Inequalities and Disparities in New Zealand’s Health

• Sarah Jane D. Calamasa

There is generally a relationship between wealth and health. Yet, queries occur about why and how some groups gain access to the social and economic means to live longer and healthier lives while others do not. In colonized countries, such as Aotearoa/New Zealand these mechanism have their roots in history.[1]

To understand disparities and inequalities, we look at it in a different aspect; inequality is the existence of unequal opportunities and rewards for different positions within a group. While disparity defined as inequality that occur when member of the certain group do not profit from the other.These disparity and inequality were present in new Zealand based on their historical, social, economic and political aspects that have contributed between the maori and non-maori health status which has been evident for all of the imposing history of the country.

Inequalities in health are attributed to the unequal distribution and unequal access to the social and economic determinants of health. Access to housing, education, employment and income all have an obvious impact on the wellbeing of the people, but health outcomes are also influenced by gender, geographical place, age and ethnicity.[2]

To address inequality and disparity in current society of system, we have to understand and investigate the historical, social, economic, and political background. By doing so, we can give a wide variety of world views with different values and priorities.The first renowned interaction between Maori and Europeans occurred in 1769, at the time of James Cook’s expedition to New Zealand from Britain. In 1840 the Treaty of Waitangi, a formal agreement for British settlement and a guarantee of protection of Maori interests, was signed by representatives of the British crown and some of the Maori chiefs.[3]

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The Treaty of Waitangi is the main instrument through which Maoris have required to have their unique rights as the primitive people of New Zealand.The treaty’s intention was to protect and maintain the well-being of all citizens, and its health implications relating to processes of good government and view of participation and equity are significant. Since the 1970s, public awareness of the Treaty of Waitangi has continued to increase, primarily as a result of growing Maori aspirations for self-determination. In particular, it has been argued that the continuing disparities in health between Maoris and non-Maoris represent evidence that Maori health rights are not being protected as guaranteed under the treaty and that social, cultural, economic, and political factors cannot be overlooked in terms of their contribution to the health status of this group.In recent government health documents, the indigenous status health of maoris has been recognized, and the treaty of waitangi has been acknowledge as a fundamental component of the relationship between maoris and the government.However, the treaty has never been included in social policy legislation and there is a clear gap between acceptance of the treaty and translation of its aim into actual health gains for maori.[4]

Along with understanding and challenging issues of power and demotion, a critical component of cultural safety education is recognizing the role of wider societal processes in maintaining health disparities between Maoris and non-Maoris through discrimination and racism..Social and economic factors are fundamental determinants of health inequalities; among them, income, education, employment, occupation, housing and racism.In 1998 the National Health Committee said it was important to improve the health status of the most disadvantaged groups because doing so was fair, benefited wider society and made economic sense.For example, school failure is more often experience in low socioeconomic groups, which in turn can lead to relatively poor paid work that is less secure and exposes people to physical and chemical hazards, as well as to poorer housing.[5]

Shaw and Deed (2010) indicate that “November 1999 brought yet another change in government with a new structure and policy direction for health as the labour-Alliance Coalition was elected. Leading up to the elections the National Party declared that “health needs stability” and that they would be making no further policy changes, whereas, the labour party argued in their election manifesto that the national party had allowed the health system to be run down, privatized and commercialized. The public health and disability act (2000) changed the structure of health services to district health board 9DHBs)”.

The government is reconfiguring the health and disability sector to improve the overall health status of new Zealanders. Local decision-making will also help to deliver the Government’s commitment to reduce inequalities and improve health status. District Health Boards will be responsible for the health of their local population.[6]

An analysis of Maori health in the context of New Zealand’s colonial history may suggest possible explanations for inequalities in health between Maoris and non-Maoris, highlighting the role of access to health care. Two potential approaches to improving access to and quality of health care for Maoris are (1) development of a system of Maori health care provider services and (2) initiation of cultural safety education. Explanations for differences in health between Maoris and non-Maoris can be gathered into four major areas concentrating on socioeconomic factors, lifestyle factors, access to health care, and discrimination. These clarifications are not commonly limited, but it is useful to consider them separately while bearing in mind that they are inseparably connected.[7]

• Socioeconomic Factors-The significance of social environment in determining health has been established by the influential and continuing relationship between social and economic inequalities and poor health conclusions .Furthermore, survey outcomes obviously specified that undesirable health consequences are not consistently disseminated through the population.[8]
• Lifestyle Factors-It can be debated that lifestyle factors such as smoking signify one of the instrument by which socioeconomic factors affect health status. However, it has been understood that different lifestyle may be a justification to differences in health status between maori and non-maori.
• Access to Health Care-There is increasing indication that Maoris and non-Maoris vary in terms of admission to both primary and secondary health care services, that Maoris are less likely to be signified for surgical care and specialist services, and that, given the disparities in mortality, they obtain lesser than expected levels of quality hospital care than non-Maoris.
• Discrimination– Specialists have been revealed to be less likely to advocate for preventive measures for Maori patients than for non-Maori patients, and Maoris may be less likely than non-Maoris to be mentioned for surgical care.[9]

Shaw and Deed (2010) says that “Maori embrace distinctive ideas of health. Metge(1996) claims that although Maori concepts may seem to agree to western ideas, the resemblances are artificial, and while there may be overlap there are also significant differences. Maori conceptual meanings are compounded by pakeha cultural influences and generate debate about exactly what constitutes traditional customary maori belief and practice. Concepts of maori health are indisputably influence by the colonial experience articulated today with the crowns application of the treaty principles to health. Each tribe has a unique traditional concept of health that is shaped by their culture,language,geography of their land and their response to colonization.maori customs are dynamic and respond to change, but this does not mean that anything goes in maori society, because they must conform to basic and generic customary beliefs and practices (Durie, 1998)”.

Child mortality and infectious disease, mental health and addictions, life expectancy, education and imprisonment – in all these areas Maori bear an unfair burden.

• Maori children are 23 times more likely than European children to suffer rheumatic fever
• Maori have 50% higher rate of mental illness than non-Maori
• Maori life expectancy is 8 years lower than European life expectancy
• One in four Maori males have spent some time in prison
• One in four Maori young people are unemployed
• Maori students make up disproportionate share of the children left behind by our education system.[10]

The modifications between sex and gender needs investigating into the historical context in which understandings about gender have arose eventually. knowing that gender is a concept informed by social structures makes an chance to discover how gender is measured on a range, typically between masculine and feminine but with many mixtures in between.it is also important to recognize that traditional ideas about the gender are challenged and reframed as society improves. the idea of how power relationships show themselves in relation to gender has been discovered, in particular how power contributes to understanding of health, health inequalities and the way in which health services are delivered.[11]

The significance of observing ethnic disparities over time has been confirmed by the Ministry of health (Ministry of Health 2007).Understanding better maori health and reducing inequalities are key intentions in numerous health and disability strategies. The capability to measure and observe maori health status, outcomes, and ethnic inequalities is essential to attaining these goals. Though the chasing of disparities are reduced. This embraces satisfying crown responsibilities, but also as maori communities have an ongoing interest and stake in quality data that allows for an improved and more complete understanding of health issues of interest and concern.[12]

Some of the government’s main objectives, which monitors public sector policy and performance, is to minimized inequalities in education, employment, housing and health for all poor groups mainly for maori and pacific peoples and between men and women. The ministry of health’s formal requirements to contribute to the achievement of this goal is set out in its statement of intent (SOI), which is tabbed in Parliament with the budget.[13] As indicated by the ministry of health 2002.”District Health Board have a statutory responsibility for reducing health inequalities.(new Zealand Public Health and Disability Act 2000), which is reinforced through their main accountability documents-the crown funding agreements. These key health sector organizations have a powerful mandate to direct health resources as needed at the local level. District Health Boards and the ministry of health should negotiate and monitor service agreements with providers in such a way as to ensure service provision reduces inequalities in health”.

These changes give us a selection of world views, with dissimilar morals and significances. The numerous groups may view health differently, each influenced by their collective experience, their customs and beliefs and their place in society. To increase health and reduce health inequalities, we must appreciate and value these dissimilarities and work with people to address their health priorities as they define them, in methods that will work for them.[14]

Maintaining optimal health is a goal within society to provision the welfare of people and societies. There are number of elements that influence on it and may result in inequalities. There is overwhelming evidence that, within Aotearoa/NewZealand population live with disability. Government policies have been established to monitor accomplishment in addressing health and disability needs and redressing differences through society.[15]

Minimizing inequalities in health proposes principles that must be beneficial to whatever arrangements we commence in the health area to assure that those activities advantage to overcome health inequalities. We should be enterprise the source explanations of health inequalities, the social, economic and historical factors that regulate health. We must directing material, psychological and behavioral issues that enable the impact of fundamental issues on health .We should assume definite actions within health and disability services and diminish the influence of disability and illness on socioeconomic position.[16]

Concluding the gap in a generation approves that achievement in the social areas affecting health is important if the health status of different groups of people is to be made equal. The main endorsements are putting main importance on primary child growth and education. Cultivating living and working conditions, creating social protection policy supportive of all and creating conditions for a successful older life.[17]

References:

Shaw, S. & Deed,B.(2010).Health and Environment in Aotearoa/New Zealand.South Melbourne victoria Australia:Oxford University Press

Ellison-Loschmann,L.&Pearce,N.(2006).Improving access to healthcare among new zealand’s maori population.96(4)612-617

Ministry of Health.(2002).Reducing inequalities in health.wellington new zealand

King,A.(2000).The new Zealand health strategy discussion document.Ministry of Health

Ibid.

Ellison-Loschmann,L.&Pearce,N.(2006).Improving access to healthcare among new zealand’s maori population.96(4)612-617

Maori bear an unfair burden of the impact of inequality.Retrieved from:http//:closertogether.org.nz/maori-and-inequality.

Shaw, S. & Deed,B.(2010).Health and Environment in Aotearoa/New Zealand.South Melbourne victoria Australia:Oxford University Press

Cormack,D.&Harris,R.(2009).Issues in monitoring maori health and ethnic disparities:an update.University of otago.7-8.Retrieved from:http://external-file/ethnicity%20%.pdf.

Ministry of Health.(2002).Reducing inequalities in health.wellington new Zealand

Ministry of Health.(2002).Reducing inequalities in health.wellington new Zealand

Shaw, S. & Deed,B.(2010).Health and Environment in Aotearoa/New Zealand.South Melbourne victoria Australia:Oxford University Press

Ministry of Health.(2002).Reducing inequalities in health.wellington new Zealand

Public Health Association of New Zealand(2008).Health Inequalities.Retrieved from:http://external-file/PHANews0810.pdf.2

[1] Shaw, S. & Deed,B.(2010).Health and Environment in Aotearoa/New Zealand.South Melbourne victoria Australia:Oxford University Press

[2] Ibid.

[3] ibid

[4] Ellison-Loschmann,L.&Pearce,N.(2006).Improving access to healthcare among new zealand’s maori population.96(4)612-617

[5] Ministry of Health.(2002).Reducing inequalities in health.wellington new zealand

[6] King,A.(2000).The new Zealand health strategy discussion document.Ministry of Health

[7] Ibid.

[8] Ibid.

[9] Ellison-Loschmann,L.&Pearce,N.(2006).Improving access to healthcare among new zealand’s maori population.96(4)612-617

[10] Maori bear an unfair burden of the impact of inequality.Retrieved from:http//:closertogether.org.nz/maori-and-inequality.

[11] Shaw, S. & Deed,B.(2010).Health and Environment in Aotearoa/New Zealand.South Melbourne victoria Australia:Oxford University Press

[12] Cormack,D.&Harris,R.(2009).Issues in monitoring maori health and ethnic disparities:an update.University of otago.7-8.Retrieved from:http://external-file/ethnicity%20%.pdf.

[13] Ministry of Health.(2002).Reducing inequalities in health.wellington new Zealand

[14] Ministry of Health.(2002).Reducing inequalities in health.wellington new Zealand.6

[15]Shaw, S. & Deed,B.(2010).Health and Environment in Aotearoa/New Zealand.South Melbourne victoria Australia:Oxford University Press

[16] Ministry of Health.(2002).Reducing inequalities in health.wellington new Zealand

[17] Public Health Association of New Zealand(2008).Health Inequalities.Retrieved from:http://external-file/PHANews0810.pdf.2