We need more honesty in debate on health equity
AT THE forthcoming equality conference on 4 July, Dr Nikki Brink, director of public health, will be hosting a workshop entitled Health Equality or Health Equity, which will explore the current practice in providing equal access to health care for all. A subject that will shortly be very topical as our politicians wrestle with the implication of the review into drugs, treatments and devices, soon to be published by the Committee for Health & Social Care for debate in the States in July.
So what is the difference between health equality and health equity?
Equity and equality are two strategies used in an effort to produce fairness. Equity is giving everyone what they need to be successful. Equality is treating everyone the same. Equality aims to promote fairness, but it can only work if everyone starts from the same place and needs the same help. The conundrum for a health service is that no one starts from the same place or has the same health needs, meaning equality of service is almost impossible to achieve.
Health equity means giving or getting the health treatment needed to achieve the best possible outcome for each individual. That of course means treating people differently. This is the fundamental problem for our health committee.
HSC sidesteps this fatal flaw in its health policy by declaring its belief in an ‘ethical system for decision making’. A decision-making policy full of principles, criteria, process and mechanisms encapsulated in a turgid document named G1033. A system that ultimately treats everyone at the same basic level, a system that cannot react to individual needs or respond in a timely manner when the situation requires or justifies another health solution available and in normal use in other jurisdictions.
Our health service isn’t failing, the people in it are doing some amazing things, but it is being failed by years of underfunding and poor pay and we are being failed by process and policy. A policy that focuses on inputs rather than outcomes, leaving people in pain, preventing them from working and excluding them from social activities. It rations health care, creating competition between vulnerable groups. It disables and excludes people.
The answer will be tough to swallow for many of us and will be played out when the drug and treatment review is published in the coming weeks. Some real honesty and leadership will be required by our senior politicians to tackle the huge expenditure issues facing health, education, and employment and social security. Savings, cuts and efficiencies are not enough any more; robbing Peter to pay Paul or kicking the can down the road will not solve this. It is time to introduce a GST or raise income tax, the question is by how much?
MIKE READ
Vue de l’Eglise,
Forest.