Abstract:
Background: Pacific people in New Zealand are highly urbanised, many work in low skilled occupations, have low incomes, below average housing and live in neighbourhoods of high deprivation. Households tend to be larger and support more people on less money. Pacific people experience higher levels of chronic illness, a three times greater incidence of diabetes, and are five times more likely to die from diabetes than New Zealand Europeans. The impact of diabetes on households from changes to work participation and income is unknown. Aim: To explore the impact of diabetes on work income, work participation, illness-related costs and financial decision-making in Samoan households. Methodology: In-depth interviews were conducted with 20 Samoan adults in 10 large households. Ten index participants in recent paid employment, who had been hospitalised with diabetes within the previous 12 months, were jointly interviewed with a financial decisionmaker from the same household. Data were analysed using qualitative methods. Findings: Loss of work income due to diabetes significantly impacted Samoan households already in financial distress. Total weekly household income was approximately half the national median for the same household type. Diabetes-related costs had a contributory although relatively minor impact on overall household expenditure. The cultural practice of fa'alavelave was temporarily re-positioned from 'major priority' to 'discretionary cost' to relieve additional financial burden. Children's education was seen as crucial to achieving intergenerational upward social and financial mobility that would benefit the extended family in the longer term. Sickness presenteeism was driven by the need to provide financial security, not from a lack of knowledge, but from a lack of choice. Sickness presenteeism worked against participants genuine attempts to self-manage their diabetes. Conclusion: Health professionals who care for Samoan people experiencing diabetes need to understand the complexity of living in severe hardship that forces sickness presenteeism. Flexible work arrangements and paid or alternative leave options could reduce sickness presenteeism. Policy makers informed about the socioeconomic determinants of health can build equity into policies that benefit Pacific people and others with chronic conditions.