Healthcare inequities and COVID-19 – Expert Reaction

A new model predicts how COVID-19 could spread through different groups in the New Zealand population.

The study – which has not yet been formally peer reviewed – finds that Māori and Pacific communities could be hit the hardest due to inequities in health and healthcare access. The researchers say low access to health services could allow a second COVID-19 outbreak to go undetected for longer.

The SMC asked experts to comment on the model.

Professor Denise Wilson, Taupua Waiora Māori Health Research Centre, Auckland University of Technology, comments:

“Te Pūnaha Matatini modelling serves as a timely warning that, in responding to COVID-19, Māori are at risk of worsening inequities. Māori already experience disproportionate health and social inequities compared to other groups of people within Aotearoa. The economic impacts of COVID-19 threaten to make inequities in health and healthcare access worse for Māori.

“What is known is factors like stress, poverty, housing quality and mental health are all associated with ill-health and worsening chronic disease in ‘good times’. Further, childhood poverty has life-long health consequences for children – many tamariki Māori and their whānau already live in conditions of deprivation, and the aftermath of COVID-19 will impact tamariki.

“In the long-term, having timely access to the healthcare Māori need and having access to the appropriate treatment is crucial to prevent deterioration in the inequities that already exist for Māori. However, racism is a recognised barrier to Māori accessing healthcare. Also, income, quality of food and food and housing security are all factors that contribute to health.

“Government and health services need to continually be mindful of these risks, which have long-term health and economic impacts for Aotearoa. It would be positive to see the government continuing to work with Iwi and Māori communities to ensure Māori health needs are recognised and met. Sustaining the high-trust environment that has seen Iwi and Māori communities identifying and responding effectively to the needs of whānau within their communities with government support becomes critical.”

No conflict of interest.

Dr Maryann Heather, GP and Senior Lecturer in Pacific Health, University of Auckland, comments:

“This paper shows a structured model for the spread of COVID-19 by modelling age and healthcare inequalities. It looks at two case studies at particular age groups and the effect of inequitable access to healthcare and testing. Real time modelling and analysis of COVID-19 needs to use high quality ethnicity data available.

“As a General Practitioner working in South Auckland who has approximately 5300 enrolled patients that are 94% Pacific, 3% Māori, and 3% from other ethnic groups, COVID-19 is a serious concern whilst caring for an already vulnerable and very high-risk community. Not only does the Pacific community have fears around COVID-19, but added to the situation are job losses, financial constraints, psychological effects of COVID-19, having to deal with other socio-economic factors as well as health conditions. How do we protect our Pacific community? How do we reduce transmission and keep them safe? How do we deal with a second wave of COVID-19 now that we have reduced alert levels?

“Therefore, when making decisions and prioritising resources in healthcare, priority must be addressed and focused on the most vulnerable and high risk populations – such as Māori and Pacific communities and older populations – and the compounding factors that can affect these communities. It is not a one-size-fits-all policy and this is reflected in this paper.

“This paper highlights why we need to focus resources on addressing health inequalities for Māori and Pacific communities in New Zealand who are at risk of undetected outbreaks of COVID-19, therefore increasing testing for this community is a must. We see that in yet another COVID-19 case of the Marist school cluster in Auckland, which shows the uncertain duration of COVID-19 in the community. At least 51 cases were Pacific people. This again highlights why it is important that we continue to test for COVID-19 in the community.

“The important consideration we must be cognisant of is that New Zealand is the gatekeeper to the Pacific Islands. There is a lot of travel between New Zealand and the Pacific countries by the Pacific community each year, as well as the close ties with New Zealand in varying capacities like foreign aid and assistance.

“If COVID-19 were to spread to the other Pacific nations, this could be severe and they would not be able to cope with the overwhelming stress on health services. This was evident by the recent measles outbreak in Samoa in 2019. We in New Zealand have an obligation to protect our Pacific Island nations as they are looking to New Zealand for how we are handling the pandemic and what guidelines we have in effect.

“Health equity must be at the basis and heart of every decision and action that we make. We must protect and care for our vulnerable community. Every life is valuable and deserves access to equitable healthcare.”

No conflict of interest.