Contents
What is Health Equity?
New Zealand Resources
Websites
Toolkits and Guidelines
Selected Reading
Selected Journals
International Resources
Websites
Toolkits and Guidelines
Selected Reading
Selected Journals
What is Health Equity?
Health equity is the absence of avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically (WHO)
The concept acknowledges that not only are differences in health status unfair and unjust, but they are also the result of differential access to the resources necessary for people to lead healthy lives (NZ MoH)
A window on the quality of Aotearoa New Zealand's health care 2019 – a view on Māori health equity | Health Quality & Safety Commission (hqsc.govt.nz)
Every year the Commission publishes a document we call A window on the quality of Aotearoa New Zealand’s health care. The Window provides a snapshot of the quality of health care in the country. While equity has always been a component of the report’s analysis over its four-year history, this year’s report focuses solely on equity.
The Health Quality & Safety Commission has developed a te ao Māori framework in partnership with Māori health providers, Whānau Ora providers and participating district health boards across Aotearoa New Zealand. The initial framework concept is shown below, followed by a brief description.
The aim of the framework is to improve the quality of care afforded to whānau Māori across Aotearoa New Zealand and advance the uptake and implementation of te ao Māori and mātauranga Māori concepts into general health system design and health practice for all.
There are two downloadable PDFs at the bottom of this page, which include the basic framework concept plus a backgrounder on how and why it was developed.
We are currently developing resources to support providers with implementation of the framework and will publish them here in due course.
We would like to acknowledge and thank our partner providers who gave their information freely in the hope that much-needed change could happen and be sustained over time.
Te ao Māori framework concepts
Wairuatanga
The holistic nature of Māori health, which links physical illness to emotional and spiritual wellbeing. Hence wairuatanga is in the middle position of the framework, which makes culture a central focus in the design of services. The goal of wairuatanga is to embed tikanga Māori and cultural safety into the health system.
Pātuitanga
The growing and fostering of strong partnerships with Māori, which is fundamental to ensuring the right concepts are included in the design and delivery of services.
Whānau
Whānau need and improving health outcomes for whānau are the drivers to why services are created and designed.
Rangatiratanga
The inclusion of Māori leadership in decision-making processes when services are designed.
Te ao Māori framework design
Each of the outer sections have two koru representing tapu and noa. The haehae lines bind each section together and connect and interact with each other.
The inside koru of each concept opens into wairuatanga, which allows wairuatanga to flow seamlessly throughout the entire framework.
The outside koru opens into te ao Mārama. The pītau design on the edge of the outer sections represents new beginnings and is the interconnection between te ao Māori and te ao Mārama.
Downloadable attachments
Editorial from the NZMJ (2021): 'Closing the gaps: health equity by 2040'
The main goals of the “once in a generation” Health and Disability System Review, which has led to a major system restructuring that’s now in its early stages, included better health outcomes for all and greater health equity, despite the review accepting that most of a person’s health status is determined by factors outside the system. In July this year, the Association of Salaried Medical Specialists (ASMS) and the Christchurch Charity Hospital Trust (CCHT) co-hosted a conference of health professionals to discuss the broader range of policies that are needed to address health inequities and improve health outcomes for all. This article outlines some of the key issues and recommendations to government emanating from that conference and contain in our report, Creating Solutions Te Ara Whai Tika: a roadmap to health equity by 2040.
Māori Health Priorities Report (2022)
This Māori Health Priorities report draws focus to the biggest contributors to health loss and health inequity for Māori, and also represent the greatest potential for intervention. This report was commissioned by Te Aka Whai Ora to inform our positioning on the priorities for the interim New Zealand Health Plan (iNZHP) for Māori.
Health Equity at CM Health
Health equity at ADHB
Fact and action sheets on health inequities [University of Otago and New Zealand Medical Association]
These fact and action sheets were prepared in the lead up to a visit by Sir Michael Marmot in July 2011, hosted by the New Zealand Medical Association. The purpose of these sheets includes an attempt at a brief stocktake on health inequities in New Zealand, both on what the current state of play is and what the future policy priorities might be.
Equity is the new black—and black lives matter (2020)
Editorial from New Zealand Medical Journal
"There is overwhelming evidence of inequities in health outcomes for Māori—you need look no further than the previous issue of NZMJ or the Wai 2575 Māori Health Trends Report. COVID-19 also presents a concern for the likely disproportionate impact on Māori.
Council encourages all doctors, employers, training and professional organisations to consider the findings in the cultural safety Report, draw on the data, and use this as a basis for achieving long-term, positive change for the benefit of all patients and whānau.
While the Report offers an insight into current practice, it is only the first step on a long journey. It sets a baseline for ourselves and our stakeholders to use when developing programmes, strategies and policies that support us to drive change."
Racism
Whiria te Muka Tangata: Anti-Racism Systems Change.
Ministry of Health. 2023
This publication outlines a preliminary systems change model that provides an organisational and system-level blueprint for anti-racism action in health.
Evolution of Racism and Anti-Racism – Lessons for the Aotearoa New Zealand Health System (Stage One Literature Review)
Minsitry of Health 2022
Evolution of Racism and Anti-Racism – Lessons for the Aotearoa New Zealand Health System.
This is the first literature review in the Ao Mai te Rā series. This review traces how understandings of racism and anti-racism have shifted over time and explores various concepts, language and definitions that have been used to date. The review considers how we might frame and think about racism and anti-racism within the Aotearoa New Zealand context and has been used to inform the Ministry’s position statement and working definitions for racism and anti-racism in health.
Best Practice Approaches to Addressing Racism – Lessons for the Aotearoa New Zealand Health System (Stage Two Literature Review)
Minstry of Health. 2023
This is the second literature review for phase one of Ao Mai te Rā: the Anti-Racism Kaupapa. This review explores best practice approaches to addressing racism in all its forms.
Anti-Racism Maturity Models – Lessons for the Aotearoa New Zealand Health System (Stage Three Literature Review)
Ministry of Health. 2023
This is the third and final literature review for phase one of Ao Mai te Rā: the Anti-Racism Kaupapa. This review examines the key features and characteristics of an anti-racism maturity model approach.
Evolution of Racism and Anti-Racism Literature review and Summary Document (2022)
Position statement and working definitions for racism and anti-racism in the health system in Aotearoa New Zealand (2022)
Understanding 'white privilege?'
Racism and White Defensiveness in Aotearoa: A Pākehā Perspective (2018)
Māori health: 'We have to be talking about racism' (2018)
Videos
Māori lives matter [HQSC]
In this presentation from the Health Quality & Safety Commission's Ō tātou hiranga advance care planning hui, Hector Matthews shines the spotlight on Māori inequity and the systemic biases that perpetuate inequities. He challenges us to confront some uncomfortable truths about inequity and explore ways we can truly place people’s cultural framework at the centre of their care and wellbeing.
Dr Lance O'Sullivan on a mission for health equity [Ko Awatea ]
Dr Lance O'Sullivan is at Middlemore Hospital working on a new health equity programme. In a 2016 interview on Te Karere he talks about his belief that regardless of race, age or income, people should have the same health opportunities as the next.
What is Health Equity? [Health Equity Institute]
This three-minute motion graphic video explains how social, economic, and environmental conditions can create health inequities and how these inequities can affect health disparities.
What Is Health Equity, and Why Does It Matter? [IHI]
David R. Williams, Professor of Public Health at the Harvard T.H. Chan School of Public Health, has been researching health inequities in the United States for two decades. In this video, he sits down with Don Berwick, MD, President Emeritus and Senior Fellow at IHI, to talk about health equity and why it’s important.
Social Media
twitter #healthequity
New Zealand Resources
Websites
Equity [Ministry of Health]
Equity Explorer [HSQC]
The Equity Explorer provides information on how health and health care varies between groups of people, and between district health board (DHB) areas of Aotearoa New Zealand (NZ).
Two types of group are compared: ethnic groups and groups based on socioeconomic status (deprivation).
The health conditions compared are diabetes, asthma and gout.
Maori Health Clearinghouse
Pacific Health Clearinghouse
Asian Health Clearinghouse
Health system quality dashboard
Health & Quality Safety Commission (NZ).
In partnership with Te Tumu Whakarae, HQSC has developed a new specific Māori Health Equity Report, using distinct data.
Toolkits and Guidelines
Hospital Ethnicity Data Audit Toolkit | Ministry of Health (2021)
A resource for assessing the quality of ethnicity data in New Zealand hospital settings, and supports quality improvement in this area.
The scope of the Toolkit (also known as HEDAT) includes four tools to assess the quality of ethnicity data and systems for data collection, recording and output within a hospital setting, and provides guidance on quality improvement activities. The Toolkit helps hospitals assess health care ethnicity data against the HISO 10001:2017 Ethnicity Data Protocols and, more broadly, against current best practice.
Medicine access equity monitoring and outcomes framework (NZ: 2021)
Pharmac
We’re establishing baseline measures of inequity for access to funded medicines for our priority conditions.
These reports mark the first time we have measured equity of access to funded medicines for these key long-term conditions. Our insights are drawn from dispensing data for Māori and Pacific peoples to treat:
- asthma
- cardiovascular conditions
- chronic obstructive pulmonary disease (COPD)
- gout
- type 2 diabetes.
We are publishing our insights to raise awareness of current medicine access inequities. We hope they spark discussions on medicine access equity across the health sector. We welcome any feedback on our insights.
Creating Solutions Te Ara Whai Tika: A roadmap to health equity by 2040. (NZ: 2021)
Associated of Salaried Medical Specialists
The Creating Solutions Te Ara Whai Tika report by the Association of Salaried Medical Specialists Toi Mata Hauora, recommends a national goal of achieving health equity for all New Zealanders by 2040 and lays out a roadmap of policies to get there.
It follows presentations, discussions, and input from more than 200 health professionals who attended a virtual conference co-hosted by ASMS and the Canterbury Charity Hospital Trust, established by Dame Sue and Associate Professor Phil Bagshaw.
Achieving Equity in Health Outcomes: Highlights of selected papers [NZ; 2018]
Both in New Zealand and globally, our ability to address equity challenges in health has significantly improved over the past decades. In the Western world life expectancy has increased for all populations. However persistent disparities in health access, quality of services and outcomes remain. In Aotearoa New Zealand, Māori and Pacific and those in low socioeconomic groups remain the most disadvantaged.
The Government has mandated the Ministry of Health to take a bold approach that delivers tangible changes to system behaviour with measurable results in a three to five-year horizon. An approach that operates on a repeating cycle based around deepening the understanding of equity gaps, shifting thinking about where priorities for investment of time and resources lie, followed by increasing direct action to address inequalities is being developed.
This paper traces the beginnings of health equity and the philosophical and ethical foundations that sit behind it. It looks at a selection of the international and local literature to help understand definitions of equity. It considers how framing and thinking about the concept of equity and approaches to addressing equity have evolved, and how progress to address equity can be measured.
The Health Equity Assessment Tool: a User's Guide [NZ]
The Health Equity Assessment Tool: A User's Guide, has been developed by the University of Otago, Wellington, to help facilitate the use of the Health Equity Assessment Tool (HEAT).
The Health Equity Assessment Tool: A User's Guide gives a brief overview of inequalities in health, introduces the HEAT and its use, presents an in-depth look at each of the HEAT questions, and provides case examples of the tool's use. This publication is an essential guide for those working in the health and disability to apply a strong equity focus to their work.
Equity of Health Care for Māori: A Framework [NZ]
This framework guides health practitioners, health organisations and the health system to achieve equitable health care for Māori through leadership, knowledge and commitment.
Quality improvement: no quality without equity? [NZ; 2017]
This ‘think piece’ from the Health Quality & Safety Commission signals our intention to tackle health inequities.
Central Region Equity Framework
TAS, 2019
The Central RegionEquity Framework has been developed by theCentral Regionand was endorsed by the Central Region Chief Executives in April 2019. The Central Region is a combination of MidCentral DHB, Hawke’s Bay DHB, Whanganui DHB, Wairarapa DHB, Hutt Valley DHB and Capital and Coast DHB.
The Central Region Service Planning Forum (CRSPF) commissionshealth and disability services that aim to improve health outcomes and achieve equity for all populations living in the central region district health board areas. This Framework1provides guidance to the CRSPF on strengthening their commissioning to achieve equity within activities identified within the Central Region’s Regional Service Plan (RSP). In the Central Region, equity in health is based on the WHO definition of equity –the absence of avoidable or remediable difference among groupsof people. The concept acknowledges that these differences in health status are unfair and unjust. However,they are also the result of differential access to the resources necessary for people to lead healthy lives. Peoplewho are poor, have chronic conditions/diseases, live with disabilities, live rurallyand are of different ethnicities, will have poorer health, greater exposure to health risks and poorer access to health services2.These variables are unlikely to exist in isolationasthey are deeplyinterwoven.The concept of intersectionality is vital when exploring the fundamental causes of inequity.In New Zealand, inequalities between Māori and non-Māori are the most consistent and compelling inequities in health. The Central Region Chief Executives and the Central Region Māori General Managers hold the view that these differences are not random.They exist because of institutional racism3and the impact of colonisation and its continuing processes4.Achieving equity for Māoriis a priority, as the health gaps across the life-coursearesignificant for Māori.The Treaty of Waitangi was signed to protect the interests of Māori. It is not in the interest of Māorito be disadvantaged in any measure of social or economic wellbeing5.A companionTreaty of Waitangi document will be developed, with the purpose of providing direction to the Central Region DHBs on what they need to do to meet theirTreaty of Waitangi obligations.
HE PIKINGA WAIORA IMPLEMENTATION FRAMEWORK
University of Waikato, 2016
The Framework has indigenous self-determination at its core. All four elements have conceptual fit with Kaupapa Māori aspirations and all have demonstrated evidence of positive implementation outcomes.
A coding scheme derived from the Framework was applied to 13 studies of diabetes prevention in indigenous communities in Australia, Canada, New Zealand, and the United States. Cross-tabulations demonstrated that cultural centeredness (p=.008) and community engagement (p=.009) explained differences in diabetes outcomes and community engagement (p=.098) explained difference in blood pressure outcomes.
The Framework is intended as a planning tool to guide the successful development and implementation of interventions. Funders can use the Framework to assess the likely effectiveness of proposed interventions.
Community organizations can use the Framework to work with researchers or policy makers to strengthen each of the four elements.
Pitama, S., Huria, T., & Lacey, C. (2014). Improving Maori health through clinical assessment: Waikare o te Waka o Meihana. The New Zealand Medical Journal (Online), 127(1393).
Health professionals play an important role in addressing indigenous health inequalities. This paper describes the further development and a new conceptualisation of the Meihana model (2007) and the Hui process (2011), which together have formed the indigenous health framework in the University of Otago, Christchurch undergraduate medical education programme for 4th–6th year medical students over the past 5 years. The components of the framework are defined followed by description of their application to clinical assessment. The indigenous health framework has been evaluated by medical students, health practitioners, Māori patients and whanau over this time and has been rated favourably as a clinically relevant framework that supports health practitioners to work effectively with Māori patients and whānau.
This study highlights the importance and relevance of relational approaches to engaging Māori and their whānau accessing health services. It signals the necessary foundations for health practitioners to build trust-based relationships with Māori. Key elements for a Māori-centred model of relational care include whakawhanaungatanga (the process of building relationships) using tikanga (cultural protocols and processes) informed by cultural values of aroha (compassion and empathy), manaakitanga (kindness and hospitality), mauri (binding energy), wairua (importance of spiritual wellbeing).
Literature Review to Inform the Development of a Culturally Appropriate Assessment Model for Māori (2022)
Introduction
The purpose of this literature review is to inform the development of a culturally appropriate assessment model that meets the need of Māori and whānau and will enable a holistic assessment of needs and inform the provision of care and support services. Capturing relevant findings from the literature will ensure that the processes undertaken to develop a culturally appropriate model are evidence based. The findings of the review are intended to assist the Francis Health project team and wider steering group in how best to approach this work. The wider project is underpinned by a kaupapa Māori approach, one framework being utilised is the Te Pā Harakeke Framework. This literature review as an input contributes to Te Puawai in the framework. Te Puawai references the flower head of the harakeke plant and refers to the processes used within each function to give effect to the strategy of the kaupapa. Largely, it seeks to inform ways to weave Kaupapa Māori approaches with interRAI assessment to enable positive outcomes for Māori. The literature review is one of many information streams that is feeding into the project.
The scope of the literature review includes:
− Approaches undertaken to make established assessment tools culturally appropriate
− Approaches undertaken to develop assessment tools that are compliant with Te Ao Māori
− How to implement relational Māori models of health within an assessment tool
Whānau Ora Health Impact Assessment
Ministry of Health, 2007
The Whānau Ora Health Impact Assessment tool was published in April 2007 by the Ministry of Health and builds on the Public Health Advisory Committee’s, ‘A Guide to HIA: A Policy Tool for New Zealand’ (2005).
The Whānau Ora HIA tool follows the same methodology: Screening, Scoping, Appraisal and Reporting and Evaluation. It follows the same methodology: Screening, Scoping, Appraisal and Reporting and Evaluation.
It was developed for use by policy makers as a tool for assessing the positive and negative impact of their policies on Māori and to identify ways in which these could be enhanced or adapted. It complements other resources aimed at promoting Māori health including the Health Equity Audit Tool.
It was produced in response to the fact that the Māori population experiences significantly poorer health outcomes than the rest of New Zealand’s population and as a way to support delivery of the Ministry of Health’s strategic vision to improve health outcomes and reduce inequalities for Māori outlined in He Korowai Oranga: Māori Health Strategy 2002.
At the heart of the tool is the concept of ‘Whānau ora’, which means, ‘Māori families being supported to achieve their maximum health and well being’. Its overarching aim is to ensure equity in health for Māori.
Reducing Inequalities in Health
Ministry of Health, 2002
Summary
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.
Te Rōpū Whakakaupapa Urutā Analysis of Health Sector Equity Tools
Te Rōpū Whakakaupapa Urutā
There is an existing suite of equity tools that clearly articulate and define the ways in which equity can be placed at the heart of the health system.
Equity resources
The following frameworks, guidelines and statements have informed the principles that underpin our recommendations and specific actions:
Te Rōpū Whakakaupapa Urutā Position Statement
He Pikinga Waiora Implementation Framework (Healthier Lives NSC, 2016)
Governance for Health Equity (World Health Organisation, 2013)
He Ara Hauora Māori: A Pathway to Māori Health Equity (Medical Council of NZ, 2019)
Equity Tools
Gustafson, P., Lambert, M., Bartholomew, K. et al. Adapting an equity-focused implementation process framework with a focus on ethnic health inequities in the Aotearoa New Zealand context. Int J Equity Health 23, 15 (2024). https://doi.org/10.1186/s12939-023-02087-y
The framework presented in this study is the first equity-focused process-type implementation framework to be adapted for the Aotearoa NZ context. This framework is intended to support and facilitate equity-focused implementation research and health intervention implementation by mainstream health services.
Reducing Inequalities in Health Framework
Health Equity Assessment Tool - A Users Guide
Whānau Ora Health Impact Assessment
Equity of Healthcare for Māori: Framework
Central Region DHB's Equity Framework
Analysis of Equity Tools
In preparation for the restart of the health system and recovery from COVID-19. Te Rōpū Whakakaupapa Urutā has carried out a quick review and analysis of the existing equity tools currently available to the health sector. Our analysis provides information about each tool's development, origins, what the tool is, how long it has been in the system, examples of where the tools have been implemented and a view of their usefulness.
As we plan for a restart of the health services and a desire to reset the system so that it achieves equity for Māori, being aware of these tools and using/adapting them might be helpful.
All tools to some degree use an intervention logic: problem definition, engagement with stakeholders, intervention planning, monitoring and evaluation.
Additionally they are likely to be more useful in specific contexts.
For example:
The Equity of Health Care for Māori, the Central Region DHBs Equity Framework and the Health Equity Assessment Tool and its’ users guide are health services focused.
The Whānau Ora Health Impact Assessment can be used at both a policy and project level with its strength being on the health impacts resulting from other sector activities.
The Reducing Health Inequalities Framework is a useful background document which identifies that actions needs to be in four areas: system, intermediary environments, health services and impact of ill health and disability it is best used with another tool that is more intervention focused.
Our quick review and analysis is available here (doc attached)
Selected Reading
Gustafson, P., Lambert, M., Bartholomew, K. et al. Adapting an equity-focused implementation process framework with a focus on ethnic health inequities in the Aotearoa New Zealand context. Int J Equity Health 23, 15 (2024). https://doi.org/10.1186/s12939-023-02087-y
The framework presented in this study is the first equity-focused process-type implementation framework to be adapted for the Aotearoa NZ context. This framework is intended to support and facilitate equity-focused implementation research and health intervention implementation by mainstream health services.
Maranga Mai! = The dynamics and impacts of white supremacy, racsim and colonisation upon tangata whenua in Aotearoa New Zealand
Te Kaahui Tika Tangata, the New Zealand Human Rights Commission (2022)
The report provides a crucial perspective on extremely challenging issues which will define Aotearoa for years to come. It compels us to acknowledge the white supremacy and institutional racism woven into the fabric of the colony as immigrants settled in these islands,” said Te Amokapua Chief Human Rights Commissioner Paul Hunt.
Maranga Mai outlines the immense harm caused to Māori by more than 180 years of colonisation – resulting in discrimination, violence and impoverishment
A three-year Truth, Reconciliation and Justice Commission, as recommended by the report, would aid understanding of the injustices affecting Māori and help with the healing and reconciliation. It would also provide a path to realising constitutional certainty before the bicentenary of Te Tiriti in 2040, he said. Maranga Mai explains that to be free of discrimination and to determine their own future, tangata whenua want tino rangatiratanga under Te Tiriti restored, as well as their indigenous rights under the United Nations Declaration on the Rights of Indigenous Peoples (Undrip). Maranga Mai recommended: Committing to constitutional transformation. Establishing a Truth, Reconciliation and Justice Commission. Establishing an independent body or bodies to uphold Te Tiriti and indigenous rights. Appointing an Indigenous Rights Commissioner and exploring the option for an independent Indigenous Rights Commission.
Ki te whaiao, ki te ao Mārama Community Engagement Report for developing a National Action Plan Against RacismTe Kaahui Tika Tangata, the New Zealand Human Rights Commission (2022)
The report describes the long history of racism in Aotearoa affecting tangata whenua and ethnic and religious communities. It has more than 40 recommendations, including: Eliminating racism in key sectors (housing, employment, work and income, health, education, criminal justice). Addressing the land issues of tangata whenua in a Tiriti-based way. Constitutional transformation. Education about the history of colonisation and racism in Aotearoa. A campaign encouraging the public to take anti-racist action. Requiring or incentivising public and private organisations to take anti-racist action.
Mortality outcomes and inequities experienced by rural Māori in Aotearoa New Zealand
The Lancet (2022)
The excess Māori all-cause mortality across the rural: urban spectrum is consistent with existing literature documenting other Māori health inequities. A similar but more pronounced pattern of inequities is observed for amenable mortality that reflects ethnic differences in access to, and quality of, health care. The excess all-cause and amenable mortality experienced by rural Māori, compared to their urban counterparts, suggests that there are additional challenges associated with living rurally.
A Critical Tiriti Analysis of the Pae Ora (Healthy Futures) Bill
New Zeland Medical Journal (2022)
The Pae Ora (Healthy Futures) Bill is the framework for a reformed health system intended to embed Te Tiriti o Waitangi and centre equity. The Bill is informed by the Wai 2575 Health Kaupapa Waitangi Tribunal Inquiry and the Health and Disability System Review, both of which established an urgent mandate to transform the health sector. This desktop review explores to what extent the proposed Bill is likely to uphold Te Tiriti.
The whitewashing of contracts: Unpacking the discourse within Māori health provider contracts in Aotearoa/New Zealand
Health and Social Care in the Community (2021)
Success of the proposed health reforms and the Māori Health Authority should require dismantling of non-Māori ways of commissioning and contracting, otherwise there is the continued risk of discriminatory contracting practices limiting the expression of self-determination for Māori health providers.
The Choosing Wisely campaign and shared decision-making with Māori
New Zealand Medical Journal (2021)
This work identified some structural issues in Choosing Wisely New Zealand that have limited the campaign’s ability to mitigate health inequities for Māori and helped to define a potentially transformative way forward. There was wide agreement among our participants that shared decision-making is not just a quality practice, but that it also has the potential to address health inequity among Māori by facilitating participation in healthcare that better meets self-identified need. “Practitioner dependent” factors like consumer trust, autonomy, good relationships and rapport with health providers and culturally appropriate resources are important and are as demanding of attention as systemic causes of health inequity, such as inadequate access to services, the social determinants of health and the structural determinants of health, including racism.
Barriers and facilitators for Māori in accessing hospital services in Aotearoa New Zealand
New Zealand Medical Journal (2021)
Māori health inequities result from systematic failures in the provision of healthcare by the public health system and historical structural failures that have led to the inequitable distribution of the social determinants of wellbeing for Māori compared to non-Māori.
He Tamariki Kokoti Tau: Tackling preterm incidence and outcomes of preterm births by ethnicity in Aotearoa New Zealand 2010‐2014.
International Journal of Gynecology & Obstetrics.(2021)
Conclusion
This study demonstrates that the Aotearoa New Zealand maternity system privileges whiteness, suggesting that clinical pathways for evidence-based medical care are not delivered systemically and equitably for all. Health pathways that focus on equity as a fundamental right will enhance health outcomes for Māori women and their infants.
The human and health costs of failure to implement pro-Tiriti and pro-equity health policies: let’s act as if we know this
New Zealand Medical Journal. Vol 134 No 1542: 17 September 2021
After a twenty-year period of relative stability in the health system, we are entering a period of very considerable change. These changes are driven, in part, by a clearly stated desire on the part of government for fairer health outcomes for Māori.
Inequities in people with gout: a focus on Māori (Indigenous People) of Aotearoa New Zealand / Te Karu, L., Dalbeth, N., & Stamp, L. K.
Therapeutic Advances in Musculoskeletal Disease (2021)
Health equity can be defined as the absence of systematic disparities in health between more and less advantaged social groups. Gout is one of the most common forms of arthritis and disproportionally affects Indigenous peoples, including Māori in Aotearoa New Zealand. Inequities in gout management are well documented and clearly evidenced in Indigenous populations. For example, while gout occurs at a younger age and is more severe in Māori, there is less regular dispensing of urate-lowering therapies. Indigenous peoples are also under-represented in clinical trials. Herein, we will review inequities in gout using Aoteoaroa New Zealand as an example. We will explore reasons for health inequities and challenges that need to be faced to achieve health equity.
Creating an Indigenous Māori-centred model of relational health: A literature review of Māori models of health (2021)
This study highlights the importance and relevance of relational approaches to engaging Māori and their whānau accessing health services. It signals the necessary foundations for health practitioners to build trust-based relationships with Māori. Key elements for a Māori-centred model of relational care include whakawhanaungatanga (the process of building relationships) using tikanga (cultural protocols and processes) informed by cultural values of aroha (compassion and empathy), manaakitanga (kindness and hospitality), mauri (binding energy), wairua (importance of spiritual wellbeing).
My role in tackling health inequalities: a frameworkl for allied health professionals
KingdFund (2021)
The King’s Fund has worked with AHPs from across the UK to develop a framework to support any AHP to think through and understand their contribution to tackling health inequalities, whatever their role. The framework details how AHPs can raise awareness, take action and optimise advocacy through six lenses: self; patients; clinical teams, pathway and service groups; communities and networks; systems; and nurturing the future.
The framework is designed to support AHPs to do whatever they can – large or small – to tackle health inequalities.
Rapua Te Ara Matua: Equity report
Waikato DHB (2021)
WDHB endorsed the report, taking active ownership and explicitly acknowledging their DHB is:
"embedded in a healthcare system which has privileged the needs of the majority while failing to meet the needs of all"
"Waikato DHB is party to the systematic failure to adequately address and eliminate equity gaps and provide services that are culturally competent and holistic for Tangata Whenua"
The report provides a clear view of the inequities experienced by Maori people and Pacific people and the systemic failure they continue to receive. While some of the data is undoubtedly confronting- the reality is this is what our priority populations endure on a daily basis.
Among other actions, the report identified (and we may have heard this before..) "Maori-led structural change was needed within the DHB to address the gaps in health equity."
Telehealth as a tool for equity: pros, cons and recommendations
NZMJ. Issue: Vol 134 No 1530: 19 February 2021
In this viewpoint, we consider whether telehealth is an equity-positive tool that might help to overcome some important barriers to health care access for Māori and Pacific people. We consider the equity ramifications of a shift toward models of care that maximise the use of telehealth solutions, and our recommendations regard how we might best achieve the equity-positive potential of telehealth for Māori and Pacific people.
Achieving Equity in Health Outcomes: Summary of a discovery process.
Ministry of Health. 2019.
In 2018, the Ministry of Health initiated a work programme on achieving equity in health outcomes. Specifically, this programme aims to ensure that equity is at the heart of the way New Zealand’s health and disability system operates and to promote the cultural shift needed to achieve that. This report provides a brief summary of phase one of the Achieving Equity Work Programme: The Discovery Phase. The aim of the discovery phase was to identify where practical and coordinated effort could be undertaken to achieve a measurable shift in health equity in the next three to five years. Through an examination of the literature; a review of evidence; and consideration of what people said needs to be tackled in the health and disability system, common challenges and opportunities for achieving health equity in Aotearoa/New Zealand have been explored.
The Waitangi Tribunal’s WAI 2575 Report: Implications for Decolonizing Health Systems
Health and Human Rights Journal (2020)
Te Tiriti o Waitangi, a treaty negotiated between Māori (the Indigenous peoples of Aotearoa) and the British Crown, affirmed Māori sovereignty and guaranteed the protection of hauora (health). The Waitangi Tribunal, established in 1975 to investigate alleged breaches of the agreement, released a major report in 2019 (registered as WAI 2575) about breaches of te Tiriti within the health sector in relation to primary care, legislation, and health policy. This article explores the implications of this report for the New Zealand health sector and the decolonial transformation of health systems. The tribunal found that the Crown has systematically contravened obligations under te Tiriti across the health sector. We complement the tribunal’s findings, through critical analysis, to make five substantive recommendations: (1) the adoption of Tiriti-compliant legislation and policy; (2) recognition of extant Māori political authority (tino rangatiratanga); (3) strengthening of accountability mechanisms; (4) investment in Māori health; and (5) embedding equity and anti-racism within the health sector. These recommendations are critical for upholding te Tiriti obligations. We see these requirements as making significant contributions to decolonizing health systems and policy in Aotearoa and thereby contributing to aspirations for health equity as a transformative concept.
Baseline Data Capture: Cultural Safety, Partnership and Health Equity Initiatives FINAL REPORT (2020)
The Medical Council of New Zealand, in partnership with Te Ohu Rata O Aotearoa (Te ORA), is pleased to release an independent report outlining findings of the current state of cultural safety and health equity delivered by doctors practicing in Aotearoa New Zealand and experienced by patients and whānau. Māori patients’ experiences are the focus of the report, however many of the challenges and solutions will be applicable to other ethnic groups and populations who experience inequitable healthcare.
Creating an Indigenous Māori‐centred model of relational health: A literature review of Māori models of health. Journal of Clinical Nursing. (2021)
This study highlights the importance and relevance of relational ap-proaches to engaging Māori and their whānau accessing health services. It signals the necessary foundations for health practitioners to build trust- based relation-ships with Māori. Key elements for a Māori-centred model of relational care include whakawhanaungatanga (the process of building relationships) using tikanga (cultural protocols and processes) informed by cultural values of aroha (compassion and empa-thy), manaakitanga (kindness and hospitality), mauri (binding energy), wairua (impor-tance of spiritual wellbeing).
Racism and health in Aotearoa New Zealand: a systematic review of quantitative studies (2020)
Quantitative racism and health research in New Zealand consistently finds that self-reported racial discrimination is associated with a range of poorer health outcomes and reduced access to and quality of healthcare. This review confirms that experience of racial discrimination is an important determinant of health in New Zealand, as it is internationally. There is a pressing need for effectively designed interventions to address the impacts of racism on health.
Experiences of Māori of Aotearoa New Zealand's public health system: a systematic review of two decades of published qualitative research (2020)
Australia and New Zealand Journal of Public Health
This paper aims to synthesise the broader perspectives of Māori patients and their whānau (extended family, family group) of their treatment within the public health system. Our research question was ‘What are the experiences of Māori in the public health and/or hospital system in Aotearoa New Zealand?’
Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition [NZ]
International Journal for Equity in Health
There is growing recognition of the importance of cultural competency and cultural safety at both individual health practitioner and organisational levels to achieve equitable health care...A move to cultural safety rather than cultural competency is recommended. We propose a definition for cultural safety that we believe to be more fit for purpose in achieving health equity, and clarify the essential principles and practical steps to operationalise this approach in healthcare organisations and workforce development.
Tofa Saili: A review of evidence about health equity for Pacific Peoples in New Zealand'
Pacific Perspectives (2019)
This report describes the health equity issues faced by Pacific families and communities. The report highlights approaches based on Pacific values and the strengths of Pacific communities. It is informed by the Pacific Aotearoa vision (Ministry of Pacific Peoples, 2019).
A window on the quality of Aotearoa New Zealand's health care 2019 – a view on Māori health equity
HQSC, 2019
Every year the Commission publishes a document we call A window on the quality of Aotearoa New Zealand’s health care. The Window provides a snapshot of the quality of health care in the country. While equity has always been a component of the report’s analysis over its four-year history, this year’s report focuses solely on equity.
A window on the quality of Aotearoa New Zealand’s health care 2019 – a view on Māori health equity (Window 2019) highlights a number of areas where change is needed in the health system. The report is divided into three chapters. The first analyses inequity between how Māori and non-Māori access and receive health services, and the effects on equity of improvement activities in our system. The second chapter asks why these inequities exist, and the third chapter addresses opportunities for improvement.
Addressing equity in intergenerational wellbeing: Valuing community perspectives
Deloitte and Victoria University of Wellington, 2019.
Our partners at Victoria University of Wellington’s School of Government look at New Zealand’s wellbeing frontier and the importance of bringing in community perspectives to build effective policy.
Understanding inequalities: summary report. The impact of inequalities in the early
years on outcomes over the life course: Using international evidence to identify creative policy solutions.
Growing up in New Zealand, 2019.
The findings from the Growing Up in New Zealand study demonstrate that Maori and Pasifika children experience the highest burden of socioeconomic disadvantage in their early years as well as an unequal burden of significant co-morbidities in terms of health and development throughout their life course. By the time they start school (at age 5 years) many are already falling behind their peers in terms of preparedness for formal education and readiness to engage in learning.
The study has shown that inequalities in developmental opportunities and outcomes have their origins in early in life. Risk factors for early vulnerability cluster and there is no one single proxy marker of disadvantage. Additionally, morbidity and poor outcomes cluster. Persistent adversity is associated with a graded likelihood of poor outcomes (across the population). Further service use is not meeting measured need. Currently, access to early life universal services may be widening inequalities. A proportional-universalism approach to services is required if they are to meet real need and reduce inequalities.
'HAUORA: Report on Stage One of the Health Services and Outcomes Kaupapa Inquiry'
Waitangi Tribunal.
Our stage one report addresses claims concerning the way the primary health care system in New Zealand has been legislated, administered, funded, and monitored by the Crown since the passing of the New Zealand Public Health and Disability Act 2000 (‘the Act’) Statistics. In our report we explore whether the persistent inequitable health outcomes suffered by Māori are indicators of Treaty breach. In doing so, we ask whether a cause of the inequitable health statistics suffered by Māori is the legislative and policy framework of the primary health care system itself. n approaching our task, we identified four main thematic issues to focus on for this stage of the inquiry : the Treaty-compliance of the Act and framework ; funding arrangements for primary health care ; accountability arrangements for primary health care ; and the nature of Treaty partnership arrangements in the primary health care sector.
He oranga mo Aotearoa: Māori wellbeing for all
Deloitte
We consider various Māori wellbeing frameworks and measurements, the barriers to Māori wellbeing and the drivers and changes that could improve it.
Delivering better outcomes together: Policies that reflect our diverse cultures
Deloitte
The cultural and ethnic face of Aotearoa New Zealand is changing. We explore why and how our institutions and policies need to move closer toward multi-culturalism to achieve better outcomes for all.
The health equity measurement framework: a comprehensive model to measure social inequities in health
International Journal for Equity in Health201918:36
Clinical research trials achieving equitable health outcomes for Māori. ACTA International Clinical Trials Conference 2019. Assoc Prof Matire Harwood.Dept General Practice, FMHS, University of Auckland
Includes discussion of the model for 'Explaining Ethnic Determinants of Health'.
Ethnic bias and clinical decision-making among New Zealand medical students: an observational study [NZ]
BMC Medical EducationBMC series – 201818:18 (2018)
Lessons for Achieving Health Equity Comparing Aotearoa/New Zealand and the United States [NZ]
Health Policy 2019
To authentically commit to achieving health equity, nations should: 1) Explicitly design quality of care and payment policies to achieve equity, holding the healthcare system accountable through public monitoring and evaluation, and supporting with adequate resources; 2) Address all determinants of health for individuals and communities with coordinated approaches, integrated funding streams, and shared accountability metrics across health and social sectors; 3) Share power authentically with racial/ethnic minorities and promote indigenous peoples’ self-determination; 4) Have free, frank, and fearless discussions about impacts of structural racism, colonialism, and white privilege, ensuring that policies and programmes explicitly address root causes.
Achieving health equity in Aotearoa: strengthening responsiveness to Māori in health research (2017).
N Z Med J. 2017 Nov 10;130(1465):96-103.
Excellent health research is essential for good health outcomes, services and systems. Health research should also build towards equity and in doing so ensure that no one is left behind. As recipients of government funding, researchers are increasingly required to demonstrate an understanding of their delegated responsibilities to undertake research that has the potential to address Māori health needs and priorities. These requirements form the basis of responsiveness to Māori in health research, and several research institutions have implemented systems to support their organisational approach to this endeavour. However, many health researchers have a narrow view of responsiveness to Māori and how it might be relevant to their work. In this viewpoint paper we provide an overview of existing frameworks that can be used to develop thinking and positioning in relation to the Treaty of Waitangi and responsiveness to Māori. We also describe an equity-based approach to responsiveness to Māori and highlight four key areas that require careful consideration, namely: (1) relevance to Māori; (2) Māori as participants; (3) promoting the Māori voice, and; (4) human tissue. Finally, we argue for greater engagement with responsiveness to Māori activities as part of our commitment to achieving equitable health outcomes.
The Determinants of Health for Pacific Children and Young People in New Zealand (2014) (Determinants of Health for Children and Young People). New Zealand Child and Youth Epidemiology Service (2016)
Te Ohonga Ake The Determinants of Health for Māori Children and Young People in New Zealand Series Two (2016) New Zealand Child and Youth Epidemiology Service (2016)
The cost of child health inequalities in Aotearoa New Zealand: a preliminary scoping study[NZ]
BMC Public Health 12.1 (2012): 1.
Geography matters: the prevalence of diabetes in the Auckland Region by age, gender and ethnicity [NZ]
New Zealand Medical Journal 2016; 129 (1436): 25-37
Health equity in the New Zealand health care system: a national survey. [NZ]
International Journal for Equity in Health 10.1 (2011): 1.
Health equity: what does it mean for child health [NZ]
New Zealand Medical Journal 2011; 124 (1347)
Health inequalities: unfair, measurable and remediable? The case of New Zealand. [NZ]
Paper prepared for the WHO Commission on Social Determinants of Health.
Policy implementation for health equity in Aotearoa: examining healthy eating and physical activity programmes in Maaori and Pasifika communities [NZ]
Paper prepared by Arnell Hinkle (2010)
Solutions to child poverty in New Zealand [NZ]
Report prepared for the Office of the Children;s Commissioner (2012)
The politics of Māori health (2016)
The Social, Cultural and Economic Determinants of Health in New Zealand: Action to Improve Health
A Report from the National Advisory Committee on Health and Disability (National Health Committee) (1998)
The principal findings of this report are:
social, cultural and economic factors are the main determinants of health
there are persisting health inequalities as a result of socioeconomic factors in New
Zealand and some evidence that these may be worsening
current trends in many socioeconomic factors in New Zealand are likely to widen
health inequalities further
there are good reasons for intervening to reduce socioeconomic inequalities in health
there are evidence-based interventions for reducing these inequalities
Selected Journals
Australia and New Zealand Journal of Public Health
Maori Health Review [NZ]
Pacific Health Review [NZ]
Asian Health Review [NZ]
International Resources
Websites
Equity [World Health Organisation]
Health Equity Initiative [HEI]
Toolkits and Guidelines
What are health inequalities?
The Kings Fund, 2020
Interventions to tackle health inequalities need to reflect the complexity of how health inequalities are created and perpetuated, otherwise they could be ineffective or even counterproductive. For example, efforts to tackle inequalities of health status associated with behavioural risks (such as poor diets) should address the wider network of factors that influence these behaviours (such as access to affordable healthy food, marketing and advertising regulations) and the impact that these behaviours have on health outcomes (such as access to clinical services).
Health inequalities are not inevitable and the gaps are not fixed.
Evidence shows that a comprehensive approach to tackling them can make a difference. Concerted, systematic action is needed across multiple fronts to address the causes of health inequalities. This includes, but goes well beyond, the health and care system.
This explainer provides an overview of how health inequalities are experienced in England’s population
Health inequalities: place-based approaches to reduce inequalities: Guidelines to support local action on health inequalities.
Public Health England, 2019
This guidance aims to reinforce a common understanding of the complex causes and costs of health inequalities and provide a practical framework and tools for places to reduce health inequalities. The accompanying documents include a slide set providing a summary and examples of how to use a place-based approach to reduce health inequalities.
Vibrant and Healthy Kids: Aligning Science, Practice, and Policy to Advance Health Equity
National Academy of Sciences. 2019
This report provides a brief overview of stressors that affect childhood development and health, a framework for applying current brain and development science to the real world, a roadmap for implementing tailored interventions, and recommendations about improving systems to better align with our understanding of the significant impact of health equity.
Incorporating concerns for equity into health resource allocation. A guide for practitioners [UK]
“Unfair differences in health care access, quality or health outcomes exist between and within countries around the world, and improving health equity is an important social objective for many governments and international organizations. This paper summaries the methods for analysing health equity available to policymakers regarding the allocation of health sector resources.”
100 Million Healthier Lives [US]
100 Million Healthier Lives is an unprecedented collaboration of change agents across sectors who are pursuing an unprecedented result.
Mission: 100 million people living healthier lives by 2020.
Vision: to fundamentally transform the way the world thinks and acts to improve health, wellbeing, and equity to get to breakthrough results.
Together, we are systematically creating a community of solutions to the most intractable challenges that stand in the way of achieving health, wellbeing and equity across the globe. Includes guidelines and resources.
Achieving Health Equity: A Guide for Health Care Organisations [US]
This white paper provides guidance on how health care organizations can reduce health disparities related to racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.
The IHI White Paper includes:
A framework, with five key components, for health care organizations to improve health equity in the communities they serve:
Make health equity a strategic priority
Develop structure and processes to support health equity work
Deploy specific strategies to address the multiple determinants of health on which health care organizations can have a direct impact
Decrease institutional racism within the organization
Develop partnerships with community organizations to improve health and equity
Guidance for measuring health equity
A case study of one health care organization that has strategically integrated work to improve health equity throughout their system
A self-assessment tool for health care organizations to gauge their current focus on and efforts to improve health equity
Equity of Care: a Toolkit for Eliminating Health Care Disparities [US]
This toolkit is a user-friendly “how-to” guide to help accelerate the elimination of health care disparities and ensure our leadership teams and board members reflect the communities we serve.
Fair Foundations [Aus.]
Fair Foundations: The VicHealth framework for health equity is a planning tool for health promotion policy and practice. It outlines the social determinants of health inequities, suggesting entry points for action.
Health Equity and Prevention Primer [US]
Health inequities are more than disparities or differences in health and safety outcomes. Inequity describes unfairness and the systematic nature of disparities. The Health Equity and Prevention Primer (HEPP) serves as a web-based training series for public health practitioners and advocates interested in policy advocacy, community change, and multi-sector engagement to achieve health equity. The Primer helps practitioners integrate a health equity lens into their initiatives in pursuit of overall health and safety.
Health Equity Resource Toolkit for State Practitioners Addressing Obesity Disparities [US]
This document was created to provide examples of strategies and surveillance data which can be used to inform obesity prevention initiatives.
Improving Health Equity Through Data Collection AND Use: a Guide for Hospital Leaders [US]
To meet the needs of their diverse populations, hospitals and health systems will need to bridge the gap between collecting meaningful patient data and reviewing the data to identify inequities in health care provision and utilization, and to implement simple yet effective interventions to improve care for patients.
Improving Quality and Achieving Equity: a Guide for Hospital Leaders [US]
This guide for hospital leaders presents the evidence for racial and ethnic disparities in health care and provides the rationale for addressing them with a focus on quality, cost, risk management, and accreditation. The guide also highlights case studies and model practices, and recommends activities and resources that can help hospitals identify and address disparities in order to achieve equity for patients.
Improving Quality and Achieving Equity: the Role of Cultural Competence in Reducing Racial and Ethnic Disparities in Health Care [US]
This report identifies aspects of cultural competence that are synergistic with current efforts to develop a system that delivers higher-quality care and discusses strategies by which the quality and cultural competence movements could be linked.
A Practitioner's Guide for Advancing Health Equity [US]
Designed to help public health practitioners advance health equity through community prevention strategies. While health disparities can be addressed at multiple levels, this guide focuses on policy, systems, and environmental improvements designed to improve the places where people live, learn, work, and play. It is designed for those who are new to the concept of health equity, as well as those who are already working to create equitable environments.
Roadmap to Reduce Disparities [US]
A US guide for health care organisations to improve minority health and foster equity, which includes a 6-step framework for incorporating disparities-reduction into quality improvement processes.
What Makes Us Healthy [UK]
A new series of infographics and accompanying blogs and commentaries to describe and explain the social determinants of health in an accessible and engaging way.These determinants include political, social, economic, environmental and cultural factors which shape the conditions in which we are born, grow, live, work and age. Creating a healthy population requires greater action on these factors, not simply on treating ill health further down stream.
Selected Reading
Five Essential Conditions for Health Equity
Public Health Wales (2023)
This report uses the WHO Five Essential Conditions, an innovative rights- and evidence based multi[1]sectoral policy action framework, aiming to address complex and persistent health gaps, accelerate action and increase opportunities to achieve healthy prosperous lives for all, leaving no one behind.
Health Equity Measurement: Considerations for Selecting a Benchmark
Robert Wood Johnson Foundation (2023)
This brief summarizes the advantages and disadvantages of four common approaches to health equity benchmarking.
Health equity frameworks as a tool to support public health action: A rapid review of the literature. National Collaborating Centre for Determinants of Health (2023)
Much is known about the existence of health inequities across Canada, and the underlying structural drivers of these inequities. Less is known about how to advance equity across the public health system. Health equity frameworks are one tool to disrupt systems of oppression and promote health equity. This report presents the results of a review conducted to answer the question: which health equity frameworks exist that can be used to inform public health planning, decision making and service delivery?
The enduring effects of racism on health: Understanding direct and indirect effects over time
SSM - Population Health (2022)
We examine the role of racism as a key driver of ethnic inequalities in health. We examine the direct and indirect effects of racism on mental and physical health. Racism severely and negatively impacts health over time and across the life course. Repeated exposure to racism leads to accumulation of disadvantage and poorer health. Policy and academic debates must focus on the fundamental role of racism on health.
Understanding Indigenous Health Inequalities through a Social Determinants Model
National Collaborating Centre for Indigenous Health (Canada) (2022)
“The authors begin by providing a brief overview of Indigenous health inequalities, followed by a description of social determinants across the life course. They then explain how root (structural), core (systemic), and stem (immediate) environments influence Indigenous health at individual, community, and population levels. Loppie and Wien highlight the importance of Indigenous self-determination and cultural resurgence as vital pathways to wellness.”
An overview of reviews on strategies to reduce health inequalities
International Journal for Equity in Health(2020)
The strategies that facilitate the reduction of health inequalities must be intersectoral and multidisciplinary in nature, including all sectors of the health system. It is essential to continue generating interventions focused on strengthening health systems in order to achieve adequate universal health coverage, with a process of comprehensive and quality care.
Driving forward health equity – the role of accountability, policy coherence, social participation and empowerment
WHO, 2019
A scientific expert review process coordinated by the WHO European Office for Investment for Health and Development of the WHO Regional Office for Europe identified societal and institutional factors that singly and in combination offer new explanations on why progress on health equity has not been as fast as had been hoped when the association between individual determinants and inequities was first established. These four key drivers of health equity are: accountability, policy coherence, social participation and, underlying them, empowerment. Work on these drivers informs the Health Equity Status Report initiative (HESRi) and has resulted in three independent companion papers each elaborating further on one of the common goods for health equity – accountability, policy coherence and social participation – as well as this summary paper.
A Health Equity Approach to Obesity Efforts: Proceedings of a Workshop—in Brief
National Academy of Sciences. 2019
On April 1, 2019, the National Academies of Sciences, Engineering, and Medicine held a public workshop, A Health Equity Approach to Obesity Efforts, in Washington, DC. The workshop explored the history of health equity issues in demographic groups that have above-average obesity risk, and considered principles and approaches to address these issues as part of obesity prevention and treatment efforts. Speaker presentations addressed three areas: current policies and practices that either perpetuate health inequities or advance health equity; mechanisms to support community-driven solutions that can influence the social determinants of health; and approaches for fostering multisector collaboration to address disparities by exploring the issues related to the creation, implementation, and evaluation of equity-oriented programs, policies, and systems changes. Participants also discussed research needs to inform and mobilize equity-centered obesity prevention and treatment actions. This publication briefly summarizes the presentations and discussions from the workshop.
Advancing Equity in Health Systems by Addressing Racial Justice
Stanford Social Innovation review. 25 June, 2019
Lessons on racial equity underscore the need to set explicit aims, build coalitions, and flatten hierarchies in order to strengthen healthcare’s role in undoing systems of oppression.
Inclusion of equity in economic analyses of public health policies: systematic review and future directions (2017)
Twenty‐nine relevant studies were identified. The majority of studies comparing two or more interventions left interpretation of the size of the health and financial inequality differences to the reader. Newer approaches include: i) use of health inequality measures to quantify health inequalities; ii) inclusion of financial impacts, such as out‐of‐pocket expenditures; and iii) use of equity weights.
Improving Health Equity: 5 Guiding Principles for Health Care Leaders [US: IHI] (2018)
In January 2017, a team from IHI argued that health care organizations must make health equity a strategic priority. The authors identified five key steps for health care organizations: make health equity a leader-driven priority, develop structures and processes that support equity, take specific actions that address the social determinants of health, confront institutional racism within the organization, and partner with community organizations.
Insiders’ Insight: Discrimination against Indigenous Peoples through the Eyes of Health Care Professionals [Canada] (2019)
A Framework for Educating Health Professionals to Address the Social Determinants of Health [US]
Better Health Through Equity: Case Studies in Reframing Public Health Work (2015) [US]
Closing The Gap in A Generation: Health Equity Through Action on the Social Determinants of Health (Commission on the Social Determinants of Health, CSDH 2008)
Equity and Excellence: Liberating the NHS [UK]
Evidence review: Settings for addressing the social determinants of health inequities [Aus.]
Fair Society, Healthy Lives (The Marmot Review): Strategic Review of Health Inequalities in England Post 2010 (Marmot et al, 2010) [UK]
Fairer decisions, better health for all: Health equity and cost-effectiveness analysis [UK]
Health literacy: a necessary element for achieving health equity [US]
Leveraging Culture to Address Health Inequalities: Examples from Native Communities: Workshop Summary [US]
WHO European Review of Social Determinants of Health & the Health Divide (Marmot et al 2012) [EU]
Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care [US; 2003]
Seminal report. Racial and ethnic disparities in health care are known to reflect access to care and other issues that arise from differing socioeconomic conditions. There is, however, increasing evidence that even after such differences are accounted for, race and ethnicity remain significant predictors of the quality of health care received.
In Unequal Treatment, a panel of experts documents this evidence and explores how persons of color experience the health care environment. The book examines how disparities in treatment may arise in health care systems and looks at aspects of the clinical encounter that may contribute to such disparities. Patients' and providers' attitudes, expectations, and behavior are analyzed.
Selected Journals
Diversity and Equality in Health Care
Ethnicity and Health
International Journal for Equity in Health
see also
PubMed Database Search: Health Equity
last updated 6 May 2024
The atlas collects together health, behaviour and socio-economic indicators for Māori. Most indicators compare Māori outcomes with those of non-Māori:
immunisation coverage
oral health
participation and attainment in science subjects (for students in years 11-13)
quit (smoking) attempts
risk behaviour (smoking/ gambling)
intentional self-harm
diabetes (crude rates derived from the virtual diabetes register)