Inequalities 2005 - PowerPoint PPT Presentation

1 / 58
About This Presentation
Title:

Inequalities 2005

Description:

Maori are 50% less likely compared to non-Maori to leave ... The STOMP trial. The PROMPT evaluation. The Polypill trial. Indigenous research collaboratives ... – PowerPoint PPT presentation

Number of Views:59
Avg rating:3.0/5.0
Slides: 59
Provided by: ngama
Category:

less

Transcript and Presenter's Notes

Title: Inequalities 2005


1
Inequalities - 2005
2

Some thoughts
  • a scenario - (data)
  • viewed from different mountain tops -
    (analysis)
  • within the culture, values and norms of that
    place (ideology)
  • become truisms (evidence)

3
Statistics many views
4
Interpretations
  • Headline More Maori are failing in schools
  • Maori are 50 less likely compared to non-Maori
    to leave school with a qualification
  • Non-Maori are 50 more likely to leave school
    with a qualification
  • 50 of Maori are failing the systems
  • Or the system is failing 50 of Maori compared to
    20 of non-Maori
  • The system shows non-Maori privilege?
  • THINK ABOUT THE GAZE and multiple interpretations

5
Why bother?Equity and the layers
  • A link with justice and fairness
  • An egalitarian society
  • Good for all
  • Cost effective?
  • A link to the Treaty

6
Equity
  • Equity of access
  • Into the system
  • Equity of process
  • Through the system
  • Equity of outcome
  • Out of the system
  • The definition used is critical

7
Which population groups
  • Maori
  • Pacific Peoples
  • Low SES
  • Refugees and new immigrants
  • Mental health patients
  • Asian peoples

8
The Cause
  • Socioeconomic determinants
  • Structure of society
  • Biological effects
  • Cultural effects
  • Racism and privilege
  • The inverse care law
  • Other

9
Root and Surface Causes
Williams 1997 AEP 7322-333
10
Equity
  • Equity of access
  • Into the system
  • Equity of process
  • Through the system
  • Equity of outcome
  • Out of the system
  • The definition used is critical

11
Inequalities
  • Difference in status social or economic
    disparity between people or groups
  • Lack of equal treatment unequal opportunity or
    treatment based on social or economic disparity
  • State of being unequal the condition or an
    instance of not being equal

12
Who
  • Maori
  • Pacific Peoples
  • Low SES
  • Refugees
  • The homeless
  • Mental health patients

13
The Cause
  • Socio-economic determinants
  • Structure of society
  • Biological effects
  • Cultural effects
  • Racism and privilege
  • The inverse care law
  • Other
  • Multiple confounders but.

14
(No Transcript)
15
Ethnic disparities - three levels
  • Differences in access to the resources of society
  • Differential access to health care
  • Differences in quality of care received

16
Distribution Gap
17
Ethnic disparities - three levels
  • Differential access to health determinants or
    exposures - differences in disease incidence
  • Differential access to health care
  • Differences in quality of care received
  • Jones, 2001

18
Ischaemic Heart DiseaseMortality 1996-99 and
Interventions 1990-99 Male standardised rates
per 100,000
Ajwani et al 2003 Tukuitonga
Bindman 2002
19
Ethnic disparities - three levels
  • Differential access to health determinants or
    exposures - differences in disease incidence
  • Differential access to health care
  • Differences in quality of care received
  • Jones, 2001

20
Differential quality of care
  • lower satisfaction with care
  • preventive asthma medication less likely
  • antidepressants less likely
  • fewer caesarean sections even when main
    confounders controlled for
  • fewer cardiovascular interventions
  • diabetes - equity in quality can be improved
    through monitoring, feedback and protocols but
    still need to address inadequate coverage/access

21
How do we move forward in health?
  • Think gaze and systems
  • Governance
  • Adjust methodology
  • Equal explanatory power
  • Multiple approaches
  • Novel approaches
  • Culturally appropriate approaches
  • Examples later
  • Criteria for success

22
How do we move forward in health?
  • Needs based funding is race based funding
  • Ethnicity data the right to be counted
  • Raise awareness
  • Policy development
  • Intersectoral links

23
Moving forward
  • Reorientation of health services
  • Attempt to measure unmet need
  • Extend reach of services into community
  • Go to those in need
  • Community development and empowerment
  • Community involvement and governance
  • Community responsiveness

24
Moving forward
  • Reorienting health services
  • Performance indicators and times
  • Ethnicity data collection and accuracy
  • Monitoring of referral pathways
  • Integration of the public health, primary and
    secondary care
  • By Maori for Maori services
  • By Pacific for Pacific services

25
Moving forward
  • Work on the SE determinants of health
  • Macro policy change
  • Redistribution of resources and wealth
  • Improved standard of living for all
  • Employment and housing
  • Examples of intersectoral collaboration
  • Healthy Housing
  • Social Services
  • Walking buses

26
Examples of Maori research moving forward
  • Changing mainstream paradigms
  • The STOMP trial
  • The PROMPT evaluation
  • The Polypill trial
  • Indigenous research collaboratives

27
When is
  • Enough is Enough
  • Maybe when there is a 10 year gap in life
    expectancy?

28
Indigenous health disparities. A comparison
between New Zealand, Australia, Canada and the
United States.
29
Overview of presentation
  • Project outline and aims
  • Methodology
  • Results
  • Discussion points and policy analysis
  • Conclusions

30
Project outline
  • Disparities in health status for indigenous
    peoples have been documented in New Zealand,
    Australia, Canada and the United States
  • A paucity of information exists comparing
    indigenous non-indigenous health status across
    countries
  • A reduction in indigenous health disparities has
    become a common theme for health policy makers

31
Aims
  • To describe and compare the health status of the
    indigenous population of New Zealand, Australia,
    Canada and the United States, with the
    non-indigenous population, over a range of health
    indicators
  • To review the quality of indigenous health data
  • To review the policy response to indigenous
    health disparities

32
Methodology
  • Selection of a wide range of health indicators
  • Collection and analysis of comparative health
    indicator data, including crude mortality data
  • Review of the policy response to disparities with
    the aid of international experts

33
Results the life expectancy gap
  • New Zealand
  • Males 7.3 years
  • Females 7.9 years
  • Australia
  • Males 20.6 years
  • Females 19.1 years
  • Canada
  • Males 7.4 years
  • Females 5.2 years
  • United States
  • Males 6.7 years
  • Females 5.3 years

34
Results - smoking
35
Results - diabetes
36
Results measles, mumps and rubella immunisation
coverage
37
Results renal transplant
38
Maori/non-Maori mortality risk ratio versus
Australian Indigenous/non-Indigenous risk ratio
 
   
39
Maori/non-Maori mortality risk ratio versus
AIAN/ White risk ratio
   
40
Results health data quality
  • Lack of ethnicity data collection
  • Mortality datasets
  • Treatment datasets
  • Prevalence surveys
  • Primary care
  • Inaccuracy of numerator counts
  • Inaccuracy of denominator counts

41
(No Transcript)
42
Policy - New Zealand
  • Historical context the Treaty
  • Crown response based on three principles
  • Partnership
  • Participation
  • Protection
  • Cultural competency by all and mainstream
    engagement
  • Funding 14.7 of total health expenditure for
    15.4 of the population

43
Policy - New Zealand
  • By Maori for Maori health service development
  • Increase workforce training and capacity
  • Governance and ownership mechanisms
  • New funding mechanisms
  • Ethnicity adjuster
  • Population based approach
  • Legislative action

44
(No Transcript)
45
Policy - Australia
  • Historical context - Terra Nullius
  • Mabo - 1992 restores legal doctrine of native
    title into Australian law
  • Native Title Act -1993, enabling Indigenous
    people throughout Australia to claim traditional
    rights to unalienated land

46
Policy - Australia
  • Ownership - six different portfolios since 1968.
    Office of Aboriginal and Torres Strait Islander
    Health since 1995
  • Funding - 2.2 of total health spending for 2 of
    the population
  • Cultural competency and indigenous capacity
    slowly increasing
  • Problems - double burden, low SES, access and
    small indigenous workforce

47
(No Transcript)
48
Policy - United States
  • Historical context - nations within a nation
  • Via laws and treaties - federal responsibility
    for health founded
  • 558 federally recognized tribes
  • Since 1970s movement toward self determination
    in health
  • Transfer of autonomy to tribes
  • Heterogeneity

49
Policy - United States
  • Indian Health Service
  • Receive all care from
  • Receive from to operate own care
  • Under funding of services - 50 increase needed
    to meet average federal health plan
  • Public health - community models of care delivery
  • Problems - double burden of disease, small
    indigenous workforce and urbanization

50
(No Transcript)
51
Policy - Canada
  • Historical context -assimilation and treaties
  • Royal Commission on Aboriginal Peoples
  • Period of restitution
  • Monitoring and co-ordination of policy -First
    Nation and Inuit Health Branch of Health Canada
  • Health funding 60 higher per capita

52
Policy - Canada
  • Priorities
  • Transfer of autonomy and control of health
    programs and resources to local communities
  • Partnership in delivery of care
  • Support action on inequalities as identified by
    local communities
  • Institute of Aboriginal Peoples' Health - has a
    focus on capacity, research and collaboration

53
Discussion
  • Disparities exist across many indicators
  • Largest in Australia and New Zealand
  • Some disparities are not universal
  • Disparities may not be intractable

54
Discussion
  • Indigenous health data quality poor
  • Common themes regarding poor health data quality
  • New Zealand has the highest levels of indigenous
    health information available
  • Improvement is needed in data collection

55
Discussion
  • Health sector response to indigenous disparities
    differ across countries
  • Multiple factors influence
  • Historical context important
  • All share a history of colonization, land loss,
    marginalization and low SES

56
Discussion
  • Common themes
  • Double burden of disease
  • Movement toward self autonomy in health affairs
  • Chronic under-funding, given health need
  • Increasing cultural awareness
  • Lack of critical mass in health workforce and
    research capacity

57
Summary
  • Indigenous peoples suffer from large health
    disparities
  • The quality of indigenous health data available
    is poor
  • Different approaches have been taken to reduce
    disparities, though common themes exist

58
Acknowledgements
  • The Commonwealth Fund
  • Dr. Mark Chassin and Prof. Rod Jackson
  • Dr. Fadwa Al-Yamen (Australia)
  • Adam Probert (Canada)
  • Prof. Spero Manson (United States)
  • Co-authors, collaborators and friends at Mount
    Sinai
Write a Comment
User Comments (0)
About PowerShow.com