Changing the course for Pasifika
Simpson health review must change the course for Pasifika
With the release of the Government’s Health and Disability System Review, we have the opportunity to navigate a new and a more aspirational course.
The report is comprehensive, and clearly identifies what Pacific people have known for a long time: that the health system does not deliver what we need, and is fundamentally inequitable.
It is no secret that 380,000 of our team of five million have disproportionately worse health outcomes than everyone else. Pacific people live five years less than the national average; 300 Pacific children under the age of 5 are hospitalised annually; 60 per cent of rheumatic fever cases are among the Pacific population; Pacific people have higher preventable death rates, respiratory disease, heart disease and diabetes.
In short, Pacific people are at the bottom of the pile when it comes to pretty much all the indicators, and I think we can say, without argument, that the health system is failing this fast-growing section of the New Zealand population.
Isabella Mapusua and Kitiona Tauira at Pacific Health Plus. Sixty percent of PHP's patients are categorised as high-needs.
Inevitably, some remedies have been signalled in the report. For example, to move to greater devolvement of ownership, management and delivery of health services by the communities they are there to serve.
But while this has been succinctly stated for Māori in the report, there is no such equivalency indicated for the Pasifika population.
What is missing is a tailored response made on the basis of need, irrespective of ethnicity. By this I mean an assessment of where the greatest needs lie, and then a bespoke action plan to change that.
The approach, as it is described for Māori in the report, must have Pacific leadership and representation at all levels of health – governance, management, and service delivery, informed by the communities the system is there to help.
In short, to truly solve our biggest health problem we need a Pacific health authority for exactly the same reasons you would have one for Māori. With the same ultimate goal to change downward spiralling health statistics.
John Fiso, chairman of Pacific Health Plus: "The new health report needs a much stronger focus on early investment at the front line and for prevention, just as we invest in roading projects and infrastructure for the long term."
In Porirua, which has the highest Pacific population outside South Auckland, despite 10 years of "investment" and intervention, life expectancy for Pacific people is eight years lower than for others, and this gap has not narrowed over that period.
This must change. At our health practice in Cannons Creek, eastern Porirua, 60 per cent of our patients are high-needs, which means they have serious underlying conditions.
When we initially took over the practice, we had very little access to resources, which meant we had to search for innovative partners and programmes, particularly in the areas of heart disease, diabetes and related diseases. We quickly realised we also had to move into education and preventative programmes to stop the spiral.
In March, during the Covid pandemic, we had to source our own PPE gear offshore and hunt for flu jabs from other practices to make up the shortfall. This came as a huge shock because, knowing the significant underlying health vulnerabilities, combined with high-density housing, low or no incomes and limited access to healthcare, it would be carnage in the community if the virus caught on.
It was hard to fathom that the health system’s funding model prioritised a "mainstream" practice across the road ahead of a high-needs Pacific practice funded at a lower level. That is unacceptable.
Over time we have started dealing directly with the Pacific directorate of the Ministry of Health, the Pacific division of the Capital & Coast DHB, and a Whānau Ora provider of Pacific Futures, and we get a much more targeted, efficient and less bureaucratic response. This means resources get to the front line quickly.
The new health report needs a much stronger focus on early investment at the front line and for prevention, just as we invest in roading projects and infrastructure for the long term. We also need integrated health services to include education, mental health, workforce development and housing. Complex solutions are required for a multi-faceted problem.
And Pacific people must be involved at all levels. Without this partnership, we risk the new system being deaf and blind to the needs of Pasifika, and the opportunity for real change is lost.
There is a new Pacific generation coming through the ranks who are young, talented, educated, aspirational and confronting. They must be empowered to insist on an equal place in all parts of New Zealand. If we can do this, then Pasifika can make a rightful contribution to the social, cultural and economic wellbeing of the country.
The health and disability review has identified that it is time to navigate a new course in health and, as the original explorers in the Pacific, we are ready to set sail and lead the way.