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Strategies to reduce inequalities in child health: Perspectives from Aotearoa/NZ

Strategies to reduce inequalities in child health: Perspectives from Aotearoa/NZ. Annual Health Services Research Meeting Seattle, 25 th June 2006 Dr Sue Crengle. Overview. Briefly describe two examples of ethnic health disparities and strategies to address these

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Strategies to reduce inequalities in child health: Perspectives from Aotearoa/NZ

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  1. Strategies to reduce inequalities in child health: Perspectives from Aotearoa/NZ Annual Health Services Research Meeting Seattle, 25th June 2006 Dr Sue Crengle

  2. Overview • Briefly describe two examples of ethnic health disparities and strategies to address these • Identify general principles necessary for achieving desired outcome • SIDS prevention • Meningococcal vaccination

  3. SIDS mortality rates per 1000 live births by ethnicity 1980- 1986 (Source NZHIS 2005)

  4. SIDS case control study • 1987-1990 nation-wide case-control study • Number of ‘unmodifiable’ factors • Four ‘modifiable’ risk factors for SIDS • Prone sleeping position • Maternal smoking • Not breast feeding • Infant bed sharing Mitchell EA, Scragg R et al NZ Med J 1991;104:71-6 Mitchell EA, Taylor BJ et al J Paediatr Child Health 1992; 29(Suppl 1):S3-8 Scragg R, Mitchell E et al BMJ 1993; 307: 1312-1218

  5. SIDS reduction campaign • Campaign to reduce these risk factors came out 1991/2 • Campaign to reduce these risk factors failed Mäori

  6. SIDS mortality rates per 1000 live births by ethnicity 1980- 1994 (Source NZHIS 2005)

  7. Key messages didn’t reach Mäori • Inappropriate and ineffective messagesfor Mäori community • Inappropriate dissemination methods • No provision of culturally acceptable alternatives esp. with bed sharing

  8. SIDS prevention • 1994… • Mäori SIDS prevention team funded • Spent time listening and talking to community • 1996 • developed Mäori appropriate education / prevention • Sites • Messages • Staff

  9. SIDS prevention • 1996 • developed Mäori appropriate education / prevention • Sites • Messages • Staff

  10. Mäori SIDS prevention • 1996 – developed Mäori appropriate • Family assistance • Workers who go to SIDS death- work with family in short and sometimes longer term. • Work with coroners and others in sector to ensure safe and appropriate interactions between agencies and families

  11. SIDS mortality rates per 1000 live births by ethnicity 1980-99(Source NZHIS 2003)

  12. NZ meningococcal vaccine programme • My role of previous permanent advisor Māori • Sub-serotype specific Men B epidemic since 1991 • Three strands to delivery • Under 5 years – GP based delivery • 5 – 18 (at school) – school based delivery • Young people not at school – GP based delivery • MoH role • DHBs role

  13. NZ meningococcal vaccine programme • ‘General’ population programme • Some Māori ‘add ons’ • ‘communication’ strategy • Media, stakeholders, providers • Use of Māori providers already delivering immunisation outreach (no increase in these services) • General population programmes usually increase inequalities e.g. SIDS prevention

  14. NZ meningococcal vaccine programme • Māori advice largely unheeded until serious inequalities in coverage apparent (c. early 2005) • Further Māori media strategy • Increase outreach services • Accompanying discourses • ‘There are problems with the data’ • ‘Māori families are ‘low and slow’ to vaccinate their children’ • School based programme in CMDHB – Māori highest consent rate but lowest coverage

  15. Doing it right… • Te Whānau ā Apanui health service • 1 doctor, 2 nurses, 1 receptionist • ~ 2000 registered patients • ~160 under 5 y olds • 92% Māori • HIGHLY deprived / low SE area • Rural • ~ 2 ½ hours by road to nearest hospital • LARGE catchment area • 100% coverage of < 5 year olds • Dose 1 and 2 over approx three weeks • Dose 3 over four to five weeks

  16. How? • Communication • Formal at sites in community several months before programme • With patients via newsletter • Informal communication with whānau in community • Appropriate service • Careful planning of approach • Sites of delivery • At all clinics • At kohanga reo • At home (planned and “drive-by’s”) kohanga reo - Māori language child care centres Hapū - tribal subgroup

  17. How?? • Practice systems to foster efficient implementation • Staff • Positive reinforcement for children • They also ‘took over’ the school programme and had similar results

  18. Re-learning what we know… • ‘General’ programmes do NOT reduce disparities • Programme designed for those experiencing disparities works for all • Multiple points • Consultation, communication, service delivery etc • ‘80% of $ for last 20%’ • Maybe not if programme design approp

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