Avoidable health inequities are unnecessary and unjust differences in the health of groups of people. In New Zealand, ethnic identity is an important dimension of health disparities. The Ministry of Health (the Ministry) acknowledges that cancer is a significant health concern, particularly for Māori and Pacific people, and has a major and disproportionate impact on their communities. For these populations inequities exist in exposure to risk and/or protective factors for cancer, in incidence and outcomes, and in access to cancer services. Comorbidities are a contributing factor to cancer outcomes so this Framework has relevance to other areas of health which deal with long-term conditions.
“For people affected by cancer the social determinants of health play an important role” (World Health Organisation, 2015).
For example a person’s cancer journey can also be influenced by:
· Distance from treatment centres, which creates access issues.
· A person’s socio-economic status, which impacts on their ability to access care
· Varying populations’ needs including a person’s age, gender and sexual orientation, which can influence engagement.
· Whether a person can speak and/or understand English, which creates barriers to care.
· Supportive care planning and delivery needs to ensure that equity is considered at each stage of the process.
Avoidable health inequities are unnecessary and unjust differences in the health of groups of people.
The Treaty of Waitangi, New Zealand’s founding document, outlines the partnership between Māori and the government. From a health perspective the principles upheld in the Treaty can be described as follows:
· Partnership – working together with iwi, hapū, whānau and Māori communities to develop strategies for Māori health gain and appropriate health and disability services
· Participation – involving Māori at all levels of the sector in decision-making, planning, development and delivery of health and disability services
· Protection – working to ensure Māori have at least the same level of health as non-Māori and safeguarding Māori cultural concepts, values and practices.
He Korowai Oranga: Māori Health Strategy 2014 outlines the Ministry and DHB’s commitment to improving Māori health and includes the following four implementation pathways:
· Supporting whānau, hapū, iwi and community development
· Supporting Māori participation at all levels of the health and disability sector
· Ensuring effective health service delivery
· Working across sectors.
Equity of Health Care for Māori: A Framework (MOH, 2014) guides health practitioners, health organisations and the health system to achieve equitable health care for Māori. There are three actions that support the framework:
· Leadership – by championing the provision of high-quality health care that delivers equitable health outcomes for Māori
· Knowledge – by developing a knowledge base about ways to effectively deliver and monitor high-quality health care for Māori
· Commitment – by providing high-quality health care that meets the health care needs and aspirations of Māori.
The Māori philosophy towards health is based on a wellness or holistic health model. The Te Whare Tapa Wha Model describes the four cornerstones of Māori health as whānau (family health), tinana (physical health), hinengaro (mental health) and wairua (spiritual health) and is a well-recognised
model in the health sector. Consideration has been given to this model of health to ensure the four taha outlined in Te Whare Tapa Wha are attended to in this Framework.
Whānau Ora, the well-being of whānau, is a key government policy area and is described as:
· An inclusive approach to providing services and opportunities to all families in need across New Zealand. It empowers whānau as a whole – rather than focusing separately on whānau members and their problems – and requires multiple government agencies to work together with families rather than separately with individual relatives (Ministry of Social Development, 2014).
Whānau Ora is about transformation of whānau with whānau who set their own direction. It is driven by a focus on six whānau outcomes identified by the Taskforce on Whānau-Centred Initiatives:
1. that whānau will be self-managing
2. living healthy lifestyles
3. participating fully in society
4. confidently participating in te ao Māori
1. (the Māori world)
5. economically secure and successfully involved
2. in wealth creation, and
6. are cohesive, resilient and nurturing (Te Puni
3. Kokiri, 2013).
Whānau Ora promotes integrated service delivery and a seamless and coordinated approach to meeting multiple needs (Ministry of Health, 2010). The health and disability sector continues to promote a whānau-centred and holistic approach to quality service delivery. The outcome of the Whānau Ora approach in health will be improved health outcomes for whānau through quality services that are integrated (across social sectors and within health), responsive and whānau-centred. This document supports the use of the Whānau Ora Assessment Tool as a measure of success.
The Māori philosophy towards health is based on a wellness or holistic health model.
Ala Mo’ui: Pathways to Pacific Health and Wellbeing 2014–2018 is the Government’s national plan for improving health outcomes for Pacific people. The plan’s long-term vision is:
· Pacific ’āiga, kāiga, magafaoa, kōpū tangata, vuvale and fāmili experience equitable health outcomes and lead independent lives.
Ala Mo’ui seeks to achieve the following four priority outcomes:
· Systems and services meet the needs of Pacific people
· More services are delivered locally in the community and in primary care
· Pacific people are better supported to be healthy
· Pacific people experience improved broader determinants of health.
The Fonofale Model designed by Fuimaono Karl Pulotu-Endemann in 2001 is a recognised holistic model of Pacific health and incorporates values and beliefs important to Pacific people. It builds on the Te Whare Tapa Wha model and incorporates values and considerations. Together with Whānau Ora it aims to support the vision for Pacific families “Prosperity for all Pacific families in Aotearoa/New Zealand by supporting and building ’āiga, kāiga, magafaoa, kōpū tangata, vuvale, fāmili, family capability” (Ministry of Pacific Island Affairs, 2013). This model has also informed our thinking in the development of this Framework.
The Supportive Care Framework
seeks to address equity for all peoples and improve Māori health and Pacific health by:
· Ensuring equity considerations are included in all components of the Framework
· Mirroring the levels of the Equity of Health Care for Māori Framework by identifying actions to improve equity at the health system, health organisation and health practitioner levels
· Embedding the concepts from the Māori and Pacific health models and Whānau Ora
· Promoting culturally appropriate care considerations and competencies at all levels, i.e. workforce, service/organisation and system
· Inclusion of equity-focused tools and resources
· The use of person centred care philosophies and values
· Increasing the profile of working with whānau to improve overall health
· Working intersectorally in line with the principles of Whānau Ora
· Outlining key practice points for groups at risk.
Last Updated October 2016