How does the operation of PHARMAC's 'Community Exceptional ...

distorted the outcomes of the research and invalidated the findings. Naturally
Wilkinson and Pickett dispute this and have subsequently defended their data.
The New Zealand Medical Association developed a ‘Health Equity Position
Statement’ in which the differentiation is made between equity and equality.
This position statement uses the term equity in preference to equality
because it better recognises that people differ in their capacity for health
and their ability to attain or maintain health. Consequently, equitable
outcomes in health may require different (i.e., unequal) inputs to achieve
the same result. This is the concept of vertical equity (unequal, or
preferential, treatment for unequals) in contrast to horizontal equity
(equal treatment for equals).
(New Zealand Medical Association, 2010)
The statement described the link between income inequality, social deprivation
and heath inequity. The statement called on the government to give doctors
adequate information, time and resources (including finances) to work
innovatively and collaboratively to develop systems to reduce health inequities
(New Zealand Medical Association, 2010).
Successive New Zealand governments have been aware of the widening gap
between the highest and lowest income families. The Minister of Health in 2000
introduced legislation, the NZPHDA 2000, with the express purpose of reducing
what she described as shameful inequalities (King, 2000a), particularly in
relation to the health status of Maori and Pacific people. PHARMAC was
established under this Act and has included the improvement of health status of
Maori and Pacific people as one of its decision making criteria.
Wilkinson and Picket (2007) thus posed a fascinating question when they
asserted that increasing health status might be more driven by societies
achieving greater income equality than striving to achieve ever higher access to
increasing volumes of costly health services. The example of the USA shown in
the Commonwealth Fund study (discussed on p.32) showed that highest
investment in health care of all the countries provided the lowest equitable
distribution.
The New Zealand Medical Association has proposed that influencing social
determinants of health lies beyond the mandate of the health workforce. If
36