title: Halting the 'sad degenerationist parade': medical concerns about heredity and racial degeneracy in New Zealand psychiatry, 1853-99.

authors: Dawson, Mark

subjects: Mental hospital

abstract: Historians have focused on early twentieth-century positive eugenics in New Zealand. In this article, I argue that the response came from a tradition of concern about heredity and white racial degeneracy, which extended beyond the British Empire. This article focuses on concerns about heredity at the Auckland Mental Hospital between 1850 and 1899, and contextualises these concerns in New Zealand mental hospital statistics from the late–nineteenth century. This article also considers Australasian, British, North and South American medical and immigration legislation history, and contrasts this with the legislation and medical discourses which formed part of a fear of heredity, racial degeneracy, immigration and mental illness in New Zealand.

text: Halting the 'sad degenerationist parade': medical concerns about heredity and racial degeneracy in New Zealand psychiatry, 1853-99. Historians have focused on early twentieth-century positive eugenics in New Zealand. In this article, I argue that the response came from a tradition of concern about heredity and white racial degeneracy, which extended beyond the British Empire. This article focuses on concerns about heredity at the Auckland Mental Hospital between 1850 and 1899, and contextualises these concerns in New Zealand mental hospital statistics from the late–nineteenth century. This article also considers Australasian, British, North and South American medical and immigration legislation history, and contrasts this with the legislation and medical discourses which formed part of a fear of heredity, racial degeneracy, immigration and mental illness in New Zealand.

year: 2012

title: Culture and Cognitive Theory: Toward a Reformulation

authors: Thakker, Jo

subjects: culture

abstract: In a provocative and important recent article Anthony Marsella (1998) makes an eloquent plea for the forging of a new metadiscipline of psychology that he labels global-community psychology. Marsella argues that we need a radical rethinking of the fundamental premises of psychology, rooted as they are in Western cultural traditions. Features of an emergent global-community psychology include an emphasis on multicultural and multidisciplinary approaches to human behavior that draw attention to the importance of context and meaning in human lives. Marsella's call for a global-community psychology reflects, in part, a growing body of literature that demonstrates the importance of cultural factors in a diver-sity of psychological domains such as cognition, emotion, social behavior, and psychopathology.

text: Culture and Cognitive Theory: Toward a Reformulation In a provocative and important recent article Anthony Marsella (1998) makes an eloquent plea for the forging of a new metadiscipline of psychology that he labels global-community psychology. Marsella argues that we need a radical rethinking of the fundamental premises of psychology, rooted as they are in Western cultural traditions. Features of an emergent global-community psychology include an emphasis on multicultural and multidisciplinary approaches to human behavior that draw attention to the importance of context and meaning in human lives. Marsella's call for a global-community psychology reflects, in part, a growing body of literature that demonstrates the importance of cultural factors in a diver-sity of psychological domains such as cognition, emotion, social behavior, and psychopathology.

year: 2001

title: Real world initiation of newly funded empagliflozin and dulaglutide under special authority for patients with type 2 diabetes in New Zealand

authors: Chepulis, Lynne Merran

subjects: GLP1RA

abstract: Background: Type 2 diabetes (T2D) is sub-optimally managed for many in Aotearoa New Zealand, and disproportionately affects Māori and Pacific peoples. In February 2021, SGLT2i/GLP1RA agents were funded for use for the first time with prioritisation for Māori, Pacific and those with cardiovascular and/or renal disease or risk (CVRD). This study evaluates the impact of health system factors on initiation of SGLT2i/GLP1RA therapy. 

Methods: Primary care data was collected for patients with T2D aged 18–75 years from four primary care organisations (302 general practices) in the Auckland / Waikato region of New Zealand (Feb 2021 – July 2022). Initiation of SGLT2i/GLP1RA therapy was reviewed by patient (age, gender, ethnicity, CVRD status) and health system variables (funding, provider type, staffing, patient numbers, rurality, after-hours access). Logistic regression was used to estimate the odds ratio of a patient being dispensed SGLT2i/GLP1RA. 

Results: Of 57,743 patients with T2D, 22,331 were eligible for funded SGLT2i/GLP1RA access and 10,272 of those (46.0%) were prescribed. Initiation of therapy was highest in Māori (50.8%) and Pacific (48.8%) patients (vs. 36·2–40·7% of other ethnic groups; P < 0.001), but was comparable in those with and without CVRD (47·1% vs. 48·9%; P = 0.2). Prescribing was highest in practices with higher doctor/patient numbers, low-cost fees, Māori health providers and clinics without after-hours access.

Conclusion: Prioritised access for SGLT2i/GLP1RA appears to be associated with a reduced health equity gap for Māori and Pacific patients with T2D in NZ, but work is required to improve prescribing for patients with CVRD.

text: Real world initiation of newly funded empagliflozin and dulaglutide under special authority for patients with type 2 diabetes in New Zealand Background: Type 2 diabetes (T2D) is sub-optimally managed for many in Aotearoa New Zealand, and disproportionately affects Māori and Pacific peoples. In February 2021, SGLT2i/GLP1RA agents were funded for use for the first time with prioritisation for Māori, Pacific and those with cardiovascular and/or renal disease or risk (CVRD). This study evaluates the impact of health system factors on initiation of SGLT2i/GLP1RA therapy. 

Methods: Primary care data was collected for patients with T2D aged 18–75 years from four primary care organisations (302 general practices) in the Auckland / Waikato region of New Zealand (Feb 2021 – July 2022). Initiation of SGLT2i/GLP1RA therapy was reviewed by patient (age, gender, ethnicity, CVRD status) and health system variables (funding, provider type, staffing, patient numbers, rurality, after-hours access). Logistic regression was used to estimate the odds ratio of a patient being dispensed SGLT2i/GLP1RA. 

Results: Of 57,743 patients with T2D, 22,331 were eligible for funded SGLT2i/GLP1RA access and 10,272 of those (46.0%) were prescribed. Initiation of therapy was highest in Māori (50.8%) and Pacific (48.8%) patients (vs. 36·2–40·7% of other ethnic groups; P < 0.001), but was comparable in those with and without CVRD (47·1% vs. 48·9%; P = 0.2). Prescribing was highest in practices with higher doctor/patient numbers, low-cost fees, Māori health providers and clinics without after-hours access.

Conclusion: Prioritised access for SGLT2i/GLP1RA appears to be associated with a reduced health equity gap for Māori and Pacific patients with T2D in NZ, but work is required to improve prescribing for patients with CVRD.

year: 2025