Having a common understanding of equity is an essential foundation for coordinated and collaborative effort to achieve equity in health and wellness.
John Whaanga, Deputy Director-General Māori Health
Dale Bramley, Waitemata DHB CE
Definition of equity
Having a common understanding of equity is an essential foundation for coordinated and collaborative effort to achieve equity in health and wellness. The definition can be used in all work and engagements within the health and disability system including government agencies involved in the broader social and economic determinatns of health. The definition can provide a common understanding of what is meant by equity.
The definition is designed to:
- fit the New Zealand context
- align with Te Tiriti o Waitangi obligations to go beyond just remedying disadvantage and reducing inequities, enabling Māori to flourish and lead their aspirations for health
- be principle based
- be inclusive enough to incorporate all possible dimensions of equity (indigenous, socio-economic, geographically, disability, etc.)
- reflect the international literature on equity
- reflect the definition put forward by the World Health Organization.
The Ministry's definition of equity is:
In Aotearoa New Zealand, people have differences in health that are not only avoidable but unfair and unjust. Equity recognises different people with different levels of advantage require different approaches and resources to get equitable health outcomes.
This definition of equity was signed-off by Director-General of Health, Dr Ashley Bloomfield, in March 2019.
Equity work programme
The Equity Work Programme was initiated in 2018 and has been supported by previous ELT members, including Alison Thom, former Acting Deputy Director-General Māori Health and Dr Jill Clendon, former Acting Chief Nursing Officer. Watch Alison and Jill discussing the importance of equity in the videos below.
Alison Thom, Māori Leadership, Senior Responsible Officer – Achieving equity
Kia ora. Nga mihi ki a kotou.
Addressing significant health disparities in Aotearoa New Zealand is both important and urgent. That Māori kids are much more likely than other kids to end up in ED, with issues that could’ve been dealt with easier and more early in primary care, is not ok. That people with serious mental health issues have a life expectancy 25 years less than others is shocking.
Delivering equitable outcomes to all New Zealanders is a priority for the Government, it’s a lead line in the New Zealand Health Strategy and it’s been something we’ve been working on for some time, with some gains. And yet still there are alarming inequalities when you look at the health and wellbeing of some groups of New Zealanders. Māori, Pasifika, people with disabilities and others.
It’s useful to talk about equity, to come to a common understanding and to figure out what we could be doing better. For instance, I often hear people talking about equity only in terms of access to services. Access to services is important, but it’s only one dimension of a very deeply ingrained, complex problem.
In short, inequity of health outcomes is a wicked problem and something that we all need to be working on. Some of the things that we should be thinking about include:
- How resources are allocated.
- Are services the right fit for people?
- Are services accessible?
- Is the system flexible and responsive to people, their needs and their circumstances?
- And how does unconscious bias in the system play out for people’s health outcomes?
If the success of the New Zealand health system is measured by how it consistently delivers equitable outcomes to all New Zealanders, then we’ve got quite a bit of work to do.
So what are we doing here at the Ministry? I’m leading this key priority, Achieving equity, working right across the Ministry and also in partnership with the sector.
With this renewed focus on equity we know we’re not starting from scratch and we do know that everyone cares about this and everyone needs to be involved.
I look forward to keeping you updated on what we’re doing in this work programme and also to working with you to make a difference.
Noho ora mai.
Dr Jill Clendon, Chief Nursing Officer
Everything we do should have an equity lens on it. We need to be thinking about ‘if we do this activity over here, what does that mean for all of these groups in our population – what does this mean for Māori? What does it mean for Pacific? What does it mean for people on low incomes? How can the work that I do as a clinician, as a stakeholder in the health sector, the decisions that I make, the choices that I make around care provision – what does that look like in terms of an equity focus for those populations that need support to achieve the same outcomes as everybody else?’
So in New Zealand we’ve spent a lot of time looking at different definitions of equity from around the world. We wanted to take an approach that was going to give us something that was strengths-based, something that enables us to move forward in the conversations that we’re having around equity.
Those differences that people have in health are ‘not only avoidable but they’re also unfair and unjust’. So equity recognises that ‘different people have different levels of advantage, and that those different levels of advantage may require different approaches and resources to get the same outcomes.’ So that definition helps guide our work, helps guide our discussions, helps enable us as clinicians and as stakeholders in the sector to really focus our work, bring an equity lens to our work and understand the strengths-based approach that we can bring to working with those who have differences in outcomes, who are experiencing challenges around equity and how we can support them.
There are a number of barriers. I believe that one of the biggest barriers is ourselves, and it’s our understanding of what equity is and how we can really work on our own understanding of what equity is and how we can contribute in that space as clinicians.
Every single one of us has the ability to, and should be, working toward achieving equity in New Zealand. That is, every single clinician, every single manager, every single person needs to be thinking about the way they’re working, the way that they’re interacting, the cultural lens that they bring to their work, the strengths-based approach: considering ‘how does every single activity that I do, what actions do I take – how do they impact on the people that I’m working with, and how can I ensure that my activities result in improved equity, improved outcomes for the people that I’m working with?’
So we all absolutely have a role in this, it’s not just about the Ministry of Health having a high level definition of equity. It’s about every single one of us as clinicians, as workers, really working together to ensure that the work we do addresses equity issues.
The Ministry’s Equity Work Programme aims to facilitate an equity focus across the health system’s operational landscape while promoting the cultural shift needed to affect the system change that achieves equity in health outcomes.
Collaboration is a key part of making equity real. We’re closely working with communities and organisations around Aotearoa New Zealand to make health outcomes more equitable.