Access to health care for rural underserved populations in New Zealand and the United States

This presentation will describe issues related to access to health care for rural underserved populations in New Zealand and the United States; specifically a rural Mãori population and a rural Indiana population. Despite the geographic distance and the cultural differences which exist, the health problems related to access to health care are similar in both settings. Both populations share adverse social statistics which affect access to appropriate health care and health status. These include higher unemployment, poorer, sub-standard housing conditions, disparity in income and lower educational attainment. Common health problems for both populations include diabetes, obesity, cardiac and respiratory illnesses, and mental health issues which result in disparities affecting morbidity and mortality. Nurse-managed health centers have been instrumental in addressing the issues of access and advocacy in both settings. The centers deliver family and community-oriented primary health care and utilize a community development model to plan, implement and evaluate health services. Attending to factors of cultural competency and cultural safety have proved to be essential in affecting both the perceptions of nurse-managed services and the health outcomes. Cross cultural research has demonstrated a high level of client and community satisfaction with care in these nurse-managed centers. Nurse-managed care has been shown to balance both the immediate and long term needs of the populations by addressing the social determinants of health and reducing inequalities in health care access. Opportunities for nurses to impact the development of health policy for vulnerable populations in both settings will be discussed.