I trained as a public health physician in the UK, and although I have spent many years managing healthcare, in various settings, my resolve to ensure fair and equitable health for everyone is a priority for me in my role as chief executive of Hawke’s Bay District Health Board.
As part of that resolve I commissioned Dr Caroline McElnay, the district health board’s Director of Population Health, to take a good look at health equity in Hawke’s Bay. I told her not to pull any punches, to make sure she painted the real story and to be clear about what and where the issues are.
Her report, recently released, has done exactly that. We now know that although Hawke’s Bay might be a beautiful place to live, our community faces some real challenges such as:
• One third of our children live in poverty;
• The high rate of smoking amongst pregnant Maori women is a public health crisis;
• The rate of serious assaults resulting in injury in Hawke’s Bay is twice the New Zealand average;
• People living in areas like Camberley are three times more likely to die from an avoidable cause of death than people who live in Havelock North;
• One in four adults in Hawke’s Bay is a hazardous drinker – this means they are likely to be causing harm to their own health or causing harm to others through their behaviour;
• 62% of 15-24 year old males drink hazardously compared to 34% nationally, and it’s just as bad for women with 36% of 15-24 year old women drinking hazardously compared to 18% nationally. That’s double the rate for both genders compared to the rest of New Zealand;
• It is startling that three out of four Maori will be dead before their 75th birthday, compared to one in three European. And possibly even worse, one in four Maori will die before their 50th birthday compared to one in twenty European.
I find these statistics shocking and unacceptable.
Much of the work we do in health is focused on reducing inequity, trying to reduce the gap so everyone has the same opportunities for health. It’s part of our vision for the next five years through our Transform and Sustain programme. The 11 key areas of this programme all contain elements to make sure equity is addressed, when we determine how we spend our money.
Recognising and identifying the issues through this report will help us work to reduce the gap, but the health system alone cannot solve inequity. To make real inroads will take a multi-agency response and a commitment for all agencies to work together. There cannot be any patch protection. We need to work together and that’s the challenge I make to all organisations – that’s the only way we can make a difference.
We know it can be done.
As part of the rheumatic fever ‘Say Ahh’ programme, which has targeted the Flaxmere community, we have been able to address poor housing, overcrowding, and have linked families with other services such as GPs and WINZ.
There is little point in addressing health issues without addressing the causes of that ill-health. We have made a difference – we have seen the cases of rheumatic fever drop from 7.1 cases per 100,000 people in 2010 to 1.9 cases per 100,000 people in 2013 – a drop not seen elsewhere in New Zealand. That’s a great effort – so it can be done. In the long run these initiatives also save the community money. That money previously spent on hospital care for children with rheumatic fever can be diverted into other areas, so that we all benefit.
On a personal level, I know that barriers to inequity can be overcome. I grew up in a poor community. Many of the friends I grew up with are now dead, as they faced similar barriers to health and healthcare. But it can be overcome, through education, easy access to healthcare, particularly primary care, and the readiness of a community to want to do something about it.
A multi-sectoral group of agencies, politicians and civic leaders has already met and been briefed on the findings of the Health Equity Report. The next stage is to develop an ambitious plan which will need to be followed through with decisive action, but to enable the necessary change it must be tackled collectively and responsibly as a community.
Inequities affect us all – this is not someone else’s problem. If we want to prosper in Hawke’s Bay, then we all need to resolve to do something about this.
The health system will play its role fully, but we have a lot of work to do to close the gap, which stretches well beyond the health system. The overall life expectancy of the Hawke’s Bay population is less than the national average. Many within our community suffer ill health and die many years before they should as a result of poverty and inequity. In this day and age that’s simply not good enough.
Everyone plays a role, everyone is affected and this is everyone’s problem.