Back down under
Three years ago I attended the International Society on Priorities in Healthcare conference in Melbourne Australia. Here is the blog I wrote then
I am now back in Australia having just attended the 10th Health Services and Policy Research Conference at Surfers Paradise on the Gold Coast, Queens Land (as they say an academic’s journey is a long and weary one). The conference was organised by the Health Services Research Association of Australia and New Zealand, and brings together both country’s main researchers and policy makers every two years. This year the emphasis was on achieving a balance between acute and primary care, an issue that is close to my heart, so I was delighted to be invited to give a presentation in conjunction with my collaborators from Otago University Dunedin, New Zealand. You will remember in my last blog that I was impressed with the New Zealand approach to Health Systems change, so I decided to join them.
The opening conference plenaries were by Professor Judith Smith from Birmingham University UK, who presented the evidence base for the shift from acute to primary (community) care. She demonstrated that making the shift can improve quality but not necessarily at a reduced cost. She introduced the audience to the “Institute of Disappointment”, where health services researchers have to advise policymakers and politicians that their latest health initiative did not work.
The second presenter was Robin Gauld (my host for the following few weeks), Co- Director of the Centre for Health Systems and Technology, and Dean of the Business School and Pro-Vice Chancellor Commerce at the University of Otago. He continued the previous theme with the “School of Disillusionment”, but by the end of the session, and certainly by the end of the conference, a “Department of Hope” had instead been designed. What was evident after the three days was that health service research is active and vital in this part of the world.
It was also clear that there was an increasingly successful drive to reduce health inequalities. I saw the best depiction of how to explain inequalities from Tim Stokes, Elaine Gurr Professor and Head of the Department of General Practice and Rural Health, University of Otago and Co-Director of the Centre for Health Systems and Technology, when he presented the New Zealand Health Research strategy. An old “NICE colleague” (and my second host), he outlined a model that aims to address the determinants of variation in health status rather than patching up the effects.
Equality versus Equity
In the first image it assumes that everyone will benefit from the same intervention – they are treated equally – but the outcome is very different. In the second image everyone is given different levels of support in order for them to have equal access to the game – they are treated equitably. In the third image all three can see the game without any support or accommodations because the cause of the inequity was addressed. The system barrier has been removed. However a footnote from me, being closer to the height of the right hand person I think that the little guy might prefer scenario 2. But that ethical debate is for another day
This approach appears to be working as Dr Rawiri, an indigenous doctor from New Zealand, informed the audience that medical schools in New Zealand had achieved the right proportion of indigenous graduates after implementing an explicit strategy – Oxford and Cambridge take note for their North/South divide initiatives!
Both Otago and Auckland Medical Schools have achieved population parity for Māori graduates. In 2016 16.5% (45/273) of the students graduating at Otago, and 14.9% (32/215) at Auckland, were Māori medical graduates. The estimate for the national Māori population is 15.4%. Tim tells me that the MB ChB graduation ceremony last December was quite an affair – “Māori students wearing ceremonial cloaks (korowai) over their gowns, Pacific students likewise… with spontaneous hakas from family (whanau) in the audience.“
Tomorrow I fly off to Dunedin to hear how our joint project on fairness in prioritising health in New Zealand (funded by the New Zealand lottery fund) has got on, so I will tell you how it goes. But today I am visiting what this part of Australia is famous for (beaches)!