Equity – the only thing that matters in rebuilding a failed healthcare system


Equity – the only thing that matters in rebuilding a failed healthcare system

Bryn Jones

Bryn Jones
Bryn Jones is a Kahungunu GP with expertise in health policy, Māori health and action to achieve health equity

Bryn Jones is intolerant of a health system that continues to fail those with the least agency and autonomy. It’s long past time health services made health equity for Māori the primary goal, he writes

Inequity and unsustainable costs are inextricably linked; both are driven by a reluctance to invest in the early years, and reckless spending on low-v

Chin MH, King PT, Jones RG, et al. Lessons for achieving health equity comparing Aotearoa/New Zealand and the United States. Health Policy 2018; online 14 May. https://bit.ly/2IWF8YJ


Some things will never be achievable in our lifetime - equity in health and equity in employment. We are neither funded (or employed) to be either public health strategists or field mice.

Even if we could find one our nurses are not even Goverment subsidised

It's the biomedical paradigm. It's wrong but it is entrenched because some of it does work. We tell, we don't ask. When we do ask we hear (sometimes) but we don't listen. We believe that we make a difference but we won't accept that sometimes the difference we make is entirely negative. We insist we are evidence-based but when the evidence contradicts our perceived and/or anecdotal opinions we claim the evidence is wrong: "fake news" or "alternative facts". The more qualified we are the less we accept that we could be wrong. Change the paradigm, accept the biopsychosocial model and start listening and maybe the inequities and inequalities will be reduced.

Three years ago  the  then  National  government   committed  $90million to   a  system of     smoking  cessation  interventions that  avoided paying for  the   use of  General Practice as the  most  efficient   and cost effective  purveyor of   integrated  funded   stop smoking services . The  dollars involved  could  have  provided  useful  access to   a large part of the  population  with  the  free  Smoking cessation    advice,  medication  and support  being  the   patient  lead into a whole raft of preventative health  measures . Instead in Whanganui   we had a former private  business  receiving  around  $900,000  of tax payers money  and  helping  possibly  as  many (or as  few )  as   300 people  to  stop  smoking  over the  three years at an  estimated  $3,000  per  successful  quit .  General practice over the  same  3 years was paid  about  $60,000 to  help may be  1,000- 2000  smokers to make  a change to  their  habit .

At  the  start of the three years  the ministry   reported about  9,000 smokers in the  DHB.   At the end  of the three years it looks  like  being  about  9,000  smokers .Because  Whanganui   PHO   got  nearly  twice as  much   funding  per smoker  as  virtually every other  stop  smoking  service,    according to  the   Ministry   official  based  on " need, " it  looks  like  Whanganui, where the  quit clinic   concept  was  originally   trialled  with  a budget of $50,000, has  effectively   squandered   hundreds  of  thousands  of scarce  primary care  dollars based on  dodgey if  not  frankly wrong  data information  and  reporting . Did  most of it  fund administration costs and  overheads?

 What  is  Mr  Clark  going to  offer  primary  care  for  the  next  3 years   to  try  and achieve   smoking  health  equity ? A free   suicide  pill    and  open slather  on  cannabis ?

A good challenging article Bryn.

I fear the only way through is a three tier Primary health system rather than two. Private/ Partly funded capitated Primary Care as now/ Maori for Maori funded care.  None will be adequately funded I fear and doomed to failure. NZ Primary Care unfortunately is replete with experimentation in the guise of progress. 

Good luck.