Understanding Health Equity in New Zealand's Health and Disability Sector

 
Health and Disability Consumer
Representative Training
 
MODULE THREE
Evidence base
 
 
Housekeeping
Ground rules
Introductions - who we are and our backgrounds
 
Welcome
 
The NZ health and disability
environment
Consumer engagement
Inequities
Research
Clinical trials
Your experience
Roles & responsibilities
Meetings
Leadership
Co-design
Peer support
 
Inequities
Research
Clinical trials
 
 
To understand the equity issues for different groups
in New Zealand’s health and disability sector.
To increase your knowledge about research in health and
disability sector as the evidence base for change and
improvement.
To learn about clinical trials and how you can be involved in
these.
 
Goals for the day
 
 
Image courtesy of Interaction Institute for Social Change | Artist: Angus Maguire.
http://interactioninstitute.org
 | 
www.madewithangus.com
 
 
What is health equity?
 
‘the absence of avoidable differences among groups of people,
whether these groups are defined socially, economically,
demographically or geographically’
(World Health Organization)
‘The presence of systematic disparities in health between groups’
(
Fact and Action Sheets on Health Inequities
,
New Zealand Medical Association, 2011)
‘…avoidable, unnecessary and unjust differences in the health of
groups of people.’
(
Reducing Inequalities in Health
, 
Ministry of Health, 2002)
 
 
Age.
Gender.
Ethnicity.
Poverty (deprivation).
Socioeconomic position.
Impairment.
Geographical region.
Housing.
Health care service designs
Government policies.
 
Factors that can influence health equity
 
 
There is considerable evidence, both internationally and in New
Zealand, of significant inequalities in health between
socioeconomic groups, ethnic groups, people living in different
geographical regions and males and females
 
Acheson D. 1998. 
Independent Inquiry into Inequalities in Health
. London.
Howden-Chapman P, Tobias M (eds). 2000. 
Social Inequalities in Health: New Zealand
1999.  Wellington: Ministry of Health.
 
Health inequities in New Zealand
 
 
Ethnic identity is an important dimension of health inequities.
Māori and Pacific peoples experience lower life expectancy and
health disadvantage across most mortality and morbidity
indicators compared with Pākehā.
(
The pervasive effects of racism: experiences of racial discrimination in
New Zealand over time and associations with multiple health domains
,
Harris & Cormack et al, 2012
)
 
Health inequities for Maori and
Pacific peoples
 
 
Māori populations still have higher levels of unmet
need for GP care than non-Māori, are more than
twice as likely as non-Māori to have reported not
collecting prescriptions.
(
Tatau Kahukura: M
ā
ori Health Chart Book 2015, 3rd edition
,
Ministry of Health, 2015)
Māori health status remains unequal across almost all chronic
and infectious diseases as well as injuries, including suicide.
Māori life expectancy is considerably lower than non-Māori.
Mortality rates are also higher for Māori at nearly all ages.
 
Inequities in health – Māori
 
 
New research is painting a bleak picture of the problems Māori
patients face in getting equitable access to medicines.
Dr Matire Harwood (Ngapuhi) says the latest research shows a
clear and urgent need to improve medicines management
services, but there are positive signs at a grass roots level.
(From 
Nine To Noon
, 9:33 am on 11 July 2018)
https://www.radionz.co.nz/national/programmes/ninetonoon/audio/2018653116/urge
nt-call-to-improve-medicine-access-for-maori
 
‘Urgent call to improve medicine access
for Māori’
 
’Ala Mo’ui Progress Report – June 2016:
Life expectancy of Pacific men = 74.5 years
– 5 years less than for total men in New Zealand.
Life expectancy of Pacific women = 78.7 years
– 4.5 years less than for total women in New Zealand.
Poor health outcomes are related to social determinants, such
as income, employment, housing quality and education
(
’Ala Mo’Ui: Pathways to Pacific Health and  Wellbeing 2014–2018
,
Ministry of Health, 
2014)
 
Inequities in health – Pacific people
 
 
Pacific peoples are well connected socially
and culturally.
Pacific peoples, on average, report higher
psychological distress and depressive symptoms.
Stigma surrounding mental health issues is
high among Pacific peoples.
Some Pacific peoples don’t know where to get help for
mental distress and awareness of national mental health
websites is low.
 
Te Kaveinga - Mental health and
wellbeing of Pacific peoples: Report
 
 
Supports and encourages Pasifika families and communities to
unleash their full potential.
Designs and develops evidence-based resources, tools,
information, knowledge and support services for the best
possible health and wellbeing outcomes.
Recalls and applies traditional values in a contemporary way.
 
Le Va website
 
 
Positive health outcomes are shown in a range of
health indicators for Asian ethnic groups, especially
Chinese.
However, indicators among Indian ethnic group,
include:
Self-reported diabetes over three times higher.
Indian boys are 1.5 times more likely to be
hospitalised for asthma.
Indian males and females have significantly
higher cardiovascular disease hospitalisation
and mortality rates.
 
Inequities in health – Asian people
 
(Asian Health Chart Book
, Ministry of Health, 2006)
 
 
What other groups of people might experience inequities in
health care, and how?
 
Group discussion
 
 
DHBs have a statutory responsibility under the New Zealand
Public Health and Disability Act 2000 to:
reduce health inequalities in their regions.
improve outcomes for Māori.
Tools and strategies developed to help achieve this include:
Health Equity Assessment Tool (Ministry of Health).
He Korowai Oranga – NZ’s Māori Health Strategy
.
Equity of Health Care for Māori: A framework
.
Atlas of Healthcare Variation (HQSC).
 
Addressing inequalities
 
 
Developed by the Commission to show 
variations in the health
care received by people in different geographical regions 
of
New Zealand.
Designed to raise questions about health service use and to
stimulate improvement through debate
.
Organised by 
16 domains
, which cover specific clinical areas.
An 
online tool on the Commission’s website
, includes easy-to-
use maps, graphs, tables and commentary.
 
Atlas of Healthcare Variation
 
 
 
Health and disability research
Clinical trials
Consumer involvement
 
Next three topics
 
 
The HRC is responsible for managing the Government’s
investment in health research.
The New Zealand Health Research Strategy 2017-2027 
aims to
:
1.
Invest in excellent health research that addresses the health
needs of all New Zealanders.
2.
Create a vibrant research environment in the health sector.
3.
Build and strengthen pathways for translating research
findings into policy and practice.
4.
Advance innovative ideas and commercial opportunities.
 
Health & disability research
 
 
Health Research Council of New Zealand (HRC) is committed to
ensuring that all research involving human participants is 
based
on good science
, meets ethical standards and 
complies with
international best practice
:
research involving human participants funded by HRC
requires appropriate ethical approval
HRC–funded clinical trials, evaluations or intervention
studies are monitored to ensure safety of participants and
protect integrity of data collected.
(
http://www.hrc.govt.nz/ethics-and-regulatory)
 
Ethics of including consumers in research
 
 
Health and disability researchers can access funds from:
Health Research Council of New Zealand
District health boards
Cancer Society of New Zealand
New Zealand Breast Cancer Foundation
Drug companies
Private organisations, such as the Hugh
McKenzie Trust
Lottery Grants.
 
Accessing research funds
 
 
48 x Projects – $54.35m
26 x Pacific Health Research grants 
$1.88m
20 x Māori Health Research grants 
$2.34m
16 x Career Development Awards 
$5.55m
12 x Emerging researching first grants – $2.85m
10 x Explorer grants – $1.5m
9 x Feasibility studies – $2.23m
5 x Programmes – $24.61m
 
 
HRC funding – 2018
 
 
Evidence-based healthcare benefitting consumers:
How Cochrane and its library benefit consumers and providers
by publishing information (
7-minute video
).
Consumers improving health:
How consumers around the world are networking and
contributing to evidence-based health care. (
9-minute video
)
Consumer Advocacy:
The role of consumers in promoting evidence-based health care
(
6-minute video
).
http://consumers.cochrane.org/introduction-consumer-involvement-collaboration
 
 
‘If Australian health research is to take into account important
social contexts and consequences, it must involve consumers.’
(
Saunders C, Girgis A, 
Status, challenges and facilitators of consumer involvement in Australian
health and medical research
, 2010)
Active involvement by consumers:
must include informed and explicit consent
benefits:
the quality and direction of research itself
the research development process
people affected by health and disability issues.
 
Consumer involvement in research
 
 
1.
What do you see as the most important needs for health and
disability research?
2.
What would you need to do to be involved in a research
project?
 
Group exercise
 
 
Helps promote reliable, relevant 
research important to
consumers and carers
.
Presents the 
needs and views of consumers 
to the research
community.
Encourages research questions to 
include social and emotional
aspects 
of health often missing from clinically led research.
Ensures issues important to consumers are identified and
prioritised.
 
Why is the consumer voice
important to health research?
 
 
A clinical trial is defined as a prospective scientific experiment
usually conducted 
to assess the safety and effectiveness 
of an
intervention in groups of subjects.
Interventions may be 
diagnostic, preventative, or therapeutic
in nature and may include drugs, biologics, medical devices, or
methods of screening.
Interventions may also include 
procedures that aim to improve
the quality of life 
or to better understand how the intervention
works in the study participants.
(
www.researchreview.co.nz
)
 
Clinical trials
 
 
Access to a novel treatment 
before it is widely available
, or
access to the global standard comparator (which may not be
freely available in New Zealand).
Close medical oversight and 
regular access to study nurse and
physician
.
Close 
scrutiny of adverse events
.
Provision of care 
within a health care facility committed to
improving best practice
.
 
Benefits to consumers of being
involved in clinical trials
 
 
Not everyone gets treated the same or has equal access to
health and disability support services, and this can result in
inequities for Māori, Pacific peoples, Asian and other minority
groups.
Health science is complex and ever-changing, with new
research contributing to new treatments.
Consumer involvement in setting up research is important and
so is the opportunity to be offered the choice to give informed
consent to participate in clinical trials.
 
Summary
 
 
Questions?
Comments?
Evaluation
 
Slide Note

FACILITATOR NOTES

BEFORE GETTING STARTED:

Ø Take note of the cultural make-up of the group. You could consider opening and closing with a karakia, or hosting sessions on a marae if appropriate.

Ø Find a venue that meets the needs of participants. For example, meets any disability needs indicated on the registrations (access, furniture, lighting etc) and has suitable parking and/or public transport access.

Ø Invite speakers with relevant expertise to present on specialist topics (eg Ministry of Health, Health Quality & Safety Commission).

Ø Arrange morning and afternoon teas and lunch if required.

Ø Print copies of relevant/useful handouts:

The PowerPoint in notes pages format

References list - https://www.hqsc.govt.nz/assets/Consumer-Engagement/Partners-in-Care-Resource-page/ConsumerTraining/Consumer_training_-_references_list_19-10-2018.docx

A list of acronyms - https://www.hqsc.govt.nz/assets/Consumer-Engagement/Partners-in-Care-Resource-page/ConsumerTraining/Consumer_training_-_acronymns_list_19-10-2018.docx

Blakely and Simmers article on ‘Health inequalities and action fact sheet’ – http://www.pha.org.nz/documents/fact-action-health-inequalities.pdf

Involving consumers in research – status, challenges and facilitators of consumer involvement - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2998503/

Evaluation form - https://www.hqsc.govt.nz/assets/Consumer-Engagement/Partners-in-Care-Resource-page/ConsumerTraining/Consumer_training_-_evaluation_form_19-10-2018.docx

ON THE DAY:

Ø Hand out copies of the PowerPoint.

Ø Establish the group members’ knowledge of topic areas (for use in sharing experience/examples later).

Embed
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This module covers topics such as consumer engagement, roles and responsibilities, partnership, inequities, research, clinical trials, and more in the context of New Zealand's health and disability sector. It includes discussions on the factors influencing health equity and aims to increase knowledge on research and clinical trials for positive change. Visual aids and definitions provided for better understanding.


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  1. Health and Disability Consumer Representative Training MODULE THREE Evidence base

  2. Welcome Housekeeping Ground rules Introductions - who we are and our backgrounds 2

  3. The NZ health and disability environment Consumer engagement Your experience Roles & responsibilities Meetings Health and disability context Experience base 1 2 4 3 Evidence base Partnership Leadership Co-design Peer support Inequities Research Clinical trials 3

  4. Health and disability context Experience base 1 2 4 3 Evidence base Partnership Inequities Research Clinical trials 4

  5. Goals for the day To understand the equity issues for different groups in New Zealand s health and disability sector. To increase your knowledge about research in health and disability sector as the evidence base for change and improvement. To learn about clinical trials and how you can be involved in these. 5

  6. Image courtesy of Interaction Institute for Social Change | Artist: Angus Maguire. http://interactioninstitute.org | www.madewithangus.com 6

  7. What is health equity? the absence of avoidable differences among groups of people, whether these groups are defined socially, economically, demographically or geographically (World Health Organization) The presence of systematic disparities in health between groups (Fact and Action Sheets on Health Inequities, New Zealand Medical Association, 2011) avoidable, unnecessary and unjust differences in the health of groups of people. (Reducing Inequalities in Health, Ministry of Health, 2002) 7

  8. Factors that can influence health equity Age. Gender. Ethnicity. Poverty (deprivation). Socioeconomic position. Impairment. Geographical region. Housing. Health care service designs Government policies. 8

  9. Health inequities in New Zealand There is considerable evidence, both internationally and in New Zealand, of significant inequalities in health between socioeconomic groups, ethnic groups, people living in different geographical regions and males and females Acheson D. 1998. Independent Inquiry into Inequalities in Health. London. Howden-Chapman P, Tobias M (eds). 2000. Social Inequalities in Health: New Zealand 1999. Wellington: Ministry of Health. 9

  10. Health inequities for Maori and Pacific peoples Ethnic identity is an important dimension of health inequities. M ori and Pacific peoples experience lower life expectancy and health disadvantage across most mortality and morbidity indicators compared with P keh . (The pervasive effects of racism: experiences of racial discrimination in New Zealand over time and associations with multiple health domains, Harris & Cormack et al, 2012) 10

  11. Inequities in health Mori M ori populations still have higher levels of unmet need for GP care than non-M ori, are more than twice as likely as non-M ori to have reported not collecting prescriptions. (Tatau Kahukura: M ori Health Chart Book 2015, 3rd edition, Ministry of Health, 2015) M ori health status remains unequal across almost all chronic and infectious diseases as well as injuries, including suicide. M ori life expectancy is considerably lower than non-M ori. Mortality rates are also higher for M ori at nearly all ages. 11

  12. Urgent call to improve medicine access for M ori New research is painting a bleak picture of the problems M ori patients face in getting equitable access to medicines. Dr Matire Harwood (Ngapuhi) says the latest research shows a clear and urgent need to improve medicines management services, but there are positive signs at a grass roots level. (From Nine To Noon, 9:33 am on 11 July 2018) https://www.radionz.co.nz/national/programmes/ninetonoon/audio/2018653116/urge nt-call-to-improve-medicine-access-for-maori 12

  13. Inequities in health Pacific people Ala Mo ui Progress Report June 2016: Life expectancy of Pacific men = 74.5 years 5 years less than for total men in New Zealand. Life expectancy of Pacific women = 78.7 years 4.5 years less than for total women in New Zealand. Poor health outcomes are related to social determinants, such as income, employment, housing quality and education ( Ala Mo Ui: Pathways to Pacific Health and Wellbeing 2014 2018, Ministry of Health, 2014) 13

  14. Te Kaveinga - Mental health and wellbeing of Pacific peoples: Report Pacific peoples are well connected socially and culturally. Pacific peoples, on average, report higher psychological distress and depressive symptoms. Stigma surrounding mental health issues is high among Pacific peoples. Some Pacific peoples don t know where to get help for mental distress and awareness of national mental health websites is low. 14

  15. Le Va website Supports and encourages Pasifika families and communities to unleash their full potential. Designs and develops evidence-based resources, tools, information, knowledge and support services for the best possible health and wellbeing outcomes. Recalls and applies traditional values in a contemporary way. 15

  16. Inequities in health Asian people Positive health outcomes are shown in a range of health indicators for Asian ethnic groups, especially Chinese. However, indicators among Indian ethnic group, include: Self-reported diabetes over three times higher. Indian boys are 1.5 times more likely to be hospitalised for asthma. Indian males and females have significantly higher cardiovascular disease hospitalisation and mortality rates. (Asian Health Chart Book, Ministry of Health, 2006) 16

  17. Group discussion What other groups of people might experience inequities in health care, and how? 17

  18. Addressing inequalities DHBs have a statutory responsibility under the New Zealand Public Health and Disability Act 2000 to: reduce health inequalities in their regions. improve outcomes for M ori. Tools and strategies developed to help achieve this include: Health Equity Assessment Tool (Ministry of Health). He Korowai Oranga NZ s M ori Health Strategy. Equity of Health Care for M ori: A framework. Atlas of Healthcare Variation (HQSC). 18

  19. Atlas of Healthcare Variation Developed by the Commission to show variations in the health care received by people in different geographical regions of New Zealand. Designed to raise questions about health service use and to stimulate improvement through debate. Organised by 16 domains, which cover specific clinical areas. An online tool on the Commission s website, includes easy-to- use maps, graphs, tables and commentary. 19

  20. 20

  21. Next three topics Health and disability research Clinical trials Consumer involvement 21

  22. Health & disability research The HRC is responsible for managing the Government s investment in health research. The New Zealand Health Research Strategy 2017-2027 aims to: 1. Invest in excellent health research that addresses the health needs of all New Zealanders. 2. Create a vibrant research environment in the health sector. 3. Build and strengthen pathways for translating research findings into policy and practice. 4. Advance innovative ideas and commercial opportunities. 22

  23. Ethics of including consumers in research Health Research Council of New Zealand (HRC) is committed to ensuring that all research involving human participants is based on good science, meets ethical standards and complies with international best practice: research involving human participants funded by HRC requires appropriate ethical approval HRC funded clinical trials, evaluations or intervention studies are monitored to ensure safety of participants and protect integrity of data collected. (http://www.hrc.govt.nz/ethics-and-regulatory) 23

  24. Accessing research funds Health and disability researchers can access funds from: Health Research Council of New Zealand District health boards Cancer Society of New Zealand New Zealand Breast Cancer Foundation Drug companies Private organisations, such as the Hugh McKenzie Trust Lottery Grants. 24

  25. HRC funding 2018 48 x Projects $54.35m 26 x Pacific Health Research grants $1.88m 20 x M ori Health Research grants $2.34m 16 x Career Development Awards $5.55m 12 x Emerging researching first grants $2.85m 10 x Explorer grants $1.5m 9 x Feasibility studies $2.23m 5 x Programmes $24.61m 25

  26. Evidence-based healthcare benefitting consumers: How Cochrane and its library benefit consumers and providers by publishing information (7-minute video). Consumers improving health: How consumers around the world are networking and contributing to evidence-based health care. (9-minute video) Consumer Advocacy: The role of consumers in promoting evidence-based health care (6-minute video). http://consumers.cochrane.org/introduction-consumer-involvement-collaboration 26

  27. Consumer involvement in research If Australian health research is to take into account important social contexts and consequences, it must involve consumers. (Saunders C, Girgis A, Status, challenges and facilitators of consumer involvement in Australian health and medical research, 2010) Active involvement by consumers: must include informed and explicit consent benefits: the quality and direction of research itself the research development process people affected by health and disability issues. 27

  28. Group exercise 1. What do you see as the most important needs for health and disability research? 2. What would you need to do to be involved in a research project? 28

  29. Why is the consumer voice important to health research? Helps promote reliable, relevant research important to consumers and carers. Presents the needs and views of consumers to the research community. Encourages research questions to include social and emotional aspects of health often missing from clinically led research. Ensures issues important to consumers are identified and prioritised. 29

  30. Clinical trials A clinical trial is defined as a prospective scientific experiment usually conducted to assess the safety and effectiveness of an intervention in groups of subjects. Interventions may be diagnostic, preventative, or therapeutic in nature and may include drugs, biologics, medical devices, or methods of screening. Interventions may also include procedures that aim to improve the quality of life or to better understand how the intervention works in the study participants. (www.researchreview.co.nz) 30

  31. Benefits to consumers of being involved in clinical trials Access to a novel treatment before it is widely available, or access to the global standard comparator (which may not be freely available in New Zealand). Close medical oversight and regular access to study nurse and physician. Close scrutiny of adverse events. Provision of care within a health care facility committed to improving best practice. 31

  32. Summary Not everyone gets treated the same or has equal access to health and disability support services, and this can result in inequities for M ori, Pacific peoples, Asian and other minority groups. Health science is complex and ever-changing, with new research contributing to new treatments. Consumer involvement in setting up research is important and so is the opportunity to be offered the choice to give informed consent to participate in clinical trials. 32

  33. Questions? Comments? Evaluation 33

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