NZMA position on health inequity

Written By: - Date published: 2:54 pm, May 3rd, 2011 - 17 comments
Categories: equality, health - Tags: , , ,

There is a very interesting “Positional Statement” from the New Zealand Medical Association on Health Inequity.  It was published on the 4th of March, but it didn’t get the coverage it deserved.

The NZMA is considered by some a conservative organisation, with lots of wealthy doctors as its members.  But this is a very radical document – one that strikes clearly against Don Brash’s version of “equality”, and in fact advocates many of Labour’s policy positions.

The whole document (8 pages) is worth reading; I’ll quote the core position statement in full at the bottom.

It starts by defining the difference between “equality” (what Don Brash talks about – treating everyone the same) and “equity” – an ethical principle aimed at reducing systematic disparities.  It looks at overseas studies that suggest that New Zealand’s poor performance on a number of health measures is down to health inequity – whilst recognising that this is a complex system of which there cannot be complete certainty about causes and effects.

And then it sees a core problem that goes to the health of our society as a whole: Income Inequality.  Income inequality strikes in 2 ways: material deprivation and psychosocially – causing stress, shame and distrust.  The material effects are obvious for those who can’t afford quality housing, the same level of health and education access etc; the psychosocial effects lead to more smoking, overeating, violence and less community involvement.

As a specific example, cardiovascular disease hits the poor harder.  They have higher levels of smoking and obesity, but there’s still a 20% difference when accounting for those and similar factors that appears to from the stress of low status.  The NZMA suggest you can treat the material differences by removing GST from healthy food, and banning smoking in more areas; but the only way to fix the psychosocial effect is to reduce New Zealand’s increasing income inequality.

The NZMA also look at the importance of a child’s in utero and early childhood experience; and how essential it is that we as a society focus on giving children the best possible start for them to ever be able to achieve their potential.  Ensuring they don’t suffer the consequences of early inequity; get full health and educational support and freedom from stress and violence.

By investing up front, we save later on: in our health budget, by reduced sick leave for businesses and by reduced numbers in our prisons and size of our police force.

But beyond the economic benefits, the NZMA is calling for a fundamental change in how we evaluate our society:

[T]hat economic growth should not be viewed as the sole measure of a country’s success and that the fair distribution of health, well-being and environmental and social sustainability are equally important goals.

The most complete prescription for society NZMA quote comes from Britain’s Marmot Review.  The Marmot Review advocates giving children the best possible start, giving them the life and work skills necessary to get fulfilling jobs, and ensuring those jobs exist.  It pushes for decent incomes, health support and communities for all.  NZMA also note that the recommendations on reducing social inequality has a “synergy of purpose” with tackling climate change, “often requir[ing] similar decisions and actions.”

All this is necessary to improve health outcomes for the population; that is why it is a medical issue.

New Zealand doctors are saying that for Aotearoa to be a healthy society we need a government that gives equity to our society, puts kids first, takes GST off healthy food, invests in education and prevention to save money on hospitals and prisons, and creates more jobs (of higher quality).  With John’s lack of a plan, and Don’s flying in the wrong direction, New Zealand will need to vote for change this year if we’re going to get a healthier society.

The core position statement reads:

The NZMA:

20. Believes that in order to eliminate inequities in health a whole of government approach will be required. In particular, policies addressing education, employment, poverty, housing, taxation and social security should be assessed for their health impact.

21. Believes that economic growth should not be viewed as the sole measure of a country’s success and that the fair distribution of health, well-being and environmental and social sustainability are equally important goals.

22. Calls on the government to recognise that while addressing health inequities is primarily a human rights issue, doing so is also cost effective in the long term. Inaction on the social determinants of health, and hence worsening health inequities, threatens to undermine economic growth.

23. Notes that tackling the social determinants that underlie health inequity, and tackling climate change, often require similar decisions and actions. This synergy of purpose needs to be recognised and exploited.

24. Urges the government to, wherever possible, introduce the concept of proportional universalism into all its social policies: this is action that benefits all members of society, but preferentially benefits those who experience more suffering.

25. Calls on the government to continue to urgently address the inequities in health status experienced by Māori, Pacific Island Peoples, refugees, migrants and other vulnerable groups. These health inequities are compounded by inequities in exposure to risks, in access to resources, and opportunities to lead healthy lives.

26. Supports the move to totally ban cigarette sales by 2020, and supports research-proven initiatives, such as removing GST from healthy food, that promote the increased consumption of healthy food.

27. Calls for the government to adopt the following policy objectives as set out in the ‘Marmot Review’:
a) Give every child the best start in life.

i) Reduce inequities in the early development of physical and emotional health, and cognitive, linguistic and social skills.
ii) Ensure high quality maternity services, parenting programmes, childcare and early years education to meet need across the social gradient.
iii) Build the resilience and well-being of young children across the social gradient.

b) Enable all children young people and adults to maximise their capabilities and have control over their lives:

i) Reduce the social and ethnic gradient in skills and qualifications.
ii) Ensure that schools, families and communities work in partnership to reduce the gradient in health, well being and resilience of children and young people.
iii) Improve the access and use of quality life long learning across the social gradient.

c) Create fair employment and good work for all:

i) Improve access to good jobs and reduce long term unemployment across the social gradient.
ii) Make it easier for people who are disadvantaged in the labour market to obtain and keep work.
iii) Improve the quality of jobs across the social gradient.

d) Ensure a healthy standard of living for all:

i) Establish a minimum income for healthy living for people of all ages.
ii) Reduce the social gradient in the standard of living through reducing income inequities.
iii) Reduce the ‘cliff edges’ faced by people moving between benefits and work.

e) Create and developing healthy and sustainable places and communities:

i) Develop common policies to reduce the scale and impact of climate change and health inequities.
ii) Improve community capital and reduce social isolation across the social gradient.

f) Strengthen the role and impact of ill health prevention:

i) Prioritise prevention and early detection of those conditions most strongly related to health inequities.
ii) Increase availability of long-term and sustainable funding in ill health prevention across the social gradient.

28. Urges the government to include in its deliberations the recommendations of the recently released The Best Start in Life: Achieving effective child health and wellbeing. In particular the NZMA calls on the government to do the following in order to improve the access and use of quality life-long learning across the social gradient:

  • strengthen leadership to champion child health and wellbeing
  • develop an effective whole-of-government approach for children
  • establish an integrated approach to service delivery for children
  • monitor child health and wellbeing using an agreed set of indicators.

17 comments on “NZMA position on health inequity”

  1. ak 1

    Well well – clinician-led policy backed by solid research, and not an idle back-room bureaucrat in sight. I wonder what our bold “clinician-first” minister will do….

  2. r0b 2

    By an amazing coincidence (?), Labour is promising policy to put children first.

    I hope they’re serious about it. I can’t wait to see the details!

    • Bunji 2.1

      There were some good details at a meeting in West Auckland last night apparently, but I wasn’t there. Hope to get notes soon. Longer paid parental leave with some being able to be used by the father was part of it anyway…

      Also in Labour policies advocated: GST off healthy food, more emphasis on skills & education, a commitment to lower unemployment, and reducing of income inequality through $15 minimum wage & first $5000 tax-free…

    • Uncle Helen 2.2

      Labour is promising policy to put children first.

      Translation: “Higher taxes for decent Kiwis in order to pay for the P habits of the DPB parasites who have children (that they abuse) solely to qualify for a State-provided income.”

      • rosy 2.2.1

        So you’d agree with taxes being spent on creating jobs, strengthening customs detection and improving early childhood education as well as improving health management and mentoring for new mothers? (e.g. improving Plunket funding so they can make more home visits)

      • Ben Clark 2.2.2

        Nice trolling.

        I’m yet to find anyone who come up with an actual person (as opposed to their cousin picking up a hitchhiker who heard from a guy at the pub about this lass…) who had children to get a benefit. The DPB is hardly a luxurious lifestyle for parents who have been left in reduced circumstances – many times having been left in the lurch by their partner who escapes any DPB stigma.

        It is also for the children, not the parent; albeit there seem to be many who are content to mete out punishment on children for the “sins” of their parents. Even if it means they end up paying for that child on the unemployment benefit later.

        If your focussed on the economic argument, rather than a happier society, it still needn’t mean higher taxes. Focussing on children is an investment in the future. The ECE costs that National aren’t prepared to meet have a $13:$1 return. Reduced prison and hospital requirements, and more taxes from the ECE-enhanced childer’s better jobs all mean that if we invest now in our children we all stand to benefit from a happier, healthier, wealthier society.

        But obviously that’s long-term thinking, not something National and its defenders would go for.

        • Uncle Helen 2.2.2.1

          I’m yet to find anyone who come up with an actual person (as opposed to their cousin picking up a hitchhiker who heard from a guy at the pub about this lass…) who had children to get a benefit. The DPB is hardly a luxurious lifestyle for parents who have been left in reduced circumstances

          Feel free to address your ignorance, be the first of your Labour-voting welfare-guzzling kind to actually inform yourself prior to having the temerity to voice an opinion:

          http://lindsaymitchell.blogspot.com/2010/04/when-dpb-pays-more-than-average-female.html

          It is also for the children, not the parent; albeit there seem to be many who are content to mete out punishment on children for the “sins” of their parents. Even if it means they end up paying for that child on the unemployment benefit later.

          If Labour actually cared for children in poverty they’d be advocating food stamps, so that welfare actually reached children, rather than being flushed on the drug and alcohol lifestyle-choices of the Labour-voting child abusers and murderers.

          • McFlock 2.2.2.1.1

            AH – it was apparently unimpressive on her blog (reading the comments) and it’s equally unimpressive as a source here.

            Two reasons: it assumes that a woman on the minimum wage is not receiving additional support; and it also assumes that the costs of, oh, feedingclothingwashingheatinghousingeducatingtransportingetcetcetc two children does not approach the Trump-like income boost that the DPB allows.

            Those are two reasons you and your semi-numerate blogging kamerade are nutbars.

          • millsy 2.2.2.1.2

            Are you perfectly willing for mothers and their babies to live on the streets there, Uncle Helen?

        • Afewknowthetruth 2.2.2.2

          ‘if we invest now in our children we all stand to benefit from a happier, healthier, wealthier society’

          You still don’t get it, do you Ben?

          Oil is the foundation on which wesern economies have been built. When global oil extractioin is declining (which it is), the vast majority of people get poorer by the month. We are in the early sages of the reversal of the Industrial Revolution. What we have seen thus far is just a tiny taste of what is to come. Current economic and social arrangemnents have no future.

          When governments refuse to address out of control CO2 emissions for decades (which they have), the global environment rapidly turns to custard. The climate instability we have seen thus far is just a tiny taste of what is to come. Industrial civilisation has no long term future.

          I guess you’ll wake up to reality when it hits you really hard in the face. That may take another year or two. .

        • Robert Atack 2.2.2.3

          >But obviously that’s long-term thinking, not something National and its defenders would go for<

          So are you a defender of National now Ben? – Being a supporter of Kiwisaver is a clear indicator that you haven't a long term thought in your mind, you are just kowtowing to the current mind set of destroy everything as fast as we can and bugger the kids. That is what Kiwisaver is dependent on … yet Labour and the greeds promoted this planet destroying scam ?
          Watch this http://www.youtube.com/watch?v=F-QA2rkpBSY&feature=related ,think (as in use your brain) then, please explain how an 18 year old is going to get a payout in 47 years time?

      • Colonial Viper 2.2.3

        DPB parasites

        Ah, you’re someone who needs to victimise a struggling disempowered underclass and bash them for your own pleasurable gains.

        A woman hating bully in other words.

  3. McFlock 3

    Damned fools – don’t they know that health, particularly infant health, is just a lifestyle choice?
    /sarc

  4. Afewknowthetruth 4

    Words come easily.

    e) Create and developing healthy and sustainable places and communities:

    This cannot be done within the framework of the present economic system, which is predicated continuous expansion of the industrialism which destroys sustainability.

    i) Develop common policies to reduce the scale and impact of climate change and health inequities.

    Reducing the impact of climate change also reqires a halt to industrialism. It’s not going to happen. Economists and politicians will keep promoting business as usual and keep destroying the future until they can’t.

  5. RedLogix 5

    Impressive coming from the NZMA. Thanks for this… the thing about doctors, GP’s especially, is that they are the people at the coal-face of social distress and dysfunction day in, day out. If there is any professional group, save perhaps teachers, it must be these people who have to wade through the consequences of inequality more intimately than any other.

    What is striking is to me is how matter of fact this document is, how plainly the realities of poverty and inequality are stated, clearly naming who is paying the price of capitalism. But then that’s how capitalism works, a few make off with the spoils, while the rest of us get to clean up the mess.

  6. millsy 6

    A marked contrast from the days when the NZMA (back when it was under the British Medical Association), fought tooth and nail against the 1935-49 Labour Government’s efforts to make healthcare services avalible to all, regardless of ability to pay.

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    No-one on the anti-capitalist left in this country today puts forward a case that Labour is on the side of the working class.  There are certainly people who call themselves ‘socialist’ who do, but they are essentially liberals with vested interests in Labourism – often for career reasons. Nevertheless, there ...
    RedlineBy Admin
    1 week ago
  • New Fisk
    No Right TurnBy Idiot/Savant
    1 week ago
  • Labour’s failure
    When National was in government and fucking over the poor for the benefit of the rich, foodbanks were a growth industry. And now Labour is in charge, nothing has changed: A huge demand for emergency food parcels means the Auckland City Mission is struggling to prepare for the impending arrival ...
    No Right TurnBy Idiot/Savant
    1 week ago
  • Ardern attempts to vaccinate Clarke Gayford live on television to prove that it’s safe
    Gayford, pictured here on The Project, before things got wildly out of control. A bold public relations move by the Government to encourage parents to vaccinate their children has gone horribly wrong. Prime Minister Jacinda Ardern appeared on tonight’s episode of Three’s The Project, where the plan was for her ...
    The CivilianBy admin
    1 week ago
  • Has Mr. Whippy gone too far by parking on our front lawns?
    Mr. Whippy’s business model has driven it down a dark road of intimidation. Residents in major centres around the country are becoming disgruntled by the increasingly aggressive actions of purported ice cream company Mr. Whippy, who have taken to parking on people’s front lawns and doorsteps in a desperate attempt ...
    The CivilianBy admin
    1 week ago
  • Cleaning up the water
    Today the government released its Action Plan for Healthy Waterways, aimed at cleaning up our lakes and rivers. Its actually quite good. There will be protection for wetlands, better standards for swimming spots, a requirement for continuous improvement, and better standards for wastewater and stormwater. But most importantly, there's a ...
    No Right TurnBy Idiot/Savant
    1 week ago
  • Fronting up
    Today I appeared before the Environment Committee to give an oral submission on the Zero Carbon Bill. Over 1,500 people have asked to appear in person, so they've divided into subcommittees and are off touring the country, giving people a five minute slot each. The other submitters were a mixed ...
    No Right TurnBy Idiot/Savant
    1 week ago
  • Politics of science – making a silk purse out of a sow’s ear
    Anti-fluoride activists have some wealthy backers – they are erecting billboards misrepresenting the Canadian study on many New Zealand cities – and local authorities are ordering their removal because of their scaremongering. Many New Zealanders ...
    1 week ago
  • Democracy – I Don’t Think So
    So, those who “know best” have again done their worst. While constantly claiming to be the guardians of democracy and the constitution, and respecters of the 2016 referendum result, diehard Remainers (who have never brought themselves to believe that their advice could have been rejected) have striven might and main ...
    Bryan GouldBy Bryan Gould
    1 week ago
  • Government says it will now build just one really nice home
    Following publication of this article, the Ministry has requested it to be noted that this supplied image is not necessarily representative of what the final house will look like, and it “probably won’t be that nice.” As part of today’s long-anticipated reset of the Government’s flagship KiwiBuild policy, Housing Minister ...
    The CivilianBy admin
    2 weeks ago
  • Imperialism and your cup of coffee
    Over the next week or two we will be running three synopses of parts of the opening chapter of John Smith’s Imperialism in the 21st Century (New York, Monthly Review Press, 2016).  The synopsis and commentary below is written by Phil Duncan. Marx began Capital not with a sweeping historical ...
    RedlineBy Admin
    2 weeks ago
  • Still juking the stats
    The State Services Commission and Ombudsman have released another batch of OIA statistics, covering the last six months. Request volumes are up, and the core public service is generally handling them within the legal timeframe, though this may be because they've learned to extend rather than just ignore things. And ...
    No Right TurnBy Idiot/Savant
    2 weeks ago
  • Hard News: Time for a New Deal: 25 years on
    In 1994, I was editing an ambitious street mag called Planet, from a fabled office at at 309 Karangahape Road. The thirteenth issue of the magazine was published in the winter of that year and its cover embodied a particularly ambitious goal: the end of cannabis prohibition.I wanted to do ...
    2 weeks ago
  • Not impressed
    KiwiBuild was one of the Ardern government's core policies. The government would end the housing crisis and make housing affordable again by building 100,000 new homes. Of course, it didn't work out like that: targets weren't met, the houses they did build were in the wrong place, and the whole ...
    No Right TurnBy Idiot/Savant
    2 weeks ago
  • Solar beats coal
    As the climate crisis escalates, it is now obvious that we need to radically decarbonise our economy. The good news is that its looking easy and profitable for the energy sector. Wind is already cheaper than fossil fuels, and now solar is too:The levellised cost of solar PV has fallen ...
    No Right TurnBy Idiot/Savant
    2 weeks ago
  • A Step Too Far.
    A Crown Asset? For reasons relating to its own political convenience, the Crown pretends to believe that “No one owns the water.” To say otherwise would re-vivify the promises contained in the Treaty of Waitangi – most particularly those pertaining to the power of the chiefs and their proprietary rights ...
    2 weeks ago
  • Where Money Comes From
    Most people would say, no doubt, that they have a pretty good idea of what money is. They live with the reality of money every day. It is what is needed to buy the necessities of life and to maintain a decent standard of living. You get money, they would ...
    Bryan GouldBy Bryan Gould
    2 weeks ago
  • Banned by the Green Party leadership: Jill Abigail on women’s rights and trans rights
    The article below was an opinion piece that appeared in the Spring 2019 issue of Te Awa (the NZ Green Party’s newsletter) and on the Greens website.  In keeping with their policy of hostility to women defending women’s right to female-only spaces, Green bureaucrats have since removed the opinion piece.  ...
    RedlineBy Admin
    2 weeks ago
  • The fallacy of the proximity argument.
    Longer term readers may remember my complaining that, as a political scientist, it is burdensome to have non-political scientists wanting to engage me about politics. No layperson would think to approach an astrophysicist and lecture him/her on the finer details of quarks and black holes, but everybody with an opinion ...
    KiwipoliticoBy Pablo
    2 weeks ago
  • Where We Stood: Chris Trotter Replies To Stevan Eldred-Grigg.
    Joining The Fight: Stevan Eldred-Grigg's argument for New Zealand staying out of the Second World War fails not only on the hard-headed grounds of preserving the country’s strategic and economic interests; and not just on the soft-hearted grounds of duty and loyalty to the nation that had given New Zealand ...
    2 weeks ago
  • Universities back the climate strike
    On September 27, School Strike 4 Climate will be striking for a future to pressure the government for meaningful climate action. This time, they've asked adults to join them. And now, Lincoln University and Victoria University of Wellington have signed on:Victoria University of Wellington has joined Lincoln University in endorsing ...
    No Right TurnBy Idiot/Savant
    2 weeks ago
  • Another constitutional outrage
    Another day, another constitutional outrage in the UK. This time, the government is saying that if parliament passes a law to stop Brexit before being prorogued, they may just ignore it:A senior cabinet minister has suggested Boris Johnson could defy legislation to prevent a no-deal Brexit if it is forced ...
    No Right TurnBy Idiot/Savant
    2 weeks ago
  • Ending dairy in Canterbury
    Environment Canterbury has finally proposed nitrogen limits to stop dairy farmers from poisoning Christchurch's water supply. And naturally, farmers are whining about it:A proposed move by Environment Canterbury (ECan) to protect Christchurch's drinking water by setting tough – some would say, draconian – nitrate reductions in the decades ahead and ...
    No Right TurnBy Idiot/Savant
    2 weeks ago
  • Is National the party of climate arson?
    The Zero Carbon Bill is currently before select committee. While its targets are weak, its a generally sensible bill that promises to establish a long-term framework to guide emissions reductions. But National hasn't made up its mind on whether it will support it - and according to Andrea Vance in ...
    No Right TurnBy Idiot/Savant
    2 weeks ago
  • Experts warn Harold the Giraffe “well past” typical giraffe life expectancy, may not have long
    Dum-de-doo. Children across New Zealand have known him for generations as the lovable giraffe who tells them to exercise, hydrate and not to shove lit cigarettes up their nostrils. But a world renowned giraffe expert says we shouldn’t be getting attached to Life Education’s Harold the Giraffe, as he is ...
    The CivilianBy admin
    2 weeks ago
  • August ’19 – NZ blogs sitemeter ranking
    Image credit: 22 BLOGGERS WITH ADVICE FOR RESEARCHERS AND EVALUATORS, ILLUSTRATED I notice a few regulars no longer allow public access to the site counters. This may happen accidentally when the blog format is altered. If your ...
    2 weeks ago
  • Bye, bye to the collusion lie
    Sums it up, really. ...
    2 weeks ago
  • Opinion: Treat your car by buying extra petrol to snack on while you aren’t driving
    By Mike Hosking. Yesterday morning, I waltzed into work, and as I walked past the drones aggressively typing out news on the computers I’ve repeatedly asked to be moved further away from, I caught a glimpse of the words “climate change”, and noticed that suspiciously they weren’t in condescending quotation ...
    The CivilianBy admin
    2 weeks ago
  • US imperialism, Huawei, racism and imperial anxiety
    by Tony Norfield US political opinion against China has two solid bases. The first is the longstanding racist and protectionist sentiment in the white working class; the second is a more recent anxiety about China’s economic prowess in America’s ruling elite. This article notes some historical aspects of anti-Chinese racism ...
    RedlineBy Admin
    2 weeks ago

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