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IUHPE 4apr19 Whare Haumaru - Injury Prevention in Maori Homes
- 1. Whare Haumaru Injury Prevention in Maori Homes Chris Webber Engagement tool and Doctoral research project to: “examine effects of the Maori Home Injury Prevention Initiative (MHIPI) to reduce falls hazards present in Maori homes” IUHPE Conference 9 April 2019 – WebberNZ@gmail.com 350%, 110% 50%, 30% 250% 5-50% 35% 40% 50% 45% 45,000 1 in 3 1 in 7 $55M $500M
- 2. Timeline & Whakapapa HIPI - Home Injury Prevention Initiative 2010-14 850 homes RCT HHI Assessed Falls hazards reduced (~$600) ACC injuries per home Reduced fall injuries 26-39% DALY Benefit 6x (12x) cost Benefit +60% previous falls MHIPI - Maori Home Injury Prevention Initiative (+150 homes) 2013-16 Whare Haumaru - Chris Webber, Doctorate 2017-20
- 3. Examining the Effects of MHIPI Activity Reports Stakeholders/150 House Audits Maori Housing/MHIPI Surveys/ACC Injuries Effectiveness Interviews/Surveys Appropriateness/Safety Discussion/Desktop Maori lens
- 4. Wairuatanga Whakapapa Kotahitanga Whanaungatanga Manaakitanga Rangatiratanga Ukaipotanga Kaitiakitanga Reo Process People Places Tinana Wairua Hinengaro …...Service Provider Whanau Pae Mahutonga Taura Tieke Treaty ... Tinana – Body/Physical Wairua – Spirit Hinengaro – Mind Whanau - Family Wairua-tanga – Spirituality Whakapapa – Connectedness Kotahi-tanga – Unity Whanaunga-tanga – Relatedness Manaaki-tanga – Caring Rangatira-tanga – Leadership Ukaipo-tanga – Belonging Kaitiaki-tanga - Guardianship Reo – Communication
- 6. Tikanga Customs Tangata People Taiao Environment Children Injuries Suicide Visitors Older People Adults Youth Sports School Occupation al Traffic Home Leisure Violence Rangatira Kaitiaki Reo Whakapapa Kotahi Manaaki SC2 SC1 SC4 SC5 SC6 SC3 Values: Wairua - SC4 Seeing the Need & SC5 Effectiveness; Whanaunga - SC1 Working Together & SC2 Reaching People; Ukaipo - SC3 Priority Care & SC6 Communicating Pa Model* for Safe Communities 2015 Evaluation • Yes • No • • • • • • Pa Model by C Webber Graphic by G. Christie. 1 2 3 65 4 1 Safe as Houses 3 Home Heat 5 Driveway Safety Te Pae Mahutonga (Southern Cross), Maori Health Promotion Model (Durie, 1999)
- 7. Early Signs • High prevalence of mould, Insufficient insulation • Lack of working smoke alarms • High hazard rates stairs, steps, decks, paths • Housing WoF failure on a third of items • Lower quality housing for Maori • More deprived areas in worse condition, more dampness/mould, more injury hazards • Older and overcrowded houses lower quality, more exterior hazards (path, step, light) • Lower standards of ‘acceptable’ housing evident
- 8. Examples of Falls Related Housing Condition ● Bathroom slippery surface 60%, grab rails present 11%, small space 11% ● Stairs in ¼ homes – 4/5 no gate, most without rails, 50% poor lighting ● Window fall hazards - 1/3 high, 1/6 low, 1/10 no latches ● Path falls – 50% (1/3 high), Paths – 50% unsafe, wheelchair access 13% ● Exterior lighting – 1/3 poor ● Glass – 1/5 safety glass ● Yards – 50% poorly fenced (drive/road), 2/3 play area falls hazards ● Fire – 1/6 insufficient fire exits, 1/5 no alarm, 1/5 potential fire risk
- 11. Some Questions ● Who are the stakeholders to consider in this work impacting Maori wellbeing? ● What aspirations and expectations of such work should be involved? ● What indicators/frameworks should be used to plan/evaluate/track progress? ● How does such work impact mauri (life force) of homes or tikanga Maori (customs)? Kia ora – Mauri Ora! C.Webber@Massey.ac.nz
Editor's Notes
- Kia Hiwa Ra Kia Hiwa Ra - kei whakapurua koe ki te toto...traditional call to warn of danger. This research is part of that call - first some figures about injuries: Māori adults (15-64yrs) are 50% more likely than non-Māori to die from unintentional injury (30% more likely to be hospitalised) Maori children (0-14yrs) are 350% more likely than non-Maori to die from unintentional injury (110% more likely to be hospitalised) “Maori are (250 times) more likely than others to sustain serious life-changing injuries, but (5-50%) less likely to access ACC services and around 35% less likely to be referred for elective surgery” ACC SOI 2018-22 So...one of the highest causes of unintentional injury is Falls which comprise nearly 40 percent of ACC claims - nearly half of these are from falls in homes (ACC, 2018). Around 45% of home injuries are from falls. So we’re looking at falls in homes - where people spend most time. There were more than 45,000 home injury claims to ACC by Maori in 2017 1 in 3 were for children (0-14), 1 in 7 were for elderly (60+), active claims cost $55 million ACC spent about $500 million in the past year for (425,000) injuries in homes (to June 2018)
- The Home Injury Prevention Initiative (HIPI) reduced falls injuries 26% by remedying home hazards (39% where environmental contributors identified) - REDUCED INJURIES BY A QUARTER TO 40% Benefits of injuries prevented (DALYs) are at least 6 times intervention cost (or 12x for elderly) 600-1200% ROI 60% higher benefit for those with previous falls (may or may not be cumulative) HIPI (& MHIPI) Process Random Controlled Trial of 840 (+150) homes assessed for housing quality (Healthy Housing Index) and hazards Falls hazards reduced - half at start, half at end after 3 years Differences in ACC injuries per home noted An average of $600 spent per home included things like: smoke alarms, anti-skid mat fixings and bathmats, carpet fold repairs, better illumination, high visibility/non-slip edgings and fixing of handrails and broken steps/stairs So what’s the story for Maori?...
- Initial stakeholder interviews will help scope observed and aspirational indicators around the project - for example which house audit information most needs to be tracked (house size, smoke alarms, homes with stairs etc.)? Cf 200+ measures & no fung shui or hangi stones The MHIPI safety surveys and ACC injury data will be correlated with random control trial Participants from a 10 to 20% sample of MHIPI homes will be interviewed and surveyed regarding their experience of the programme, particularly any positive and negative effects The engagement methodology and issues to arise will be discussed ...