There is considerable evidence, both internationally and in New Zealand, of significant inequalities in health between socioeconomic groups, ethnic groups, people living in different geographical regions and males and females (Acheson 1998; Howden-Chapman and Tobias 2000).
Research indicates that the poorer you are, the worse your health. In some countries with a colonial history, indigenous people have poorer health than others.
Reducing inequalities is a priority for government. The New Zealand Health Strategy acknowledges the need to address health inequalities as ‘a major priority requiring ongoing commitment across the sector’ (Minister of Health 2000).
Inequalities in health are unfair and unjust. They are also not natural; they are the result of social and economic policy and practices. Therefore, inequalities in health are avoidable (Woodward and Kawachi 2000).
The following set of questions has been developed to assist you to consider how particular inequalities in health have come about, and where the effective intervention points are to tackle them. They should be used in conjunction with the Ministry of Health’s Intervention Framework (PDF, opens in new window) (Ministry of Health 2002).
- What health issue is the policy/programme trying to address?
- What inequalities exist in this health area?
- Who is most advantaged and how?
- How did the inequality occur? (What are the mechanisms by which this inequality was created, is maintained or increased?)
- What are the determinants of this inequality?
- How will you address the Treaty of Waitangi in the context of the New Zealand Public Health and Disability Act 2000?
- Where/how will you intervene to tackle this issue? Use the Ministry of Health Intervention Framework to guide your thinking.
- How could this intervention affect health inequalities?
- Who will benefit most?
- What might the unintended consequences be?
- What will you do to make sure it does reduce/eliminate inequalities?
- How will you know if inequalities have been reduced/eliminated?
(Adapted from Bro Taf Authority. 2000. Planning for Positive Impact: Health inequalities impact assessment tool. Cardiff: Bro Taf Authority.)
Amended by Ministry of Health. May 2004.
Source: Te Roopu Rangahau a Erü Pomare., Ministry of Health and Public Health Consultancy. 2003. A Health Equity Assessment Tool. Wellington: Public Health Consultancy, Wellington School of Medicne and Health Sciences.
Acheson D. 1998. Independent Inquiry into Inequalities in Health. London: The Stationery Office.
Howden-Chapman P, Tobias M (eds). 2000. Social Inequalities in Health - New Zealand 1999. Wellington: Ministry of Health.
Minister of Health. 2000. The New Zealand Health Strategy. Wellington: Ministry of Health.
Ministry of Health, Public Health Consultancy, Te Roopu Rangahau Hauora a Eru Pomare. 2002. A Health Equity Assessment Tool. Department of Public Health, University Otago and Ministry of Health
Woodward A, Kawachi I. 2000. Why reduce health inequalities? Journal of Epidemiology and Community Health 54(12): 923.