{"id":49201,"date":"2020-12-10T17:21:26","date_gmt":"2020-12-10T16:21:26","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=49201"},"modified":"2020-12-10T17:21:26","modified_gmt":"2020-12-10T16:21:26","slug":"covid-19-an-urgent-threat-and-an-opportunity-for-indigenous-and-minority-groups-in-high-income-countries","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2020\/12\/10\/covid-19-an-urgent-threat-and-an-opportunity-for-indigenous-and-minority-groups-in-high-income-countries\/","title":{"rendered":"Covid-19: an urgent threat and an opportunity for Indigenous and minority groups in high-income countries"},"content":{"rendered":"<p><span style=\"font-weight: 400\">Beyond the devastating direct impacts of the covid-19 pandemic, there is an additional threat to the health of minority and Indigenous peoples. The covid-19 pandemic is stretching health and social systems worldwide, leading to <\/span><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/32604016\/\"><span style=\"font-weight: 400\">reduced access to care<\/span><\/a><span style=\"font-weight: 400\"> and support for non-covid-19 health concerns. These significant health gaps will increase morbidity and mortality unrelated to covid-19 infections. Covid-19 health gaps will have a <\/span><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/32628335\/\"><span style=\"font-weight: 400\">greater impact on Indigenous<\/span><\/a><span style=\"font-weight: 400\"> and minority peoples in high-income countries because they already experience reduced access to healthcare and poorer health outcomes because of systemic racism. The pandemic has added the <\/span><a href=\"https:\/\/www.bmj.com\/content\/369\/bmj.m1557\"><span style=\"font-weight: 400\">cumulative <\/span><span style=\"font-weight: 400\">burdens<\/span><\/a><span style=\"font-weight: 400\"> of unemployment, reduced connectivity and housing, and food insecurity.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Potential covid-19 health gaps include, but are not limited to:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">cancer screening and treatment\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">maternity care<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">chronic disease management<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">childhood vaccination.\u00a0<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400\">Urgent planning, action, and investment could lessen the negative impact of these health gaps and avert substantial personal and public health costs. <\/span><span style=\"font-weight: 400\">Just as there are &#8220;shovel-ready&#8221; projects identified by governments around the world for investment to stimulate economies in response to the pandemic, we should be identifying and using innovative &#8220;ready-to-go&#8221; pathways and equitable approaches to reduce <\/span><span style=\"font-weight: 400\">avoidable harm and death.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Key to this is the health system working in partnership with Indigenous and minority communities to achieve common goals.<\/span><span style=\"font-weight: 400\"> The partnership must define the health pathway,\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">The health care pathway could be as simple as introducing <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6529022\/\"><span style=\"font-weight: 400\">HPV self-testing to prevent cervical cancer<\/span><\/a><span style=\"font-weight: 400\">. This safe, effective test has <\/span><a href=\"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/full\/10.1111\/ajo.12933\"><span style=\"font-weight: 400\">high acceptability for Indigenous<\/span><\/a><span style=\"font-weight: 400\"> and minority women, is contactless, and will enable screening to catch up and increase coverage.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">We have used this proactive framework to address covid-19 maternity care gaps for M\u0101ori, the Indigenous peoples of Aotearoa\/ New Zealand. As a result of the stay-at home edicts, <\/span><a href=\"https:\/\/gh.bmj.com\/content\/5\/6\/e002967\"><span style=\"font-weight: 400\">pregnant women are not connecting<\/span><\/a><span style=\"font-weight: 400\"> to essential maternity care.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Time-sensitive maternity care in the first trimester of a pregnancy is essential to avoid later morbidity and mortality for women and babies. When we went into countrywide lockdown, we immediately formed a community \/ tribal and clinician partnership to improve access to time-sensitive care for pregnant M\u0101ori women (hap\u016b m\u0101m\u0101) and their families. This collaboration produced the first trimester maternity care toolkit &#8211; <\/span><a href=\"http:\/\/www.hapumamaconnecting.org.nz\"><span style=\"font-weight: 400\">Hap\u016b M\u0101m\u0101 Connecting<\/span><\/a><span style=\"font-weight: 400\"> (HMC) &#8211; which is endorsed by the Royal New Zealand College of General Practitioners.<\/span><\/p>\n<p><span style=\"font-weight: 400\">The toolkit can be used by GPs, nurses, and midwives to triage care and further assessment over the phone, guiding time-sensitive, evidence-based care. As a single-page form covering clinical care and wraparound support prompts, such as housing and food security, the tool can &#8220;sort&#8221; pregnancies and families that need timely intervention, provide treatment support, and connect women to their next stage in the maternity pathway. For example, if a woman has previous pre-eclampsia the toolkit prompts the health worker to ensure she receives aspirin and calcium at the critical point in her pregnancy and then referred to a specialist service.<\/span><\/p>\n<p><span style=\"font-weight: 400\">An integral part of the HMC approach is increasing community awareness. In this example, we deliver messages about timely care to M\u0101ori women who might be pregnant through tribal networks and organisations, M\u0101ori health providers and tribal partners who are active members of the research team. <\/span><a href=\"https:\/\/www.facebook.com\/HarlemCruzAtarangiIhaia\/photos\/a.1791729784474817\/2535316813449440\/\"><span style=\"font-weight: 400\">M\u0101ori social media ambassadors<\/span><\/a><span style=\"font-weight: 400\"> are sharing messages to increase the spread of information and encourage women to access time-sensitive care.<\/span><span style=\"font-weight: 400\">\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">In this model general practice is central, representing a trusted carer with expertise paired with local tribal or minority peoples\u2019 networks and messages, to enhance access to under-served families.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Also key to policy changes to improving equity is the voice of Indigenous peoples. Some of the nation\u2019s leading M\u0101ori medical and health experts including Primary Care Specialists, Public Health experts, Public Health Physicians, M\u0101ori Nurses and iwi leaders came together\u00a0 to form Te R\u014dp\u016b\u00a0Whakakaupapa Urut\u0101 (M\u0101ori Pandemic committee) to inform, address and innovate for M\u0101ori as we face these unique times.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">As well as the devastating direct impact of the covid-19 virus, the potential health gaps associated with reduced access to care and support threaten already underserved communities. Health systems and providers need to take this as an opportunity to do things differently to improve outcomes\u2014to be innovative\u2014and to share what is working. There are no excuses for waiting until after the pandemic to count the costs of covid-19 health gaps for Indigenous and minority peoples.<\/span><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Bev Lawton<\/strong> (ONZM), from the M\u0101ori (Indigenous peoples of New Zealand) tribal group Te-Aitanga-a-Hauiti, is the founder\/director of Te T\u0101tai Hauora o Hine (the Centre for Women\u2019s Health Research) at Victoria University of Wellington, New Zealand. The mission of the centre is to eliminate avoidable harm with a focus on Indigenous health and wellbeing.\u00a0<\/span><\/em><\/p>\n<p><em><span style=\"font-weight: 400\">Contributing authors include Hap\u016b M\u0101m\u0101 Connecting R\u014dp\u016b, an expert advisory group of Iwi (tribal) Elders and leaders, clinicians, and researchers, including Bev Lawton (Chair), Francesca Storey, Dr Liza Edmonds, Matthew Bennett, Charles Lambert, Professor Stacie Geller, Dr John McMenamin, Professor Peter Stone, Anna Adcock, Potace Bennett, Dr E Jane MacDonald, Wendy Dallas-Katoa, Jordy Hermens &amp; Tarra McNally.\u00a0<\/span><\/em><\/p>\n<p><em><strong>Competing interests<\/strong>: None declared.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Beyond the devastating direct impacts of the covid-19 pandemic, there is an additional threat to the health of minority and Indigenous peoples. The covid-19 pandemic is stretching health and social [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2020\/12\/10\/covid-19-an-urgent-threat-and-an-opportunity-for-indigenous-and-minority-groups-in-high-income-countries\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":66,"featured_media":46950,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[263],"tags":[],"class_list":["post-49201","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-global-health"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Covid-19: an urgent threat and an opportunity for Indigenous and minority groups in high-income countries - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2020\/12\/10\/covid-19-an-urgent-threat-and-an-opportunity-for-indigenous-and-minority-groups-in-high-income-countries\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Covid-19: an urgent threat and an opportunity for Indigenous and minority groups in high-income countries - The BMJ\" \/>\n<meta property=\"og:description\" content=\"Beyond the devastating direct impacts of the covid-19 pandemic, there is an additional threat to the health of minority and Indigenous peoples. 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