“Nan had it, Dad had it, so you're going to get it”: Intergenerational Indigenous Heart Health in Aotearoa New Zealand

Abstract

Cardiovascular disease is the leading cause of death worldwide. To date, very little qualitative research has focused on understanding how those most ‘at risk’ of cardiovascular disease, and those most impacted by systemic inequities and insufficiently resourced health systems, are experiencing heart health. In this paper, we centre the lived experiences of elderly Māori (Kaumātua) and Pacific people living in Te Tairāwhiti, a remote region on the east coast of the North Island of New Zealand with the country's highest heart health mortality rates. Drawing upon focus groups with 54 patients and 24 staff (predominantly Māori and Pacific) in an Iwi [tribal] health provider, we reveal how intergenerational trauma associated with heart health and negative experiences with the medical system continue to prevent many patients and whānau [extended family] from seeking early support from their general practitioners. With such insight, we identify the need for local health services to better recognize intergenerational heart health knowledge and practices (including silencing and fear), and the need for more culturally responsive systems that will not only prevent premature cardiovascular disease and death but also improve the quality of life for current and future generations. Ultimately, this paper encourages a shifting of attention beyond individual disease management and towards intergenerational knowledge, historical trauma, family relationships, trust, and Indigenous understandings of heart health.