The Social, Cultural and Economic Determinants of …

1 The social , Cultural and EconomicDeterminants of health in New Zealand:Action to Improve HealthA Report from the National Advisory Committeeon health and Disability(National health Committee)June 1998Fi rst publis hed in Ju ne 1998 bythe National Advisory Committee on health and DisabilityWellingt on, New ZealandCopyrig ht reserved 1998 ISBN: 0-478-10474-XFurther copi es of this report are available from theNational Advisory Committee on health and DisabilityPO Box 5013, (04) 496 2296, Fax (04) 496 2050 The social , Cultural and Economic Determinants of health in New Zealand: Action to Improve HealthA Report from the National health Committee3 Committee forewordThe National Advisory Committee on health and Disability (National health Committee)advises the Minister of health on the kinds and relative priorities of personal health ,disability support and public health services that should, in the Committee s opinion, bepublicly funded.

2 In addition to advising on health and disability support servicepriorities, the health and Disability Services Act (1993), as amended in 1995, states thatthe National health Committee is also to advise the Minister of health on: Other matters relating to public health , including -(i) Personal health matters relating to public health ; and(ii) Regulatory matters relating to public health ; .. The National health Committee interprets Other matters relating to public health as arequirement to consider, among other things, the wide range of factors that affect health ,including factors that may lie outside the health sector. This interpretation was supportedby participants at a Committee consultation workshop on public health in June 1996,who identified as a high priority the need to state explicitly what are the majordeterminants of health , communicate the Determinants of health in New Zealand andexamine strategies to address them.

3 In response, the Committee commenced aprogramme of work on the social , Cultural and Economic Determinants of health in April1997. The overall purpose of the programme is to provide advice to the Minister ofHealth on practical strategies that will improve the health of New Zealanders and reducesocioeconomic inequalities in health . Such strategies may be policies, population-basedinterventions, or programmes targeted to specific groups or initial step in the work programme was the establishment of a health determinantsadvisory group. The group s eight members come from a range of backgrounds includingpublic health , economics, Ma ori community health , ethics and social sciences background papers were commissioned and they are major background referencesfor this report (Howden-Chapman and Cram 1998; Woodward et al.)

4 1998). The papersare available from the National health Committee on partly on the work of the two background papers, the members of the advisorygroup compiled this report which has been adopted by the National health Committee asthe basis for its own advice to the Minister of health . In addition to summarising theevidence on social , Cultural and Economic Determinants of health in New Zealand, thereport examines strategies for intervening to reduce socioeconomic inequalities in healthand makes specific recommendations for action to the Minister of principal findings of this report are: social , Cultural and Economic factors are the main Determinants of health there are persisting health inequalities as a result of socioeconomic factors in NewZealand and some evidence that these may be worsening current trends in many socioeconomic factors in New Zealand are likely to widenhealth inequalities further there are good reasons for intervening to reduce socioeconomic inequalities in health there are evidence-based interventions for reducing these social , Cultural and Economic Determinants of health in New Zealand.

5 Action to Improve Health4A Report from the National health CommitteeAction to reduce inequalities in health resulting from social , Cultural and economicdeterminants requires a comprehensive approach involving strategies both within andoutside the health sector. This is not an easy task. It requires broad acknowledgement ofthe important role of social , Cultural and Economic factors that determine health and ofsocioeconomic inequalities in health . It also requires a long term commitment to confirmthat interventions are improving the health of low socioeconomic that lie beyond the responsibility of the Minister of health have veryimportant effects on health .

6 Therefore, the recommendations - which are to theMinister of health - do not cover all the areas discussed in this report, including anumber of areas of concern which are highlighted. The emphasis is on strategieswhere there is good reason to believe that action by the Minister of health will leadto improved population health and a reduction in socioeconomic inequalities inhealth. In other areas of concern, the National health Committee hopes that thisreport will extend the debate about social , Cultural and Economic Determinants andhealth inequalities beyond the health sector to a wider understanding of the exact nature and extent of the problem of socioeconomicinequalities in health , as well as the most effective strategies to deal with them, is stillimperfect but there is sufficient evidence to make a start.

7 The National health Committeewill continue to do work in this area to identify further effective strategies to reducesocioeconomic inequalities in health . However, action can and should be taken now. TheCommittee urges the Minister of health to act on our GriffithsActing ChairpersonNational health Committee Further copies of this report and copies of the two background papers are available fromthe National health Committee at the address below. We welcome your feedback on thisreport and ideas for future work by the Committee in this area. You are invited to sendcomments to: Dr Ashley Bloomfield National health Committee Secretariat PO Box 5013, Wellington Phone: 04 496 2296 Fax: 04 496 2050 E-mail: social , Cultural and Economic Determinants of health in New Zealand.

8 Action to Improve HealthA Report from the National health Committee5 Members of the health Determinants Advisory Group Robert Beaglehole (Chairperson) Professor of Community health , University of Auckland Toni AshtonHealth Economist, Department of Community health , University of Auckland Chris CunninghamDirector, Te Pumanawa Hauora, Ma ori health Research Centre, Massey Univesity Rirepeti JoyceMa ori Community health Worker, Papakura Marae Andrew MooreLecturer, Department of Philosophy, University of Otago Charlotte PaulAssociate Professor and Public health Physician, Department of social and Preventive Medicine, University of Otago Charles WaldegraveDirector, Family Centre, Lower Hutt [Alf Kirk, a consultant of Wellington.]

9 Is also a member of the group but was unable tocontribute to the writing of this report]. Ashley Bloomfield provided National health Committee secretariat support to the HealthDeterminants Advisory Group Acknowledgements Members of both the National health Committee and the health Determinants AdvisoryGroup wish to acknowledge the authors commissioned to write the two backgroundpapers. In the first, Philippa Howden-Chapman and Fiona Cram summarised thedeterminants of health in New Zealand, incorporating the latest international and nationalevidence. The second paper, by Alistair Woodward and Ichiro Kawachi discussed insome detail the rationale for acting to reduce socioeconomic inequalities in health .

10 Thelatter paper forms the basis for chapter four of this report. A number of people provided helpful comments on earlier drafts of this report and otherswere consulted over the types of interventions that are identified in therecommendations. The Committee would like to thank these people for their very usefulcontributions. The National health Committee also acknowledges the efforts of individual members ofthe health Determinants Advisory Group who contributed chapters to this report. Inparticular, the considerable commitment by the Chairperson of the Advisory Group,Professor Robert Beaglehole, is gratefully social , Cultural and Economic Determinants of health in New Zealand: Action to Improve Health6A Report from the National health Committee Contents MEMBER OF THE health Determinants ADVISORY SUMMARY.