The allied oral health team in New Zealand serving Māori people

1. The allied oral health team in New Zealand serving Māori people Dr L A Foster Page University of Otago BSc, BDS, Dip Clin Dent, M Com Dent, PhD

2. History • NZ government noted the appalling state of soldiers teeth in WWI • Survey showed 90% of NZ children required dental care • Introduced trained women into primary schools to educate children and families on healthy living and nutrition and provide treatment • World first • 1921 SDS began with “dental nurses” entering the workforce 2 years later

3. Dental Therapy Training • Two training institutes in NZ • AUT University • Bachelor of Health Sciences in Oral Health 2002 • Bachelor of Health Sciences in Oral Health 2006 (Hygiene/Therapy) intake numbers doubled • Plan to introduce Adult Scope into degree in future • University of Otago • Diploma in Dental Therapy 1999 • Bachelor of Health Sciences (Dental Therapy) 2002 • Bachelor of Oral Health 2007 (Hygiene/Therapy) • HPCA • Dental therapists registered 2003

4. Bachelor of Oral Health Three year degree Three kete, created especially for all BOH students by KahutoiTeKanawa, were unveiled and these tell the story of the new degree. Combination of three skills Dental hygiene, dental therapy and health promotion

5. BOH Programme at the University of Otago Coates DE, Kardos TB, Moffat SM, Kardos RL. Dental Therapists and Dental Hygienists Educated for the New Zealand Environment. Journal of Dental Education 73: 1005 – 1012; August 2009

6. Dental Therapists Scope of Practice • Dental therapists and dentists have a consultative working relationship. • Documented in an agreement between the parties. • Work in collaboration with dentists and other health care professionals. • In partnership with individuals, whãnau and communities. • Dental therapists provide oral health assessment, treatment, management and prevention services for children and adolescents up to age 18. • Disease prevention and oral health promotion and maintenance are core activities.

7. Dental Hygienists Scope of Practice • Dental hygienists practise in a team situation with clinical guidance provided by a practising dentist or dental specialist1, though some aspects of the scope of practice are provided under direct clinical supervision2. • 1Clinical guidance means the professional support and assistance provided to a dental hygienist by a practising dentist or dental specialist as part of the provision of overall integrated care to the patient group. • 2Direct clinical supervision means the clinical supervision provided to a dental hygienist by a practising dentist or dental specialist when the dentist is present on the premises at the time the dental hygiene work is carried out.

8. Safety and OHT Scope • Safety • HPCA 2003 • No disciplinary proceedings undertaken to date • Lowest disciplinary fee on their APC compared with dentists and dental technicians • Annual report • www.dentalcouncil.org.nz • Scopes • NZ dual qualified practitioners • Decide how/if scopes of practice require change • Change of name? OHT or OHP • Supervision/clinical guidance/adult scope • Working group August 19th in NZ – Chair

9. Treaty of Waitangi • New Zealand’s “founding document” • Signed in 1840 • Basis of relationship between Crown (government) and Māori • Living document • Three articles • Māori and English versions

10. Can Māori Health Status Be Considered a Breach of the Treaty? Article 1 – good governance • Life expectancy, disparities in health status, differences in outcomes from health sector activity Article 2 – self-determination • Right to be involved with provision of health services • Health as a taonga (treasured thing) Article 3 – equity of outcome • Inequities

11. Holding a mirror to society? The socio-demographic characteristics of the University of Otago’s health professional students

12. Socio-demographic characteristics of BOH • 2010 Male 12.9% Female 87.1% • Does not reflect NZ (Male 49%, Female 51%) • 2010 Deprivation reflect NZ more than the other health science professions • Reflect NZ society of mixed socioeconomic advantage Crampton et al. NZMJ 2012, Vol 125 No 1361; ISSN 1175 8716 P URL: http://www.nzma.org.nz/journal/125-1361/5323/

13. Socio-demographic characteristics of BOH 2007 34 students enrolled in BOH (all years), 1 was Māori (3.0%) 2010 116 students (all years), 7 Māori (6.1%) 2013 126 students (all years), 9 Māori (7.2 %)

14. Holding a mirror to society? • Indigenous health and Pacific health are areas of special responsibility because of history and our location as a Pacific nation. • In the case of Māori health New Zealand’s Universities, acting as agents of government, have a dual obligation • To honour both the contractual obligations defined in the Treaty of Waitangi • The responsibility to correct the inequitable health outcomes experienced by Māori populations. • Selection policies should attempt to counter some of these historical and social forces.

15. University Policy • University of Otago has a range of strategic policies • Play our part in modifying the historic imbalances • Two categories: • Those aimed at attracting and recruiting students from diverse backgrounds, • Those aimed at responding to the specific learning needs of vulnerable student groups (for example, those from high deprivation schools).

16. How can we achieve this • University of Otago has a two semester Health Sciences programme • Prepares Māori students academically for their first year of tertiary study and a future career in Māori health. • TūKahikaprogramme http://www.otago.ac.nz/tukahika/ • University of OtagoMāori Centre

17. How can we achieve this • Support for Science programmes for Māori students at high school • Scholarships from Māori Providers, DHBs and Iwi • Mentoring by Te Ao Marama • All Māori students in all our programmes can attend • Provide opportunities for cultural education programs with Māori Providers • Dental assisting in clinics to encourage young Māori into the workforce

18. Future directions for a Māori dental therapy workforce • Published in March 2011 by the Ministry of HealthNew Zealand • This document is available on the Ministry of Health’s website: http://www.moh.govt.nz • ISBN 978-0-478-37433-9 (online)HP 5292

19. Policy implications • 1. Māori children and young people urgently need good oral health care. • 2. Māori secondary school student science attainment needs to Increase. • 3. The number of Māori training to be dental therapists needs to increase. This recruitment should be actively supported by scholarships for these students. • 4. The provision of other tertiary options for educating Māori dental therapists should be explored. • 5. DHBs need to make the working conditions and remuneration more attractive. • For Māori dental therapists this also means making the workplace supportive of them being Māori and practicing dental therapy in a way that is compatible with this.

20. Māori training • The number of Māori dental therapists needs to increase. • Enroll at least 8 –10 Māori dental therapy students each year for the next six years • Māori dental therapy workforce that is proportionate to the 0–17-year-old Māori population in 2018. • This recruitment should be actively supported by scholarships for these students.

21. Mere and Awhina

22. Māori College

24. Thank you