Restarting the health system
Restarting the health system as part of the COVID-19 recovery process provides a unique opportunity to plan a new normal where equity at the centre is a priority
An equity-led COVID-19 Healthcare Service Recovery
The COVID-19 pandemic has dramatically interrupted health services delivery in Aotearoa.
There is significant evidence that shows that Māori experience inequitable health outcomes from the current health system and it is likely that the disruption to healthcare during Alert Level 4 and Alert Level 3 will have negatively and disproportionately affected Māori.
All New Zealanders can expect that unless deliberate and determined pro-equity approaches are developed and implemented, the health system will continue to compound and exacerbate the current health inequities that impact on Māori and many other New Zealanders.
Restarting the health system, and ensuring that equity is at the centre, is therefore necessary and just.
To do otherwise would be negligent and inaction in the face of demonstrable need - a clear and recognised feature of institutional racism.
We now have an opportunity to plan a better future for Māori and all New Zealanders.
A better future
Inequity is part of our past and current health system. Māori have a right to, and need for a different future.
Achieving a better future will require systemic transformation of the health system, grounded in different values, a different worldview, a different mix of people at the table, different power dynamics and different thinking.
It will require a health system that it is held accountable for meeting its Treaty of Waitangi obligations.
Chin et al advises that to achieve health equity, healthcare organisations and systems should:
Explicitly design quality of care and provider incentives to achieve equity, holding the health system accountable through public monitoring and evaluation and supporting with adequate resources
Address all determinants of health for individuals and communities with coordinated approaches, integrated funding streams, and shared accountability metrics across health and social sectors
Share power authentically with racial/ethnic minorities and promote Indigenous people's self-determination
Have free, frank and fearless discussions about impacts of structural racism, colonialism, and white privilege, ensuring that policies and programmes explicitly address root causes.
The commitment to achieve equitable health outcomes for Māori must be expressly stated in all documents that make up the policy framework for the health system restart, including strategies, plans, prioritisation tools and other documents.
The need for accurate, reliable and ethnicity disaggregated data and real-time monitoring is critical.