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Counties Manukau Health Library Database & Resource Directory

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Health Equity Clearinghouse

Contents

What is Health Equity?
New Zealand Resources
  Websites
  Toolkits and Guidelines
  Selected Reading
  Selected Journals
International Resources
  Websites
  Toolkits and Guidelines
  Selected Reading
  Selected Journals

*see also Counties Manukau Health Library Childhood Obesity Clearinghouse

 

What is Health Equity?

Health equity is the absence of avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically (WHO)

 

The concept acknowledges that not only are differences in health status unfair and unjust, but they are also the result of differential access to the resources necessary for people to lead healthy lives (NZ MoH)

 

Te ao Māori framework

The Health Quality & Safety Commission has developed a te ao Māori framework in partnership with Māori health providers, Whānau Ora providers and participating district health boards across Aotearoa New Zealand. The initial framework concept is shown below, followed by a brief description.

The aim of the framework is to improve the quality of care afforded to whānau Māori across Aotearoa New Zealand and advance the uptake and implementation of te ao Māori and mātauranga Māori concepts into general health system design and health practice for all. 

There are two downloadable PDFs at the bottom of this page, which include the basic framework concept plus a backgrounder on how and why it was developed. 

We are currently developing resources to support providers with implementation of the framework and will publish them here in due course.

We would like to acknowledge and thank our partner providers who gave their information freely in the hope that much-needed change could happen and be sustained over time.

Te ao Māori framework concepts

Wairuatanga

The holistic nature of Māori health, which links physical illness to emotional and spiritual wellbeing.  Hence wairuatanga is in the middle position of the framework, which makes culture a central focus in the design of services. The goal of wairuatanga is to embed tikanga Māori and cultural safety into the health system.

Pātuitanga

The growing and fostering of strong partnerships with Māori, which is fundamental to ensuring the right concepts are included in the design and delivery of services.

Whānau

Whānau need and improving health outcomes for whānau are the drivers to why services are created and designed. 

Rangatiratanga

The inclusion of Māori leadership in decision-making processes when services are designed.

Te ao Māori framework design

Each of the outer sections have two koru representing tapu and noa. The haehae lines bind each section together and connect and interact with each other.

The inside koru of each concept opens into wairuatanga, which allows wairuatanga to flow seamlessly throughout the entire framework. 

The outside koru opens into te ao Mārama. The pītau design on the edge of the outer sections represents new beginnings and is the interconnection between te ao Māori and te ao Mārama.

Downloadable attachments

 

Health Equity at CM Health

Health equity at ADHB

 

Fact and action sheets on health inequities [University of Otago and New Zealand Medical Association]

These fact and action sheets were prepared in the lead up to a visit by Sir Michael Marmot in July 2011, hosted by the New Zealand Medical Association. The purpose of these sheets includes an attempt at a brief stocktake on health inequities in New Zealand, both on what the current state of play is and what the future policy priorities might be.

 

Equity is the new black—and black lives matter (2020)

Editorial from New Zealand Medical Journal

"There is overwhelming evidence of inequities in health outcomes for Māori—you need look no further than the previous issue of NZMJ or the Wai 2575 Māori Health Trends Report. COVID-19 also presents a concern for the likely disproportionate impact on Māori.

Council encourages all doctors, employers, training and professional organisations to consider the findings in the cultural safety Report, draw on the data, and use this as a basis for achieving long-term, positive change for the benefit of all patients and whānau.

While the Report offers an insight into current practice, it is only the first step on a long journey. It sets a baseline for ourselves and our stakeholders to use when developing programmes, strategies and policies that support us to drive change."


Understanding 'white privilege?'

Institutional racism - our duty of care to patients (2020)

Racism and White Defensiveness in Aotearoa: A Pākehā Perspective (2018)

Māori health: 'We have to be talking about racism' (2018)

 

Videos

 

'Should we still be arguing about equity?'
Keynote presentation by Pat Snedden, board chair, Auckland DHB,  at the Health Quality and Safety Commission February 2021 Quality improvement scientific symposium (2021)

 

Māori lives matter [HQSC]
In this presentation from the Health Quality & Safety Commission's Ō tātou hiranga advance care planning hui, Hector Matthews shines the spotlight on Māori inequity and the systemic biases that perpetuate inequities.  He challenges us to confront some uncomfortable truths about inequity and explore ways we can truly place people’s cultural framework at the centre of their care and wellbeing.

 

Dr Lance O'Sullivan on a mission for health equity [Ko Awatea ]
Dr Lance O'Sullivan is at Middlemore Hospital working on a new health equity programme. In a 2016 interview on Te Karere he talks about his belief that regardless of race, age or income, people should have the same health opportunities as the next.


What is Health Equity? [Health Equity Institute]
This three-minute motion graphic video explains how social, economic, and environmental conditions can create health inequities and how these inequities can affect health disparities.

What Is Health Equity, and Why Does It Matter? [IHI]
David R. Williams, Professor of Public Health at the Harvard T.H. Chan School of Public Health, has been researching health inequities in the United States for two decades. In this video, he sits down with Don Berwick, MD, President Emeritus and Senior Fellow at IHI, to talk about health equity and why it’s important.
 
Social Media

twitter #healthequity

 

New Zealand Resources

 

Websites

Equity [Ministry of Health]

Equity Explorer [HSQC]
The Equity Explorer provides information on how health and health care varies between groups of people, and between district health board (DHB) areas of Aotearoa New Zealand (NZ).

Two types of group are compared: ethnic groups and groups based on socioeconomic status (deprivation).

The health conditions compared are diabetes, asthma and gout.

Maori Health Clearinghouse

Pacific Health Clearinghouse

Asian Health Clearinghouse

 

Health system quality dashboard
Health & Quality Safety Commission (NZ).
In partnership with Te Tumu Whakarae, HQSC has developed a new specific Māori Health Equity Report, using distinct data.

Toolkits and Guidelines

 

Achieving Equity in Health Outcomes: Highlights of selected papers [NZ; 2018]
Both in New Zealand and globally, our ability to address equity challenges in health has significantly improved over the past decades. In the Western world life expectancy has increased for all populations. However persistent disparities in health access, quality of services and outcomes remain. In Aotearoa New Zealand, Māori and Pacific and those in low socioeconomic groups remain the most disadvantaged.

The Government has mandated the Ministry of Health to take a bold approach that delivers tangible changes to system behaviour with measurable results in a three to five-year horizon. An approach that operates on a repeating cycle based around deepening the understanding of equity gaps, shifting thinking about where priorities for investment of time and resources lie, followed by increasing direct action to address inequalities is being developed.

This paper traces the beginnings of health equity and the philosophical and ethical foundations that sit behind it.  It looks at a selection of the international and local literature to help understand definitions of equity. It considers how framing and thinking about the concept of equity and approaches to addressing equity have evolved, and how progress to address equity can be measured.

The Health Equity Assessment Tool: a User's Guide  [NZ]
The Health Equity Assessment Tool: A User's Guide, has been developed by the University of Otago, Wellington, to help facilitate the use of the Health Equity Assessment Tool (HEAT).

The Health Equity Assessment Tool: A User's Guide gives a brief overview of inequalities in health, introduces the HEAT and its use, presents an in-depth look at each of the HEAT questions, and provides case examples of the tool's use.  This publication is an essential guide for those working in the health and disability to apply a strong equity focus to their work.

Equity of Health Care for Māori: A Framework [NZ]
This framework guides health practitioners, health organisations and the health system to achieve equitable health care for Māori through leadership, knowledge and commitment.

Quality improvement: no quality without equity? [NZ; 2017]
This ‘think piece’ from the Health Quality & Safety Commission signals our intention to tackle health inequities. 


Central Region Equity Framework

TAS, 2019

The Central RegionEquity Framework has been developed by theCentral Regionand was endorsed by the Central Region Chief Executives in April 2019.  The Central Region is a combination of MidCentral DHB, Hawke’s Bay DHB, Whanganui DHB, Wairarapa DHB, Hutt Valley DHB and Capital and Coast DHB.

The Central Region Service Planning Forum (CRSPF) commissionshealth and disability services that aim to improve health outcomes and achieve equity for all populations living in the central region district health board areas.   This Framework1provides guidance to the CRSPF on strengthening their commissioning to achieve equity within activities identified within the Central Region’s Regional Service Plan (RSP). In the Central Region, equity in health is based on the WHO definition of equity –the absence of avoidable or remediable difference among groupsof people.  The concept acknowledges that these differences in health status are unfair and unjust. However,they are also the result of differential access to the resources necessary for people to lead healthy lives. Peoplewho are poor, have chronic conditions/diseases, live with disabilities, live rurallyand are of different ethnicities, will have poorer health, greater exposure to health risks and poorer access to health services2.These variables are unlikely to exist in isolationasthey are deeplyinterwoven.The concept of intersectionality is vital when exploring the fundamental causes of inequity.In New Zealand, inequalities between Māori and non-Māori are the most consistent and compelling inequities in health. The Central Region Chief Executives and the Central Region Māori General Managers hold the view that these differences are not random.They exist because of institutional racism3and the impact of colonisation and its continuing processes4.Achieving equity for Māoriis a priority, as the health gaps across the life-coursearesignificant for Māori.The Treaty of Waitangi was signed to protect the interests of Māori. It is not in the interest of Māorito be disadvantaged in any measure of social or economic wellbeing5.A companionTreaty of Waitangi document will be developed, with the purpose of providing direction to the Central Region DHBs on what they need to do to meet theirTreaty of Waitangi obligations.

 

HE PIKINGA WAIORA IMPLEMENTATION FRAMEWORK

University of Waikato, 2016

The Framework has indigenous self-determination at its core. All four elements have conceptual fit with Kaupapa Māori aspirations and all have demonstrated evidence of positive implementation outcomes.

A coding scheme derived from the Framework was applied to 13 studies of diabetes prevention in indigenous communities in Australia, Canada, New Zealand, and the United States. Cross-tabulations demonstrated that cultural centeredness (p=.008) and community engagement (p=.009) explained differences in diabetes outcomes and community engagement (p=.098) explained difference in blood pressure outcomes.

The Framework is intended as a planning tool to guide the successful development and implementation of interventions. Funders can use the Framework to assess the likely effectiveness of proposed interventions.

Community organizations can use the Framework to work with researchers or policy makers to strengthen each of the four elements.

 

Whānau Ora Health Impact Assessment

Ministry of Health, 2007

The Whānau Ora Health Impact Assessment tool was published in April 2007 by the Ministry of Health and builds on the Public Health Advisory Committee’s, ‘A Guide to HIA: A Policy Tool for New Zealand’ (2005).

The Whānau Ora HIA tool follows the same methodology: Screening, Scoping, Appraisal and Reporting and Evaluation. It follows the same methodology: Screening, Scoping, Appraisal and Reporting and Evaluation.

 

It was developed for use by policy makers as a tool for assessing the positive and negative impact of their policies on Māori and to identify ways in which these could be enhanced or adapted. It complements other resources aimed at promoting Māori health including the Health Equity Audit Tool.

It was produced in response to the fact that the Māori population experiences significantly poorer health outcomes than the rest of New Zealand’s population and as a way to support delivery of the Ministry of Health’s strategic vision to improve health outcomes and reduce inequalities for Māori outlined in He Korowai Oranga: Māori Health Strategy 2002.

At the heart of the tool is the concept of ‘Whānau ora’, which means, ‘Māori families being supported to achieve their maximum health and well being’. Its overarching aim is to ensure equity in health for Māori.

 

Reducing Inequalities in Health

Ministry of Health, 2002

Summary

In New Zealand, ethnic identity is an important dimension of health inequalities. Maori health status is demonstrably poorer than other New Zealanders; actions to improve Maori health also recognise Treaty of Waitangi obligations of the Crown. Pacific peoples also have poorer health than Pakeha. In addition, gender and geographical inequalities are important areas for action.

Addressing these socioeconomic, ethnic, gender and geographic inequalities requires a population health approach that takes account of all the influences on health and how they can be tackled to improve health. This approach requires both intersectoral action that addresses the social and economic determinants of health and action within health and disability services themselves.

Reducing Inequalities in Health proposes principles that should be applied to whatever activities we undertake in the health sector to ensure that those activities help to overcome health inequalities. The proposed framework for intervention entails developing and implementing comprehensive strategies at four levels.

  1. Structural – tackling the root causes of health inequalities, that is, the social, economic, cultural and historical factors that fundamentally determine health.
  2. Intermediary pathways – targeting material, psychosocial and behavioural factors that mediate the impact of structural factors on health.
  3. Health and disability services – undertaking specific actions within health and disability services.
  4. Impact – minimising the impact of disability and illness on socioeconomic position.

Intervention at these four levels should be undertaken nationally, regionally and locally by policy-makers, funders and providers.

The framework can be used to review current practice and ensure that actions contribute to improving the health of individuals and populations and to reducing inequalities in health. It also highlights the importance of factors outside the direct control of the health sector in shaping the health of our population. Those outside the health sector – particularly The Treasury, the social welfare, education, housing and labour market sectors, and local government – can contribute significantly to the task of reducing inequalities in health. Success in reducing inequalities in health brings positive results for the individual, the economy and society. It enables New Zealanders to live healthier, longer lives. In turn, a healthier population will increase the country’s prosperity.

 

Te Rōpū Whakakaupapa Urutā Analysis of Health Sector Equity Tools

Te Rōpū Whakakaupapa Urutā

There is an existing suite of equity tools that clearly articulate and define the ways in which equity can be placed at the heart of the health system.

Equity resources

The following frameworks, guidelines and statements have informed the principles that underpin our recommendations and specific actions:

Te Rōpū Whakakaupapa Urutā Position Statement ​

He Pikinga Waiora Implementation Framework (Healthier Lives NSC, 2016)​

Governance for Health Equity (World Health Organisation, 2013)

He Ara Hauora Māori: A Pathway to Māori Health Equity (Medical Council of NZ, 2019)

 

Equity Tools 

 

Reducing Inequalities in Health Framework 

Health Equity Assessment Tool - A Users Guide

Whānau Ora Health Impact Assessment

Equity of Healthcare for Māori: Framework

Central Region DHB's Equity Framework

 

Analysis of Equity Tools 

In preparation for the restart of the health system and recovery from COVID-19. Te Rōpū Whakakaupapa Urutā has carried out a quick review and analysis of the existing equity tools currently available to the health sector. Our analysis provides information about each tool's development, origins, what the tool is, how long it has been in the system, examples of where the tools have been implemented and a view of their usefulness.

​As we plan for a restart of the health services and a desire to reset the system so that it achieves equity for Māori, being aware of these tools and using/adapting them might be helpful. 

​All tools to some degree use an intervention logic: problem definition, engagement with stakeholders, intervention planning, monitoring and evaluation.  

Additionally they are likely to be more useful in specific contexts. ​

For example:

The Equity of Health Care for Māori, the Central Region DHBs Equity Framework and the Health Equity Assessment Tool and its’ users guide are health services focused.  

The Whānau Ora Health Impact Assessment can be used at both a policy and project level with its strength being on the health impacts resulting from other sector activities.   

The Reducing Health Inequalities Framework is a useful background document which identifies that actions needs to be in four areas: system, intermediary environments, health services and impact of ill health and disability it is best used with another tool that is more intervention focused.​

Our quick review and analysis is available here  (doc attached)



Selected Reading

 

The human and health costs of failure to implement pro-Tiriti and pro-equity health policies: let’s act as if we know this
New Zealand Medical Journal.  Vol 134 No 1542: 17 September 2021
After a twenty-year period of relative stability in the health system, we are entering a period of very considerable change. These changes are driven, in part, by a clearly stated desire on the part of government for fairer health outcomes for Māori. 

Inequities in people with gout: a focus on Māori (Indigenous People) of Aotearoa New Zealand / Te Karu, L., Dalbeth, N., & Stamp, L. K.
Therapeutic Advances in Musculoskeletal Disease (2021)
Health equity can be defined as the absence of systematic disparities in health between more and less advantaged social groups. Gout is one of the most common forms of arthritis and disproportionally affects Indigenous peoples, including Māori in Aotearoa New Zealand. Inequities in gout management are well documented and clearly evidenced in Indigenous populations. For example, while gout occurs at a younger age and is more severe in Māori, there is less regular dispensing of urate-lowering therapies. Indigenous peoples are also under-represented in clinical trials. Herein, we will review inequities in gout using Aoteoaroa New Zealand as an example. We will explore reasons for health inequities and challenges that need to be faced to achieve health equity.

Creating an Indigenous Māori-centred model of relational health: A literature review of Māori models of health (2021)
This study highlights the importance and relevance of relational approaches to engaging Māori and their whānau accessing health services. It signals the necessary foundations for health practitioners to build trust-based relationships with Māori. Key elements for a Māori-centred model of relational care include whakawhanaungatanga (the process of building relationships) using tikanga (cultural protocols and processes) informed by cultural values of aroha (compassion and empathy), manaakitanga (kindness and hospitality), mauri (binding energy), wairua (importance of spiritual wellbeing).

 

My role in tackling health inequalities: a frameworkl for allied health professionals
KingdFund (2021)

The King’s Fund has worked with AHPs from across the UK to develop a framework to support any AHP to think through and understand their contribution to tackling health inequalities, whatever their role. The framework details how AHPs can raise awareness, take action and optimise advocacy through six lenses: self; patients; clinical teams, pathway and service groups; communities and networks; systems; and nurturing the future. 

The framework is designed to support AHPs to do whatever they can – large or small – to tackle health inequalities.

 

Rapua Te Ara Matua: Equity report
Waikato DHB (2021)

WDHB endorsed the report, taking active ownership and explicitly acknowledging their DHB is:

"embedded in a healthcare system which has privileged the needs of the majority while failing to meet the needs of all"
"Waikato DHB is party to the systematic failure to adequately address and eliminate equity gaps and provide services that are culturally competent and holistic for Tangata Whenua" 


The report provides a clear view of the inequities experienced by Maori people and Pacific people and the systemic failure they continue to receive. While some of the data is undoubtedly confronting- the reality is this is what our priority populations endure on a daily basis.

Among other actions, the report identified (and we may have heard this before..) "Maori-led structural change was needed within the DHB to address the gaps in health equity."

Telehealth as a tool for equity: pros, cons and recommendations
NZMJ. Issue: Vol 134 No 1530: 19 February 2021
In this viewpoint, we consider whether telehealth is an equity-positive tool that might help to overcome some important barriers to health care access for Māori and Pacific people. We consider the equity ramifications of a shift toward models of care that maximise the use of telehealth solutions, and our recommendations regard how we might best achieve the equity-positive potential of telehealth for Māori and Pacific people.

 

Achieving Equity in Health Outcomes: Summary of a discovery process.
Ministry of Health. 2019.
In 2018, the Ministry of Health initiated a work programme on achieving equity in health outcomes. Specifically, this programme aims to ensure that equity is at the heart of the way New Zealand’s health and disability system operates and to promote the cultural shift needed to achieve that.  This report provides a brief summary of phase one of the Achieving Equity Work Programme: The Discovery Phase. The aim of the discovery phase was to identify where practical and coordinated effort could be undertaken to achieve a measurable shift in health equity in the next three to five years. Through an examination of the literature; a review of evidence; and consideration of what people said needs to be tackled in the health and disability system, common challenges and opportunities for achieving health equity in Aotearoa/New Zealand have been explored.

 

The Waitangi Tribunal’s WAI 2575 Report: Implications for Decolonizing Health Systems
Health and Human Rights Journal (2020)
Te Tiriti o Waitangi, a treaty negotiated between Māori (the Indigenous peoples of Aotearoa) and the British Crown, affirmed Māori sovereignty and guaranteed the protection of hauora (health). The Waitangi Tribunal, established in 1975 to investigate alleged breaches of the agreement, released a major report in 2019 (registered as WAI 2575) about breaches of te Tiriti within the health sector in relation to primary care, legislation, and health policy. This article explores the implications of this report for the New Zealand health sector and the decolonial transformation of health systems. The tribunal found that the Crown has systematically contravened obligations under te Tiriti across the health sector. We complement the tribunal’s findings, through critical analysis, to make five substantive recommendations: (1) the adoption of Tiriti-compliant legislation and policy; (2) recognition of extant Māori political authority (tino rangatiratanga); (3) strengthening of accountability mechanisms; (4) investment in Māori health; and (5) embedding equity and anti-racism within the health sector. These recommendations are critical for upholding te Tiriti obligations. We see these requirements as making significant contributions to decolonizing health systems and policy in Aotearoa and thereby contributing to aspirations for health equity as a transformative concept.

Baseline Data Capture: Cultural Safety, Partnership and Health Equity Initiatives FINAL REPORT (2020)
The Medical Council of New Zealand, in partnership with Te Ohu Rata O Aotearoa (Te ORA), is pleased to release an independent report outlining findings of the current state of cultural safety and health equity delivered by doctors practicing in Aotearoa New Zealand and experienced by patients and whānau. Māori patients’ experiences are the focus of the report, however many of the challenges and solutions will be applicable to other ethnic groups and populations who experience inequitable healthcare.

Creating an Indigenous Māori‐centred model of relational health: A literature review of Māori models of health. Journal of Clinical Nursing. (2021)
This study highlights the importance and relevance of relational ap-proaches to engaging Māori and their whānau accessing health services. It signals the necessary foundations for health practitioners to build trust- based relation-ships with Māori. Key elements for a Māori-centred model of relational care include whakawhanaungatanga (the process of building relationships) using tikanga (cultural protocols and processes) informed by cultural values of aroha (compassion and empa-thy), manaakitanga (kindness and hospitality), mauri (binding energy), wairua (impor-tance of spiritual wellbeing).

Racism and health in Aotearoa New Zealand: a systematic review of quantitative studies (2020)
Quantitative racism and health research in New Zealand consistently finds that self-reported racial discrimination is associated with a range of poorer health outcomes and reduced access to and quality of healthcare. This review confirms that experience of racial discrimination is an important determinant of health in New Zealand, as it is internationally. There is a pressing need for effectively designed interventions to address the impacts of racism on health.

Experiences of Māori of Aotearoa New Zealand's public health system: a systematic review of two decades of published qualitative research (2020)
Australia and New Zealand Journal of Public Health
This paper aims to synthesise the broader perspectives of Māori patients and their whānau (extended family, family group) of their treatment within the public health system. Our research question was ‘What are the experiences of Māori in the public health and/or hospital system in Aotearoa New Zealand?’

Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition [NZ]
International Journal for Equity in Health
There is growing recognition of the importance of cultural competency and cultural safety at both individual health practitioner and organisational levels to achieve equitable health care...A move to cultural safety rather than cultural competency is recommended. We propose a definition for cultural safety that we believe to be more fit for purpose in achieving health equity, and clarify the essential principles and practical steps to operationalise this approach in healthcare organisations and workforce development.

Tofa Saili: A review of evidence about health equity for Pacific Peoples in New Zealand'
Pacific Perspectives (2019)
This report describes the health equity issues faced by Pacific families and communities. The report highlights approaches based on Pacific values and the strengths of Pacific communities. It is informed by the Pacific Aotearoa vision (Ministry of Pacific Peoples, 2019).

A window on the quality of Aotearoa New Zealand's health care 2019 – a view on Māori health equity
HQSC, 2019
Every year the Commission publishes a document we call A window on the quality of Aotearoa New Zealand’s health care. The Window provides a snapshot of the quality of health care in the country. While equity has always been a component of the report’s analysis over its four-year history, this year’s report focuses solely on equity. 

A window on the quality of Aotearoa New Zealand’s health care 2019 – a view on Māori health equity (Window 2019) highlights a number of areas where change is needed in the health system. The report is divided into three chapters. The first analyses inequity between how Māori and non-Māori access and receive health services, and the effects on equity of improvement activities in our system. The second chapter asks why these inequities exist, and the third chapter addresses opportunities for improvement.

Addressing equity in intergenerational wellbeing: Valuing community perspectives
Deloitte and Victoria University of Wellington, 2019.
Our partners at Victoria University of Wellington’s School of Government look at New Zealand’s wellbeing frontier and the importance of bringing in community perspectives to build effective policy.

Understanding inequalities: summary report. The impact of inequalities in the early
years on outcomes over the life course: Using international evidence to identify creative policy solutions.
Growing up in New Zealand, 2019.
The findings from the Growing Up in New Zealand study demonstrate that Maori and Pasifika children experience the highest burden of socioeconomic disadvantage in their early years as well as an unequal burden of significant co-morbidities in terms of health and development throughout their life course. By the time they start school (at age 5 years) many are already falling behind their peers in terms of preparedness for formal education and readiness to engage in learning.

The study has shown that inequalities in developmental opportunities and outcomes have their origins in early in life. Risk factors for early vulnerability cluster and there is no one single proxy marker of disadvantage. Additionally, morbidity and poor outcomes cluster. Persistent adversity is associated with a graded likelihood of poor outcomes (across the population). Further service use is not meeting measured need. Currently, access to early life universal services may be widening inequalities. A proportional-universalism approach to services is required if they are to meet real need and reduce inequalities.

'HAUORA: Report on Stage One of the Health Services and Outcomes Kaupapa Inquiry'
Waitangi Tribunal. 2019
"The Waitangi Tribunal said in a report released today that the Crown had breached the Treaty of Waitangi by failing to set up and run the primary health system in a way that reduced the gap between Maori and non-Maori health outcomes."

He oranga mo Aotearoa: Māori wellbeing for all
Deloitte
We consider various Māori wellbeing frameworks and measurements, the barriers to Māori wellbeing and the drivers and changes that could improve it.

Delivering better outcomes together: Policies that reflect our diverse cultures
Deloitte
The cultural and ethnic face of Aotearoa New Zealand is changing. We explore why and how our institutions and policies need to move closer toward multi-culturalism to achieve better outcomes for all.

The health equity measurement framework: a comprehensive model to measure social inequities in health
International Journal for Equity in Health201918:36

Ethnic bias and clinical decision-making among New Zealand medical students: an observational study [NZ]
BMC Medical EducationBMC series – 201818:18 (2018)

Lessons for Achieving Health Equity Comparing Aotearoa/New Zealand and the United States [NZ]
Health Policy 2019
To authentically commit to achieving health equity, nations should: 1) Explicitly design quality of care and payment policies to achieve equity, holding the healthcare system accountable through public monitoring and evaluation, and supporting with adequate resources; 2) Address all determinants of health for individuals and communities with coordinated approaches, integrated funding streams, and shared accountability metrics across health and social sectors; 3) Share power authentically with racial/ethnic minorities and promote indigenous peoples’ self-determination; 4) Have free, frank, and fearless discussions about impacts of structural racism, colonialism, and white privilege, ensuring that policies and programmes explicitly address root causes.

Achieving health equity in Aotearoa: strengthening responsiveness to Māori in health research (2017). 
N Z Med J. 2017 Nov 10;130(1465):96-103.
Excellent health research is essential for good health outcomes, services and systems. Health research should also build towards equity and in doing so ensure that no one is left behind. As recipients of government funding, researchers are increasingly required to demonstrate an understanding of their delegated responsibilities to undertake research that has the potential to address Māori health needs and priorities. These requirements form the basis of responsiveness to Māori in health research, and several research institutions have implemented systems to support their organisational approach to this endeavour. However, many health researchers have a narrow view of responsiveness to Māori and how it might be relevant to their work. In this viewpoint paper we provide an overview of existing frameworks that can be used to develop thinking and positioning in relation to the Treaty of Waitangi and responsiveness to Māori. We also describe an equity-based approach to responsiveness to Māori and highlight four key areas that require careful consideration, namely: (1) relevance to Māori; (2) Māori as participants; (3) promoting the Māori voice, and; (4) human tissue. Finally, we argue for greater engagement with responsiveness to Māori activities as part of our commitment to achieving equitable health outcomes.

The Determinants of Health for Pacific Children and Young People in New Zealand (2014) (Determinants of Health for Children and Young People). New Zealand Child and Youth Epidemiology Service (2016)

Te Ohonga Ake The Determinants of Health for Māori Children and Young People in New Zealand Series Two (2016) New Zealand Child and Youth Epidemiology Service (2016)

The cost of child health inequalities in Aotearoa New Zealand: a preliminary scoping study[NZ]
BMC Public Health 12.1 (2012): 1.

Geography matters: the prevalence of diabetes in the Auckland Region by age, gender and ethnicity [NZ]
New Zealand Medical Journal 2016; 129 (1436): 25-37

Health equity in the New Zealand health care system: a national survey. [NZ]
International Journal for Equity in Health 10.1 (2011): 1.

Health equity: what does it mean for child health [NZ]
New Zealand Medical Journal 2011; 124 (1347)

Health inequalities: unfair, measurable and remediable? The case of New Zealand. [NZ]
Paper prepared for the WHO Commission on Social Determinants of Health.

Policy implementation for health equity in Aotearoa: examining healthy eating and physical activity programmes in Maaori and Pasifika communities [NZ]
Paper prepared by Arnell Hinkle (2010)

Solutions to child poverty in New Zealand [NZ]
Report prepared for the Office of the Children;s Commissioner (2012)

The politics of Māori health (2016)

Selected Journals


Australia and New Zealand Journal of Public Health

Maori Health Review [NZ]

Pacific Health Review [NZ]

Asian Health Review [NZ]

 

International Resources

Websites

Equity [World Health Organisation]

Health Equity Initiative [HEI]

WHO World Database on Intersectoral Action for Health Equity (ISACS)

Toolkits and Guidelines

What are health inequalities?
The Kings Fund, 2020
Interventions to tackle health inequalities need to reflect the complexity of how health inequalities are created and perpetuated, otherwise they could be ineffective or even counterproductive. For example, efforts to tackle inequalities of health status associated with behavioural risks (such as poor diets) should address the wider network of factors that influence these behaviours (such as access to affordable healthy food, marketing and advertising regulations) and the impact that these behaviours have on health outcomes (such as access to clinical services). 

Health inequalities are not inevitable and the gaps are not fixed. 

Evidence shows that a comprehensive approach to tackling them can make a difference. Concerted, systematic action is needed across multiple fronts to address the causes of health inequalities. This includes, but goes well beyond, the health and care system.

This explainer provides an overview of how health inequalities are experienced in England’s population

Health inequalities: place-based approaches to reduce inequalities: Guidelines to support local action on health inequalities.
Public Health England, 2019
This guidance aims to reinforce a common understanding of the complex causes and costs of health inequalities and provide a practical framework and tools for places to reduce health inequalities. The accompanying documents include a slide set providing a summary and examples of how to use a place-based approach to reduce health inequalities.

Vibrant and Healthy Kids: Aligning Science, Practice, and Policy to Advance Health Equity
National Academy of Sciences. 2019
This report provides a brief overview of stressors that affect childhood development and health, a framework for applying current brain and development science to the real world, a roadmap for implementing tailored interventions, and recommendations about improving systems to better align with our understanding of the significant impact of health equity.

Incorporating concerns for equity into health resource allocation. A guide for practitioners [UK]
 “Unfair differences in health care access, quality or health outcomes exist between and within countries around the world, and improving health equity is an important social objective for many governments and international organizations. This paper summaries the methods for analysing health equity available to policymakers regarding the allocation of health sector resources.”

100 Million Healthier Lives [US]
100 Million Healthier Lives is an unprecedented collaboration of change agents across sectors who are pursuing an unprecedented result.

Mission: 100 million people living healthier lives by 2020.
Vision: to fundamentally transform the way the world thinks and acts to improve health, wellbeing, and equity to get to breakthrough results.

Together, we are systematically creating a community of solutions to the most intractable challenges that stand in the way of achieving health, wellbeing and equity across the globe.  Includes guidelines and resources.

Achieving Health Equity: A Guide for Health Care Organisations [US]
This white paper provides guidance on how health care organizations can reduce health disparities related to racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.

The IHI White Paper includes:

A framework, with five key components, for health care organizations to improve health equity in the communities they serve:

Make health equity a strategic priority
Develop structure and processes to support health equity work
Deploy specific strategies to address the multiple determinants of health on which health care organizations can have a direct impact
Decrease institutional racism within the organization
Develop partnerships with community organizations to improve health and equity
Guidance for measuring health equity
A case study of one health care organization that has strategically integrated work to improve health equity throughout their system
A self-assessment tool for health care organizations to gauge their current focus on and efforts to improve health equity

Equity of Care: a Toolkit for Eliminating Health Care Disparities [US]
This toolkit is a user-friendly “how-to” guide to help accelerate the elimination of health care disparities and ensure our leadership teams and board members reflect the communities we serve.

Fair Foundations [Aus.]
Fair Foundations: The VicHealth framework for health equity is a planning tool for health promotion policy and practice. It outlines the social determinants of health inequities, suggesting entry points for action.

Health Equity and Prevention Primer [US]
Health inequities are more than disparities or differences in health and safety outcomes. Inequity describes unfairness and the systematic nature of disparities. The Health Equity and Prevention Primer (HEPP) serves as a web-based training series for public health practitioners and advocates interested in policy advocacy, community change, and multi-sector engagement to achieve health equity. The Primer helps practitioners integrate a health equity lens into their initiatives in pursuit of overall health and safety.

Health Equity Resource Toolkit for State Practitioners Addressing Obesity Disparities [US]
This document was created to provide examples of strategies and surveillance data which can be used to inform obesity prevention initiatives.

Improving Health Equity Through Data Collection AND Use: a Guide for Hospital Leaders [US]
To meet the needs of their diverse populations, hospitals and health systems will need to bridge the gap between collecting meaningful patient data and reviewing the data to identify inequities in health care provision and utilization, and to implement simple yet effective interventions to improve care for patients.

Improving Quality and Achieving Equity: a Guide for Hospital Leaders [US]
This guide for hospital leaders presents the evidence for racial and ethnic disparities in health care and provides the rationale for addressing them with a focus on quality, cost, risk management, and accreditation. The guide also highlights case studies and model practices, and recommends activities and resources that can help hospitals identify and address disparities in order to achieve equity for patients.

Improving Quality and Achieving Equity: the Role of Cultural Competence in Reducing Racial and Ethnic Disparities in Health Care [US]
This report identifies aspects of cultural competence that are synergistic with current efforts to develop a system that delivers higher-quality care and discusses strategies by which the quality and cultural competence movements could be linked.

A Practitioner's Guide for Advancing Health Equity [US]
Designed to help public health practitioners advance health equity through community prevention strategies. While health disparities can be addressed at multiple levels, this guide focuses on policy, systems, and environmental improvements designed to improve the places where people live, learn, work, and play. It is designed for those who are new to the concept of health equity, as well as those who are already working to create equitable environments.

Roadmap to Reduce Disparities [US]
A US guide for health care organisations to improve minority health and foster equity, which includes a 6-step framework for incorporating disparities-reduction into quality improvement processes.


What Makes Us Healthy [UK]
A new series of infographics and accompanying blogs and commentaries to describe and explain the social determinants of health in an accessible and engaging way.These determinants include political, social, economic, environmental and cultural factors which shape the conditions in which we are born, grow, live, work and age. Creating a healthy population requires greater action on these factors, not simply on treating ill health further down stream.

 

Selected Reading

 

An overview of reviews on strategies to reduce health inequalities
International Journal for Equity in Health(2020)
The strategies that facilitate the reduction of health inequalities must be intersectoral and multidisciplinary in nature, including all sectors of the health system. It is essential to continue generating interventions focused on strengthening health systems in order to achieve adequate universal health coverage, with a process of comprehensive and quality care.

Driving forward health equity – the role of accountability, policy coherence, social participation and empowerment
WHO, 2019
A scientific expert review process coordinated by the WHO European Office for Investment for Health and Development of the WHO Regional Office for Europe identified societal and institutional factors that singly and in combination offer new explanations on why progress on health equity has not been as fast as had been hoped when the association between individual determinants and inequities was first established. These four key drivers of health equity are: accountability, policy coherence, social participation and, underlying them, empowerment. Work on these drivers informs the Health Equity Status Report initiative (HESRi) and has resulted in three independent companion papers each elaborating further on one of the common goods for health equity – accountability, policy coherence and social participation – as well as this summary paper.

A Health Equity Approach to Obesity Efforts: Proceedings of a Workshop—in Brief
National Academy of Sciences. 2019
On April 1, 2019, the National Academies of Sciences, Engineering, and Medicine held a public workshop, A Health Equity Approach to Obesity Efforts, in Washington, DC. The workshop explored the history of health equity issues in demographic groups that have above-average obesity risk, and considered principles and approaches to address these issues as part of obesity prevention and treatment efforts. Speaker presentations addressed three areas: current policies and practices that either perpetuate health inequities or advance health equity; mechanisms to support community-driven solutions that can influence the social determinants of health; and approaches for fostering multisector collaboration to address disparities by exploring the issues related to the creation, implementation, and evaluation of equity-oriented programs, policies, and systems changes. Participants also discussed research needs to inform and mobilize equity-centered obesity prevention and treatment actions. This publication briefly summarizes the presentations and discussions from the workshop.

Advancing Equity in Health Systems by Addressing Racial Justice
Stanford Social Innovation review. 25 June, 2019
Lessons on racial equity underscore the need to set explicit aims, build coalitions, and flatten hierarchies in order to strengthen healthcare’s role in undoing systems of oppression.

Inclusion of equity in economic analyses of public health policies: systematic review and future directions (2017)
Twenty‐nine relevant studies were identified. The majority of studies comparing two or more interventions left interpretation of the size of the health and financial inequality differences to the reader. Newer approaches include: i) use of health inequality measures to quantify health inequalities; ii) inclusion of financial impacts, such as out‐of‐pocket expenditures; and iii) use of equity weights.

Improving Health Equity: 5 Guiding Principles for Health Care Leaders [US: IHI] (2018)
In January 2017, a team from IHI argued that health care organizations must make health equity a strategic priority. The authors identified five key steps for health care organizations: make health equity a leader-driven priority, develop structures and processes that support equity, take specific actions that address the social determinants of health, confront institutional racism within the organization, and partner with community organizations.

Insiders’ Insight: Discrimination against Indigenous Peoples through the Eyes of Health Care Professionals [Canada] (2019)

A Framework for Educating Health Professionals to Address the Social Determinants of Health [US]

Better Health Through Equity: Case Studies in Reframing Public Health Work (2015) [US]

Closing The Gap in A Generation: Health Equity Through Action on the Social Determinants of Health (Commission on the Social Determinants of Health, CSDH 2008)

Equity and Excellence: Liberating the NHS [UK]

Evidence review: Settings for addressing the social determinants of health inequities [Aus.]

Fair Society, Healthy Lives (The Marmot Review): Strategic Review of Health Inequalities in England Post 2010 (Marmot et al, 2010) [UK]

Fairer decisions, better health for all: Health equity and cost-effectiveness analysis [UK]

Health literacy: a necessary element for achieving health equity [US]

Leveraging Culture to Address Health Inequalities: Examples from Native Communities: Workshop Summary [US]

WHO European Review of Social Determinants of Health & the Health Divide (Marmot et al 2012) [EU]

 



Selected Journals

Diversity and Equality in Health Care

Ethnicity and Health

International Journal for Equity in Health

see also

PubMed Database Search: Health Equity


 

 

 last updated  3 September 2021

This page was last updated at 9:55AM on September 20, 2021.