Healthcare Assignment: Socio-Political & Cultural Determinants Of Health
Task: Write a 2000-word healthcare assignmentfollowing the instructions below. Use the following as a guide for your assessment:
a) Identify one socio-political determinant of health and provide specific links to how it affects individuals and whnau in New Zealand.
b) Identify one cultural determinant of health and provide specific links to how it affects individuals and whnau in New Zealand.
c) Explain one socio-political or cultural health determinants that impact the health of three different cultural or ethnic groups in Aotearoa/New Zealand.
d) Analyse the implications of your chosen health determinant to the overall health outcomes in Aotearoa/New Zealand.
Analyse the five principles of primary healthcare. The analysis requires you to address this section with the Primary Health Care strategy themes in New Zealand. Please illustrate each principle with an example from New Zealand Primary Health Care.
a) Develop a Health Promotion Project addressing one of the identified health challenges inNew Zealand/Aotearoa. The project must include a vision, mission, background, challenges, and future plans. The health promotion project should propose suggestions relevant to current New Zealand health outcomes and socio-political context.
b) Analyse the application of all five action points of the Ottawa Charter as the global framework for the Health Promotion Project that you developed.
c) Analyse one underpinning theory of the developed Health Promotion Project.
Healthcare Assignment Part A:
Social determinants of health (SDH) are factors that affect the health of people within a community. According to definition given by WHO,these include income, education, social, food, and job security, childhood conditions, housing, and access to healthcare. WHO also states that 30-55 per cent of health outcomes are affected by SDH The inequity in the health status among individuals, or within families and communities are impacted by SDH following a social gradient with the lowest socio-economic quintiles being affected most adversely ("Social determinants of health", 2021).
In this section we shall discuss the effects of one socio-political determinant of community health, one cultural determinant of community health in Aotearoa/New Zealand. The impact of the sociopolitical determinant shall be illustrated using three examples of three different ethnic communities in the country followed by the health outcomes of impact.
a) Colonialism, a sociopolitical health determinant
Racial/ethnic minorities confront prejudice and institutional and personal racism exist, which has major health repercussions (Harris et al., 2012) Indigenous peoples have been persecuted, marginalized, and alienated as a result of legalized racism leading to economic inequality. Discrimination based on is a substantial impediment to receiving care. Some people in Aotearoa/New Zealand cannot afford to make co-payments to general practitioners.
b) Low literacy rate, a cultural determinant
Only 25-40% of Maori people are known to have level-three education. The Maori and other non-white ethnicities are known to attain limited formal education and have lower literacy rates which lead to low health literacy, poor cultural competency of clinicians, and insufficient childcare are among the many challenges to accessing high-quality healthcare in New Zealand. Cultural aspects fostered by low literacy rates also leads to failure to receive proper healthcare. Male stoicism, shyness are cultural determinants that prevent the Maori from consulting a physician until the disease is at an advanced stage and chances of recovery are low, such as Cancer. The pacific people show non-confidence in the mainstream healthcare system which again acts as a cultural determinant in the late diagnosis of cancer (Lilo, et al, 2020). The Asian people tend to have cultural beliefs like Karma which leads to these people not seeking medical help when they are sick, again leading to untimely access to healthcare treatment.
c)Impact of low literacy rates on Maori, Pacific People and MELAA
Low literacy rates lead to general social backwardness along with economical backwardness. Low financial capacities heavily affect the healthcare of the Maori, Pacific People and MELAA in this country as illustrated in the following examples:
In the case of colon cancer patients, per cent of those in the poorest socioeconomic “Aotearoa/NZ Deprivation (NZDep) quintile” presented to an emergency room rather than primary care, compared to 29 per cent at the wealthy quintile (Jackson, et al., 2017).
Delayed diagnosis of cancer was found in 51 per cent of Pacific individuals, compared to 33 per cent of non-Mori-non-Pacific persons (Jackson, et al., 2017).
Preventable fatalities have occurred among individuals with cardiovascular disease belonging to MELAA ethnicities due to a limited accession to life-saving cardiac treatments (TeKaru, et al., 2018).
d)Effects on Health outcomes due to Cultural Determinants
Cultural division, racial/ethnic systemic oppression leading to economical backwardness in the native populations of the country, are prime examples of cultural determinants influencing health outcomes in the Maori people in this country. This can be illustrated through an example of late diagnosis of cancer and how that leads o increased mortality in the Maori people. Delayed diagnosis of cancer was found in 51 per cent of Pacific individuals, compared to 33 per cent of non-Mori-non-Pacific persons (Jackson, et al., 2017). Although the government provides a bigger amount of health financing in Aotearoa/New Zealand, there are some gaps in providing healthcare to the Maori in terms of both infrastructure and cultural sensitivity among healthcare practitioners. However, cultural determinants alone form a large contributor for poor health outcomes in the Maori. For example, most Maori women would not seek medical help during the early onsets of cervical cancer.
This leads to delayed to late diagnosis and poor prognosis.
PART B: Analysis of five Principles of Primary Health care
The “five principles of primary healthcare” are “equity, empowerment, access, self-determinism, and intersectoral collaboration” (TAPUHI, 2021)
1) Equity is a major healthcare goal in the country for achieving desirable health outcomes. Much study focuses on the clinical explanations of disparities in health status and outcome, such as why a demographically varied group of people with similar ailment might not have similar gains in health when given the same therapy. Although discrepancies in outcomes are often correlated to clinical factors, the “Commission on the Social Determinants of Health” is unmistakable in its assertion that the underlying causes of health inequity are social and not everyone have the same ability to benefit from given opportunities (Tpk.govt.nz, 2021). Barriers to fair healthcare in Aotearoa New Zealand have been recognized as physical access, health care system, political context, colonialism, acceptability, and cultural considerations. Inequitable health outcomes and experiences are hampered by a collection of underpinning systemic and structural problems, like “institutionalized racism”. In research, clinical outreach, and community programmes, initiatives that appear to be successful are modified to the local environment and include self-determination.
2) Empowerment is possible through economic and education improment. Chin, et al., 2018, reviewed that less effective policies with incentives, support and enforcement exist in Aotearoa/New Zealand that is deliberately geared to create fairness for “racial/ethnic minority and socioeconomically disadvantaged people”. District Health Boards (DHBs) in Aotearoa/New Zealand in legally obligated to Mori to enhance health outcomes and lower disparities with the goal of removing them. DHBs are “regional, government-funded health organizations” responsible for planning, providing, and purchasing eighty per cent of Aotearoa/New Zealand's healthcare services. The “Office of the Auditor General (OAG) determined” in 2012 that “the combination of lack of information in the annual reports on Mori health needs and on targets to reduce disparities makes it hard to gauge DHBs’ progress” was a problem. The OAG reviewed this issue in the year 2014 and noted that the performance had improved, albeit multiple concerns remained, stating “several DHBs still needed to provide better information about the extent of disparities for their Mori population, the initiatives and programmes to reduce disparities, and the progress that has been made in reducing those disparities” (Part 5: Reducing health disparities for Mori, 2010/11).
3) Access to healthcare is a crucial part of community healthcare. ”Public health and disability services” for inpatient, preventive, outpatient, prescription drugs, primary care, mental healthcare, dental care for children, and long-term residential care for older adults, and disability support are available in Aotearoa/New Zealand for citizens and permanent residents. Co-pays are often needed, however private health spending accounts for roughly 20% of Aotearoa/NZ health spending, with the other 80% being publicly funded. These lines are primarily avoided by 86 New Zealand residents with private insurance and wealth. The migrant communities, especially refugees, have restricted access to services (Tenbensel, et al., 2017). Practices that agree to restrict “patient co-payments for general practice” visits are eligible for VLCA financing, which provides a greater level of government support. The original goal was to create an alternative funding mechanism for practitioners, especially those serving populations with little financial resources (Willing, 2014).
4) Self-determinism is important for the improvement of healthcare. Inhabitants and residents to Aotearoa/NZ receive from the “the universal no-fault Accident Compensation Corporation (ACC)” “universal coverage for injuries, including treatment expenses, and up to 80% of pre-injury wages to Aotearoa/NZ citizens” (Acc.co.nz. (2021). The Accident Compensation Corporation (ACC) was established in to remedy imbalances and poor incentives connected with the prior litigation system for injury compensation. Irrespective of the fact that ACC is a universal right, Mori face disparities in access and outcomes. “Government capitation contributions (per enrolled patient) and fee-for-service” are used to support primary care (FFS). VLCA financing, which began in 2006, is used by about 30 per cent of primary care providers in Aotearoa/New Zealand. As a result, this financing approach was confined to clinics with more than 50 per cent "high needs" patients (the poorest quintiles, Mori, and Pacific peoples).
5) Intersectional collaboration is required to provide better healthcare to all the ethnicities equally. Issues of equal access continue to exist. About 500,000 "high needs" patients do not have registration in a VLCA practice in Aotearoa/New Zealand, whereas a comparable number of non-"high needs" patients are enrolled in VLCA practices. Because the younger age profile of “high needs” demographic groups has the greatest influence on the amount of government capitation contributions, any increased financing for VLCA procedures is likely to be negated.
Critical analysis of the Ministry of health strategies based on the 5 principles of Healthcare
As Aotearoa/New Zealand spends a significant amount on social services than on healthcare, there is a larger emphasis on social determinants of health (Bradley, et al., 2011) Whanau Ora, Aotearoa/New Zealand's post-2008 strategy, sought to give whanau (extended family) greater influence and provide treatments tailored to their needs and ambitions. As a result, certain health and social services have been integrated, and collaborative accountability for outcomes has been encouraged (Tpk.govt.nz, 2021). “The Aotearoa/NZ Social Investment Agency” is a multi-agency entity focused on investments driven by value in Aotearoa/NZ (SIU, 2017). The Agency determines population requirements and provides feedback on the budgetary consequences of spending or not investing using integrative “administrative datasets” of varying coverage and quality. The Social Investment Agency has sparked a lot of debate. Predictive risk modeling, according to proponents, might streamline useful services for individuals. Critics point out the significant danger of propagating cognitive and structural biases, as well as the fact that equations prioritize cost reductions over social advantages. Policies that follow might be seen as punitive, possibly hurtful, and stigmatizing to people. Due to the limitations of available data, analyses may fail to focus services on the people who need them the most. The right to privacy has been violated, and the state's possession of such precise information might be hazardous (Swa.govt.nz. 2021). Efficient methods and analysis approach need to be established inside a community which actually emphasizes enhancing well-being of individuals over lowering public spend, say commentators to enhance “health equity” and prevent harmful unintentional effects. Developing an ethics code, making the data analysis procedure and usage clear, reviewing the influence on equality, and analyzing not just people but also groups are all potential protections for predictive analytics (Rosenberg, 2015).
a) Development of Health Promotion Project
Many physicians in Aotearoa/New Zealand split their time between the public and private sectors, aggravating imbalances if they prefer private patients. “Community-governed practice’s in Aotearoa/New Zealand is for patients from low socioeconomic classes to provide cheaper prices than commercially run primary care clinics. Community health professionals have been included in team-based initiatives that have been successful. Successful programmes take care of social and medical determinants of health at several levels, including the patient, physician, community, organization, and policy. Promising programs have followed after the principles to achieve goals.
b) Application of Ottawa Charter
The Ottawa Charter suggests that “the fundamental conditions and resources for health are “peace, shelter, education, food, income, a stable eco-system, sustainable resources, social justice and equity” (Thomson, Watson, Tilford, 2018). Aotearoa/New Zealand is known across the world for the quality ethnic data in its health databases, which is crucial for assessing and reporting disparities in care quality to all ethnic groups. For many years, “indigenous health experts” have fought for this, ensuring that every ethnic minorities are included (Anderson, et al., 2018). It is however only beginning to publicly releasing “standardized national clinical performance statistics” divided by “race/ethnicity status (MoH, 2013).
The “DHB Mori Health Profiles” compare major health signs between Mori and non-Mori people. In Te Reo Mori (the Mori language), summary profiles are offered. The Equity Explorer of Aotearoa/New Zealand's “Health Quality and Safety Commission” and the “Trendly database” both contain limited data on Mori performance measures, while Trendly is the most updated of the two. Aotearoa/New Zealand does not regularly provide national performance statistics that reflect public and government priorities by ethnicity or disadvantage, instead opting for the total population indicator (Came, Tudor, 2017) The New Zealand government's Pharmaceutical Management Agency uses cost-effectiveness assessments to build an evidence-based national prescription formulary and negotiates reduced drug costs with pharmaceutical corporations.
c)Theory of Health Promotion Project
The majority of disparities in population healthcare in Aotearoa/NZ are explained by social health determinants, such as social environments (Tung, et al, 2017) and factors like “education, social cohesion, income, and neighborhood quality, with healthcare” accounting for approximately 10 per cent of the inequity. Colonialism, which is marked by present and historical dispossession, subjugation, and forced assimilation, has harmed Mori culture with negative consequences comparable to those experienced by indigenous peoples in New Zealand and across the world (McGovern, Miller, Hughes-Cromwick, 2014).
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