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The Greatest hurdle in healthcare – Te Ururoa Flavell


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‘What is the greatest hurdle to the ongoing provision of healthcare?

When the Maori Party looks at your question, ‘What is the greatest hurdle to the ongoing provision of healthcare in New Zealand and how can we best address it?” the answer lies in the statistics.

We know that as a population group, Maori have on average the poorest health status of any ethnic group in New Zealand. We know also that M?ori have poorer health status and outcomes compared to non-Maori, are more likely to be exposed to risk factors for poor health, and are deterred from visiting a doctor mainly because of cost.

This is absolutely not acceptable, and we must be committed to reducing the health inequalities that affect Maori.

While we may ask the question, ‘what is the greatest hurdle’ – we are most interested in what is the greatest outcome that we could hope for – and that would be for M?ori to live longer, to have healthier lives, and fulfil their potential to participate in New Zealand society.

And so to do that, then the factors that cause inequalities in health need to be addressed.

We have a very clear goal in our M?ori Party manifesto – and that is that we want our wh?nau to be the best that they can be and to be supported
by an equitable, sustainable health system. We want to accelerate clinical and service integration; and achieve more of a focus on targets which enable public reporting.

But I come back to our question – what is the greatest hurdle to the ongoing provision of healthcare?

While there are any number of areas that we could look at – diabetes, respiratory failure, oral health, heart disease to name a few, I want to focus on asthma as a clear example of testing out the issues around the hurdles in current healthcare.

Any observed differences in the prevalence of asthma between Maori and non-Maori are relatively small and do not explain the more marked difference in hospitalisation rates. This suggests something else is going on.

So here’s a couple of the facts around asthma:
· Maori of all ages are hospitalised more frequently from the illness than non-M?ori, in every age group but most markedly in childhood

· M?ori are over four times more likely to die of asthma than non-Maori

· Asthma is the most common respiratory cause of hospitalisation for M?ori.

So how do we explain this?

The evidence tells us that access to preventative health care and differential asthma treatment by ethnicity are factors contributing to asthma inequalities for Maori. In other words, ethnic differences in the management and control of asthma in the community may be an important factor in the disparities in hospitalisation rates.

So what’s that about? How can these ethnic inequalities exist? How do we explain that? We might call it institutional racism. We might call it an inability to engage Maori in the design and delivery of health promotion activities. We in the Maori Party call it not good enough.

In a study commissioned by the Asthma Foundation in 2009 it showed that Maori children had lower levels of parental asthma knowledge, and received less asthma medication and asthma education, than other children.

The Maori Party believe that much more needs to be done to ensure Maori children have the same opportunity as non-Maori to benefit from elements of best practice asthma care, including education, regular asthma reviews, appropriate medication and an asthma management plan.

Any approaches to develop strategies to improve asthma care for Maori need to proceed in partnership with Maori, if effective and lasting gains are to be made in relation to asthma for Maori.

Another – what we might call a universal factor in understanding inequalities in health, is related to socio-economic deprivation.

Coming to our asthma case study then – inequalities in asthma can also be accounted for by the fact that Maori are significantly over-represented in the more deprived socio-economic deciles. Put bluntly what we know is that socio-economic deprivation increases the likelihood of dying from respiratory disease.

Over 56% of Maori are in the three most deprived socioeconomic deciles. But what is also of note is that socio-economic deprivation influences Maori respiratory death rates more than non-Maori. This means that socio-economic deprivation is not only more common for Maori, but it has a stronger effect on health for Maori.

Finally, the third key factor we see through asthma treatment and care – but which again could be applied to other outcomes in health – is the lack of coordination across sectors, across government, across the whole family.

One of the things that the Maori Party has been really pleased about in our Relationship Accord with National has been the progress in our work on healthy homes.

In the agreement we signed up to last year there was a commitment that within the Warm Up NZ: Heat Smart programme there would a target of 20,000 low income homes for home insulation. We also achieved a commitment that every state house built before 1978 which can be practically insulated will be insulated.

So how does this apply to the discussion around the greatest hurdle to the ongoing provision of health-care.

What we know is that Healthy Housing has significantly reduced the risk and rate of housing-related diseases (such asthma, respiratory diseases, rheumatic fever, cellulitis and meningitis), injuries (falls and burns), addressed conditions (obesity and reduced mobility) and improved wellbeing.

The results of investment in healthy housing show us that insulation made houses drier and warmer, and the health of occupants improved.

I want to just finish with a few of the ideas that the Maori Party has introduced as the key to making a difference not just in the health arena but also wider across the social sector.

The first is the appreciation that culture and health gains are associated. The Maori Party has been a big supporter of the concept of cultural competence – that is the acquisition of skills to achieve a better understanding of members of other cultures.

We have championed the importance of cultural competency in all agencies to ensure the quality of services, and equity of access and outcomes to bring out well-being. We would like cultural competency to be an employment standard in justice, health, education and social services.

The second is the understanding that to make a difference in addressing inequalities we actually have to face the wider socio-economic determinants.

That is why in the Agreement we made with National we agreed to establish a Ministerial Committee on Poverty to bring a greater focus to, and improve co-ordination of, government activity aimed at alleviating the effects of poverty in Aotearoa.

Part of the gains we have achieved already with this committee have been in doubling the funding of the Government’s rheumatic fever programme to $24m; and the Warm Up NZ: Heat Smart programme I mentioned before.

And of course the ultimate outcome and approach that we are seeking is in Whanau Ora.

Whanau Ora is about caring for our own; taking collective responsibility for the wellbeing of the group. It’s about relying on our own resources, our marae coming to life; believing in our way of doing things. We believe that every opportunity should be afforded to support wh?nau, hap? and iwi in their own growth and development.

Whanau Ora is our most significant opportunity to address the hurdles to the ongoing provision of healthcare that I mentioned earlier. It is about working together, taking a comprehensive approach, addressing the real needs and priorities of wh?nau in a holistic way. It is about joining the dots – integrating services – so that we don’t just write the prescription and apply the medication – but we address the living environment, the attitudes and behaviours – the lifestyle choices that whanau make.

But most important of all – Wh?nau Ora is about taking responsibility for creating our own solutions – it is about transformation that we design and develop our own way.

And that is the greatest opportunity for progress we can all believe in.

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