|“Making inroads into the elimination of child poverty may just be the remedy we all need for the ever increasing costs to the health system. Keeping people well, it seems, is the much cheaper option.”
Trevor Simpson, Deputy Executive Director,
Health Promotion Forum – Runanga Whakapiki Ake i te Hauora o Aotearoa
An article in the 15 December Manawatu Standard, Inequalities stymie health gains for Polynesians, makes a poignant statement and raises important concerns on Māori and Pacific health. Highlighting statistical data gleaned from the New Zealand Health Survey results for 2013 and 2014, the report covered the wide gap in health outcomes between Māori and Pacific and other ethnic groups. A staggering array of both causes and conditions were listed, describing a situation in which certain social groups experience a greater burden of disease than their existing counterparts (see ‘Health promotion, human rights and equity’ on the Health Promotion Forum website).
Most of these outcomes can be attributed to social inequities; that is, those unfair, avoidable and unjust factors that impact negatively on the health of social groups. A closer look shows that these outcomes are systemic and relate to what Sir Michael Marmot has described as the social determinants of health (see HPF paper ‘Health and social inequalities; issues of justice and fairness’)
In the article, interviewee Chrissy Paul touches on a number of key points as to why these disparities may persist. As she accurately points out, these outcomes cannot simply be put down to ethnicity. It can also be shown that they cannot be classed as behavioural or cultural but rather structural i.e. how society is arranged. The entire breadth of a situation must be considered when questioning why any health outcome occurs. For example if Māori and Pacific people are experiencing higher rates of psychological duress then the reasons for this could emanate from a range of social, environmental, political and economic factors. Chrissy further provided an important clue by referencing the fact that negative health statistics are found in “[Deprivation] Decile 10 areas,” that is communities that experience higher levels of deprivation.
On this topic it is timely, for proponents of preventative health, that a nationwide discussion has focussed on poverty and the widening gap between the ‘haves’ and ‘have nots’. For example, Bryce Edwards, in his NZ Herald opinion piece on Monday 15th December suggests that ‘Inequality’ could be the word of the year in New Zealand politics. The correlations between poverty and health outcomes are now very well-known and understood. It is true that poverty exists across all ethnicities but it is hard to overlook the stark contrast between Māori and Pacifica peoples and other groups.
Children are a case in point. The Child Poverty Monitor: 2014 Technical Reportshows that 1 in 3 Māori and Pacifica children live in poverty as compared to 1 in 6 European children. It also states that three out of 5 of these children are likely to live this way for many years. The impact of this on health across the life continuum is obvious, not to mention extremely costly. For example rates of hospitalisations for children living in the most deprived areas (NZDep deciles 9–10) were nearly 3 times higher than for those in areas with the least deprivation (NZDep deciles 1–2). Further the majority of hospital admissions were due to infectious and respiratory diseases among children aged 0–14 years. During 2009–2013, 82% of these admissions were for asthma and wheeze, acute bronchiolitis, acute upper respiratory infections, gastroenteritis, viral infection of unspecified site, skin infections or pneumonia (bacterial, non-viral). In many cases these outcomes were completely preventable.
One simple solution is to reinstate a universal child benefit; to lift not only poor families, but all struggling whānau, above the bread line. Other answers can be found in the Office of the Children’s Commissioners report Choose kids: why investing in children benefits all New Zealanders.
Making inroads into the elimination of child poverty may just be the remedy we all need for the ever increasing costs to the health system and our communities. Keeping people well, it seems, is the much cheaper option.
16 December 2014