29 Jul 2019 | Health Quality Intelligence
Aotearoa New Zealand’s health system must understand and address inequities in how Māori and non-Māori access and receive health services, says a report released today.
A window on the quality of Aotearoa New Zealand’s health care 2019 – a view on Māori health equity, published by the Health Quality & Safety Commission, highlights a number of areas where change is needed in the health system.
The Window is an annual report from the Commission and provides a snapshot of the quality of health care in this country. While equity has always been a component of the report’s analysis, this year’s report focuses solely on health equity for Māori.
Professor Alan Merry, chair of the Commission, says the report outlines why the health system must commit to equity and Māori health advancement. The sector needs to ensure services are where they are most needed and that they are appropriate to meet need, he says.
‘The report lays down a challenge for the health and disability sector to identify and remove institutional racism. Tools to do this include partnership models in decision making and a co-design approach to developing services with consumers and Māori communities.
‘We need to give our services, organisations and staff the knowledge, tools and official sanction to do this work.’
The report shows a pattern of inequities between Māori and non-Māori over their lifetimes.
‘From before birth through to old age we see inequity. Services are not as accessible for Māori, and even after services are accessed, Māori do not experience the same benefits as non-Māori,’ Professor Merry says.
Māori die on average seven years earlier than non-Māori, and are two-and-a-half times more likely to die from diseases that are potentially preventable with timely and effective health care. Māori get diseases commonly associated with older age earlier than non-Māori, and have higher rates of disability and multiple disability.
‘While broader social factors influence a person’s health, the patterns of inequities shown in this report suggest engagement with health services does not reduce inequity. In fact, the results suggest the health system creates further disadvantage for Māori.’
The report considers the harm for Māori from the intergenerational effects of colonisation, along with the failure to meet the requirements of Te Tiriti o Waitangi.
‘The presence of such inequities is highlighted in definitions of institutional racism. The challenge is moving from identifying these inequities, as this report does, to changing them.’
Professor Merry says while these issues are not new, the report’s data provides an evidence-informed discussion to support the health sector to understand where improvements need to be made.
‘Creating an awareness that institutional racism has severe effects – from psychological ill-health to physical harm to early death – is an important focus for improving the quality of health services.’
The report says a genuine commitment to Te Tiriti o Waitangi is required for the health system to achieve health equity for Māori.
‘The articles of Te Tiriti o Waitangi provide a framework to build and maintain appropriate long-term improvement.
‘Māori knowledge and worldviews, including Māori data and analysis approaches, can strengthen and broaden evidence bases for health care.
‘It is important Māori continue to use the health system while changes are made. This document reflects the start of a conversation involving Māori, the health sector, and other sectors,’ he says.
‘We expect a range of work to emerge from this discussion, both for the Commission and others.’
In the report’s foreword, Sir Mason Durie says ‘The report is clear. Action is needed on multiple fronts. A collective approach and a collective commitment are critical to remedying a situation that has lasted too long.’
Measures of access – services are less accessible for Māori
Barriers to health services prevent Māori from having the same access to health care as non-Māori. Multiple systemic factors result in measures that indicate:
Measures of quality – services are not providing the same benefits for Māori
Even if services are accessed, the quality of those services is not equitable, as Māori do not benefit from them as much as non-Māori do.
Measures of improvement – efforts to improve health care do not always improve equity for Māori
National quality improvement programmes that address specific areas of harm to patients have achieved good results for non-Māori in many cases, but some have increased inequity in some areas for Māori.