UCAN Health Charter
This text is from a speech presented by Professor Don Matheson at the launch of the 2016 UCAN Health Charter to the prospective Capital and Coast District Health Board (CCDHB) Board candidates in the 2016 election cycle.
An open letter to DHB Board members.
This letter comes from a network called UCAN that is supporting action being taken to ensure everyone in New Zealand enjoys the right to health.
One area that Boards can make a difference is Primary Care.
We recommend you eliminate access inequalities (increase availability, acceptability, and decrease price barriers) to primary health care services in your DHB area.
This will require differential investment to promote equity of access, by strengthening the primary care providers whose focus is on the provision of care and improved access for people on low incomes, Māori, Pacific, refugees and those with chronic illnesses, including mental illness. These providers may be mainstream general practices, Maori, NGO, or publicly provided services.
In strengthening primary care provision in the Board’s area, support models of care that are responsive to and respectful of the diversity of the Board’s community. One size does not fit all, and a single organisation outside of the public sector, monopolising primary health care provision in the Board’s area is to be avoided.
The DHB can fund this by stopping the current leakage and underspend that for a number of years has been shifting the Board’s resources from the community and primary care to the Board’s provider arm and the hospital. See this report for the situation in your Board. (Analysis of District Health Board Performance to 30 June 2015, Published June 2016, The Treasury, New Zealand Government)
In addition, we recommend you act collectively with other Boards and the Minster to address the national funding mechanism (base capitation formula, Very Low Cost Access, Services to Improve Access) so practices have money available to subsidise fees for patients who currently are struggling to access services. The current capitation formula is not adjusted to meet the high needs found in deprived areas, those on low incomes irrespective of where they live, or amongst Maori and Pacific populations.
That right is being denied to many in Aotearoa/ New Zealand, through poor access to health services, an unfair economic and education system that strongly favours the wealthy over the poor, inadequate and unhealthy housing, poor living environments that alienate vulnerable sections of the community. We have not met our Treaty obligations.
We believe as a nation we can and must do better than this.
The UCAN Charter for Health 2017
Everyone’s right to the health care they need
Free primary medical care available in every community. One million people have an unmet need for primary medical care. The cost of care is the biggest barrier, including the cost of drugs. There is low availability of primary medical care services, particularly in deprived areas. Barriers are bigger for those with chronic conditions, especially mental illness. A primary health care approach with a focus on equity and social justice is required across the health system.
Everyone’s right to a living income
Support a living wage and income for all, including beneficiaries. The gap between the rich and the poor is rapidly growing in New Zealand and this is bad for our health. More and more New Zealanders in work don’t get paid enough to meet their needs, to eat healthy food, and live dignified and healthy lives. Just to survive, many are left with no time for leisure or opportunity to participate in society. In addition, poverty is health damaging reality for many beneficiaries, and especially for 28% of our children who live in poverty.
Everyone’s right to a home
Support affordable, safe and healthy housing. We are failing as a nation to adequately house our children and other vulnerable groups. They are exposed to housing conditions that damage their health and are not fit to live in. You need a Warrant of Fitness for a car, but not a house. People with severe mental illness are often living in substandard temporary housing with insecure tenure. They have been betrayed by a failed market model for housing provision.
Everyone’s right to take part in our society
Support community centres, drop in centres, with free internet connectivity and public transport. We are denying more and more groups the right to actively take part in our society. More people are working are working longer hours, leaving less time for involvement in their communities. We used to house people with severe mental illness in asylums. This role has shifted to the community, but the social contract that community support would be there, has been broken.
Everyone’s right to a safe environment
Support improved access to healthy food, water and air. Regulate and tax foods full of sugar, fat and salt. Ban advertising of unhealthy foods and alcohol. Protect our water and the air we breathe from contamination.. Exposure of children to foods that are harmful to their health, and unrestricted marketing of unhealthy products are now leading causes of later illness. Our water and the air we breathe needs to be protected from contamination, as does the physical environment from which they are generated.
Everyone’s right to education
Support accessible educational opportunities for all. Student loans, unequal and unfair outcomes for children from poor communities, reduced educational opportunities for the elderly and beneficiaries are all opportunities lost.
Questions and Answers
What does a “Right” mean?
An entitlement that humans have by the fact of being human, such as the right to life and the right to be free from torture or degrading treatment. The highest attainable standard of health is a fundamental right of every human being. Health is a reflection of a society’s commitment to equity and justice. Health and human rights should prevail over economic and political concerns.
Can the country afford free health care?
Improved access to primary health care will reduce inappropriate use of hospitals, and help to keep health care costs down overall. Healthier people in the community also has an economic benefit.
What is Primary Health Care?
The main ideas are; that health care is focused on health needs; involves an enduring personal relationship between health workers and the community, particularly for those people with a chronic illness; is comprehensive (not just one illness) continuous (no barriers for patients needing care in both hospitals and the community) and person centred; responsibility for the health of everyone in the community at all stages of life; tackles the determinants of ill-health; and people are partners in managing their own health and that of their community.
Primary Health Care is a social justice and pro equity approach to health care described in the World Health Organisation’s Alma Ata Declaration of 1978 and updated by WHO in 2008. It encompasses primary medical care, hospital care, public health and the wider determinants of health.
Can the country afford a Living Wage?
A living wage has been shown to improve the economy of a country. People are a country’s greatest asset, and our children are our future. Addressing child poverty through supporting a living wage and income is a wise investment in the future.
Can the country afford decent housing?
Housing is not a cost to the economy- it is an asset, an essential piece of infrastructure, as important, if not more so, as a road, or a bridge, or an airport. Once built it has a monetary value, outside of its contribution towards nurturing the next generation.
Can the country afford education that achieve fair outcomes for all?
Like housing, education increases rather than decreases, the overall wealth of the community. Barriers to educational opportunities do not make sense – at any age.
Does the country have enough money for this?
Many of these features will have low cost or even improve the economy. The country has enough wealth to provide for all its citizens if that is made a priority. Currently the country’s wealth is poorly distributed and the provision of basic rights for all citizens is a low priority. The economy has a profound influence on people’s health. Economic policies that prioritise equity, health and social well‐being can improve the health of the people as well as the economy.
Does the UCAN Charter cover all the important issues?
The UCAN charter covers the issues its supporters see as most important at this time. There are a number of other important issues (the right to education, the protection of the planet from global warming) that we support, but are the subject of action led by other groups.