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The high price of being labelled "high risk": Social context as a health determinant for sudden unexpected infant death in Māori communities

Abstract:

Background: For over 25 years, nationwide efforts to address sudden infant death in New Zealand have focused on advising parents to avoid four risk factors labelled as modifiable. But Māori infants still have sudden unexpected death in infancy (SUDI) at five times the rate of non-Māori. Aim: This paper expands the conceptualisation of SUDI risk factors and suggests a reconsideration of the use of risk factor terminology. Discussion: Working from the assumption that health outcomes are influenced by social determinants, we put forward two key propositions. Firstly, we argue (using maternal smoking as a case in point) that greater attention must be paid to the role of social and socio-economic factors in the prevention of SUDI in Māori communities. Secondly, we propose that the language of risk reduction impedes Māori engagement with health services because the discourse associated with being "at risk" and "vulnerable" casts Māori in a deficit framework affecting how Māori are perceived by health professionals and, more importantly perhaps, how Māori see themselves.

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indigenous health, infant mortality, Māori health, risk reduction, social determinants of health, sudden unexpected death in infancy