Board determined to find fix

HEALTH FOCUS: Hawke's Bay District Health Board senior staff and board members were fully engaged by the first ever Health Equity report presented to it last week. PHOTO/DUNCAN BROWN

Differences between Maori and Pakeha health are nothing new, but last week's Health Equity in Hawke's Bay report is stirring a political will to close the gap.

It is the first report collated specifically to identify inequities in Hawke's Bay. One of the most telling statistics is that Maori males can expect to live eight years fewer than pakeha.

One quarter of Maori men die before the age of 50, compared with 5 per cent Pakeha. All people in poorer areas are more likely to die earlier.

The region is doing worse than the national average in hazardous drinking, teen pregnancy, death rates, mental disorders, smoking, GP access, dental visits and injury from assaults.

While health inequity is not solely a race-based issue, Maori feature in most categories. Maori are six times more likely to die from lung cancer.

The rates for child hospital admissions relating to social and living conditions is increasing, particularly for Maori.

One in three adults in Hawke's Bay is obese, with one in two Maori.

The report's author, Hawke's Bay District Health Board (HBDHD) director of population health Dr Caroline McElnay, said much of the information was not new. Addressing inequalities was already a part of its vision statements.

"For most of our indicators we are on the right track - equity is improving - but we have still got areas of inequity so maybe things aren't moving fast enough."

Of the 15 areas where Hawke's Bay rates worse than the national average, high smoking rates among pregnant Maori women (46 per cent) caused her the greatest concern.

Smoking during pregnancy was an inter-generational "health crisis".

"You are much more likely to get smaller babies, you are likely to have premature births, you are actually affecting the development of the foetus through that effect of smoking. The baby is actually being exposed."

She said the region's health service successfully tackled another intergenerational health disparity for Maori - child immunisation.

"We could not see any reason why there was that. It wasn't that Maori parents were more likely to not immunise - we had no information that suggested in any way that they will were less likely to want their children to be immunised.

"We worked really closely with general practices, which do the majority of immunisations. We looked at the evidence to see where people had made it work elsewhere. "

The evidence showed it was likely a systemic problem and changes made closed the gap in the five years to 2013. Not only has the gap closed but the region has seen a sustained lift in all immunisation rates. Maori rates are now higher than Pakeha.

It is doubtful other health gaps will be as easily fixed. Ingrained health behaviours, social and economic factors will not be as easy to turn around.

The Ministry of Health already has health targets for District Health Boards, which HBDHB chairman Kevin Atkinson said the board must follow.

"The priorities will always be the minister's priorities," he said.

"We have no choice about it, otherwise you get your head chopped off."

While a veteran of health statistics he said he was "horrified" at alcohol abuse. One in four Hawke's Bay adults is a hazardous drinker - likely to cause harm to their own or someone else's health. The Maori rate of hazardous drinking is nearly one in two.

He said not only was it a cost to the health system and wider population the procurement of alcohol would likely exacerbate financial difficulties for lower income households.

Despite Health Ministry targets the board challenged HBDHB management to present strategies to close the gaps at the December board meeting.

"I imagine those strategies could well evolve into establishing some targets for HBDHB to measure itself against," Mr Atkinson said. "My feeling around this is previously we have had plenty of reports - health status reports - going back a dozen years or so. The general theme hasn't changed a hell of a lot over a decade but what we really want to see is some strategies to start to make key differences.

"Some of those indicators are going to take a generation to change, but we may be able to see some positive results within 12 months."

Strategies would likely be incorporated in the annual plan but any proposed solutions must be piloted.

"It is really important that we don't invest a whole lot of energy and money into a solution unless we have proven it produces results we are looking for.

"I would think it is inevitable that management will come back with a strategy that involves piloting some new innovative ways of doing things. Some of them might be quite radical."

He did not wish to pre-empt management proposals but a possibility was providing free primary health care in Wairoa, which had "significant health issues" to remove the barrier of affordability.

"I think be quite easy to ring fence the region to look at something like that."

He said the HBDHB already met with other Hawke's Bay agencies to discuss issues.

"A number of the strategies that will come up in the December board meeting are going to need the support of sectorial agencies whether that be housing, education, police, justice - all of those are going to have a role to play and get us back in the right half of those results."

Dr McElnay said the next step for the HBDHB was to "get the report out and start having lots of conversations with different agencies and communities around the findings".

"My report just presents the facts. What I really want is to start seeing the conversation happening around what we can do.

"Do we accept these facts? Do we want this to be the situation in five years' time? Should we do everything or should we choose one of two areas to really focus on?

"That is where we are at the moment, having these conversations. As a district health board we cannot turn this around by ourselves - we need the rest of the community to really get behind this."