level 1 classification 7.9% gave more than one response. In relation to the indigenous people of New Zealand, of all those who recorded Māori as one or more of their ethnic groups, only 56% recorded Māori only. In the younger age groups, less than half the Māori ethnic group were Māori only. Single ethnic categories disguise considerable within-group diversity in outcomes. Conclusion. While single ethnic group disparity studies have been useful in the past, we suggest that more sophisticated ways of conceptualising and analysing ethnicity data in relation to health disparities are now required in New Zealand. Based on the New Zealand experience, we also suggest that as international migration continues, and as intermarriage becomes more frequent in most countries, there will be pressure to move from single group race-based measures towards culturally-based complex ethnicity measures.

Globalisation, localisation and implications of a transforming nursing workforce in New Zealand: opportunities and challenges

Severe staff and skill shortages within the health systems of developed countries have contributed to increased migration by health professionals. New Zealand stands out among countries in the Organisation for Economic Co-operation and Development in terms of the high level of movements in and out of the country of skilled professionals, including nurses. In New Zealand, much attention has been given to increasing the number of Māori and Pacific nurses as one mechanism for improving Māori and Pacific health. Against a backdrop of the changing characteristics of the New Zealand nursing workforce, this study demonstrates that the globalisation of the nursing workforce is increasing at a faster rate than its localisation (as measured by the growth of the Māori and New Zealand-born Pacific workforces in New Zealand). This challenges the implementation of culturally appropriate nursing programmes based on the matching of nurse and client ethnicities.

Chapter 10 – Framing Debates about Risk for Skin Cancer and Vitamin D Deficiency in New Zealand: Ethnicity, Skin Color, and/or Cultural Practice?

Abstract Skin cancer is the most common cancer in New Zealand. Australia and New Zealand also lead the world in melanoma incidence rates. This is attributed to various geographical, demographic, and behavioral characteristics in both countries, including high summer ultraviolet radiation (UVR) levels, predominantly fair- to medium-skinned populations, and an outdoor lifestyle. Although excess sun exposure is harmful, some sun is beneficial, including for vitamin D production. Vitamin D is important for bone and muscle health, but there is some evidence to suggest that it may also protect against some types of cancer and other conditions. In New Zealand, the “European” ethnic group is most at risk of developing melanoma. While melanoma has been relatively rare among Maori and Pacific populations, there have been recent increases, particularly among Maori. Maori and Pacific children also have, on average, lower vitamin D levels than European children. We begin this chapter by considering recent New Zealand debates about risks for both skin cancer and vitamin D deficiency. We then highlight some lack of clarity over whether it is “race,” ethnicity, skin color, or, perhaps, cultural practices or some combination of these that are key risk factors. Against this background, we explore the conundrums presented in providing “SunSmart” advice based on group membership.