Jay Kuten: Inequality in mortality rates matters to everyone

A few weeks ago, remarks by Kate Joblin, the DHB Chairperson, quoted in the Wanganui Chronicle goaded me to reflection. Ms Joblin voiced concerns about healthcare in general and specifically noted with chagrin the difference in mortality rates between Maori and non-Maori in our community.
Seeking information to contribute to the necessary conversation we should be having regarding healthcare for all of us, whatever our ethnicity, I set about to interview the people who seemed most central to that discussion. I met with Kate Joblin and Julie Patterson, CEO of the DHB. I met with Jennifer Thompson, Chair of Te Oranganui, the major Maori Health Centre in our community and Dave Taylor, clinical director of Te Oranganui. I hope, then, to articulate a number of issues and considerations gleaned, including that from other sources in the wider world.
Some things must be stated at the outset of what may prove to be several columns on this subject. We all have a stake in the DHB and need it to succeed in its essential role to insure the health of the community. All of us, if we live long enough, will be patients at some time. Some of us, including myself, have been privileged to be directly involved in healthcare and can offer a dual perspective.
That a disparity exists between mortality rates for Maori and non-Maori can be readily determined from statistics of the Ministry of Health. Their data up to 2007 shows that such a disparity exists nationwide and is even more marked for five DHB areas, of which ours is one. The ministry explains our local statistics in terms of deprivation associated with economic factors affecting rural regions more than urban.
To take only one cohort, deaths from cancer, specifically lung cancer, adjusted mortality rates for Maori are nearly double those of non-Maori. While mortality rates for other forms of cancer are not so striking, they remain significantly higher in most cancer cases for Maori than for non-Maori.
In examining mortality from other diseases than cancer, such as heart disease and diabetes, we see similar discouraging statistics. Maori are doing worse in terms of mortality. They are dying younger than non-Maori with similar diagnoses.
Those are a few of the facts. Now what is to be done? And why is it important to all of us, whatever our ethnicity?
In strictly economic terms the fact that Maori live on average nearly five years less than non-Maori not only deprives the country of the benefits of their lost productivity but it also represents significant increased costs of medical care. Studies show that end-of-life care, especially medical care of chronic illness, is the highest contributor to overall health care costs.
And of course the loss in strictly human terms is incalculable.
When Kate Joblin expressed her concerns she was quoted as "scratching her head" over these issues. Little did I realise that I would soon come to join her in head-scratching.
In medicine, as in many other endeavours, it's a truism that an ounce of prevention is worth a pound of cure. If we would like to improve on healthcare for our community, Maori and non-Maori, we need to ask questions about programmes directed at preventing illness and managing existent conditions to decrease morbidity or worsening of ongoing chronic ailments that might lead to death or disability.
These are the areas I set out to explore in my meetings with the DHB leaders and those of Te Oranganui Medical Centre, In succeeding essays I plan to share some experiences and insights gained. I'd like to thank Kate Joblin, Julie Patterson, Jennifer Thompson and Dave Taylor for speaking with me.
My experiences of our healthcare community were not without some disquieting moments. I'll be discussing that as well.