Definitions of healthcare equity and legislative frameworks
- Healthcare outcomes and priorities within Australia, Aotearoa New Zealand, and globally
- Healthcare policy to address inequity, such as:
- National Agreement on Closing the Gap
-
strategies to improve health equity, such as:
- co-governance and co-design
- community-controlled organisations
- Kaupapa Māori health services
- Pasifika healthcare organisation
- Legislative frameworks that inform or mandate healthcare equity, such as:
- anti-discrimination legislation
- International Covenant on Economic, Social and Cultural Rights
- Pae Ora (Healthy Futures) Act 2022
- Te Tiriti o Waitangi
- United Nations’ Declaration of the Rights of Indigenous Peoples
- United Nations’ Universal Declaration of Human Rights
Health considerations for Aboriginal and Torres Strait Islander peoples
- Importance of Country and community, such as:
- connection to new Country, and how this might impact on access to health care
- cultural obligations and practices, and spiritual beliefs
- health care delivery as close to home as possible
- health care-related decisions within the context of the individual’s family and community group
- Knowledge of strategies to enhance health care interactions, such as:
- Aboriginal healthcare workers and nursing and medical staff
- Indigenous liaison officers and their role
- interpreters
- physical environment
-
supporting shared decision-making processes, such as:
- decision making by family groups
- inpatient family ‘escorts’
- The historical context of Aboriginal and Torres Strait Islander peoples’ status and health care provision, including:
- awareness of practical resources to mitigate risks of institutional racism and unconscious bias
- colonisation, history of discrimination, and inter-generational trauma
- consequent lack of trust in government-run services
- disempowerment and structural inequity
- institutional racism and unconscious bias
Health consideration for Māori
- Common models of Māori health, such as:
- Te Pae Mahutonga
- Te Whare Tapa Whā
- Te Wheke
- Culturally safe and competent consultations, including professional interactions with Pou Hāpai tiaki and kaimahi hauora
- Initiatives that improve Māori health outcomes
- Māori health practices, such as Rongoā Māori and mirimiri
- Te Tiriti o Waitangi and the application of its five principles in health care
- The role of racism and colonisation, including:
- determinants of health
- policy or system design
- quality healthcare
- socioeconomic deprivation and restricted access to decision making
- The varied determinants that affect Māori health outcomes
Health equity in non-metropolitan areas
- Differences in resource allocation and model of care between metropolitan and non-metropolitan areas
- Environmental health issues for regional areas
- Health priorities for rural and remote populations
- Rural health inequity as an intersectional issue
- Social determinants of health and wellbeing for rural and remote patients
- The benefits, limitations, and role of telehealth / telemedicine
Health equity in the rural and remote context
- Access to, availability, and functions of patient retrieval services
- Barriers to health for people and Indigenous whānau living in rural and remote areas, including the impact of having to receive complex care away from home
- Basic principles of retrieval medicine
- Broad knowledge and the ability to manage (either on-site or remotely) a wide variety of conditions across a range of diverse settings while waiting for support or tertiary transfer
- Disparities in health status and access to care for people living in rural and remote areas
- Geographical distances between rural and remote communities and the nearest hospital, and the nearest metropolitan centre
- Management planning that balances a multitude of factors to result in the desired health outcome, as defined by the clinician and patient in collaboration, with an acceptable degree of informed risk
- Person- and culture-centred decision making about care, made in collaboration with the patient and local healthcare providers
- Regional health service structures and referral pathways
- Service availability in regions within jurisdiction of practice, such as:
- aged care, disability, and other support services
- allied health
- emergency care
- pathology
- primary care
- radiology
- specialist and subspecialist care
- The level and type of clinical care that can be safely provided within the regional / remote context for patients with uncommon or particularly complex conditions, with remote guidance from subspecialists
- The nuances of providing safe and effective care with reduced access to on-site resources, such as:
- collaboration with primary care / on-site healthcare providers
- flexible approaches
- independent practice
- resource use
- the use of technology, including telehealth
- The sociodemographic and cultural profile of rural and remote communities and regions within the jurisdiction of practice and more broadly
Strategies to address inequities commonly encountered in clinical practice
- Advocating for patients to overcome bias
- Approaches to providing pro-equity care in a mana motuhake (self-determination)-enhancing fashion
- Structural causes of health inequities in each clinical setting
- The existing disparity in health-related outcomes for different populations, and the ongoing impact of all forms of systemic racism and bias
- The importance of culturally safe communication for effective health care delivery with people of all cultures and backgrounds, with a strong commitment to Indigenous peoples
- The importance of fostering culturally diverse teams and cross-cultural partnerships
- The potential impact of one’s own culture and bias on one’s own practice
