The following article is the first in our new series, ‘Equity in Focus’, which is dedicated to sharing the mahi taking place across the health system to achieve equitable health outcomes and demonstrate our commitment to Te Tiriti o Waitangi. 

According to the Ministry of Health, in Aotearoa New Zealand, people have differences in health that are not only avoidable but unfair and unjust. Equity recognises different people with different levels of advantage require different approaches and resources to get equitable health outcomes.

In Canterbury, Māori are four times more likely to be diagnosed with cervical cancer, three times more likely to be hospitalised with chronic respiratory diseases and Māori tamariki are three times more likely to have decayed, missing or filled teeth than non-Māori.*  

This is an unacceptable situation, so achieving equity is a key focus across our health system and is the guiding foundation for the Canterbury Clinical Network’s strategic focus, which includes creating productive partnerships, meaningful engagement and prioritising equity. 

Chair of the Population Health and Access Service Level Alliance Dr Lynley Cook, says “the underpinning principle to addressing inequity is genuine partnership with the communities and populations most impacted by poor health outcomes and by honouring Te Tiriti o Waitangi. This means that we must involve Māori and impacted communities in the design of health services right from the very first steps in the journey.”

Te Tiriti and Equity group
In 2019 the CCN created a Te Tiriti and Equity group with Māori leaders from across the system, including members from Te Kāhui O Papaki Kā Tai, the CCN Māori Caucus and the Canterbury DHB alongside members from the Population Health and Access Service Level Alliance and the CCN Programme Office. The group meets bi-monthly to progress specific equity-focused actions. One of the actions that has been prioritised is enhancing the health system’s approach to co-design.

Kaupapa Māori-led / Whānau-led co-design
Since the Canterbury Clinical Network was established, it has regularly applied a co-design approach to improve health services by bringing together consumers, service providers from across the health system and other government and community organisations. This approach has evolved over time. 

In 2019 a comprehensive review of the Canterbury Clinical Network’s application of co-design was started, with the aim of developing an approach that ensured the voices of Māori, Pacific, Culturally and Linguistically Diverse (CALD) communities and other minority groups were heard and influenced the changes needed in accessing health care. 

“We learnt a lot from the Maternity Co-Design that reinforced the importance of changing how we approach our co-design process to better reflect partnership at all stages and ensure the voices of those that are missing out are heard,” says CCN Programme Manager Linda Wensley. 

The Te Tiriti and Equity group is leading this piece of work to develop a kaupapa Māori co-design approach. This will improve the way we gather and use information to reduce inequities in the way health services are designed, accessed and delivered.  

In April, a draft proposal on how to progress the redesign of the co-design was discussed with the group determining:   

• a set of guiding kaupapa Māori principles is vital to underpin our co-design; 
• the approach needs to be flexible and responsive;
• the approach needs to result in authentic partnerships, which allow us to keep learning how to improve our co-design methodology.

This feedback from the group is now being used to draft a model that will guide people across the system in undertaking a kaupapa Māori co-design approach. This will be tabled with the Te Tiriti and Equity group when they next meet on 26 June, ahead of wider distribution for comment. 

“It is positive to be working together on a Canterbury kaupapa Māori co-design that will guide how we come together around matters that are important for the people and whānau that are missing out, and ensure we arrive at health service changes that will support people to flourish and lead healthy lives,” says Linda.

*Statistics taken from Māori Health Action Plan 2017/18.

Image credit - Robert Wood Johnson Foundation.