Children born into poverty and deprivation are unlikely to be raised into healthy adults no matter how much we reform healthcare. Photo / AP, File
Children born into poverty and deprivation are unlikely to be raised into healthy adults no matter how much we reform healthcare. Photo / AP, File
Opinion
OPINION
We are making significant changes to our healthcare system to deliver better, more equitable healthcare.
Closing the health gap also requires bold action to reduce poverty and deprivation.
Healthy homes and healthy food, access to a good education and early childhood development. Stable employment, safe and healthy working environment,social inclusion and non-discrimination. According to the WHO, numerous studies show this cluster of factors termed "Social Determinants of Health"; contribute 30 per cent to 55 per cent of health outcomes.
Improving insulation standards, the winter energy payment, and free school meals. A living wage and adequate welfare benefits. Curbing the proliferation of liquor shops and fast-food outlets in deprived areas may do more to enhance health than many healthcare initiatives.
Take the example of a typical young woman in New Zealand, born to a low-income family. Her home may be overcrowded and draughty; she often goes hungry, and her only treats are burgers, fizzy drinks and fries. She is overweight and has a chronic cough and asthma; her health problems and unhealthy habits can last a lifetime.
Eleven per cent of all children, and an even higher 20 per cent of all Māori and 24 per cent of Pasifika children live in material hardship; that's 125,000 children - 58,000 Māori, 60,000 Europeans, and 34,000 Pasifika.
Material hardship rates have inched slowly downwards, from 12.1 per cent to 11 per cent over the past five years. Poverty rates (less than 50 per cent of median income after housing costs) nearly doubled from 9 per cent in 1982 to 16 per cent by 1994 and haven't budged since then.
There is a direct link between deprivation and life expectancy. Statistics from the UK show that it worsens at each step of the deprivation scale. The disparity between the most and least deprived areas in the UK is 8½ years. (New Zealand doesn't measure life expectancy by deprivation decile.) In Norway, where inequality is far lower and the social welfare net much better, the disparity is only 1½ years.
The Māori/non-Māori mortality disparity in New Zealand increased steeply during the tumultuous years between the mid-1980s and the late 1990s when inequalities grew. Since then, we have made some progress; the life expectancy gap between Māori and non-Māori has declined from approximately 9 years to 7½ years (18 per cent) over the past 25 years. However, Māori life expectancy is still worse than in places such as Sri Lanka, Iran, and Macedonia.
Kushlan Sugathapala. Photo / Supplied
The mortality rate differences from some preventable diseases are even starker. Deaths from heart diseases for Māori are two times higher than non-Māori/Pacifica. For lung cancer, it is three times; Renal failure from diabetes, four times. For amputations due to diabetes, three times.
While detailed solutions to our health problems are beyond the scope of this article, we can discuss some broad issues.
Our social protection is abysmal. The current unemployment benefit is 26 per cent of the median wage for couples with children, and it's not much better for the disabled. The accommodation supplement for a family with children is a maximum of $235 a week, while the median rent nationally is $570.
Food insecurity is a massive problem; the supermarket duopoly pushes up the prices, and GST on food further worsens the burden. (Every other country in the OECD has at least a concessionary GST rate for food). And now we have inflation as well. Housing is a gnarly problem with no easy solution in sight.
We have no regulations yet to curb unhealthy food. In the UK, a conservative government introduced a sugar tax on soft drinks in 2018, something Labour is unwilling to do. As soon as the British tax was announced in 2016, manufacturers swiftly reduced the sugar content, and consumers shifted to cheaper low-sugar beverages. The sugar consumption in soft drinks has dropped by 35 per cent; the government earns tax revenues and saves on health costs. Now, more than 40 countries have a sugar tax in some form.
Yes, we need more money upfront to solve these problems, but better health will boost productivity. The income gap between the wealthiest 10 per cent and the poorest has widened since 1980. No one grudges a fair remuneration to reward society's winners, but should it be at the cost of ill health for some, many of them children? A lifetime of sickness and suffering or even untimely demise? And then we have problems that need only the political will to resolve - the fast food and liquor chains that put more stores in deprived areas profiting from the poor and passing on the health costs to the public.
