Health Inequalities

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Health Inequalities Need Pathways to
InterventionsThe Promise of Primary
CareAugust 2004
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Background

• NHC Determinants of Health
• Socioeconomic, ethnic inequalities
• NHC Primary Care

Access Population Health Approaches
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Frameworks

• Treaty of Waitiangi
• Ottawa Charter
• Mackenbach
• Different Models of Primary Care
• Inequalities Intervention Framework
• Primary Health Care as a Framework - Alma Ata
  Declaration
• Primary Care Strategy brings all this together

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Strategys Success

• Timing leadership, GP morale, vibrant third
  sector
• Improving access AND reducing inequalities
• Comprehensive Primary Health Care Model including
  general practice
• Additional Funding - lots
• Population Health opportunity to match funding
  to need

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Cont.

• Avoidable admissions premature mortality
  needing an impact player
• Shift from secondary to primary care emphasis
• PHO structure flexible inclusive niche
  providers, IPAs, communities, iwi
• Move away from managerialism competition
  culture shift

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Mackenbachs Model

• Underlying social and economic determinants
• Intermediate factors between determinants
  health
• Effect of ill health on socioeconomic position
• Health Disability services

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Social Economic Determinants

• PHC Strategy legitimises reinforces action to
  reduce inequalities
• Stronger coalitions forming CCDHB and WI
  project
• Services to Improve Access individual / family
  advocacy
• Public health / primary care interface health
  promotion
• Engagement with NGO sector and communities

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Intermediate Factors

• More inequalities focus in primary care
• Nutrition, physical activity - Porirua Cluster
• Tobacco
• Work Environment

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Effect of ill Health on Socioeconomic Position

• Income support and timely intervention
• Mental health has it reduced inequalities?
• MSD project PATHS how will it work?

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Health Disability Services Why Focus Here?

• Inverse care law
• Most to gain where poorest health
• Evidence ability to monitor progress

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• Cost barrier - Progress with access practices
• Utilisation levels - who receives care NHI
  level data
• Limits of comparative analysis complexity factor

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• Resource allocation PHO gains uneven
• Needs refinement to align with policy
• Balance of improving access AND reducing
  inequalities focus

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Table
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Opportunities

• Weighting Historical patterns
• Referred Services Funding
• Future Funding

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Opportunities

• Monitoring progress
• Enrolled populations
• NHI level data in CCDHB
• Can monitor how decisions differentially impact

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Reducing Inequalities

• Porirua Health Plus PHO
• Capital PHO

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• Existing Programmes other DHB Funding
• Chronic Disease Management
• Retinal Screening
• Whanau Models / Whanau Ora
• Pacific Service
• CHF Project

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• Early success - mechanisms
• Vision for 3-5 years?
• Low cost access
• Shift to teams, flexible funding
• Community participation - Power relationships
• Opportunities - SIA Funding, Referred Service
  Funding

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• A movement - embed culture change
• Enrolled populations - track inequalities
• Impact ?
• Access
• Premature mortality
• Avoidable admissions
• With every decision who benefits?