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.
- Structural – tackling the root causes of health inequalities, that is, the social, economic, cultural and historical factors that fundamentally determine health.
- Intermediary pathways – targeting material, psychosocial and behavioural factors that mediate the impact of structural factors on health.
- Health and disability services – undertaking specific actions within health and disability services.
- 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.
There will be opportunities to discuss this document, and to apply the principles and framework to specific health issues and service areas, as the Ministry of Health holds sector workshops over the coming months.