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Major fundamental changes required to achieve health equity

Major fundamental changes required to achieve health equity

In comparing efforts to address health inequities, researchers in Aotearoa/New Zealand (NZ) and the United States (US) have found that both countries are failing to align policy with evidence-based approaches that could help achieve equity.

A team of NZ and US researchers are working together to find ways for both countries to reduce health inequities and have just published an article, “Lessons for Achieving Health Equity Comparing Aotearoa/New Zealand and the United States,” on line in the journal Health Policy.

The authors highlighted signs of progress in isolated areas such as in NZ, sudden unexpected death in infancy among Māori babies, which is benefitting from an indigenous approach to safe sleeping. In the US, Alaska’s Nuka System of Care is improving access, care quality, and outcomes among the Alaska Native people who wholly own and operate it.

These two initiatives are examples of how self-determination, when allowed and enabled, can effectively combat inequities. These are important achievements but must be incorporated more fully into policy, the researchers say.

The research article is particularly timely in light of the recently announced major review of New Zealand’s health and disability sector.

“Right now in Aotearoa, courageous decision-making is required regarding who is and who isn’t on that review panel,” says Dr Paula King, a Māori public health physician and clinical research fellow at the University of Otago in Wellington.

“To address the root causes of persistent failure to deliver equitable health outcomes for Māori and Pacific peoples, we must prioritise the voices of those who continue to be subjugated by colonisation and are underserved by the health and disability sector,” she says.

“In order to achieve health equity, privileged groups must give up power they currently hold, to make room for others,” says health equity expert Dr Bryn Jones, another of the NZ authors.

Co-author Professor Sarah Derrett from the University of Otago’s Department of Preventive and Social Medicine adds: “Time and time again in NZ we see important reviews of health and social services undertaken that are not led by Māori experts, not co-led by Māori experts, or not even including Māori on the review team. It is imperative that this changes now to address NZ’s evident inequities.”

Despite many differences, NZ and the US share similarities in their demographics, politics, and health systems. Both countries were colonised by European settlers, who remain the largest ethnic group and retain much economic and political power.

“Aotearoa/New Zealand and the United States both have high-level aspirations to achieve equity, yet they have implemented few large-scale policies that are explicitly designed to reduce inequities,” says lead author Dr Marshall Chin, Director of Finding Answers: Solving Disparities Through Payment and Delivery System Reform.

Both countries are consistently ranked near the bottom in the Commonwealth Fund’s international rankings of health equity. Indigenous and ethnic minority groups are more likely to have worse health outcomes and receive poorer-quality and less-accessible health care.

The team recommends key strategies to help these and other nations, “authentically commit to achieving health equity.” They identify five actions that countries must take if they are fully committed to achieving equity:

Explicitly design quality of care and payment policies to achieve equity.
Hold the health care system accountable through public monitoring and evaluation.
Address determinants of health for individuals and communities across sectors.
Share power with ethnic minorities and promote indigenous peoples’ self-determination.
Have free, frank and fearless discussions about structural racism, colonialism and white privilege.

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