Lancet Editorial: Social determinants of health and outcomes in New Zealand
The Lancet, Volume 379, Issue 9821, Page 1075, 24 March 2012
In this issue of The Lancet, Michael Baker and colleagues analyse more than 5 million hospital admissions in New Zealand for infectious diseases. Two messages stand out. First, hospitalisations ascribed to infection have risen in both absolute terms (by more than 25 000 per year) and as a proportion of overall acute admissions (from 20•5% in 1989—93 to 26•6% in 2004—08). Second, the risk of hospitalisation for serious infectious diseases in New Zealand is borne disproportionately by Māori and Pacific peoples and by those who are socioeconomically disadvantaged. These groups had on average more than twice the risk of admission compared with wealthier non-Indigenous populations. The apparent widening of long-standing health disparities based on economic position and ethnicity in a country that has repeatedly tried to narrow differences is disappointing and prompts questions about the effectiveness of current policies for health equity.
After Baker and colleagues' report was published online on Feb 20, New Zealand's Prime Minister John Key agreed that some social determinants may have contributed to adverse outcomes among his country's Indigenous peoples. How this acknowledgement will be translated fully into action, and that action into improved clinical outcomes of relevance to communities and clinicians, is awaited.
Despite a small research budget, New Zealand has set an example by measuring health disparities for several outcomes in its population. By doing so, such disparities have rightly informed political debate and policy about health in vulnerable populations. To better identify and respond to the health needs of New Zealand's population as a whole, researchers in the future will have to go beyond analysing retrospective administrative data recorded by hospitals, and consider prospective studies in primary care, where most treatments are provided and unmet needs are greater as a result of co-payments.