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:
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.