Promoting Better Policies for Children.
Backgrounder 20. Published March 2002
Innes Asher, Dee Parks, and Carolyn Dakin
Socio-economic inequalities acting during the foetal and childhood period cumulatively contribute to adult health inequalities. Cumulative disadvantage over the life course, and formal and informal institutional rules that discriminate against less powerful social groups, have been proposed … as the dominant factors in creating a cycle that locks in health inequalities … ” ( ).
” The primary determinants of disease are mainly economic and social, and therefore its remedies must also be economic and social. Medicine and politics cannot and should not be kept apart.” ( )
“Income is the single most important determinant of health. There is a persistent correlation world-wide between low income and poor health” ( ).
The Child Poverty Action Group has become increasingly concerned by the evidence of deteriorating child health in Auckland and other parts of the country. This backgrounder has been put together by members Assoc. Professor Innes Asher, Head of Starship Children’s Hospital Respiratory Service, Dee Parks, health manager and researcher, and Dr Carolyn Dakin, Paediatric Respiratory Specialist.
Dr Dakin, who came to Starship Hospital a year ago from Sydney Children’s Hospital comments:
“I moved to New Zealand to work in 2001, having undertaken 14 years of clinical practice in Australia. In addition to my clinical background I have an interest in public health and health care systems. I have been struck by a number of differences in the health and health care between the two countries.
The most significant difference in health care is that primary health care or general practice, which forms the majority of health care delivered in New Zealand, is private without the safety net of equitable access provided by Medicare in Australia. Even the theoretical free access of children under 6 is not always practised and is inadequate. I am surprised that there is so little debate about this aspect of privatisation of healthcare, since access to healthcare is considered to be a basic human right (World Health Organisation (WHO) Alma Ata declaration 1987).
Not unexpectedly, New Zealand ranks 80th in WHO member states in health system performance on level of health, well below Australia(39th) and most developed countries (The WHO Report 2000). In the same report, the disability adjusted life expectancy or level of health in New Zealand is ranked 31st compared with 2nd in Australia.
The high burden of disease in New Zealand is clearly evident in my clinical practice, with diseases such as bronchiectasis and tuberculosis being far more commonly seen than Australia. Unfortunately, this burden of disease is increasing and correlates with the widening disparity between rich and poor seen in New Zealand. As always, this inequality particularly disadvantages children. While my clinical work is concerned with the effects of disease and social disadvantage, I am conscious of the social policies contributing to the burden of disease and the health policies which fail to address it.”
