He matapihi ki te kounga o ngāmanaakitanga ā-hauora o Aotearoa

• Annual publication: the quality ‘state of the nation’

• Chapter 1: What is happening?• Chapter 2: Why is this happening?• Chapter 3: How can this change?

A window on health equity for Māori

1. What is happening?

55.9

77.1

54.0

73.0

72.4

83.9

68.3

80.3

0

10

20

30

40

50

60

70

80

90

1950–52 1955–57 1960–62 1965–67 1970–72 1975–77 1980–82 1985–87 1990–92 1995–97 2000–02 2005–07 2012–14

Life expectancy at birth

Māori female Māori male Non-Māori female Non-Māori male

250.0

188.8

87.4 74.7

0.0

50.0

100.0

150.0

200.0

250.0

300.0

2009 2010 2011 2012 2013 2014 2015

Maori Non Maori, Non-Pacific

Deaths amenable to health care per 100,000 population aged 0–74 years

Understanding this inequity• ‘Life course’ approach over three domains: access,

quality, and improvement

• Indicators (including those from Atlas of Healthcare Variation) chosen for feasibility, robust, recent, a range of conditions or disease areas, rather than whether they showed inequity or not

• Pre-natal, childhood (0 – 14), youth (15 – 24), adult (24 –64) and older age (65 and over)

Worse access starts before birth

0%

10%

20%

30%

40%

50%

60%

70%

80%

2009 2010 2011 2012 2013 2014 2015 2016

Registration with a lead maternity clearer in the first trimester of pregnancy

Māori Non-Māori

Continues through childhood

67%

86%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Māori Non-Māori

Proportion of under fives enrolled with oral health services

And through the rest of life

0

5

10

15

20

25

30

35

Male Female

%

Unmet need for special equipment among disabled people aged 65 and over

Māori Non-Māori

Quality - asthmaYounger Māori children more likely to receive regular reliever medication with no preventer medication compared to non-Māori, non-Pacific children…

0%

5%

10%

15%

20%

25%

30%

5–9 years 10–14 years

Māori Non-Māori Non-Pacific

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

2012 2013 2014 2015 2016

adm

issio

ns p

er 1

000

popu

latio

n

Māori Non-Māori

… but Māori children have ~ 30% higher rates of hospital admissions for asthma

Quality - adult

80%

82%

84%

86%

88%

90%

2014 2015 2016 2017

People with diabetes who have regular HbA1c monitoring

Maori Non Maori

Percent admitted with DKA and percent with lower limb amputation

0.0%

0.1%

0.2%

0.3%

0.4%

0.5%

0.6%

0.7%

2014 2015 2016 2017

Perc

enta

ge o

f peo

ple

with

dia

bete

s adm

itted

to

hos

pita

l for

dia

betic

ket

oaci

dosis

Māori Non-Māori

0.00%

0.05%

0.10%

0.15%

0.20%

0.25%

0.30%

0.35%

2014 2015 2016 2017Pe

rcen

tage

of p

eopl

e w

ith d

iabe

tes

unde

rgoi

ng a

low

er li

mb …

Māori Non-Māori

Improvement sometimes helps…

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

Qtr

3Q

tr4

Qtr

1Q

tr2

Qtr

3Q

tr4

Qtr

1Q

tr2

Qtr

3Q

tr4

Qtr

1Q

tr2

Qtr

3Q

tr4

Qtr

1Q

tr2

Qtr

3Q

tr4

2013 2014 2015 2016 2017

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

3.5%

4.0%

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

3.5%

4.0%

2014 2015 2016 2017 2018

Māori Non-Māori

Adherence to best practice for SSIs… … reduces SSIs for everyone

National arthroplasty surgical site infection (SSI) programme

… but not always

80.0%

82.0%

84.0%

86.0%

88.0%

90.0%

92.0%

94.0%

96.0%

2012 2013 2014 2015 2016 2017 2018

Eight-month-olds who have complete age appropriate immunisations (percent)

Māori Non Māori

2. Why are there health inequities between Māori and Non-Māori?• Access: Services are less

accessible for Māori• Quality: Services are not

providing the same benefits for Māori– Improvement: health care

improvements do not always improve equity for Māori

• Differential access to determinants of health and exposure to risk

2. Why are there health inequities between Māori and non-Māori?Williams and Mohammed model of health inequity shows how socioeconomic determinants together with race and racism affect health: Basic causes Social status Differential access to resources and opportunities, Differential exposure to discrimination and overt racism, Different responses Different health outcomes

2. Why are there health inequities between Māori and Non-Māori?Window view is the causes are structural and historical, perpetuated today through our institutions, to the advantage of some.

3. How do we resolve inequities between Māori and non-Māori and support Māori health advancement?• Inequity is a complex system-wide problem. • Sustained systemic and multi-level approaches are

required.• The health system needs Māori worldviews alongside

Western and clinical worldviews to advance Māori health.

• Te Tiriti o Waitangi can provide a framework for how we operate, but also be used as an improvement tool.

Tools for equity and Māori health advancement• Māori health providers• High-quality ethnicity data, eg Te Kupenga• Cultural safety education • Māori workforce development• Equity of Healthcare for Māori framework • Health Equity Assessment Tool (HEAT)

Breastfeeding Welcome Here– Breast-feeding rates lower in Māori

mothers– The current programme not likely to

address inequity• HEAT identified actions to

improve breast-feeding rates in Māori mothers – Eg. Increasing the number of

kaimahi Māori lactation consultants, providing more support for Māori mothers, addressing transport issues

Professor Sir Mason Durie: foreword

It is not a matter of favouritism, political correctness or deference to Maori; rather it is a matter of health and wellbeing and the eradication of inequities. Moreover, Maori understandings of health and wellbeing need to

be given due attention.

The report is clear. Action is needed on multiple fronts.