What Pacific health equity must look like

10:44 am on 5 September 2020

By Saunoamaali'i Dr Karanina Sumeo and Meng Foon*

Opinion - The Covid-19 resurgence confirms that when it comes to Pacific people, the health system under successive governments is not fit for purpose.

Equal Employment Opportunities Commissioner

Equal Employment Opportunities Commissioner Saunoamaali'i Dr Karanina Sumeo. Photo: Supplied

Despite longstanding evidence of poor health outcomes and barriers to health services, Pacific people account for 75 percent of cases in the Auckland cluster and 40 percent of all cases in the 2019 Auckland measles outbreak.

The pandemic also confirms the importance of health equity for high-risk populations.

Beyond Covid-19, the government must review the health system settings and accountability for Pacific peoples, while upholding the health and Tiriti obligations to tangata whenua and advancing Māori health equity.

Equity for Māori is imperative, that is not up for debate.

We're focusing on Pasifika here because they make up most of the Covid-19 cases in the resurgence. We advocate for and amplify their voice because it is often ignored.

The Human Rights Commission receives enquiries and complaints about equity for Māori and Pacific, arguing that it is racist against Europeans. This is false.

'Equal treatment for all' assumes that all things in society are equal.

Applying a 'one size fits all' approach only magnifies inequality.

Equality is different from equity.

The Ministry of Health states: "Equity recognises different people with different levels of advantage require different approaches and resources to get equitable health outcomes."

Our law allows for positive actions to assist groups to achieve equal outcomes when compared with outcomes achieved for other groups. Such measures are not discriminatory if they are in good faith and for the purpose of enabling equality and addressing systemic disadvantage.

Even before Covid-19, Pacific people were at higher risk of infectious diseases because of financial and social strains that compound the impacts of conditions like diabetes and heart disease. People with these conditions are more likely to experience complications from Covid-19.

Likewise, a higher prevalence of disability and poorer mental health outcomes among Māori and Pacific can also contribute to further inequities, which is why health systems need to deal with where these kaupapa meet.

It's a similar story overseas. Ethnic populations are overrepresented in Covid-19 deaths in the US and the UK. Pacific people have some of the worst Covid-19 outcomes in the States.

On top of health inequities, Pacific people often experience racism and racial bias. Even so, they remain resilient and optimistic, doing their bit for our country.

Meng Foon Race Relations Commissioner and former Gisborne mayor

Race Relations Commissioner Meng Foon. Photo: Supplied

They're largely employed in our essential workforces: providing security for offices and hotels, cleaning workplaces and caring for the elderly and vulnerable, as well as caring for elders and family members with disabilities. If they become ill, this can lead to further financial strain which worsens their health.

Covid-19 has highlighted the social and economic situation for many Pacific people: limited access to Wi-Fi or devices, or students leaving school to work for the family; essential frontline workers on the lowest wages, at higher risk of contracting and spreading the virus; kids in overcrowded homes being forced to do homework in cars; and self-isolating for more than 40 days, not 14.

These are the flow-on effects when our Pacific response lacks equity.

As our political leaders often say: the health response to Covid-19 begets the best economic response.

During the first lockdown, Pacific people had the highest rates of testing and the lowest rates of Covid-19. Pacific leaders and communities helped saves lives.

The government's health equity response, with targeted support and health messaging, involved and took seriously the advice of Pacific health leaders and clinicians. This was an example of an effective policy response for Pacific people.

So how is it that months later, the Covid-19 resurgence started in the Pacific stronghold of South Auckland?

It's because the Covid-19 equity focus was a sprint instead of a long-distance run. The health equity model Pacific leaders have been advocating for decades was not the sustained norm - it was rolled out in the scariest outbreaks.

Pacific people have long been telling us the health system does not work for them and they hoped that the Health and Disability System Review led by Heather Simpson (the Simpson Review) would bring change. It promised to address inequities for Māori and Pacific by overhauling the system.

Call for independent accountability for Pacific health

Pacific health researcher and former GP Dr Debbie Ryan said in Tofa Saili (the Pacific interim Simpson Review report), that 20 years of policies mentioning Pacific health equity had made little difference, with some health outcomes worsening. Her words were prophetic.

When the Simpson Review was released in June, it was widely criticised by the Pacific health sector and leaders such as doctors Collin Tukuitonga and Ryan.

The report, designed to futureproof the health system was short on specific initiatives to address declining Pacific health. The resurgence shows what an oversight this was.

Human rights require accountability from government. We're not talking about blame and punishment, but we need to determine what works (so it can be repeated) and what isn't working (so it can be adjusted).

This poses crucial questions for the public sector.

Even without Covid-19, where is the independent accountability mechanism for ensuring Pacific health equity?

Which public sector agencies will be accountable for Pacific health outcomes, to ensure health equity is a long-distance run and not a sprint?

Whatever the mechanism or process to enable accountability, it must be Pacific-led under the human rights principle of 'nothing about us without us'.

Independent accountability will prevent Pacific health from being at the mercy of electoral cycles, or dependant on arduous lobbying by committed politicians. Without cross-party consensus and long-term commitment, Pacific health could be in the same situation in another 20 years.

Until Pacific health equity is achieved, the burden of future outbreaks will likely fall on Pacific and worsen existing inequities. Investing in Pacific health equity will pay dividends for generations and sit well alongside equity programmes for Māori and disabled people.

Considering this resurgence and future threats, we ask the government to formally review its Pacific health and accountability plans and engage key Pacific clinicians and leaders in their decision making.

* Saunoamaali'i Dr Karanina Sumeo is the Equal Employment Opportunities Commissioner and Meng Foon is the Race Relations Commissioner.

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