Pandemics affect everyone in society; however, their impact differs across individuals and groups and is heavily influenced by the social, economic, and political determinants of health. Populations already experiencing health disparities will be the most vulnerable during a pandemic. Pacific communities in Aotearoa New Zealand (NZ) share a collective worldview where they are either born in and/or have ancestral links to Polynesia[1], Micronesia, or Melanesia in the South Pacific alongside spiritual and religious affiliation. They are also seen to be highly vulnerable and a high needs population with social and economic disparities prior to the arrival of COVID-19. We believe that the success of a pandemic outcome should be measured by how well its most disadvantaged groups fare and thereby we focus on the need to include cultural processes and interventions when working with Pacific, indigenous and ethnic minority communities. As practitioners and researchers we know that inequity and disparity remain among these vulnerable yet resilient population groups. We focus on how to address the vulnerabilities that endure.
As COVID-19 came to Aotearoa NZ, Pacific leaders in the community, agencies and government such as Ministry of Pacific Peoples came together, creating a number of culturally specific initiatives to support Pacific people. Yet, in our experience, these initiatives sometimes struggled to reach the heart of communities, as the "all-of-government" response had difficulty reaching the "all-of-community" Pacific frontline. For example, much of the public-health communication was available online, a format that inadvertently eliminated many Pacific communities. Research shows Pacific people are affected by digital exclusion, with the lowest level of internet access at home, when compared with other non-Pacific ethnicities. Our direct experience with Pacific communities confirms this digital divide. We also found that many of our Pacific clients and communities consequently minimized concerns for their own health, believing that medical help was only for those with COVID-19, or they avoided vital treatment of their health conditions, due to ungrounded fear of COVID-19 infection risk at medical facilities. In addition, Pacific communities were immediately at risk because restrictions of physical contact were in direct conflict with cultural practices and protocols that identify and maintain the survival of many Pacific communities. Social and economic disparities were also present particularly when physical distancing is required yet Pacific families live in large and overcrowded homes. Secondly, abandoning mass gathering was not easy when church remains a major influence and support for Pacific families. Thirdly, the notion of staying home was another requirement though home for many Pacific communities can refer to a number of different households. Central to Pacific people is their responsibility to family members in other physical households with regular care and interaction with them. As the COVID-19 pandemic persists, a one-size-fits-all approach, that tends to be from a digitally connected, western worldview is neither appropriate nor equitable for Pacific communities The following priorities are suggested as a framework to support Pacific communities during a pandemic and beyond. We believe that it can also be shared with indigenous and other collective communities throughout the globe.
Pacific cultures have their own worldviews and knowledge that have led to their resilience across generations and ensured their survival in previous epidemics. Working within an overarching framework that incorporates Pacific indigenous knowledge and perspectives will promote and enable community survival. Despite the heterogeneity of Pacific communities, fundamental principles are similar, including our collective worldview, relational identity, and values such as respect, love, humility and reciprocity, that have particular meanings and protocols in Pacific versus non-Pacific cultures. For example, one of the principles is to ensure people are safe and supported during crises. Most support, however, is offered online via the internet or telephone, which, as noted, inadvertently excludes Pacific communities. Issues for Pacific dissemination of information are therefore two-fold: firstly, the lack of access to digital information and, secondly, loss of the traditional and valued method of engagement that is face-to-face. However, we believe that this traditional method can still be carried out by essential services who have an opportunity to engage face-to-face - yet safely - with communities during a pandemic. This is what our vulnerable communities need. With appropriate protective equipment to minimize risk, services can actively seek to support the welfare of Pacific families and draw on the principles of respect and reciprocity: respect by understanding who to engage with in the family, and reciprocity by bringing something to assist in building rapport. Appropriate cultural training is essential to ensure that the interaction is perceived as genuine; there can be an understandable mistrust of "the system" that has often judged or failed us, and experiences of entrenched racism within healthcare. Pacific families are more likely to engage with services if there is a connection that is based on more than a narrow western definition of relationship; the messenger delivering the health message is key. Pacific providers who have established relationships and accountability to Pacific communities are critical, and partnering with church or faith groups with messaging may help to ensure Pacific families are informed and continue to feel connected.
The prioritization of basic needs throughout a pandemic and post-recovery is critical in reducing the mobility among vulnerable communities that increases the spread of COVID-19. Socioeconomically disadvantaged Pacific families need food, financial help, and employment or education assistance. The ubiquity of online resources in the learning needs of children and to keep families informed about COVID-19 and external support means digital exclusion must be addressed. We know Pacific parents who have lost jobs or their hours have been reduced, resulting in their children leaving secondary school or tertiary education for full-time employment to help meet the family's basic needs. It is crucial that a planned and targeted approach to provision of practical help remains and, more importantly, considerable efforts made to provide employment, housing, and financial support to empower families toward future independent and sustainable outcomes. This must be within a culturally appropriate framework of engagement with a vision for sustainable future outcomes and community self-determination across the entire community. Pacific communities can and should be partners in this sustained response.
Messages to Pacific communities during COVID-19 and post-recovery should draw on indigenous knowledge and languages. At present, most COVID-19 messages are online, via the Ministry of Health website and social media platforms, or via radio/TV (with a TV broadcast in Pacific languages during lockdown only twice-weekly versus daily English-language briefings). As noted, Pacific communities have the lowest level of internet access at home in Aotearoa NZ. The Ministry of Health worked with church communities to disseminate information of COVID-19. Church leaders united online to talanoa[2] and seek ways to support one another in the community. A social media campaign was also launched "We got your back Aotearoa" led by key Pacific members and leaders encouraging and educating our Pacific communities.
Many resources were distributed by an "all of government" approach to provide targeted support and services to Pacific communities. Health messages were translated appropriately into Pacific languages with videos and daily radio broadcasts on Pacific radio stations drawing on the expertise of Pacific language experts and clinicians. In addition to this, we also suggest the use of spirituality and/or religious beliefs to contextualize the messages, e.g., "Stay safe with Jesus in our bubbles." This style of message portrays staying safe in one's own household bubble, at the same time acknowledging the "bubbles" that the whole community live within, and drawing on a religious context to reinforce the message. Disseminating messages via print should also be considered, to reach all our communities given the digital disparity that exists.
It may seem that vaccination and testing for COVID-19 should be the first priority, but without being grounded in a Pacific worldview (Priority 1), basic needs being addressed (Priority 2), and appropriate information understood about the communal need for vaccination and testing (Priority 3), it is harder to achieve. The history of disease and pandemic among Pacific communities and Western countries is marred with mistrust and betrayal, death and destruction for decades - from the influenza epidemic (1918-1919), that infected Samoa, Tonga, Fiji and Nauru, to the lethal measles outbreak in Samoa in 2019, that was attributed to someone travelling from Aotearoa NZ. Resistance to COVID-19 vaccination and tests, based on historical fears and biases, can only be mediated through appropriate Pacific protocols of engagement and ease of accessibility to services.
Successful solutions for the Pacific communities for vaccinations and testing included a Pacific-led and run COVID-19 CBAC (Community Based Assessment Centre) establishment. This CBAC was also unique in responding to Pacific needs by providing food parcels from its own dedicated food hubs. Stories from the frontline include tremendous community-led efforts with local Pacific social service providers working with the community to increase vaccination and testing rates. Widespread vaccination and testing is strongly recommended with mobile testing clinics able to visit families in their homes to provide vaccinations, testing and information.
Given the collective worldview of Pacific communities, it is to be expected that the impact of COVID-19 will undoubtedly affect our overall health, that includes physical, mental and spiritual wellbeing, alongside family foundation and cultural stability. While Pacific communities are known for resilience and connectedness, the risks of family violence and harm, poor mental health and substance abuse are heightened by the economic and social impacts of COVID-19. The best and safest way to respond to these risks is with the development of robust prevention and education plans. A large portion of at-risk Pacific families will have had their support services revert to online services during lockdowns, making independent monitoring and face-to-face support no longer available. This is particularly alarming where there are family violence and mental health issues. We believe that face-to-face contact, with safety measures, is even more important as COVID-19 consequences build. For example, police, as an essential service, can engage in a community partnership with Pacific service providers and churches, to conduct home visits within a culturally appropriate framework, and provide prevention and early intervention. Furthermore, risk may appear for families who have never needed social and welfare support. This needs to be managed with Pacific-led sensitivity and respect, as well as safety.
Following the development of interventions with the community, it is equally important to formally and independently evaluate such programs to inform social policy and enhance current practice. The evaluation of Pacific programs and their outcomes are crucial for the sustainability and wellbeing of Pacific communities. However, we also believe that data gathering techniques must also be prioritized in an evaluation. The way in which data are gathered and the ethnic identification of Pacific communities have remained problematic, and prevent clearly tracking health status and the development of subsequent interventions. A robust data-gathering strategy, for example, that uses appropriate cultural protocols (respect, relationship) and articulates the authentic nuances of diverse communities (island-born/NZ-born; Samoan/Tongan etc.; church-focused/less so, etc.) is needed for thoughtfully targeted approaches. Furthermore, enhanced technology (and access to it) that includes quality, well-translated education for Pacific people is likely to improve quality of care and increase opportunities for empowerment and self-determination.
While there is an "all-of-government approach" to managing COVID-19, Pacific people need an "all-of-community approach" to work alongside families for short-term solutions (e.g., food and accommodation security) and equally important long-term solutions (e.g., employment, physical and psychological health security and spiritual wellbeing). Planning with community leaders, with our most vulnerable Pacific communities in mind, is needed. This includes working within the mindset of families with limited or no access to digital resources and capability, low or no employment income, diverse Pacific family make-up (e.g., elders and young in one household and/or new migrants), disconnection from cultural and spiritual support or limited community support. Working with these significant risk factors and inequities will allow for more realistic plans of support. This will require representatives within government sectors to work with community and faith-based organizations to visit and contact families directly to determine needs and expected outcomes for current and future wellbeing.
A response to COVID-19 for Pacific and vulnerable communities requires the provision of health-promotion messages that incorporate health inequities and social justice principles by undertaking a holistic approach that is not confined to a western definition of health needs and includes (though not limited to) faith-based and spiritual context. An "all-of-community" approach responds to the recommendation that a best practice plan for COVID-19 and beyond requires transparency in the decision-making process. Community involvement is more likely to provide this transparency and build and sustain Pacific confidence and trust in government. Consonant with the Pacific collective worldview, if support for families can transition to self-sufficiency, this will result in more sustainable outcomes for communities. The successful management and elimination of a pandemic should be assessed by how well Pacific and vulnerable communities survive during such crises and beyond.
For the full article and references please refer to Ioane, J., Percival, T., Laban, W., & Lambie, I. (2021), "All-of-community by all-of-government: reaching Pacific people in Aotearoa New Zealand during the COVID-19 pandemic." The New Zealand Medical Journal (Online), 134(1533), 96-7. Retrieve from: All-of-community by all-of-government: reaching Pacific people in Aotearoa New Zealand during the COVID-19 pandemic - ProQuest.
Julia Ioane (Samoan) is a senior Clinical Psychologist and Associate Professor at Massey University; Teuila Percival (Samoan) is a Consultant Paediatrician and Senior lecturer at University of Auckland; Luamanuvao Dame Winnie Laban (Samoan) is Assistant Vice Chancellor (Pasifika) at Te Herenga Waka, Victoria University of Wellington and a New Zealand Member of Parliament from 1999 to 2010; Ian Lambie (Scottish) is Professor in Clinical Psychology at the University of Auckland and Chief Science Advisor for the Justice Sector, New Zealand Government.
For more information, please contact: Julia Ioane, School of Psychology, Massey University, Auckland, New Zealand; e-mail: j.ioane@massey.ac.nz.
[1] While Māori (indigenous to Aotearoa NZ) are part of Polynesia, they are seen independently from the Pacific people when referred to within Aotearoa NZ.
[2] This means "to discuss."