2. Turning on the H.E.A.T Introducing the…. Health Equity Assessment Tool Acknowledgement: Fiona Cram PhD Katoa Ltd www.katoa.net.nz

3. Overview What is equity? What does inequity look like? What Tools are available to help us? What is H.E.A.T? What next? CCN next steps…….

4. Equity ‘….Absence of systematic disparities in health (or in the major determinants of health) between groups with different levels of underlying social advantage/disadvantage’ (Braveman & Gruskin, 2003, p.254) In Fiona Cram PhD Katoa Ltd ‘Turning up the H.E.A.T’

5. Health equity is the difference between populations that are unfair and unjust. “Those differences don’t have to be there, we as a society have made choices that allowed those differences to be there and we can decide that they go away.” Professor Don Matheson Centre for Public Health Research, Massey University, New Zealand Opening Address Healthcare Aotearoa Hui November 2011

6. Inequity What does it look like?

7. Ischaemic Heart Disease Mortality 1996-99 and Interventions 1990-99 Male standardised rates per 100,000 Ajwani et al 2003 Tukuitonga & Bindman 2002

8. Inequalities in Cancer Outcomes All Cancers combined Blakely et al. Tracking Disparities: Trends in ethnic and socioeconomic inequalities in mortality, 1981-2004. Ministry of Health 2007. New Zealand Census Mortality Study.

9. Inequities in Cancer………… a brief summary Māori 18% more likely to be diagnosed with cancer but nearly twice as likely to die from it. Cancer specific survival is lower for Māori than non-Māori for most cancers. There is good evidence that at least some of this difference in survival is due to health service factors. Dr Diana Sarfati Director, Cancer Control and screening Research Group Department of Public Health and Jason Gurney, University of Otago, Wellington Presentation to the Hei Āhuru Mowai; National Maori Cancer Leadership Group Inaugural Hui, May 2012.

10. Ka whawhai tonu matou

11. Equity is achievable “equity is about advocacy and perseverance” Professor Don Matheson Opening Address Healthcare Aotearoa Hui November 2011 Equity

12. Celebrate and learn from Successes….

13. Views from different Mountain tops….

14. What Tools are useful ? Health Impact Assessment and Whānau Ora Health Impact Assessment Ministry of Health (2002) Intervention Framework H.E.A.T. - Health Equity Assessment Tool

15. What is the H.E.A.T Planning tool for the promotion of health equity (i.e., removal of inequalities) Enables assessment of health initiatives: policies, programmes, services 10 questions to spark consideration of health inequalities and equity Intended to improve mainstream health delivery

16. Who uses it? People making funding and planning and policy decisions Been used/may also be used by:  – Non-governmental agencies  – Community groups  – Other sectors  – Local government

17. What about evidence? Qualitative and quantitative information about: – Inequalities – Effective interventions – Evaluation Include: existing data, community input, new research

18. Inequalities has a Whakapapa This is ‘OUR’ Whakapapa – Reducing inequalities is our past, our present and our future……………………

19. Be Aware that…… The process is important Be prepared to challenge assumptions Some questions will be more relevant than others Involvement of stakeholders Keep records for transparency & accountability Share your record and your analysis

20. “Worldwide there is a growing feeling that the systems are getting less fair. Some are doing well and other aren’t. Giving communities the voice for that is important.” Professor Don Matheson Opening Address Healthcare Aotearoa Hui November 2011 Member of Asia Pacific HealthGAEN Global Action for Health Equity Regional Steering Group http://aphealthgaen.org

21. CCN Next Steps….. Mid Central Cancer and Palliative Care Network Group: Inequalities Project Honouring Te Whare Tapa Wha Goals: To encourage health care professionals to view Māori patients and whanau from a holistic lens (this is especially important when considering Whanau Ora). To ensure culturally appropriate care is being considered and provided to Māori cancer clients and their whanau. To improve relationships with Māori patients and therefore, their clinical results.

22. CCN Next Steps….. Turning ‘UP’ the H.E.A.T: Reducing Inequalities Workshops Using the H.E.A.T and other tools to reduce inequalities. Central Region 2012

23. H.E.A.T from 1840’s to 2012

24. Health Equity IS an achievable goal for us! It is achievable in a generation. We don’t lack the resources – lets make sure we don’t lack the will and the generosity of spirit, and the recognition of the role all of society can play in attaining it. Professor Don Matheson