Emerging needs,evolving services: The health of Pacific peoples in New Zealand

Abstract

From 0.1% of the total population in 1945 to 6.9% in 2006, Pacific peoples now resident in New Zealand highlight significant health policy and service delivery issues within an increasingly diverse society. Over the last decade, marked differences in the health status of Pacific New Zealanders and Palagi New Zealanders have been well documented, showing high levels of disparity and continuing negative trends. This paper provides a broad overview of the history of Pacific health and health initiatives in New Zealand from the 1940s through to the mid 2000s, highlighting the interface between Pacific peoples and the New Zealand health sector. While the New Zealand Government has become increasingly responsive to Pacific health needs, significant disparities remain between Pacific and Palagi populations. Furthermore, many of the encouraging health initiatives introduced in the past decade remain at risk due to a variety of factors, including a need to strengthen the Pacific health workforce and management expertise.     

GAUGING NEW ZEALAND'S SUCCESS AT POVERTY REDUCTION IN THE NEW MILLENIUM

This paper presents the results of the New Zealand Poverty Measurement Project's analysis of the effects of the 1990s social reforms in New Zealand on the incidence and severity of poverty, and assesses the impact of five social and economic policies introduced by the Labour‐led coalition governments since 1999: New Zealand superannuation, income‐related rents on state houses, active labour market policies for an employment‐rich economy, the Primary Health Care Strategy and the planned income support policy to reduce child poverty. Superannuation is assessed as both adequate and sustainable, rents for state houses are found to be affordable, and GDP growth and employment have increased incrementally as unemployment and benefit numbers have decreased. The Primary Health Care Strategy is an innovative initiative that will increase affordable access to general practitioners, but it and the proposed child assistance initiatives are too new to be adequately assessed. Of the challenges that remain, policy priorities should centre on housing alternatives, including home ownership for low‐income households not in state houses; income support for poor households, particularly those with children; and multi‐sector development of education and training aimed at lifting economic and social capacity.     

Hitting the target without missing the point: New Zealand’s immunisation health target for two year olds

ABSTRACT

The use of health targets as a form of performance measurement has become more prominent internationally as governments have sought to control public expenditure, produce greater efficiency and improve accountability. However, health targets have faced criticism for their potential to produce negative outcomes within a health system. This paper examines how a health target was used as a policy instrument within the New Zealand health system to improve immunisation coverage at two years of age. It explores how the immunisation health target was implemented within four case study sites and discusses the effectiveness of the health target as a policy instrument for improving immunisation coverage and addressing persistent immunisation inequities. Measuring and monitoring performance towards the immunisation health target improved accountability for immunisation coverage within the New Zealand health system and focused attention on improving immunisation coverage in a way that previous policy attempts had failed to do. Health targets may be an effective policy instrument for creating change within specific areas of a health system if their potential for dysfunctional consequences are taken into consideration at the outset.     

Transport related social exclusion in New Zealand: Evidence and challenges

Abstract

People without functional access to a car in countries where private vehicles are the predominant form of transport are at a disadvantage. Alternative modes of travel in such settings often do not meet people's mobility needs, creating barriers to participation in work, education, social activities, sport and leisure, and to accessing basic goods and services. In New Zealand, private vehicles have long been prioritised as the mode of personal transport in land transport planning policy. However, this is beginning to change with policy objectives now including improvement of access and mobility for all, and reduction of social exclusion. Despite this there is very little evidence of the experiences of those with mobility or access problems in New Zealand. This article seeks to provide qualitative data about experiences of transport related social exclusion, the efficacy of alternative modes for people's mobility needs, the impacts of these difficulties on people's lives, and the policy implications of these findings.     

The proximity filter: the effect of distance on media coverage of the Christchurch mosque attacks

ABSTRACT

The intense media coverage in New Zealand and Australia of the Christchurch mosque attacks exhibited significant disparity in editorial decision-making between the two countries. This research interrogates the different approaches taken in newsrooms and how these differences were manifested in broadcasts and publications. New Zealand media were focused largely on empathetic coverage of victims and resisted the alleged gunman's attempts to publicise his cause while their Australian counterparts showed no such reluctance and ran extended coverage of the alleged perpetrator, along with material ruled objectionable in New Zealand. It finds the editorial focus in each case exhibits the effect of proximity, identified in literature on empirical ethical decision-making as a factor in applied ethicality. The authors conclude that a proximity filter was used by New Zealand media who identified the victims as part of their own community, but the events of 15 March 2019 were seen as ‘foreign’ by Australian journalists who used perceived distance as justification for extremely graphic content.     

Complex home care: challenges arising from the blurring of boundaries between family and professional care

Over the last 50 years, increasingly complex care (such as tracheostomy management, dialysis or enteral feeding) has shifted from hospital to home, with a concomitant rise in patient self-management and care given by family members. Recognition of the importance of the contribution of family care to the health system is also growing. This article reports the findings of a New Zealand study which explored the experiences of family carers who manage technical health procedures at home. It then draws attention to some broader issues raised by shifting complex care from professional management in hospital settings to family care at home, namely the ways in which complex home care blurs the boundaries between professional and family care (creating the ambiguous position of the expert carer) and questions of safety and responsibility in family care. We also discuss the implications for policy around family caregiving in New Zealand. Given the potential physical and mental health impacts of caring, it is time for renewed consideration of what family carers should be expected or allowed to manage and how the health system can support them in their important role.     

What kind of country we want for our children: an analysis of media coverage of the 2017 New Zealand General Election

ABSTRACT

This article is the third in a series investigating media reporting of New Zealand elections. Based on content analysis of 510 articles published in the New Zealand Herald, and thematic analysis of a subset of news stories related to young people, the study examines media coverage of the 2017 elections by looking at the topics of news stories, presence of party policies, diversity of sources and references to social groups. Comparing the 2017 results with the results of the Herald’s coverage of 2014 elections, we register a shift towards a stronger presence of policy issues, more female voices in the reports and significantly higher reference to young people. We further investigated the high number of references to young people by conducting qualitative analysis on the subset of articles mentioning young people.     

‘The confidence to know I can survive’: resilience and recovery in post-quake Christchurch

This paper explores the relevance of terms such as resilience and recovery when analysing earthquake stories recorded for the Women's Voices/Ngā Reo o Ngā Wahine Project after the sequence of earthquakes and aftershocks in Christchurch, New Zealand's second-largest city, in 2010–2011. While the media focused on stories of victims, the heroic work of rescue teams, policy, army and firefighters, or the deliberations of national and local politicians, the National Council of Women of New Zealand wanted to ensure that women's everyday quake experiences were recorded for posterity. The outcome was an oral history project that documented the stories of women all over the city, both beneficiaries of earthquake support and those active in assisting others. Their narratives illustrate how resilience in the face of natural hazard events, such as this earthquake sequence, requires effort, ingenuity and imagination, but also the activation of multiple actor networks and relevant technologies. These ‘insider stories’ also highlight the ways in which expectations of ‘resilience’ can obscure vulnerability after natural hazard events and the complex and uneven processes associated with ‘recovery’. The relevance of critical reflections on discourses of resilience is explored through attention to the stories of specific women.     

The housing fulcrum: Balancing economic and social factors in housing research and policy

Abstract

We discuss the pivotal role that housing plays for both social and economic outcomes. All people need to be housed, and housing circumstances help determine social outcomes, especially for vulnerable groups. We outline an analytical framework that treats housing as a dynamic system, incorporating the life‐cycles of both individuals/households and houses. Each is long‐lived; decisions impact on housing for decades. This approach is relevant to the development of housing research and housing policy. We illustrate the issues with reference to the relationship between rental yields and measures of deprivation across New Zealand. The surprising nature of this relationship has consequences regarding potential poverty traps and wealth disparities. While highlighting an important housing market issue, any policy response to this issue is complicated by the need to take account of the life‐cycles of both individuals and of houses, and by the long‐lasting impacts of decisions.     

Cars,carbon, and Kyoto: Evaluating an emission charge and other policy instruments as incentives for a transition to hybrid cars in New Zealand

Abstract

Transition to hybrid petrol/electric vehicles (HEVs) is one means among many of reducing carbon emissions pursuant to the New Zealand emissions reduction targets under the Kyoto Protocol. The potential financial incentive value of an emissions charge was evaluated by comparing purchase and running costs of an HEV with an equivalent petrol‐fuelled car. Had a carbon tax of $15/tonne CO₂ operated in January 2006, the net fuel efficiency saving on the basis of the emissions charge and the inbuilt fuel efficiency of the HEV amounted to $655.50 annually for an HEV. When compared with a $7000 purchase price differential in favour of petrol‐fuelled vehicles, it can be concluded the proposed carbon tax would not have provided a sufficient incentive to bring about any significant change in the distribution of HEVs across the market. Shifting the norm to a higher proportion of fuel‐efficient cars will therefore require other incentives and/or policy mechanisms. We explore alternative policy options for bringing about such a shift, including the option of a tradable vehicle emission permit system.     

Beyond New Zealand's Dual Health Reforms

The New Zealand health system was substantially reformed in 1993 with the introduction of a purchaser–provider split, competitive contracting and managerialism. The new system failed to deliver the desired gains and, in 1996, the reforms were "reformed". While there has been widespread study of the 1993 reforms, there has been little discussion to date of the 1996 changes and the emerging directions for New Zealand health policy and service delivery, which remain unclear. This paper discusses the New Zealand health reforms of the 1990s. It briefly outlines the 1993 reforms and their results. Next, it details the 1996 "reforms". Third, it discusses developments since 1996, some of which have emerged out of the 1993 reforms, but which have gathered momentum only since the 1996 changes were announced. In the conclusion, the paper lists some of the directions in which the New Zealand health sector appears to be heading, noting that there is a need for coordination of the sector, and for permanence.     

The Impact of New Labour Health Policy on Social Services: A New Deal for Service Users' Health?

Summary The health policies of the Labour Government of 1997–2001included an increased emphasis on social services departments'(SSDs) contribution to promoting health. Three dimensions ofthis policy shift are discussed: first, the drive towards organisationalfusion between elements of the NHS and SSDs; second, the newmechanisms for conjoint funding of health and social services;and, finally, the new policy focus on tackling health inequalitiesby combating social inequalities on a national and localitybasis. In each case, the touchstone of our analysis is the consequencesfor the health and well-being of SSD service users as membersof socially disadvantaged groups. We conclude that New Labourhas taken some steps, particularly reducing child poverty, whichwill have long lasting health and social benefits for actualand potential service users. However, inadequate funding ofSSDs undermines their effectiveness as a partner in integratedhealth and social care. As signalled by service user initiatives,SSDs potential for promoting more equal chances of health andwell-being in ill-health will also not be realised without substantialchanges to current SSD policy and practice.     

Changing policy,changing attitudes? Public opinion on employment relations in New Zealand, 1990–2008

Abstract

Did significant policy shifts in employment relations in the 1990s lead to equally large changes in the attitudes of New Zealanders towards employment relations? Have policy modifications made since 1999 further shaped public perceptions? This paper explores the role of policy feedback in influencing public opinion towards employers and unions and towards government responsibility for jobs and wages. Using data from New Zealand public opinion surveys, most notably the New Zealand Election Study (1990–2008), the paper finds some evidence that policy feedback has occurred in the employment relations arena, but the impact is not as strong or consistent as we might expect. As such, New Zealanders do not completely endorse the ‘there is no alternative’ arguments of neoliberalism, but they do not have an overwhelming desire to return to Keynesian demand-management employment policies.     

Identifying health inequalities between Māori and non‐Māori using mortality tables

Abstract

While there is a need for more detailed information on health inequality to guide public health policy, the most complete and easily available data remain those in mortality tables. We investigate, via a comparative analysis of data from New Zealand on Māori and non‐Māori mortality, whether more detailed information than raw life expectancy may be extracted from the mortality tables. Given a parametric distribution for the mortality capable of fitting irregularities in mortality table data, the curvature of the survival and hazard rates can identify changes in mortality rates, such as infant and late‐life adult mortality, which allows for straightforward comparisons between the two sub‐populations. Our results identify an exogenous effect in earlier mortality among Maori, which correlates well with many published observations of health and health‐care inequalities between Māori and non‐Māori. This “proof of concept” for our method of analysis indicates that examination of bulk data such as those in mortality tables has a potential role in the design of more detailed studies involving causes of mortality.     

Targeting Social Expenditure in New Zealand: An Evaluation of the Current Policy Regime

This paper provides a brief account of how social expenditure in New Zealand has been targeted (i.e. means-tested) since the late nineteenth century, outlines the policy framework at the dawn of the new millennium, and assesses the strengths and weaknesses of the current targeting regime. It is argued that the existing policy settings are open to challenge on a number of counts. In particular, they are complex, inconsistent and relatively intrusive, they impose significant administrative and compliance costs, and they generate considerable incentive problems. Nor has the greater reliance on targeting since the mid-1980s prevented an increase in relative poverty and inequality. Given this situation, the paper outlines some possible reforms.     

Rising food security concerns among New Zealand adolescents and association with health and wellbeing

The current paper explores recent changes in food insecurity among adolescents and determine if food security concerns are associated with poorer wellbeing. Data were collected as part of two nationally representative surveys of the health and wellbeing of high-school students in New Zealand in 2007 and 2012. In 2012, 11% of young people reported food security concerns often or always, with 33% reporting food security concerns occasionally/sometimes. The prevalence of food security concerns at both frequencies increased significantly from 2007 (8% and 28%, respectively). Young people with food security concerns were more likely to report poor indicators of health and wellbeing, including truancy, poor general health, mental health concerns and obesity. Our findings highlight the growing concerns of food insecurity reported by adolescents in New Zealand. Interventions that address food security for families may provide a tangible means of promoting the healthy development of children and young people.     

Renting in New Zealand: perspectives from tenant advocates

Currently, around a third of New Zealand’s households, and half its population live in rental accommodation. The proportion of tenant households is growing. Tenant advocates, who are a first port of call for tenants experiencing difficulties in their housing situation, can provide unique insight into the experience of renting in New Zealand. This article presents key themes generated from semi-structured interviews with tenant advocates. Tenants are confronted with issues of poor housing quality, insecure housing, high rents relative to income, lack of autonomy, and difficulty asserting their legislative rights. These aspects of renting in New Zealand are likely to have adverse effects on health. Tenant advocates play an important role in supporting tenants to better housing. Their knowledge of the relationship between a landlord and tenant, particularly in times of trouble, means they can provide unique perspectives on policy solutions.     

Child Support: The Limits of Social Policy Based on Assumptions of Knavery Extending the Pillars of Social Policy Financing to Aged Care

Julian Le Grand has argued that a key component of welfare reform involves changes in the assumptions about human behaviour which are embedded in social policies. Policy assumptions have been transformed from espousing a belief that social service providers act as well-intentioned knights and recipients as passive pawns, to a stance in which all participants are regarded as self-seeking knaves. These ideas are particularly pertinent to policy developments concerning financial obligations for children, and this paper examines these issues in relation to child support policy in New Zealand. It highlights the evident and inevitable failure of this policy to meet its primary stated aim of revenue generation. In New Zealand this failure is compounded by the creation of parallel systems for dealing with children and families, one for financial obligations and the other for care and development, which are founded on diametrically opposed assumptions about human behaviour and capabilities. This confusion is symptomatic of a wider failure in government policy towards families in New Zealand.     

Child Poverty and Ecological Contexts of Deprivation and Well‐being: A Critical Review of Budgeting and Social Policy in India

In the context of global developments in the measurement of child poverty, this article critiques the limited success of the Indian government to develop a comprehensive social policy approach to address multi‐faceted deprivation suffered by Indian children. Since independence in 1947, Indian governments have focused on childhood deprivation through various programmes to improve food security, education and health. However, these programmes have functioned in siloes without any linkages to each other, along with poor budgetary commitment which has resulted in sub‐optimal policy outcomes. Based on the theoretical approaches of Amartya Sen's capability approach and Townsend's consensual approach to poverty measurement, this article highlights the intrinsic importance of child well‐being to society. To achieve its objectives, the article is organized into four main parts. First, the article provides an overview of Indian children's deprivation and poverty, and the policy approach. Second, it provides conceptual advancements globally on the measurement of child poverty and deprivation. Third, it highlights the importance of utilizing these indicators to measure child poverty in the Indian context. Fourth, it concludes with a critical analysis of children's budgets and social policy in India to highlight that the Indian government's approach towards child well‐being is not only conceptually flawed, but that its commitment is extremely poor.     

The influence of ideational contests of social policy on government welfare efforts

There has been limited empirical research on the interaction between media influence and governments' decision-making in the social policy field. Drawing on a wider study of the ideation of poverty in South Korea, this research tests if policy ideas represented in the media have bottom-up framing effects on policymaking and can be a reliable indicator of the government's social policy efforts. This study analysed the editorials of major Korean daily newspapers, over the period of a decade from 2000 to 2009. The analysis outcomes identified a significant correlation between the extent of poverty discussions in the media and government welfare spending.