Health inequalities between different population groups have major implications for governments. But how do we tackle differences in health outcomes that are avoidable, unfair and systematically related to social inequality and disadvantage?
This is a challenge that New Zealand is facing. Large health inequities exist in New Zealand between Maori and non-Maori. Maori life expectancy is significantly lower than non-Maori and Maori have poorer outcomes across a broad range of health measures. Maori also have lower personal incomes, lower levels of education, and higher levels of unemployment. This demonstrates the incredible complexity of interconnected and interrelated social determinants of health.
This week Sir Professor Michael Marmot – Chair of the World Health Organization’s Commission on Social Determinants of Health, which prepared the plan to eliminate inequalities in health outcomes within a generation – will be in New Zealand to discuss what policy actions are needed to address these social determinants of health. In advance of Sir Michael’s visit the New Zealand Medical Journal has released an editorial suggesting 10 actions that are needed to reduce health inequalities.
The suggestions that have garnered the most debate are to commit to making New Zealand smoke-free by 2025 and removing GST from healthy food, but perhaps the most interesting element is the suggestion that these policies should be paid for by raising the age of eligibility for New Zealand’s hallowed national superannuation scheme, which pays a guaranteed state-sponsored pension to all New Zealand citizens and permanent residents aged 65 and older regardless of their income or financial status. The New Zealand Medical Journal argues that it is fundamentally unfair for older New Zealanders to receive government support regardless of material need while 22 percent of children live in poverty.
This is the perfect example of a scenario where a health equity impact assessment is required. A health equity impact assessment would determine what groups would be affected by these policy changes, how they would be affected, and would identify what the likely impacts would be. The next step is to build a strategy to mitigate negative effects and build on positive ones – this should be done in partnership with each of the affected groups. Once policy changes or new programs are in place, it is important to monitor and evaluate them regularly to understand what works and what doesn’t.
The Wellesley Institute is active in advancing health equity as a policy priority here at home. The Wellesley’s Bob Gardener wrote the Toronto Central LHIN’s discussion paper on health equity and we have a range of health equity tools and resources available for policy makers. The solution to health inequalities in an age of high need and scarce resources is to ensure that complex policy problems are targeted in a coordinated way that recognizes and addresses the broad range of social determinants of health.
Blog post by Steve Barnes. Steve is a new policy analyst at the Wellesley Institute. You can reach him at firstname.lastname@example.org.