Health of People and Communities: Report
One in three NZ children live in poverty and those from poor families have higher rates of illness, injuries and death, a recent report says. The report, by the Public Health Advisory Committee, examines how factors such as education, employment, occupation, housing, location and income affect health. It found the strongest influences on health came from factors outside the health system, and government departments and local authorities needed to examine the impact of policies on community health.
Report's Key Points
- The strongest influences on people's health come from factors outside the health system. They include the social, cultural, physical and economic environments in which people live.
- Socioeconomic and other determinants influence health not just at one point in time, but throughout life. Adverse socioeconomic circumstances during childhood are more potent predictors of health in later life, than subsequent circumstances and lifestyle choices.
- Economic growth brings benefits such as increased incomes and material quality of life, but is not sufficient on its own to reduce poverty for marginalised groups.
- Labour market changes and changes in benefits in the late 1980s and early 1990s had a significant and adverse effect on low income households, and in particular, on children and Maori.
- A legacy of past economic policies is disparity between Maori and non-Maori socioeconomic status. This disparity has contributed to health disparities.
- During the past 20 years, Maori life expectancy improved little but has recently shown signs of improvement. However, premature death and disease in the Maori population remain at unacceptably high levels.
- The socioeconomic determinants of health impact differentially across the population creating health inequalities.
- As income decreases, rates of poor health increase.
- Poverty is multidimensional and people experience its effects throughout their lives.
- Children from poor families have higher rates of illness, injury and death than others.
- Unemployment and low levels of education are related to poor health outcomes.
- Death rates decline with each step up in occupational class.
- High housing costs contribute to considerable hardship for low-income families and have a strong influence on their health. People on low incomes are most likely to live in poor and/or crowded housing.
- The deprivation level of the small geographical areas in which people live is a predictor of variation in health status.
- Cost tends to be a barrier to accessing health care for people on low incomes. There is a differential access to health care between ethnic groups, which is independent of cost.
- Evidence for the effect of socioeconomic factors on health is accumulating and becoming more convincing, but less is known about the reasons for this effect.
- Explanations include social capital/income inequality, and material resources. Evidence is strongest for the effect of people's material circumstances on health.
- Large differences in mortality exist between ethnic groups even after allowing for differences in income.
- Explanations for the differences in health status between Maori and non-Maori include macroeconomic and structural factors, as well as differences in risk factors for disease, and differences in access to appropriate health care services.
- The evidence for a direct causal relationship between specific government policy and health outcomes is generally ambiguous, but there are indicators that suggest that socioeconomic position and resulting health outcomes are modifiable by policy.
- Policies designed to address disparities in health are more likely to be successful if they address the socioeconomic health gradient and employ a range of strategies with a mix of universal and targeted approaches.
- Inter-sectoral collaboration is required to address the fundamental determinants of ill-health, with policies routinely assessed for their potential impact on health.
The report recommended the government adopt an official poverty measure by July 2005 and aim to reduce child poverty by at least 30 percent by 2007. It urged the government to assign an appropriate body to be responsible for co-ordinating policies and monitoring the effects on health inequalities. The report also recommended routine reporting of socioeconomic status, ethnicity and health data, and research to identify ways to reduce inequalities.
The report is titled "The Health of People and Communities: A Way Forward - Public Policy and the Economic Determinants of Health". Hard copies of the report can be obtained by phoning (04) 496 2277 or emailing moh@wickliffe.co.nz |
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