Health inequities

Question 1

What are some determinants of health?

Answer 1

• Income and social status
• Low education levels
• Environment
• Employment
• Social support
• Culture
• Genetics
• Personal behaviour and coping skills
• Health services
• Gender
• Racism is also a determinant of health and experienced by Māori, Pacific Peoples and others in the NZ Health System.

Question 2

Define health inequality

Answer 2

unavoidable differences between different population groups that lead to differing health outcomes.

Question 3

Define health inequity

Answer 3

In NZ, people have differences in health that are avoidable, unfair & unjust. Different people with different levels of advantage require different approaches & resources to get equitable health outcomes.

Question 4

What are some treaty principles?

Answer 4

1. Guarantee tino rangatiratanga: acknowledge Māori control over their resources, people & Māori self-determination in the delivery & monitoring of primary health care & a holistic definition of hauora Māori.
2. Partnership (respect status and authority of one another)
3. Active protection (ensure everyone is informed extent of effort going into achieve equity)
4. Equity (express commitment to equity in all documents; ‘reducing’ equities is not enough; ensure freedom from discrimination)
5. Options (care provided in culturally appropriate way + expression of hauora maori)

Question 5

What is the framework for equitable health for Maori?

Answer 5

Leadership: provisioning high quality health care
Knowledge: developing knowledge on how to give high quality health care
Commitment: to providing high quality health care

Question 6

What is intersectionality?

Answer 6

multiple forms of discrimination that overlap due to gender, race, disability, age, etc.

Question 7

What are the health inequities between maori vs. Non-maori?

Answer 7

1. Inequity in access: services are less accessible for Māori (socioeconomic status, wait times for specialist appointments longer for Māori, services not meeting needs of Maori,
2. Inequity in quality: services are not providing the same benefits for Māori (inappropriate prescribing, poorer communication, timeliness of receiving appropriate surgery or treatment)
3. Inequity in improvement: efforts to improve quality do not always improve equity for Māori (lower diabetes monitoring, lower vaccination rates, less screening done and therefore poorer health outcomes when focus of health system shifts away from Maori).

Question 8

Why do these health inequities between Māori and non-Māori exist?

Answer 8

1. Biology, geography, social institutions and racism have downstream effects on health outcomes. Historical acts of taking land, resources and culture + the monocultural nature of today’s health system and service delivery.
2. Colonization and institutional racism have established and maintained disadvantage for Māori within the wider determinants of health + the health system. Institutional racism includes inappropriate action and/or inaction in response to need.

Question 9

How do we resolve the health inequities between Māori and non-Māori, and advance Māori health?

Answer 9

1. Quality for Māori must be defined by Māori– their knowledge and worldview
2. Eradicate institutional racism
3. use strategies, programs, practices, tools and resources