Doing more to achieve health equity
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What we are aiming for
We want to maximise our contribution to health equity and will achieve this through proactive implementation of the Pae Ora health sector principles, and by working closely with others across the health and disability system, particularly Te Whatu Ora and Te Aka Whai Ora.
Māori are our partners under te Tiriti (pātuitanga), and advancing Māori health and wellbeing in line with Māori aspirations (ōritetanga) is a key priority.
We also need to better meet the health needs of other priority groups who face barriers to access and use of medicines and experience inequitable outcomes, particularly Pacific peoples, disabled people, including tangata whaikaha, people living in high socioeconomic deprivation, the rainbow and refugee communities, and people living in rural and isolated areas.
Where we’re currently at
Focus on health outcomes across groups of people has always been part of our role, including considering which medicines to fund and how best to support their access and use. The challenge, as for the health and disability system overall, is to significantly lift the effectiveness of what we do.
Across our work, there are both strengths and limitations – given our role – for what we can do. There are things we directly control, like which medicines are funded and with what access criteria, and there are other things beyond our reach like the level of co-payment and initiatives directly targeted to health consumers in local communities. We need to be more effective at what we do and consider how best to connect our work programme with others to improve performance overall.
As we look to make improvements ahead, we are building on several initiatives that occurred during 2021/22. These included:
- Devolving support closer to priority communities by funding Whānau Ora commissioning agencies to support medicine access and use in communities
- Building in pro-equity access criteria for specific medicines to impact positively on the health outcomes of Māori and Pacific peoples (rosuvastatin, COVID-19 treatments, influenza vaccine for 2022 season)
- Supporting health professionals with equity focused tools and information – development of a range of education resources and personalised prescribing dashboards (starting with gout) for primary care health professionals through He Ako Hiringa
- Increasing our awareness and reach into Māori communities through the ‘You Are a Priority’ campaign promoting newly funded diabetes medicines
- Enhancing the diversity and equity capability of our expert advisory networks, including through implementation of Pharmac’s equity capability self-assessment tool with PTAC
- Release of gout data insight reports for Māori and Pacific peoples to inform system choices and influence policy settings (part of our implementation of a new medicine access equity monitoring and outcomes framework)
- Establishing the Malae Te Manaaki Pacific Series – Pharmac’s Pacific health leadership and capability programme, recognising that our Pacific Responsiveness Strategy is an important part of our wider equity work
- Partnering with the Health Research Council and University of Otago to support research into barriers to medicines access and use.
Actions and initiatives underway or commencing in 2022/23
Gaining a deep and specific understanding of how equity considerations relate to our work will take time and considerable engagement with other agencies and stakeholders. We are also keen to ensure we benefit from others’ views, and together work out how Pharmac’s contribution – both through things we directly control and how we influence those we don’t – can best be enhanced.
We also note that several of the improvements discussed in the Te Tiriti Excellence priority area will also have significant benefits for our equity-related work. If we are more effective in our work for Māori, we will improve our understanding of the sorts of things we need to do better or differently to support and improve outcomes for other population groups.
In addition to the above direction, to continue our progress during 2022/23 we will:
- Complete our equity policy to make clear how equity considerations relate to our work
- Explore how we can better meet the needs and interests of disabled people across our work (such as related to data-collection and our work on diversity and inclusion)
- Work further to build an inclusive work environment where all people feel they belong and can be their best – supporting both our current workforce and helping to attract additional diversity when we recruit new staff
- Increase the diversity of our expert advisory network
- Evaluate how our recent insight reports, and use of the underlying monitoring framework, have been received and utilised by other key agencies and stakeholders, to better understand the demand and clinical relevance of such reports.
- Support Te Aka Whai Ora to develop its role in monitoring system performance, including in relation to hauora Māori, and consider where our own analytical effort and sharing of data and insights are best directed to enhance system knowledge.
As noted in the priority area of enhanced assessment and decision making, we are also working to further improve how equity considerations are embedded into funding assessment work and the decisions we make.
Further work and considerations for our full response in October 2022
Better coordinating work on efforts to make optimal use of medicines
As indicated in the introductory part of our response, we believe there is benefit in considering how best to connect and integrate work focussed on the optimal use of medicines, a topic that has high relevance to improving the equity of health outcomes.
We are keen to explore how best to enhance coordination, building on important early learnings from the cross-agency governance mechanism for the immunisation system. Each year, there is considerable public interest – understandably – in the funding of new medicines. In practice, there are also likely to be significant (and potentially greater) improvements in both the overall level and equity of health outcomes from improving access and use of the medicines we already fund.
Further considering how we judge the value of our funding decisions
As discussed in the theme on enhancing assessment and decision-making, our Factors for Consideration were last reviewed in 2016 following wide consumer engagement. For some people, equity considerations can be seen in those factors – such as the considerations of Māori health priorities, health need, suitability and impacts on whānau – while others feel equity considerations aren’t sufficiently visible or addressed.
There are also other matters related to what we consider when making funding decisions. We currently take an all-of-health-system perspective; however some stakeholders also believe we should consider wider social factors as well. We also have a strong focus on funding products – whether medicines or medical devices – whereas a different approach could focus on investment packages that include initiatives (whether Pharmac’s or other agencies) that expressly supported outcomes for different groups of people.
As discussed in the theme on enhancing assessment and decision-making, we are also exploring how we better include equity considerations in our assessment and decision-making. There is also important work to be done across the health and disability system on how the effectiveness of health interventions – including those in medicines and medical devices – are monitored and reported, including across different population groups to better understand progress towards health equity.