Improved public policy could have bridged gap
One thing that politicians hate to admit is that public health is more than the sum of people’s private medical decisions. We could all enrol in a general practice, for example, and yet our collective health might remain more or less the same.
Why? Because universal access to primary care – certainly a public good in and of itself – wouldn’t necessarily transform, say, the price we pay for healthy versus unhealthy foods.
Instead, preventing disease and prolonging life and its quality turns on a series of sometimes mundane public policy decisions.
Is the Government investing in affordable housing? In the context of Covid-19 the virus rips through overcrowded homes, spreading from family member to family member. So one means of cutting it off at the neck is to ensure that as many people as possible can access warm, dry homes.
In the current outbreak the virus is carving a track through suburbs with subpar housing stock. It’s also circulating among people with no homes at all, further reinforcing that this public health crisis is also an inequality crisis.
More than 80 per cent of infections in the current outbreak, for example, are among Mā ori and Pacific peoples in underprivileged suburbs in South Auckland.
This inequality in infections bleeds into vaccination rates as well, with Mā ori and Pacific peoples lagging well behind Pā kehā – an inequality that perfectly mirrors every other in society.
Pā kehā , for example, are more likely to own their own homes than Mā ori and Pacific peoples. They’re more likely to work in higher-paid professions, giving their children access to better schooling and, eventually, better work opportunities.
When police apprehend a Pā kehā and a Mā ori for committing the same crime, the Pā kehā is less likely to face charges, further reinforcing societywide inequalities.
What unites the vaccine-hesitant is low trust in institutions. Is it any wonder that, when you’re on the wrong side of nearly every social statistic, your trust in the government is low?
Of course not. But this is an uncomfortable admission for the Government because it means publicly confirming that the current public health crisis is another front in the inequality crisis.
If previous governments had made the necessary investments in Mā ori health providers, for example, granting them the resources they needed to build community health facilities, community networks, and trust, would the same vaccine deficit exist between brown people and white people?
It’s a hypothetical, sure, but some evidence suggests the gap wouldn’t exist as it does in this particular moment. As a chasm.
... it means publicly confirming that the current public health crisis is another front in the inequality crisis.
Only 33 per cent of Mā ori have had two jabs at the time of writing. For Pā kehā , it’s 52 per cent. The country’s leading vaccinators are often Mā ori health providers, Waipareira Trust in Auckland and Te Kā ika in Dunedin, to take two examples. At the beginning of the current outbreak Mā ori made up only 3 per cent of the people the Waipareira Trust was vaccinating. But after tapping its community networks, and therefore the deep well of trust built in those communities, Mā ori now make up 14 per cent of the people Waipareira is vaccinating.
This mirrors – or is slightly above – the Mā ori share of Auckland’s population. The lesson? Mā ori providers, not the Ministry of Health, are better suited to eliminating vaccine inequalities.
The trouble is that there isn’t a Waipareira Trust for every community. Instead it exists as an outlier, a scrappy fighter that took decades to accumulate adequate resources, networks, and skills to do the work it does.
This brings us back to the thing politicians hate to admit: that public health is more than the sum of people’s private medical decisions. If different public policy decisions were made, like pursuing a strategy to build Mā ori health providers at scale in every region, there are good reasons to believe our vaccine inequalities wouldn’t exist. This is the great benefit of hindsight.
The great benefit of government is the power, even today, to do something about it. They should know where to invest now.
Lana Hart is taking a break from her column.