Much still to be done to reduce ethnic and socio-economic health inequities

Although progress has been made in reducing health inequities, an editorial in today's New Zealand Medical Journal proposes the next ten most important actions needed to further reduce significant health "gaps‟ based on ethnicity and socio-economic status in New Zealand.

The hard hitting editorial previews issues regarding health inequities to be discussed at a number of events next week, including a Symposium, at the University of Otago, Wellington. It is hosted by the NZ Medical Association featuring Sir Professor Michael Marmot from the UK.

Sir Marmot is a world renowned public health researcher and epidemiologist, immediate Past President of the British Medical Association, author of the recent review of 'Health Inequalities in England and Wales' (2010), and chair of the WHO‟s 'Commission on Social Determinants of Health'.

“New Zealand is at the cross roads in addressing health inequities,” says researcher and author Professor Tony Blakely from the Health Inequalities Research Programme at UOW. “At the Wellington Symposium next week, we will be debating what has and has not worked, and what we should do next.”

“We've significantly increased understanding of health inequities because of robust public health research, and made progress in closing some gaps, but there‟re still significant and worrying differences between ethnic and socioeconomic groups in health status in New Zealand.”

The editorial proposes the ten next most important actions needed to reduce health inequities. These range from addressing risk factors to health such as healthy eating, ensuring health services are equitable and accessible, to fair fiscal and social welfare policies.

“Governments come and go, but regardless of where each Government sits on the political spectrum it can and should adapt or modify policies to reduce inequities in health,” says Professor Blakely.

“For example, the current Government has prioritized quality in health care – ensuring high quality access and delivery of health care to socially disadvantaged populations will make some contribution to reducing health inequities.”

However Blakely says, the best results are still likely to come through a focus on public health areas such as obesity, and making New Zealand smokefree by 2025 – something the New Zealand Parliament is committed to as a goal.

“For instance, we've estimated that a smokefree nation in 2025 could result in a huge gain of five years in life expectancy for Maori, and three years for non-Maori, an overall two year reduction in the current seven year life-expectancy gap.”

He says investing in reducing inequities in health is investing in our population's future wellbeing – including economic wellbeing.

“At least some of this investment can be achieved by reallocating current Government expenditure,” says Professor Blakely “For example, $8 billion a year, or 60% of the welfare budget, is spent on universal superannuation, yet the age of entitlement is unchanged from 1899!”

The editorial argues that gradual increases in the age of entitlement would liberate funding for other policy issues, such as early childhood programmes that address inequalities.

The Marmot Symposium will take place at the University of Otago, Wellington on Wednesday July 13 from 1-5pm.

Professor Marmot's visit is supported by the NZ Medical Association, University of Otago Wellington, the Heart Foundation, the University of Auckland, the Public Health Association, the NZ College of Public Health Medicine and the Prior Centre

For further information, contact

Professor Tony Blakely
Department of Public Health
University of Otago,Wellington
Tel +64 4 918 6086
Email tony.blakely@otago.ac.nz

Attachment: Ten next most important actions to reduce health inequities in Aotearoa New Zealand

1. Equitable and fair fiscal and social welfare policy, including progressive taxation, comprehensive and fair social policy, and ensuring that everyone has a minimum income for healthy living. Policy needs to be proportionate to need – what is termed proportionate universalism in the Marmot Review 9, or a balance of targeting and universalism.
2. Maintain and enhance social cohesion, through ensuring all services are accessible by all. This requires a whole of government response and far better coordination among every branch of government, from Ministerial level to service delivery.
3. Maintaining and enhancing investment in early childhood, including the need to for there to be a visible leadership that champions child health and wellbeing. Child poverty rates need to be reduced. There needs to be greater coordination among services for children, and a visible cross-party agreement that determines the strategy for improving the environment in which children live.
4. Aligning climate change, sustainability and pro-equity policies, including programmes such as warm and healthy housing in deprived areas to environmental, health and health equity win-wins such as increased walkability of neighbourhoods and financial incentives that both reduce carbon emissions and increase healthy compared to unhealthy food production.
5. Health equity needs to be widely understood. It affects everyone, whether as a prospective parent, employer, employee, political leader or welfare beneficiary. Everybody working in a service delivery occupation needs to be able to alter their practice to reduce health inequities.
6. Ill-health prevention that addresses risk factors contributing to health inequities, including making New Zealand Smokefree by 2025 (as per Parliament's response to Māori Select Committee), encouraging or ensuring healthy food formulation (e.g. salt content in breads and cereals, clear labelling of foods that are healthy and unhealthy, packages of taxes and subsidies to improve healthy eating), and stronger policies to tackle harmful alcohol consumption.
7. Ensuring fair employment and safe and healthy workplaces, extending to include greater access to work for beneficiaries and people with disabilities, a low unemployment rate, and strengthening of occupational health policies.
8. Maintaining and enhancing Māori, Pacific and Asian policies and programmes, including health promotion, screening and health care services models that are culturally specific or tailored.
9. Ensuring health services are equitable, including ensuring a strong equity focus in prioritisation of health resource allocation, quality improvement policies and programmes, and improved information systems. This means, among other things, transparent monitoring, smoothing out regional variations in access, and on-going provider education and support.
10. Health equity research needs to continue and focus on 'what works', evaluating policies and programmes for equity impacts in processes and (eventually) outcomes such as mental health status and disease incidence.

A list of Otago experts available for media comment is available elsewhere on this website.