Lessons for achieving health equity comparing Aotearoa/New Zealand and the United States

Abstract

Aotearoa/New Zealand (Aotearoa/NZ) and the United States (U.S.) suffer inequities in health outcomes by race/ethnicity and socioeconomic status. This paper compares both countries' approaches to health equity to inform policy efforts. We developed a conceptual model that highlights how government and private policies influence health equity by impacting the healthcare system (access to care, structure and quality of care, payment of care), and integration of healthcare system with social services. These policies are shaped by each country's culture, history, and values. Aotearoa/NZ and U.S. share strong aspirational goals for health equity in their national health strategy documents. Unfortunately, implemented policies are frequently not explicit in how they address health inequities, and often do not align with evidence-based approaches known to improve equity. To authentically commit to achieving health equity, nations should: 1) Explicitly design quality of care and payment policies to achieve equity, holding the healthcare system accountable through public monitoring and evaluation, and supporting with adequate resources; 2) Address all determinants of health for individuals and communities with coordinated approaches, integrated funding streams, and shared accountability metrics across health and social sectors; 3) Share power authentically with racial/ethnic minorities and promote indigenous peoples' self-determination; 4) Have free, frank, and fearless discussions about impacts of structural racism, colonialism, and white privilege, ensuring that policies and programs explicitly address root causes.

He aha te mea nui o te ao? He tāngata! (What is the most important thing in the world? It is people!)

“…Diabetes rates for M aori sit at 7.2 per cent compared with 5.1 per cent of New Zealand European (Ministry of Health 2015a). Similar inequities are found in other Indigenous communities (Gibson et al 2015;Chin et al 2018).…”

The “Waze” of Inequity Reduction Frameworks for Organizations: a Scoping Review

“…Additionally, to be most effective, organizations should engage in difficult discussions about how structural and institutional racism impacts their daily processes. 57 Structural racism, such as residential segregation or care systems designed to preferentially attract affluent patients, systematically shapes healthcare access, utilization, and quality for racial and ethnic minority patients. 58 The focus of existing frameworks on macro-level organizational implementation processes poses another challenge and area for improvement.…”

New research directions on disparities in obesity and type 2 diabetes

“…According to the World Health Organization, "'Health equity' or 'equity in health' implies that ideally everyone should have a fair opportunity to attain their full health potential and that no one should be disadvantaged from achieving this potential." 28 This model depicts the way government and private policies impact the healthcare system, the integration of healthcare system and social services, and the relevant SDoH, and consequently health equity (e.g., related to race/ethnicity, SES, or socioeconomic deprivation)-all set within a larger context of history, culture, and values. 26 The concept of equity involves "the absence of avoidable, unfair, or remediable differences among groups of people, whether those groups are defined socially, economically, demographically or geographically or by other means of stratification."…”

“…These included a novel healthcare and community systems-oriented model for assessing policy and social/environmental factors influencing health equity, informed by joint analyses of health equity issues affecting ethnic minority populations in the United States and Aotearoa/New Zealand. 28 This model depicts the way government and private policies impact the healthcare system, the integration of healthcare system and social services, and the relevant SDoH, and consequently health equity (e.g., related to race/ethnicity, SES, or socioeconomic deprivation)-all set within a larger context of history, culture, and values. Other notable models discussed for conceptualizing health equity issues included: the Robert Wood Johnson Foundation's "Finding Answers" framework; 29 the Getting to Equity in Obesity Prevention research and action framework; 30 the Three-Axis Model of Health Inequity; 31 the Consolidated Framework for Implementation Research; 32 and behavioral change models involving beliefs, knowledge, social norms, environmental factors, and selfefficacy, and intrinsic and extrinsic motivation.…”