6 minute read
Health equity 2040
Lyndon Keene | Health Policy Analyst
In July, ASMS and the Canterbury Charity Hospital Trust joined forces to host a virtual conference – Creating Solutions: Towards health equity outcomes for all. Drawing on the discussions, we have produced a report titled Creating Solutions – Te Ara Whai Tika – A roadmap to health equity 2040. It will be submitted to Government for achieving an underlying goal of health for all by 2040. Lyndon Keene details some of its sobering trends.
The conference brought together more than 200 health professionals from throughout the health workforce. People dialled in from Australia, Fiji, India and even as far away as Afghanistan. The aim of the conference was to take a hard look at the stark and growing health inequities in Aotearoa New Zealand along with the social determinants which feed into them. It encouraged participants to reflect on their own practice in relation to health equity and come up with solutions. It featured presentations from health and social sector leaders, Health Minister Andrew Little, and prominent experts in their fields, including one of the world’s leading authorities on health equity, Sir Michael Marmot.
Closing the gaps?
Attempts to close the long-standing gaps in health inequalities in New Zealand have a dismal record.
Closing the gaps in health inequality was a priority of the New Zealand Health Strategy of 2000 and part of a broader policy to address social and economic inequalities between Ma -ori and Pasifika and other New Zealanders.
In the period 2005–07 (when data first became available in four ethnic groups: Ma -ori, Pasifika, Asian and European/ other), average life expectancy at birth for Ma -ori males was 8.6 years less than for European/other males; for females the gap was 8.1 years. By the period 2017–19 the gaps had narrowed only by 1.3 years and 0.7 years. The life expectancy gap between Pasifika and European/other during 2017–19 was 5.6 years for males and 5.5 years for females – an improvement of 0.5 years and 0.3 years respectively over the 12year period. At this rate of progress, Ma -ori males would achieve equity in life expectancy with European/other males by around 2090 – taking approximately 70 years. For Ma -ori females and Pasifika males, equity with European/other would not be achieved until well into the
90.0 22nd century – taking approximately 127 years and 134 years, respectively. Pasifika females would need to wait approximately 220 years. Comparisons of life expectancy between the poorest and wealthiest New Zealanders over the same 12-year period show a widening gap. In the period 2005–07, males in the wealthiest decile could expect to live 7.2 years longer than those in the poorest decile. By the period 2017–19 the gap had widened to 10.6 years. Life expectancy gaps for females were 5.4 years during 2005–07, increasing to 9 years during 2017–19 (Figure 1). The widening gaps are owing to a life expectancy increase in the wealthiest groups – especially over recent years – and a drop in the life expectancy of the poorest groups. There are multiple reasons for this failure to address health inequities, which are discussed in Creating Solutions – Te Ara Whai Tika – A roadmap to health equity 2040.
85.0
80.0
Years 75.0
70.0
65.0
2005-2007 2012-2014 2017-2019
Decile 1 males (least deprived) Decile 1 females (least deprived) Decile 10 males (most deprived) Decile 10 females (most deprived)
Wellbeing economics
A major shortcoming is an apparent mindset among policymakers to view health and social services in narrow financial terms, as an expenditure that needs to be controlled, rather than with a broader social and economic perspective which recognises the overwhelming evidence for investment for potentially substantial social and economic gains.
While the Government improved social spending after its ‘Wellbeing Budget’ in 2019, it has yet to demonstrate genuine transformational change. This is needed to truly implement wellbeing economics where priorities for public spending are guided by the extent to which a programme can improve population wellbeing given its expenditure requirements. The need to adopt a stronger and more urgent commitment to addressing poverty is among the most urgent issues. Creating Solutions – Te Ara Whai Tika – A roadmap to health equity 2040 recommends specifically that: • the minimum wage be set at the same level as the voluntary ‘living wage’ • the current policy of 20 hours of free early childhood education (ECE) for 3–5-year-olds is extended to 1–2-year
olds as a first step towards addressing the cost barriers to accessing ECE • benefits are set so people who depend on them are not living in poverty.
Cultural bias and racism
Cultural bias and racism are also key barriers to achieving health equity, as illustrated in our relatively recent political history. Initiatives introduced by the Labour-led Government in 2000 to ‘close the gaps’ generated such a public and political backlash amid claims that Ma -ori were receiving privileged treatment that the catch-phrase was soon abandoned and the policy re-branded by the Government as ‘reducing inequalities’, in an attempt to make the policy more popular with the public. A few years later, the then National Party leader Don Brash’s infamous ‘Orewa speech’ attacking what he saw as special privileges for Ma -ori resulted in a major surge for the National Party in public opinion polls. Recent attempts by the current National Party leader to use similar tactics in a ‘Demand the Debate’ campaign on what she calls separatist policies has so far not had the same effect. However, if the task facing the Ma -ori Health Authority to help bring about health equity were not challenging enough, the opposition to its existence from the National and ACT parties has made it a lot tougher. As speakers at the conference reasoned, to succeed, the Ma -ori Health Authority will need strong support from everyone working in the health sector, and medical specialists are in an especially influential position to lead the way. To improve cultural safety and address racism, Creating Solutions – Te Ara Whai • the Government has policies in place requiring public health and social organisations to demonstrate how they are supporting health professionals to achieve culturally safe practice and address racism • adequate resources are provided for all government services to achieve cultural safety at every level, including sufficient staffing to allow time for learning and self-reflection • the collection, monitoring, analysis, and reporting of quality ethnicity data – both from an organisational performance and workforce perspective – is substantially improved.
Creating Solutions – Te Ara Whai Tika – A roadmap to health equity 2040 is available on the ASMS and Canterbury Charity Hospital Trust websites. It features 27 recommendations that cover 13 themes to improve policies on the determinants of health as well as on improving the health and disability system. ASMS will continue to monitor these issues and report on how they develop.
Hosting a virtual conference was uncharted territory for ASMS and posed a formidable challenge.
ASMS’ Manager of Support Services Sharlene Lawrence says she went into it “slightly naive”. “I’ve run numerous large-scale, face-toface conferences so was expecting this to be a lot easier – it definitely wasn’t. There were so many moving parts and it ended up being a huge job logistically”. She says the biggest challenge was coordinating the number of presenters nationally and internationally along with the mix between pre-recorded and live presentations. Managed by the company Vidcom, the scale of the technical operation needed to support the smooth-running of the conference was impressive. For two days ASMS’ Wellington office was transformed into a fully operational recording studio, awash in wires, cords, and equipment, not to mention about a dozen separate laptops, used to host the virtual breakout groups. Sharlene says there were very few hiccups, and everyone felt a huge sense of achievement once it was over.
Behind the scenes
