Time for action on health inequalities

I get literally dozens of reports crowding my in-trays every week. This week a report arrived from the Controller and Auditor-General which I thought should have been a great read.

It was a report on the health sector: results of the 2010/11 audits.

The health sector, via the New Zealand Public Health and Disability Act 2000, mandates District Health Boards with a clear instruction - to eliminate health outcome disparities by improving health outcomes for Maori and other population groups.

The Act also states that DHBs must establish and maintain process for Maori to take part in, and contribute to, strategies for improving their health.

So here we are, over a decade since the legislation was enacted, and with some pretty clear directions about how outcomes will improve. But, as always, the proof is in the pudding - has the recipe been followed? Has the difference been made? What the Auditor General found reflects poorly on DHBs in general and the health sector as a whole.

Basically the intention to achieve health equity wasn't accompanied with any detailed information about the nature of the disparities, or specific plans linked to performance.

What annoys me the most is that we have organisations who treat people as if their teeth are separate from the rest of their body, and so forth.

The nature of contracting with providers is very disjointed. At some point DHBs and other government agencies must sit down and integrate their contracts with providers to focus on outcomes.

I read this quote which sums up my feelings about the universal truth, that actions speak louder than words: "Remember, people will judge you by your actions, not your intentions. You may have a heart of gold - but so does a hard-boiled egg." Another article I read last week may have the answers to help us move from words to actions.

The article, published in the American Journal of Public Health, described self-reported experience of racial discrimination and health care use in Aotearoa.

The study, by Te Ropu Rangahau Hauora a Eru Pomare and the Ministry of Health, basically revealed that racial discrimination by a health professional led to negative healthcare experiences. It makes pretty good sense - if people don't respect you, you're hardly going to have a good experience.

The report defined negative experiences as including not being listened to carefully, not having healthcare and treatment discussed with them as much as they wanted, and most importantly, not being treated with respect and dignity.

For Maori women there was a significant link between experience of racial discrimination by a health professional and lower cervical and breast cancer screening.

The report concluded "racial discrimination across a range of settings has the potential to impact on a wide range of health outcomes and risk factors".

The interesting thing for me is that since 2002 - about the same time frame as we have had the legislation to report on disparities - questions about racial discrimination have been included in the New Zealand Health Survey.

We have, therefore, a strong body of evidence both here and overseas which tells us that experiences of racial discrimination have been associated with healthcare delays, needs that are not met, negative patient experiences and lower levels of healthcare trust.

It's time to act now on all the information and intention, do the work to improve health outcomes, to reduce the disparities and change our future.