Nick Eichler | Public Health Registrar
In the world of public health, we are always looking at determinants – those structural and social reasons that people stay well or get sick - and how we can alter them to prevent ill health. But a person doesn’t stop carrying those determinants once they get through the doors of a hospital – their gender, sexual orientation, ethnicity, social status and many other factors still affect how they are treated by the health system. Sometimes this makes sense for biological reasons – women are less likely to have heart disease and redheads require more anaesthetics – and sometimes it’s unjust – Māori are often prescribed different treatments to Pakeha with the same disease and risk profiles. Unjust differences in care can come about through individual biases or through institutional ones – often a healthcare system or facility is designed with one particular type of patient in mind, at the expense of different types of people with different needs.
With the exponential increase in data being generated by hospitals and healthcare, public health-minded clinicians and analysts can now pick up these differences in how health institutions treat patients differently, and work to improve them. We can understand who is being served well and who is missing out on the best care – as a DHB, we promise this to everyone.
So how can health systems change to better serve disadvantaged groups? One top way is by developing a workforce that reflects the population for which we have responsibility. Medical schools in New Zealand are now training the same proportion of Māori doctors as Māori in the general population. Another is to develop alternative models of care and ways of doing things that are designed in conjunction with patients – getting first-hand accounts of where the barriers are and what might have helped. Moving services into the community and utilising new telehealth technologies are vital for overcoming barriers like distance and costs. We also need high-quality data to pair up with these experiences – showing us the potential for health gain (and lower costs) if we close an equity gap, and which parts of the pipeline to focus on.
However, the best way DHBs can address inequity is by looking upstream and making change to the circumstances of people’s lives that lead to illness. There have been some small forays into this territory, like home insulation projects and school-based health services. For the biggest gains to be made however, the next step is for many pillars of the public service to join together and implement innovative models that address social determinants and prevent people from needing the hospital at all.