Health Equity
Definition of Equity
In Aotearoa New Zealand, people have differences in health that are not only avoidable but unfair and unjust. Equity recognises that different people with different levels of advantage require different approaches and resources to get equitable health outcomes.
While each patient is given the same treatment, the factors that make patients different from one another (including but not limited to socioeconomic status, education, literacy, ethnicity, and disability, access to health care, age, gender and sexual orientation) are considered. Equity in health care accounts for those differences and focuses on delivering equivalent outcomes.
Tongan Health Society has a clear commitment to Health Equity.
Equality vs Equity
Giving everyone the same thing – it only works if everyone starts from the same place.
Equality = Sameness Equity = Fairness
Inequality = Unequal Inequity = Unfair or Unjust
Scope
All Staff employed at Tongan Health Society.
Purpose
Pursuing equitable outcomes is a journey of progressive improvements and a practice-wide responsibility. Tongan Health Society is a pro-equity practice ensuring all team members are trained in the principles and practice of health equity.
Tongan Health Society strives to understand and address bias, work in a culturally safe manner and create an inclusive and culturally safe experience for our patients, whanau or families and the communities we serve.
Objective
Pro-equity is the practice of actively working towards achieving equitable health outcomes. The RNZCGP (Royal New Zealand College of General Practitioners) have identified four areas where pro-equity elements need to be developed in order to achieve equitable health outcomes across general practice:
Nga Kaihoe/Practice Team
Te Haututanga/Organisation and Leadership
Te Whakatere Waka/Service Development and Delivery
Te Kahui Mahi/Workforce
To achieve this, Tongan Health Society will work in partnership with the RNZCGP identified pro-equity elements and in conjunction with their Māori Health Plan and Whakamaua: Māori Health Action Plan 2020- 2025, which sets the government’s direction for Māori Health advancement over the next five years.
Whakamaua is underpinned by the Ministry’s new Te Tiriti o Waitangi Framework which provides a tool for the Health and Disability system to fulfil its stewardship obligations and special relationship between Māori and the Crown.
Whakamaua outlines a suite of actions that will help to achieve four high-level outcomes. These are:
Iwi, hapu, whanau and Māori communities exercising their authority to improve their health and wellbeing
Ensuring the health and disability system is fair and sustainable and delivers more equitable outcomes for Māori
Addressing racism and discrimination in all its forms
Protecting matauranga Māori throughout the health and disability system
Rights-based rationale: Domestic and international obligations
Te Tiriti o Waitangi (the Treaty of Waitangi) is the founding document of New Zealand. It establishes the basis for Māori rights to health equity through conferring on the Crown a responsibility to protect Māori and, on Māori the rights of equal citizenship, including the right to parity of outcomes.
Overtime, the Waitangi Tribunal and the courts have established a body of jurisprudence in the form of principles of the Treaty that further outline the responsibilities of both government and Māori. Chief amongst these in the health sector context are the principles of Partnership, Participation and Protection.
Partnership involves working together with iwi, hapu, whanau, and Māori communities to develop strategies for Māori health gain and appropriate health and disability services.
Participation requires Māori to be involved at all levels of the health and disability sector, including governance, decision-making planning, development and delivery of health and disability services.
Protection involves the government working to ensure Māori have at least the same level of health as non-Māori, and safe-guarding Māori cultural concepts, values and practices.
Support and Training
All staff are trained in the principles and practice of health equity, cultural competency, culturally safe practice and bias.
All staff should consider the diversities within the practice population and ensure they can safely care for any type of presenting patient, regardless of current enrolled patient demographic.
All staff (including locums) are responsible to ensure they are fully conversant with Tongan Health Society’s Health Equity Policy as outlined in this document, in conjunction with any supporting policies and documents.
Leadership
Tongan Health Society’s leadership are committed to being a Pro-equity practice by embedding health equity practice wide.
The Clinical Quality and Administration Coordinator is the Equity Champion.
The practice has a Clinical Governance committee who are committed to the organisation-wide approach to continuous quality improvement across the practice. This committee is made up of representatives across all clinical areas of the practice.
Management actively recruit, develop and retain practice team members whose values and skills align with the practice’s pro-equity commitments. All staff are encouraged to develop and contribute to practice-wide equity activities including any community-based programs.
Health Equity Outcome
Evidence based outcomes – current and accurate quantitative and qualitative data inform initiatives to promote health equity. Policies and Procedures incorporate clear commitments toward delivering these equitable health outcomes.
One way to capture and evaluate the patient experience for a small practice is after their visit to the medical centre. This incorporates the whole experience for the patient. We have had excellent results through regular solicitation and implementation of feedback from targeted groups through patient surveys and will continue these on an annual basis.
Resources
Medical Council of New Zealand – Achieving Best Health Outcomes for Māori: a Resource
Medical Council of New Zealand – Cultural Safety – Key Documents – Cultural Safety Baseline Data Report – September 2020
NZNO- Closing the Gap: How nurses can help achieve health access and equity
Ministry of Health: Achieving Equity
Ministry of Health: He Korowai Oranga: Māori Health Equity
Whakamaua: Māori Health Action Plan 2020-2025
Westend Medical – Health Equity Policy 2020