CDE Appendix 1 Literature Review - Central East Local Health ...

The Culture, Diversity and Equity Project: Literature Review
New Zealand
Box 3.6: Monitoring Health Inequities in New Zealand
New Zealand has initiated a whole-of-government approach to reducing inequities in health, especially with
regard to the ways in which ethnicity and socioeconomic inequities interact. Key policy documents released in
2000 and 2002 have embedded a health inequity focus into all levels of the work of the health sector and have
provided a template (the Reducing Inequalities in health Framework) for how action to reduce health inequities
could be achieved. New Zealand has performed particularly well in steadfastly monitoring inequities and
reporting those inequities in ways that best facilitate action. This has been achieved through a number of
mechanisms, including a strong emphasis on ethnicity recording in the health sector, the routine matching of
census with mortality records, and widespread use of a census-based small area deprivation measure, the New
Zealand Deprivation Index. These approaches have boosted cross-sectoral interest in inequities, facilitated
discussion in academic and policy circles about the root causes of inequities, and provided social agencies with
evidence on which they can plan programmes and policies to address health inequities in their respective areas.
Original Source: WHO & PHAC, 2007; Taken from WHO, 2008.
Sweden
• “Sweden has a decentralized form of federalism and a political culture compatible with a broad,
determinants-based strategy. The motivation to address health disparities in Sweden led to a sustained national
dialogue on the determinants of health and their consequences. The government pursued a consensus-building
process that involved all political parties, an evidence-based approach and extensive public consultation. The
result was a strongly supported strategy that focuses almost exclusively on the non-medical determinants of
health” (Health Disparities Task Group, 2004).
3.3 SOME KEY LESSONS & RECOMMENDATIONS
This section concludes with some key lessons and recommendations discerned from this review of the grey and
academic literature on international health equity policies.
• Knowledge development (especially the development of appropriate health equity measures and indicators) and
dissemination through partnerships and (community-government-academic) collaboration is critical to putting
health equity on the public policy agenda and advancing health equity strategies.
• Comprehensive approaches that combine and incorporate, in varying degrees, (1) health equity and healthcare
equity policy objectives, (2) upstream, midstream and downstream (‘all stream’) interventions, and (3)
universalist and selectivist approaches have proven most effective, in part due to their design and analysis of
causal pathways of health inequity, and in part due to the politics of such multi-pronged approaches which can
appeal to multiple audiences and constituencies (depending on their emphases) across the political spectrum.
• The healthcare sector can and should play a lead role in advancing a broad inter-sectoral health equity policy
agenda that addresses social determinants of health. Intersectoral collaboration is critical to the success of a
truly comprehensive health equity policy agenda seeking to effectively reduce health inequities.
• Political will and a conducive policy/political environment is critical to the advancement of the health equity
policy agenda. Policies should thus strategically align themselves, wherever possible (i.e. while maintaining
their integrity) with local policy contexts and drivers to gain traction and fruition.
• Policies should be guided by evidence regarding the nature of the problem (health inequity) and the appropriate
intervention solutions to the greatest extent possible. In the absence of evidence (particularly in the latter
respect), pilot demonstration projects, and their evaluation, are critical. Evidence alone, however, cannot inform
and steer policy choices, as ethical views and priorities, too, play a key role. It is thus critical that ethical
commitments and foundations for policies are clearly spelled out in ways that can help inform difficult policy
choices.
• Policy objectives should be clearly articulated in realistic, operationalizable terms.
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