Covid 19 coronavirus: how health equity should be in the Pacific

COMMENTARY:

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

Despite long-standing evidence of poor health outcomes and barriers to health services, Pacific people account for 75% of cases in the Auckland group and 40% of all cases in the measles outbreak Auckland 2019.

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

Beyond Covid-19, the government should review the health system configuration and responsibility of the Pacific peoples, while respecting health and Tiriti obligations to tangata whenua and promoting health equity for Maori. .

Fairness for Maori is imperative, that’s not up for debate.

We are focusing on Pasifika here because they make up the majority of Covid-19 cases in the resurgence. We advocate and amplify your voice because it is often ignored.

The Human Rights Commission receives inquiries and complaints about fairness for Maori and the Pacific, arguing that it is racist against Europeans. That is false.

“Equal treatment for all” presupposes that all things in society are equal.

Applying a “one size fits all” approach only increases inequality.

Equality is different from equity.

The Ministry of Health states: “Equity recognizes that different people with different levels of advantage require different approaches and resources to obtain equitable health outcomes.”

Our law allows positive actions to help groups achieve equal results compared to results achieved by other groups. Such measures are not discriminatory if they are done in good faith and are intended to allow for equality and address systemic disadvantage.

Even before Covid-19, people in the Pacific were at increased risk of infectious diseases due to economic and social stresses that exacerbate the impacts of diseases such as diabetes and heart disease. People with these conditions are more likely to experience complications from Covid-19.

Similarly, higher prevalence of disability and poorer mental health outcomes among Maori and the Pacific can also contribute to greater inequalities, which is why health systems must address where these kaupapa are.

It is a similar story abroad. Ethnic populations are overrepresented in Covid-19 deaths in the US and the UK. People from the Pacific have some of the worst Covid-19 outcomes in the States.

In addition to health inequities, people in the Pacific often experience racism and racial prejudice. Even so, they remain resilient and optimistic, contributing their grain of sand to our country.

They are heavily employed in our essential workforce – providing security for offices and hotels, cleaning workplaces and caring for the elderly and vulnerable, as well as caring for the elderly and family members with disabilities. If they do get sick, this can lead to greater financial stress, making their health worse.

Covid-19 has highlighted the social and economic situation of many people in the Pacific: limited access to Wi-Fi or devices, or students dropping out of school to work for the family; essential frontline workers with the lowest wages, most at risk of contracting and spreading the virus; children from overcrowded homes are forced to do homework in cars; and self-insulating for more than 40 days, no 14.

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

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

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

The Government’s health equity response, with targeted support and health messages, engaged and took seriously the advice of Pacific health leaders and physicians. This was an example of an effective political response for the people of the Pacific.

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

It’s because Covid-19’s equity approach was a sprint rather than a long-distance run. The health equity model that Pacific leaders have been advocating for decades was not the sustained norm – it was implemented in the most terrifying outbreaks.

The people of the Pacific have been telling us for a long time that the healthcare system does not work for them and they were hoping that the Disability and Health System Review led by Heather Simpson (the Simpson Review) would bring change. She promised to address inequalities for Maori and the Pacific by reviewing the system.

Request for Independent Responsibility for Pacific Health

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

When the Simpson Review was published in June, it was widely criticized by the Pacific healthcare industry and leaders like physicians Collin Tukuitonga and Ryan.

The report, designed to prepare the health system for the future, was limited to specific initiatives to address declining health in the Pacific. The revival shows just how careless it was.

Human rights require government accountability. We are not talking about blame and punishment, but we need to determine what works (so it can be repeated) and what doesn’t (so it can be adjusted).

This raises crucial questions for the public sector.

Even without Covid-19, where is the independent accountability mechanism to ensure health equity in the Pacific?

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

Whatever the mechanism or process that enables accountability, it must be directed by the Pacific under the human rights principle of “nothing about us without us.”

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

Until health equity is achieved in the Pacific, the burden of future outbreaks is likely to fall on the Pacific and worsen existing inequalities. Investing in Pacific Health Equity will pay dividends for generations and sit well alongside equity programs for Maori and people with disabilities.

With this resurgence and future threats in mind, we ask the government to formally review its health and responsibility plans in the Pacific and to involve key Pacific physicians and leaders in its decision-making.

• Saunoamaali’i Dr. Karanina Sumeo is the Commissioner for Equal Employment Opportunity and Meng Foon is the Commissioner for Race Relations.