The high price of being labelled “high risk”: Social context as a health determinant for sudden unexpected infant death in Māori communities

Abstract

Background: For over 25 years, nationwide efforts to address sudden infant death in New Zealand have focused on advising parents to avoid four risk factors labelled as modifiable. But Māori infants still have sudden unexpected death in infancy (SUDI) at five times the rate of non-Māori. Aim: This paper expands the conceptualisation of SUDI risk factors and suggests a reconsideration of the use of risk factor terminology. Discussion: Working from the assumption that health outcomes are influenced by social determinants, we put forward two key propositions. Firstly, we argue (using maternal smoking as a case in point) that greater attention must be paid to the role of social and socioeconomic factors in the prevention of SUDI in Māori communities. Secondly, we propose that the language of risk reduction impedes Māori engagement with health services because the discourse associated with being "at risk" and "vulnerable" casts Māori in a deficit framework affecting how Māori are perceived by health professionals and, more importantly perhaps, how Māori see themselves.

A tangata whenua (people of the land) approach to conceptualising Māori health and wellbeing

“…To further improve Māori wellbeing and position in society necessitates a shift away from the deficit and narrow focus of reducing disparities that a needs-based approach such as equity might foster (4). What is required is the promotion of cultural constructs of wellbeing as prescribed by our own Māori leaders such as Pōmare, situated within positive Māori-led notions of self-determination, cultural identity and collectivity.…”

“…While such an equity approach that focuses on grouping populations by ethnicity has helped to expose Māori health inequalities, it still emphasises majority non-Indigenous standards and compares Māori against these standards, often resulting in deficit approaches, and ‘whitestream’ measurements and solutions (3). This also contributes to the stigmatisation and problematisation of Māori who are deemed ‘less than’, ‘at-risk’ or ‘vulnerable’ to worse health outcomes (4).…”