Dr Nina Scott

Transcript

1. A FOCUS ON Lung Health Equity Hei Ahuru Mowai National Maori Cancer Leadership Group through the organised efforts of society . . . lung health inequities are avoidable and fixable Dr Nina Scott, Ngati Whatua, Waikato, FNZCPHM, MPH, MBChB, DipComChildH, DipChildH Chair Hei Ahuru Mowai, National Maori Cancer Leadership Group ncott.waikato@gmail.com
2. How do inequities happen? 1. determinants of health 2. health care access 3. Health care quality Inequities are differences between groups which are Unfair – Avoidable - Fixable Assume inequities occur at every step of every care pathway unless proven otherwise small inequities add up to big inequities, so there is no silver bullet, but if I had to pick one, it would be standardisation of care inequities point to where standardisation is needed first, and show what can be achieved at a minimum for Maori, plus show where to get relatively cheap and quick health gains for the total population Jones CP. 2001. Invited commentary: “Race”, racism and the practice of epidemiology. American Journal of Epidemiology 154: 299–304. Whitehead M. 1992. The concepts and principles of equity and health. International Journal of Health Services 22: 429–445. p. 431
3. Achieving Equity our approach Systems approach – beyond victim blaming “The most likely explanation for this [inequity] is that Maori have a cultural reluctance to present for health care” Lamb DS, Bupha-Intr O, Bethwaite P, et al. 2008. Prostate cancer – are ethnic minorities disadvantaged? Anticancer Research 28: 3891–6. Its all about the ‘gaze’ where we look for the defects
4. DETERMINANTS OF HEALTH http://www.health.govt.nz/our-work/populations/maori-health/tatau-kahukura-maori-health-statistics/nga-awe-o-te-hauora-socioeconomic-determinants-health/neighbourhood-deprivation Home ownership prime parenting age 25-44 2013; gap widening since 2006 Median personal income 2013 Gap same since 2006 23.5% 6.8% 11.6% 3.8% 23.5%
5. Access. Deficits (–) or excesses (+) in dispensed medicines for Māori compared with non-Māori, adjusted for age and relative disease burden (DALY loss)1 http://www.bpac.org.nz/BPJ/2012/August/disparities.aspx
6. Poorer quality bowel cancer treatment for Maori v non-Maori elective surgery Maori less likely removal of primary treated in specialist public facility stage III referred or reviewed by oncologist offered or receive chemo longer wait times for chemo Maori more likely 5 x less lymph nodes removed require emergency surgery die after elective surgery Hill, S, Sarfati, D., Blakely, T., Robson, B., Purdie, G., Dennett, E., Cormack, D., Dew, K., Ayanian, J. Z. and Kawachi, I. (2010), Ethnicity and management of colon cancer in New Zealand. Cancer, 116: 3205–3214. doi: 10.1002/cncr.25127
7. Multiple small inequities are cumulative Maori vs non-Maori cancer pathway inequities Incidence Cut and paste data of your choice Mortality Risk factors Prevention Timely diagnosis Timely quality treatment survival
8. mortality inequity greater than incidence inequity Maori vs non-Maori cancer pathway inequities Incidence 21% Ministry of Health. 2014. Cancer: New registrations and deaths 2011. Wellington: Ministry of Health. Age-standardised Mortality 72% Risk factors Prevention Timely diagnosis Timely quality treatment survival
9. Aotearoa has an inequity generating environment
10. How to achieve lung health equity? Ask questions • What do the data say for Maori and Pacific? Data are numbers and stories • Where and what are the equity gaps? • How are we going to close the gaps? • Who can we partner with? Equity in determinants of lung health, access, timeliness and quality of lung health care
11. the Meihana Model Cuddy J, Pitama S, Huria T, Lacey C. Improving Māori health through clinical assessment: Waikare o te Waka o Meihana. N Z Med J. 2014;127(1393). http://journal.nzma.org.nz/journal/127-1393/6108
12. A Handy framework . . http://www.health.govt.nz/system/files/documents/publications/equity-of-health-care-for-maori-a-framework-jun14.pdf A handy framework . . . .
13. BASIC PRINCIPLES OF CANCER (mate pukupuku) CONTROL World Health Organisation • Leadership • Involvement of related sectors in decision-making • Partnership • Evidence based decision-making • Systemic approach - a comprehensive programme with interrelated key components sharing the same goals and integrated with other related programmes • Continuous quality improvement • Stepwise approach to planning and implementing interventions
14. A national equity focussed lung health control programme is a public health programme designed to reduce and achieve equity in the number of lung disease cases and deaths and improve quality of life for patients with lung disease and their whanau/fanau, through the systematic and equitable implementation of evidence-based strategies for prevention, early detection, diagnosis, treatment, and palliation, making the best use of available resources. http://www.who.int/cancer/nccp/en/
15. The National Bowel Cancer Working Group is concerned that there are differences in bowel cancer survival between groups of New Zealanders which are inequitable. Inequities, by definition, are unfair, avoidable and remedial. Our approach to addressing inequities in bowel cancer survival is to standardise care in the areas along the diagnosis to treatment pathway, where inequities are most likely to occur. National Bowel Cancer Working Group Equity Statement 2014
16. Equity focus for all lung health control activities; governance, priority setting, research, quality control and reporting Quality ethnicity data collection, analysis, reporting. Equal explanatory and analytical power Identification of inequity hotspots along care pathways, development of initiatives to achieve equity, monitoring “Achieve lung health equity, improve lung health for all’ Achieving Lung Health Equity
17. CANCER PRIORITIES CANCER INEQUITIES MAORI CANCER INCIDENCE smoking screening DEATHS DECILE 10 BURDEN LUNG BREAST BOWEL STOMACH PROSTATE SITE LUNG BREAST PROSTATE LIVER BOWEL RANKED BY BURDEN AND PREVENTABILITY From a project using; Unequal Impact II: Maori and Non- Maori Cancer Statistics by Deprivation and Rural Urban Status, 2002 – 2006
18. Lung cancer equity . . to do Incidence Early diagnosis Treatment Smoking prevention Smoking cessation Screening Quality improvement Quality improvement Integration of treatment services for tobacco addiction along the cancer pathway
19. The power of equity focussed standardisation of care and the potential for gain revealed by inequities
20. Maternity Quality and Safety Programme Governance Board leading a culture change to establish systems so that “every woman will get excellent high quality support for a smokefree pregnancy and motherhood”
21. Champions Incubation projects Patient ABC audit Staff training plan NRT for staff Project promotion Staff ABC audit Support 4 staff to quit Repeat ABC audit Staff do not smoke during working hours and do not bring tobacco on site >50% patients and visitors are aware that the site is smoke and tobacco free >95% of clinical staff trained in ABC Support plans are in place for all staff who smoke Audit > 95% of pregnant patients who smoke are charted NRT Annual support plans for all staff who smoke. Two yearly audit > 95% of pregnant patients who smoke are charted NRT Two yearly audit > 85% of patients aware that the site is tobacco free Hapu Mama Smokefree Pregnancies Tupeka Kore framework Incubation Onewa sliver Tuhua Bronze Pounamu gold Tupeka Kore nirvana 38 pregnant women who smoke admitted to Hospital 8/38 21% given NRT Goal = >95% 3 /38 8% referred Incentives Pilot >70% quit rate 1st/2nd trimester, Maori /Pacific women, $250 vouchers over 12 weeks. Carbon monoxide validated.
22. Lung Health Equity . . . as a group you are in a strong position to be a powerful agent for change “achieve lung health equity, improve lung health for all’ congratulations and kia kaha