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 3:
Fundamental Principles, Goals and Objectives

This section adopts a principles, goals and objectives framework. Each of the areas is discussed separately below. For definitions of terms used see the Glossary.

Principles

The New Zealand Health Strategy is based on seven underlying principles that the Government sees as fundamental. Those principles are to be applied across the sector and be reflected in any new strategies or developments.

Acknowledging the special relationship between Māori and the Crown under the Treaty of Waitangi. Good health and wellbeing for all New Zealanders throughout their lives. An improvement in health status of those currently disadvantaged. Collaborative health promotion and disease and injury prevention by all sectors. Timely and equitable access for all New Zealanders to a comprehensive range of health and disability services, regardless of ability to pay. A high-performing system in which people have confidence. Active involvement of consumers and communities at all levels.

Acknowledging the special relationship between Māori and the Crown under the Treaty of Waitangi

This principle recognises that the Treaty of Waitangi is New Zealand’s founding document and the Government is committed to fulfilling its obligations as a Treaty partner. This special relationship is ongoing and is based on the underlying premise that Māori should continue to live in Aotearoa as Māori.

The nature of this relationship has been confirmed through interpretations of the Treaty of Waitangi, which stem from decisions of the Waitangi Tribunal, the Court of Appeal and the Privy Council.

Central to the Treaty relationship and implementation of Treaty principles is a common understanding that Māori will have an important role in implementing health strategies for Māori and that the Crown and Māori will relate to each other in good faith with mutual respect, co-operation and trust.

Māori should be able to define and provide for their own priorities for health and be encouraged to develop the capacity for delivery of services to their communities. This needs to be balanced by the Crown’s duty to govern on behalf of the total population.

To date, the relationship between Māori and the Crown in the health and disability sector has been based on three key principles:

• participation at all levels

• partnership in service delivery

• protection and improvement of Māori health status.

Not only is it important to improve Māori health status, but other goals based on concepts of quity, partnership, and economic and cultural security must also be achieved.

Good health and wellbeing for all New Zealanders throughout their lives

This principle reflects the sector’s clear focus on good health and wellbeing.

This applies at both the individual level (for example, with treatment services) and the community level (for example, with health promotion services), and that continues throughout people’s lives. The Government recognises that good health and wellbeing rely on a range of factors, many of which are outside the health sector.

The sector must, therefore, seek to move towards more intersectoral ways of working to ensure these linkages can be made, both centrally and locally.

An improvement in health status of those currently disadvantaged

This principle identifies the opportunity for health improvement within the population. The benefits of health improvements are not shared equally by all sectors of society. An increase in effort is needed to address the low health status of groups with low socioeconomic status, including Māori and Pacific peoples, and people with serious mental illness.

Collaborative health promotion and disease and injury prevention by all sectors

This principle reflects the Government’s desire to have a health system that promotes good health and ‘wellness’ as well as treating illness. Many of the illnesses affecting the New Zealand population are potentially preventable, and we need to do better at addressing all the determinants of health.

Timely and equitable access for all New Zealanders to a comprehensive range of health and disability services, regardless of ability to pay

This principle reflects the fact that fairness is a fundamental value for most New Zealanders, and the health sector must ensure that New Zealanders with similar health conditions are able to achieve similar outcomes.

A high-performing system in which people have confidence

This principle reflects the fact that the health sector must continue to perform to the highest standards and reflect the needs of the people of New Zealand within available resources.

The quality of health services needs to be continually monitored and improved. Services must be co-ordinated, and providers must collaborate to ensure institutional boundaries do not compromise quality of care. Inefficiency means there are fewer health services available for each dollar spent.

Active involvement of consumers and communities at all levels

This principle identifies the need to have consumers and communities involved in decisions that affect them. This process should also ensure services at all levels of the health sector fully reflect the needs of individuals and communities.



Population health goals and objectives

Beneath the level of principles is a set of broad strategic goals. The focus for achieving these goals is sharpened as we move through objectives to targets and, ultimately, to performance measures.

The goals and objectives translate the Government’s broad intentions into the focused actions required to make a difference to improving health. Developing this nationwide set of goals and objectives, and focusing attention on priority objectives selected for immediate action, will assist the whole sector to direct its actions in a more co-ordinated and effective way.

Over time, this framework of goals and objectives will influence all health sector processes, including needs assessment, priority setting, resource allocation, outcomes monitoring, service evaluation and planning, workforce and provider development, information systems and intersectoral co-ordination.

Structuring goals and objectives

The goals and objectives have been structured to reflect the wide range of factors that affect health. The framework begins by addressing society-wide issues, such as employment and income status.

The next step is to assess the immediate environment in which people live and the potential for effecting health improvement within this environment. Consideration can then be directed towards the effects of lifestyle issues, specific diseases, and the accessibility of health services.

Other government agencies are active in addressing these goals and objectives.

In the area of injury prevention, for example, many central government and local government agencies are actively engaged in leading policy development and funding prevention programmes (for example, ACC, Land Transport Safety Authority, the Occupational Safety and Health Service of the Department of Labour, the Police, the Ministry of Emergency Management, local authority support for Safer Communities programmes).

Health agencies should continue to support these agencies’ work and ensure their activities are well co-ordinated at a national and local level. This may include developing intersectoral programmes and targets (for example, road safety programmes, Strengthening Families).

Goals and Objectives Framework

Goal	Objective
1. A healthy social environment	1. Assess public policies for their impact on health and health inequalities. 2. Support policies promoting universal access to high-quality education and training. 3. Support policies promoting workforce participation. 4. Support policies that reduce income inequalities and ensure an adequate income for all. 5. Eliminate social exclusion or discrimination against people on the basis of their health status or disability.
2. Reducing inequalities in health status	6. Ensure accessible and appropriate services for people from lower socioeconomic groups. 7. Ensure accessible and appropriate services for Māori. 8. Ensure accessible and appropriate services for Pacific peoples.
3. Māori development in health	9. Build the capacity for Māori participation in the health sector at all levels. 10. Enable Māori communities to identify and provide for their own health needs. 11. Recognise the importance of relationships between Māori and the Crown in health services, both mainstream and those provided by Māori. 12. Collect high-quality health information to better inform Māori policy and research and focus on health outcomes. 13. Foster and support Māori health workforce development.
4. A healthy physical environment	14. Support policies and develop strategies and services that ensure affordable, secure and safe housing. 15. Support policies that improve access to public transport. 16. Support policies that ensure access to an adequate supply of nutritious food. 17. Support policies and develop strategies and services that ensure all people have access to safe water supplies and effective sanitation services. 18. Reduce the adverse health effects of environmental hazards.
5. Healthy communities, families and individuals	19. Support and promote community development. 20. Develop and implement healthy workplace programmes. 21. Further develop health-promoting schools. 22. Ensure adequate support for parents and young families. 23. Ensure adequate support for caregivers in families with dependent members. 24. Support policies and programmes that enable people to be cared for in the community. 25. Support policies and programmes that support breastfeeding. 26. Support policies and programmes that promote positive ageing. 27. Reduce the incidence and impact of violence in interpersonal relationships, families, schools and communities.
6. Healthy lifestyles	28. Reduce smoking. 29. Improve nutrition. 30. Reduce obesity. 31. Increase the level of physical activity. 32. Improve sexual and reproductive health. 33. Minimise harm caused by alcohol and illicit and other drug use to individuals and the community.
7. Better mental health	34. Reduce the incidence and impact of stress. 35. Reduce the incidence and impact of depression. 36. Improve the health status of people with severe mental illness. 37. Reduce the rate of suicides and suicide attempts. 38. Reduce stigma and discrimination associated with mental illness. 39. Reduce the impact of dementia.
8. Better physical health	40. Reduce the incidence and impact of cancer. 41. Reduce the incidence and impact of cardiovascular diseases. 42. Reduce the incidence and impact of diabetes. 43. Reduce the incidence and impact of asthma and other lung diseases. 44. Reduce the incidence and impact of musculoskeletal disorders including arthritis. 45. Reduce the incidence and impact of neurological disorders. 46. Improve oral health. 47. Reduce the incidence and impact of infectious diseases.
9. Injury prevention	48. Reduce the incidence and impact of road traffic injuries. 49. Reduce the incidence and impact of falls in older people. 50. Reduce the incidence and impact of injuries (other than traffic) in children and youth. 51. Reduce the incidence and impact of workplace injuries.
10. Accessible and appropriate health care services	52. Ensure access to appropriate secondary care services. 53. Ensure access to appropriate palliative care services. 54. Ensure access to appropriate primary care, maternity and public health services. 55. Ensure access to appropriate child care services including well child and family health care and immunisation. 56. Ensure accessible and appropriate services for young people/rangatahi. 57. Ensure accessible and appropriate services for older people. 58. Ensure access to appropriate mental health services. 59. Ensure access to appropriate services for people living in rural areas. 60. Ensure services are patient-centred. 61. Ensure information about services is accessible for consumers.