Collecting accurate data is especially important if child health research is to address the unmet needs of children. Durable areas of unmet need have been identified by comparing populations in public health surveys (Hodgson, 2007). Along side the items that make up population survey questionnaires are associated determinants and with these a history that can provide a context with which to understand how differing perspectives of child health may be understood in order to provide new meaning to child health, and with this new strategies to improve health and reduce inequalities.
The health of the tamariki Māori like that of most indigenous children is poor in comparison with in-country contemporaries as illustrated in New Zealand by survey data such as the Child Nutrition Study (2003) and routine administrative health data (Parnell, Scragg, Wilson, Schaaf, & Fitzgerald, 2003). The Ministry of Health’s analysis of survey data and routine administrative data (Ministry of Health, 1999a) has supported the observations of researchers (Pomare, 1980; Pomare & de Boer, 1988; de Boer, Saxby, & Soljak, 1990; Pomare, Keefe-Ormsby, Ormsby ,Pearce, Reid, Robson, & Watene-Haydon, 1995) and District Health Boards (MidCentral District Health Board, 2005; Mitchell & Thompson, 2001) that durable health inequalities and disparities are experienced by Māori and Pacific children.
Influencing this health data are social, cultural and economic factors (Sen, 1998) or health determinants as described by the National Health Committee (NHC) in the first section of their 1998 report (National Advisory Committee on Health and Disability, 1998). The NHC observed there was “now good evidence that social, cultural and economic factors are the most important determinants of good health” (National Advisory Committee on Health and Disability, 1998) — a relationship exists between these determinants and health. Health determinants and their association with health have their genesis in the disciplines of economics and social sciences (Berkman & Kawachi, 2000). The use of social epidemiology and
economic theory provides a number of perspectives and tools with which the researcher and policy maker can explore economic and social data, and where appropriate undertake an analysis of indicators relevant to the health of the population.
The health status of New Zealand children compares unfavourably with many other OECD countries (Hodgson, 2007). Within the child population (under 17 years) there are major health inequalities and disparities between Māori and Pacific children, and children from low-income families compared to other ethnic groups. The Child Health Strategy (CHS) was set in place in 1998 because New Zealand had relatively high infant death and youth suicide rates, child immunisation
coverage statistics were static or decreasing, levels of hospitalisation for asthma and respiratory problems were unacceptably high, and unintentional injury and
poisoning rates were high (Ministry of Health, 1998b). The criteria that set the CHS in place have remained durable and so have the inequalities (Ministry of Health, 2003a: p. 1).
Child Health in Government and Non-government
The Government’s influence on the needs of children is reflected in the structure of government, external pressures and changes made by government in the health sector. This section describes the relationship between selected parts of government that have an interest in child health and well being. The external pressures on government, taking a rights-based approach follow later (see p. 23). A discussion of the impact of the last two decades of health reform follows and leads into a
description of Māori models of health (see p. 47) after a discussion of health determinants (see p. 32).
Many organisations take responsibility for maintaining the health of children in New Zealand and for promoting child health priorities. The health sector is complex though the body responsible for health policy and health funding for child health is the Ministry of Health (MoH). In addition the office of the Children’s
Commissioner and a number of other ministries have an explicit interest in the health and wellbeing of children, including the Ministry of Social Development
(MSD), the Ministry of Youth Affairs (MYA) and The Ministry of Māori Development Te Puni Kōkiri (TPK). Outside government a number of non-
Government organisations (NGO) have specific interests in children including Save the Children, Banardoes, United Nations International Children’s Emergency Fund
(UNICEF), and CORSO. All NGOs listed here are also members of an umbrella organisation, Action for Children and Youth Aotearoa-New Zealand (AYCA). AYCA is a coordinating body who provided a report to the United Nations
Committee on the Rights of The Child (UNCRC) in 2005. It provides a critical perspective on the status of New Zealand children including their health and access to child-related services (Action for Children and Youth Aotearoa, 2005). AYCA is in the process of preparing a new report for the meeting of the UNCRC in 2010.
Legislation and Monitoring Child Health
Guided by several acts and policies including the Public Health and Disability Act 2000 (Minister of Health, 2001b), the CHS (Ministry of Health, 1998b) and the New Zealand Public Health Strategy (Minister of Health, 2000), the Minister of Health is required to report annually on progress in implementing the New Zealand Health Strategy (NZHS). Implementing the New Zealand Health Strategy 2001 was the first progress report (Minister of Health, 2001b) and annual reports, in modified form, have followed (Minister of Health, 2002, 2003, 2004b, 2005, 2006).
For the past eight years the New Zealand Health Strategy (Minister of Health, 2000) has provided the framework within which the health sector is expected to develop short to medium term goals guided by milestones that inform the purchasing agreements with District Health Boards (DHB). The NZHS has also given rise to a number of supporting strategies and action plans have been updated regularly to ensure aims are achieved (Minister of Health, 2007). A comprehensive overview of the health sector, including health sector statistics, is presented annually in the Ministry’s key accountability document by the Director-General of Health, the Director-General of Health’s Annual Report on the State of Public Health (The Annual Report) (Minister of Health, 2001b, 2002, 2003, 2004a, 2004b, 2005, 2006). Prior to 2006, the Annual Report included detailed information on the Ministry’s roles and functions and outlined progress towards the Ministry outcomes identified in its 2004/05 Statement of Intent (Hodgson, 2007). The Annual Reports produced after 2005 also included an analysis of the MoH’s financial and non-financial performance for the year in The Health and Independence Report. The purpose of the Annual Report is to draw together information from across the health and disability sector to map the ministry’s progress towards outcomes.
The NZHS has been in place since 1999, but DHBs, the principle agents of the MoH which identify and fund many of the priorities of the NZHS were not enabled until 2001. Therefore implementing the NZHS has required the staged introduction of
ongoing initiatives that predate NZHS. The inclusion of established initiatives has influenced the direction set by the NZHS, The Child Health Strategy for example (Ministry of Health, 1998b).
The New Zealand Public Health and Disability Act (2000) outlines the responsibilities of DHBs and the health sector in relation to Māori. These
responsibilities reflect the Government’s overall goals for Māori under the Treaty of Waitangi. The Act has established a range of measures to further the Government’s desire for greater participation by Māori in the health and disability sector, with a view to improving Māori health outcomes and reducing health disparities between Māori and other population groups (Hodgson, 2007). The Minister of Health expects the Ministry of Health and DHBs to act in accordance with these requirements. Central to Government policy on child health is the CHS that was formulated by the Ministry of Health in 1998 under the direction of a former Minister of Health, Bill English.