Tuesday, 23 June 2009

disparities in health care

i've had a post up at the hand mirror today, about the furore raised by a aussie green party MP who brought her child into the house for a brief period.

also of interest today was this excellent discussion on radio nz (nine to noon, 9.22am) about disparities in public health care between maori and non-maori. i thought the way the issue was framed was really good, not casting aspersions at health professionals but rather explaining why they might behave in certain ways.

it's so important to have this discussion, because people who do not face this kind of thing so often refuse to believe it exists at all. they seem to believe that everyone has equal access to every service in this country, but can't see how certain behaviours or assumptions might act as a barrier for minority groups.

there are ways to deal with this issue, and the immediate one is to have maori provide services for maori, pasifika people provide services for their own and ethnic communities provide services for their own. that's the reason for the development of the ethnic women's centre in hamilton - the desire to provide an environment where women feel safe and free from discrimination, so that they are able to talk about their issues and get the help that they need.

one of the problems with this approach is that it does lead to a kind of "apartheid", where communities become separated from each other. which means they are even less likely to understand each other, and hence overcome the disparities that exist in service delivery. on the other hand, there is no way that a cultural change with existing institutions will happen overnight, and in the meantime there are people suffering and unable to access the help they need. so in the short term, the separate providers is a good idea.

in the long-term, there needs to be effort put into creating that cultural change, so that all people are able to receive the same level of service and can feel safe and confident in every environment. in order for that to happen, there first needs to be an acknowledgement that there is a problem that needs to be solved. hence the importance of this particular research and the discussion around it.


Hugh said...

Well, you brought up the 'apartheid' comparison, not me!

OK, here's the big question. Would it be appropriate for a pakeha people to only provide health services to other pakeha people? Would you support a pakeha person's right to see a non-pakeha doctor?

Or is it presumed that the cultural dominance of pakeha means they will feel safe and comfortable in any environment - or rather, that any discomfort they feel is a product of racism, rather than genuine discrimination?

stargazer said...

actually hugh, i think the big question is: how would you tackle the disparities in health care that have been highlighted in this research? or are you happy for them to exist as they are?

Hugh said...

So if I'm reading you rightly you're saying I shouldn't ask questions about your model unless I have an alternative model of my own in mind, and am similarly ready to answer questions about it?

stargazer said...

absolutely! because in good conscience, i cannot take a service away from the women who come to shama until i know that they will be getting the help they need elsewhere, with the same level of access and personal safety.

Hugh said...

OK. It's my feeling that the root cause of the difficulties some ethnic groups have accessing healthcare is economic, not cultural. Notably, ethnic groups that wealthier than average, such as Chinese or Korean people, do not seem to have worse health outcomes, despite presumably facing equal cultural barriers when approaching the average health provider.

I think reducing poverty across the board would be a solution. And I think it's something that could be started on relatively quickly, with improvements also seen relatively quickly, so temporary measures involving setting up ethnically-based healthcare providers would not be necessary.

stargazer said...

hugh, i'd agree that poverty is one source of the problem & it does need to be addressed. but there are plenty of experiences of discrimination and cultural misunderstanding or ignorance that also act as a barrier. this happens regardless of the wealth of the person.

we know, for example, that ethnic women do not stay in mainstream (yeah, hate that word but can't think of another just now) refuges. they often leave after just a couple of nights and go back to their abusive situation. when you know that is the case, then you either provide a service that will get the help they need or you just leave them to be abused. of course, for the longer term, you'd want to work with existing providers to raise issues and to try to increase the level of service provision so that it's suitable for everyone.

from your comments, my guess is that you haven't yet listened to the radio nz interview i've linked to. it's really worth listening to, because they explain it so much better than i can.