Unequal Treatment - The Role of Health Services, Department of Public Health

About us

Access to high quality, timely, affordable, appropriate health care is vital, especially for a population with less than optimum health status. Although there is substantial international evidence of unequal treatment by ethnicity, this work is relatively new in Aotearoa and not yet comprehensive. This project will build on initial work in three significant health areas: ischaemic heart disease, cervical cancer, and obstetrics.

The project aims to contribute to improved access to gold standard care for Māori through further development of evidence of unequal treatment, engagement with clinicians and others involved in health care decisions, and the development of resources for Māori patients, whānau, providers and communities.

The objectives for 2005-2008 were:

• To determine if ethnic disparities in receipt of heart procedures exist in a cohort of Māori and non-Māori patients admitted to hospital for ischaemic heart disease between 1996 and 2004, after controlling for co-morbid conditions
• To determine if ethnic disparities in treatment for cervical cancer exist in a cohort of Māori and non-Māori women registered with cervical cancer between 1996 and 2004.
• To determine the contribution of deprivation to ethnic disparities in obstetric procedures and in adverse birth outcomes for mother and/or baby, among women giving birth in hospital between 1997 and 2004, after controlling for clinical factors.
  To investigate the relationship between unequal rates of caesarean section and ethnic disparities in adverse birth outcomes, among women (and babies) at high risk of delivering (or being delivered) by caesarean section.
• Use interviews and focus groups with relevant clinicians and other health workers to explore possible explanations for any differences found and to contribute to the development of provider and system level interventions for reducing unequal treatment.
• To develop resources for Māori patients, whānau, and communities, based ofindings and discussions with clinicians.

The objectives for 2008-2011 were:

• To update and extend the cohort analyses of treatment inequalities in ischaemic heart disease, cervical cancer and obstetric care (e.g. regional differences).
• To record and analyse Māori patient (and whānau) narratives of their health journey.
• Facilitating change: Research dissemination (national and regional; quantitative and qualitative) to influence health system and service developments and outcome monitoring in three regions.
• Investigate the feasibility of measuring unequal treatment in diabetes and COPD.

For a more indepth description of the Unequal Treatment project please click on the Unequal Treatment overview document - Unequal Treatment overview

Funder

The Unequal Treatment project is funded by the Health Research Council of New Zealand.

Publications

Journal articles  

McLeod M, Cormack D, Harris R, Robson B, Sykes P, Crengle S. Achieving equitable outcomes for Māori women with cervical cancer in New Zealand: health provider views.NZ Med J 2011; 124 (1334)

Mcleod M, Harris R, Purdie G, Cormack D, Robson B, Sykes P, Crengle S, Iupati D, Walker N. Improving survival disparities in cervical cancer between Māori and non-Māori women in New Zealand: a national retrospective cohort study. Aust NZ Journal of Public Health 2010; 4(2): 193-199.

Mihaere KM, Harris R, Gander P, Reid P, Purdie G, Robson B, Neill A. Obstructive sleep apnoea in New Zealand adults. Prevalence and risk factors among Māori and non-Māori.. Sleep 2009; 32:949-956

Simmonds S, Robson B, Cram F, Purdie G. Kaupapa Māori Epidemiology. Australasian Epidemiology 2008; 15(1): 2-6

Harris R, Robson B, Curtis E, Purdie G, Cormack D, Reid P. Māori and non-Māori differences in caesarean section rates: a national review. NZ Med J 2007; 120 (1250)

Reports  

Lust J, Purdie G, Mcleod M, Robson B. Summary of Midlands Regional Data for Acute Cardiac Events. Department of Public Health, University of Otago, Wellington 2011.

McLeod M, Purdie G, Robson B. Summary of Central Regional Data for Acute Cardiac Events. Report for: Central TAS  and Central Region Cardiac Network. Te Ropu Rangahau Hauora a Eru Pomare, Central TAS, Central Region Cardiac Network, 2010.

McLeod M, Purdie G, Robson B. Summary of Northern Regional Data for Acute Cardiac Events. Technical report for  the Auckland DHB. Te Ropu Rangahau Hauora a Eru Pomare, Auckland DHB, 2010.

Dissertations  

Simmonds S. The implications of using different methods to measure ethnicity in a cohort study. Research Dissertation for the Department of Public Health, University of Otago, Wellington.

Presentations  

Simmonds S. Developing patient information resources for Māori part of the Unequal Treatment Project. Te Rōpū Rangahau Hauora a Eru Pōmare, University of Otago, Wellington, Aotearoa, 2011.

Our people  

University of Otago, Wellington

• Bridget Robson (Principal Investigator)
• Donna Cormack
• Gordon Purdie
• Matire Harwood (Ischaemic heart disease)
• Shirley Simmonds
• Ricci Harris (Cervical cancer treatment disparities)

Auckland University

• Suzanne Crengle
• Papaarangi Reid