The New Zealand Health Strategy

Full text version

Date of publication: December 2000This is the full text online version of this document. You can also download this publication in PDF format.

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Chapter 2:
Why Change?

In New Zealand we have a strong health system based on many years of investment by the community, funding (through taxes and other means) by all our citizens and the hard work, dedication and commitment of those working within the sector.

The Government believes, however, that this hard work has been hampered by the commercial focus of health care in recent years. It is clear that, despite improvements in health status, New Zealand is slipping behind other developed countries.

This is particularly evident in Māori and Pacific peoples’ communities. Behind the statistical comparisons lies the unacceptable reality that some New Zealanders live in unhealthy housing, some have poor nutrition and, in rural areas, some have limited access to clean water and sewerage systems.

Despite the commitment of those working in the sector, some members of the public have lost their trust in the health system.

They are no longer confident that they will be cared for when they are ill or will have adequate support if they have a disability. Yet the evidence shows that, when they come to use services, these concerns are often dispelled and the experience is a good one.

These are the issues that this Strategy sets out to address. This Government is committed to working together with the health sector, and other sectors, to tackle these problems, despite the difficulties involved.

This Strategy calls for the health sector to work co-operatively towards common goals rather than competing for the largest share of the health dollar. The combined goals must be the improvement in the health of our community, reduced disparities in health outcomes for all New Zealanders, including Māori and Pacific peoples, and the highest quality care for people who are sick or disabled, within the money available.

The Government, therefore, is reconfiguring the health and disability sector to improve the overall health status of New Zealanders. District Health Boards will be responsible for the health of their local populations. The introduction of District Health Boards will help ensure services reflect the needs of individuals and communities at a local level.

Local decision-making will also help to deliver the Government’s commitment to reduce inequalities and improve
health status.

The changes will:

• focus on population needs

• reduce disparities in health

• emphasise community and health services users’ involvement at all levels

• improve co-ordination across the health sector so that the whole system works for people

• improve co-ordination on health issues across all central and local government portfolios and sectors

• achieve a non-commercial, collaborative and accountable environment that encourages cooperation on common goals

• create an environment where those working in the sector feel part of the total system.

Inequalities in health

Making a difference: reducing inequalities for all New Zealanders, including Māori and Pacific peoples

To improve the overall health of New Zealanders, particular attention must be paid to those with the poorest health.

Many complex factors lead to poor health status. The impact of those factors is particularly evident amongst Māori and Pacific peoples and has resulted in disparities in Māori and Pacific peoples’ health status.

Addressing health inequalities is a major priority requiring ongoing commitment across the sector. The most effective means to reduce disparities will focus on:

• intersectoral approaches

• use of prevention strategies, with a population health focus

• building on existing initiatives

• modifying behaviour and lifestyle risk factors through appropriately tailored policies and programmes

• improved delivery of treatment services through mainstream enhancement and provider development.

The Government has given priority to reducing the disparities in social and economic outcomes for all New Zealanders, including Māori and Pacific peoples, and an intersectoral work programme is in place to ensure identifiable progress is made over the next three years to reduce those inequalities.

In order to design policies and programmes to reduce inequalities for all New Zealanders, including Māori and Pacific peoples, the Ministry of Health and District Health Boards will:

• identify community-driven initiatives that are achieving results or that have the potential to do so

• identify ways they can respond to communities’ needs and interests

• advise communities and provide them with information to help them meet their needs and fulfil their interests

• help communities to access the optimum mix of resources to achieve their own goals

• adapt policies, programmes and funding to support successful community initiatives

• implement programmes to reduce health inequalities

• liaise with other government agencies on a national and local basis to build more co-ordinated policies and programmes

• support provision of by Māori for Māori services

• support ‘by Pacific for Pacific’ initiatives

• focus on results.

More information about reducing inequalities


The health sector and determinants of health

Improving the population’s health means focusing on those factors that most influence health.

There is clear international evidence that key factors include:

• genetic inheritance

• age

• gender

• ethnicity

• income

• education

• employment

• housing

• a sense of control over life circumstances

• access to health care services.

Tackling broader determinants requires action across sectors. It requires action to:

• build healthy public policy

• create supportive environments for health

• strengthen community action for health

• develop personal skills

• reorient health services (WHO 1986).

Often other sectors are responsible for leading work at these levels (for example in housing and employment), so it is important for health policy makers, funders and service providers to develop appropriate intersectoral linkages.

This intersectoral approach is consistent with Māori approaches to maintaining and improving wellbeing.

The Whare tapa whä (Durie 1994) Māori health model, which is also known as the four cornerstones of Māori health, describes four dimensions that contribute to wellbeing: te taha wairua (spiritual aspects), te taha hinengaro (mental and emotional aspects), te taha whanau (family and community aspects), and te taha tinana (physical aspects). It is considered that good health depends on the equilibrium of these dimensions.

The health sector itself plays a key role, as recent work such as Our Health, Our Future (Ministry of Health 1999b) demonstrates.

There is the potential to reduce health inequalities through an improved focus on prevention and management of chronic diseases and their disabling consequences, especially by using health promotion approaches and primary care programmes.

Effective action therefore relies heavily on strong and effective relationships at central and local levels. Although many good relationships already exist, these can be widened and strengthened. Key relationships are those within and between:

• the public

• the public health components of the health sector

• the personal health and disability support components of the sector

• other sectors of society such as government agencies, local government and local community groups.

Sound relationships are required at all levels of the health sector with the aim of improving health outcomes for Māori.

The many good relationships that already exist need to be consolidated and developed with a view to ensuring the new structural changes continue to contribute to reducing health inequalities.