Speech Notes - Hon A King
Symposium On Explanations For Socio-Economic Differences In Health
Thank you for asking me to this important symposium. Although it began more than an hour ago, my role is to go back in
time and open it officially. I am more than happy to do so, because the theme is central to the Government's overall aim
of improving social equity.
I think the attendance of so many people here suggests it is central to the concerns of New Zealanders as well. The
symposium was shifted here, I'm told, because so many wanted to attend. That is hugely encouraging as far as I am
Before I talk from a Government perspective about inequalities that exist between socioeconomic groups, ethnic groups,
people living in different geographic regions and between men and women, I want to congratulate Massey University for
staging this symposium.
I am looking forward to talking a little later this morning to Professor Neil Pearce, the director of Massey's Centre
for Public Health Research, and also to meeting Professor George Davey Smith, the eminent visitor from the University of
Bristol who is the keynote speaker at this symposium.
In a real sense, the need to deal with socioeconomic inequalities has underpinned my role as Health Minister since the
Labour/Alliance Government took office. Sadly, it almost goes without saying that examples of such inequalities in terms
of health are never difficult to find.
In all countries, more socially disadvantaged groups have poorer health, greater exposure to health risks and poorer
access to health services. Indigenous people have poorer health even when social and economic status is taken into
As I said, that's the case in all countries, but that begs the question of why it should necessarily be so in a country
like New Zealand. You may have read comments last week by Professor Ichiro Kawachi, who trained at the Otago University
Medical School, and who is now at the Department of Health and Social Behaviour at Harvard School for Public Health.
Professor Kawachi regularly visits New Zealand, and says the gap here between rich and poor is growing spectacularly. He
particularly notes the contrasts in Auckland.
To quote the professor: "We wouldn't have put up with it 10 to 15 years ago. When the gap between rich and poor widens,
there's an accompanying erosion of social capital. People become more selfish, less trusting of each other, volunteerism
and civic engagement goes down, and we become a care-less society".
His comments are sombre, but the Labour-Alliance Government is determined New Zealand again becomes a society that cares
instead of not caring less. He acknowledges we are trying to turn the differences around, and argues that a more
egalitarian society stands to benefit everyone in the long term. I couldn't agree more.
I also accept, however, that we have a long way to go. That is why we are reviewing the future funding of health and
disability services, looking at issues like the Community Services Card, for example. The card has always been a blunt
instrument, born in the 1990s as a sop to those worst off under the former Government's market-based social reforms.
The aim is to ensure we have a funding system that supports the Government's overall goal of improving the health status
of New Zealanders and reducing disparities between population groups.
A Ministry of Health-led working group and a technical advisory group has been established. I expect the
Director-General to provide me with advice by mid-November, and to be able to report back to the Government on the
working party's recommendations before Christmas.
My period as Minister has coincided with much information on the effects of socioeconomic inequalities upon the health
of New Zealanders.
In September last year the Ministry published a detailed monitoring report on social inequalities in health. This
report is the first of what will be regular five-year reports on the determinants of health.
In the same month I launched Degrees of Deprivation in New Zealand, an atlas of socioeconomic differences that provides
compelling evidence of deprivation based on data from the 1996 census. One of the authors, Peter Crampton, has been
involved in the expert advisory group advising the Ministry on a draft framework for reducing inequalities in health.
Two other members of that expert advisory group, Dr Cindy Kiro and Dr Phillippa Howden-Chapman, are speaking to you
I understand you will also be hearing more specifically about the draft policy framework later today. The subject is
serious, but I hope I can be permitted a wry observation.
I firmly believe that socioeconomic differences in New Zealand worsened after the National Party Government's infamous
1991 "mother of all Budgets". The author of that "care-less' Budget was Ruth Richardson. The presenter of today's
Ministry segment on reducing inequalities is Ruth Richards. To paraphrase Charles Dickens, the Ruth Richards you will
hear today is a far, far different person to the Ruth Richardson I listened to angrily 10 years ago.
Population health is determined by a wide range of factors, including age, sex, heredity, social influences, living and
working conditions, gender, and general socioeconomic, environmental and cultural conditions. Health inequalities
between groups in society are created primarily by different access to social and economic resources
These inequalities were exacerbated over the 1980s and 1990s as economic change and dislocation adversely impacted on
Mäori and Pacific peoples in particular. The Ministry's monitoring report last year, for example, showed a dramatic
25-year difference in life expectancy at birth between Mäori males in most deprived areas and non-Mäori females in the
least deprived areas.
It is clear too, as the atlas demonstrated, that the health sector cannot do the job alone. The Government's overall
economic and social direction is critical to reducing inequalities in health through, for example, improving
superannuation levels, making public housing affordable, increasing resources for education in low decile areas,
increasing the minimum wage and providing a more level playing field in industrial relations. I believe there must be a
change in mind-set in much of the health sector to achieve this Government's goals of improving the health of the
overall population and reducing inequalities between different groups within the population. It needs a shift from
thinking about individuals to populations; from diseases to determinants of health; and looking for solutions not only
within health, but also in inter-sectoral action.
In Western medicine, health is traditionally considered in terms of individual health. But health can also be considered
in terms of populations, using markers such as the incidence of disease or disability, or death rates, to measure the
health of the population.
Diseases or chronic illnesses may be influenced by individual factors, or by the underlying social, economic and
cultural determinants of health. Lifestyle factors like smoking and exercise may influence disease processes at an
individual level. But these, in turn, are also influenced by the underlying social, economic and cultural determinants
of health. (What needs to happen?)
So what needs to happen? The problem of increasing health disparities between population groups has developed over many
years, dating back to the beginning of New Zealand as a nation. It therefore needs a systematic, sustained plan of
action over 10 or more years to ensure structural changes become embedded in society.
It requires an integrated whole-of-Government approach to addressing the wider determinants of health. The education,
housing and employment sectors must consider the impact of their policies on health.
The whole health sector also needs to aim not only to improve the health of individuals, but to raise the health status
of the most disadvantaged toward that of the most advantaged. We must use the health funding we have available to
improve the health of the population as a whole.
Various strategies have been developed to allow a long-term, sustained approach. The New Zealand Health Strategy
identifies the Government's priority areas and aims to ensure the highest benefits for the population, focusing in
particular on tackling inequalities in health.
The Primary Health Care Strategy focuses on populations and communities rather than individuals, with an emphasis on
prevention as well as treatment of illnesses. And the Disability Strategy demonstrates our commitment to reducing
barriers experienced by New Zealanders who have a long-term impairment, so they can reach their full potential.
I know that the high-level structural changes required to make reducing inequalities sustainable often seem
overwhelming, but there are many immediate actions that can be taken to deal with some more pressing problems. The
Government has allocated some $27 million to four new initiatives specifically intended to reduce inequalities in
1. Taitamariki suicide prevention community development programmes 2. Health Action Zones/ Inter-sectoral Community
Action for Health 3. Intensive home visiting 4. Family Violence Guidelines.
The Ministry is also funding key programmes to reduce health inequalities in areas such as injury prevention, healthy
housing, Maori and Pacific provider development, smoking cessation and many more. I only have time today to provide
brief detail about some of these programmes.
Taitamariki Suicide Prevention
We all hope that the decrease in youth suicide in the past few years can be sustained. The Taitamariki suicide
prevention programme targets Maori youths - a high-risk sector in the community. The programme aims to reduce the number
of suicides and suicide attempts, as well as other associated problems such as teenage pregnancy, mental health
problems, alcohol and drug abuse, offending and educational failure.
Health action zones/Inter-sectoral community action for health
The concept of inter-sectoral partnership combines the expertise and commitment of central and local government, iwi and
other local organisations with that of DHBs and local health providers. It is aimed at high-need communities like
Porirua, Kapiti, South Auckland and Northland, where Mäori and Pacific people make up a high proportion of the
populations. Several initiatives are already underway.
Intensive home visiting
Intensive home visiting aims to deliver services to high need populations by providing information, health education,
community support, advocacy and assisted access to existing services. The Home Visiting Project aims to address
inequalities in health status by providing a direct home visiting programme to the target population in two pilot sites.
Specifications for this service in Tokoroa have been finalised. Tokoroa is a deprived area. Its population includes 38
percent Mäori and 16 percent Pacific people. It is anticipated 70 percent of the population of 4700 households (13,800
people) will access the service. Family violence guidelines
Health professionals are working on training initiatives designed to reduce the number of tragedies associated with
family violence. Battered women and children have far worse mental and physical health than the average population. The
health professionals include the Paediatric Society, the College of Practice Nurses, the College of Emergency
Physicians, GPs, obstetricians and gynaecologists, the Medical Association, the NZ Nurses Organisation and the College
The tobacco consumption rate among young Mäori men and women is significantly higher than for non-Mäori. The main aims
of new smoking cessation initiatives for Maori, announced this week, include reducing consumption, increasing the number
of Mäori living in smoke-free environments, and reducing smoking among young, pregnant Mäori. Community injury
prevention programmes These programmes aim to reduce the number and severity of injuries through a community-based
approach to establish a safety culture. Pilot programmes in 1994 in Waitakere, Tairawhiti, Rangiora and Kawerau were
positive, with an increase in awareness of injury prevention and in safety-related behaviour. Similar projects have now
been funded in Wairoa, Counties-Manukau, Tai Tokerau and Auckland City, with the latter a joint venture with ACC.
Better homes project
And, finally, I will mention a project that began last winter in Waitara, the Better Homes Project. It aims to reduce
and quantify adverse impacts of inadequate housing on health by improving housing conditions such as low temperature,
dampness, sanitation, noise, insulation. The project involves Taranaki Electricity Trust, the New Plymouth District
Council, Work and Income, the Community Employment Group, the Energy Efficiency Conservation Authority, and the Ministry
One hundred low-income homes in Waitara were selected based on specified health and social criteria. Waitara is a low
income, high unemployment, and high Mäori population area. The final report on the project, which will lead to further
larger studies, is due in January 2003.
I hope these brief comments have provided an overview of some of what is happening from a Government perspective in
terms of addressing socio-economic differences in health. I return to Professor Kawachi's warning about becoming a
care-less society. That is what was happening in New Zealand, but this Government realises we cannot afford to let it
Thank you again for inviting me here today. I wish you well for the rest of the symposium.