Injustice killing Kiwis on grand scale

Social injustice is killing people on a grand scale says Tony Blakeley, director of the Health Inequalities Research Programme at the University of Otago.

In a New Zealand Medical Journal editorial, Dr Blakeley said widening geographic inequalities in death rates from ischaemic heart disease, diabetes, and chronic obstructive pulmonary disease have marked differences between District Health Board regions.

He based the warning on research published in the journal arguing that higher rates of ill health among poor people are leading to differences in a mortality rates between regions.

The research on geographical inequalities in health was published today in the journal by a trio of researchers led by Jamie Pearce, at Canterbury University.

They calculated a "relative index of inequality" for not only all deaths nationwide, and by DHB, but for the main illnesses in each DHB.

The "good" news was that New Zealanders stand a roughly even chance of dying of colorectal cancer no matter which region they live in.

The bad news was that there were big regional differences in the likelihood of their being killed by type-2 diabetes, with people in health board districts covering Northland, Auckland, Wellington and Wairarapa at greatest risk.

By comparison, the diabetes mellitus toll in Waitemata, Nelson, Counties Manukau, and Canterbury was light.

"More attention needs to be paid to geographical differences in health," said Dr Pearce. Such variation between district health board regions was not simply because of ethnic or social differences.

Despite a national health strategy aimed at reducing inequalities, "government policies have not been effective in reducing the spatial divide", Dr Pearce said.

The main findings of the research were increasing inequalities between districts during the 1980s and 1990s, and increased inequality between wealthy and poor areas.

Among the plausible explanations for this were changes in housing, health and education with the implementation of a "neoliberal economic and social agenda".

Other commentators have said the "Rogernomics" moves of a Labour government which took power in 1984 were reinforced by increasing reliance on "market forces" under a subsequent National government.

Dr Pearce said the changing social and political environment disadvantaged poor people and areas, as well as Maori and Pacific people. Healthcare reforms which required people to pay more for their treatment led to poorer people making less use of health services, and unequal rationing of primary healthcare had affected some regions more than others

There was also potentially an impact from selective migration patterns between regions in which skilled and educated people tended to settle in larger cities.

And some DHBs may have directly influenced the health outcomes and inequalities of local residents.

Dr Blakely, a health inequalities researcher at Wellington Medical School, looked ahead to the coming general election and warned any future government needed to consider including deprivation and ethnicity in the main funding formula for primary care.

This was because the primary health organisations could have a high-need population with a 60 percent higher mortality rate than a low-need population, but only receive up to 17 percent extra funding.

The journal also warned that "public private partnership" (PPP) models in the provision of secondary healthcare services – such as where the Government went into a joint venture with private investors to provide hospital care – " might be considered inconsistent with the tenets of a universal healthcare system".

- NZPA