The 'Authoritative' View: Social Determinants of Health & MHA with excutive decision-making sovereignty

To expand on discussion from: The 'Authoritative' View: Māori Health Authority with executive decision-making sovereignty

Given the known impacts of social determinants of health (e.g., housing, access to education/employment, justice system, etc.), which contribute to rates of smoking and access to healthy diets among many other factors, how will an MHA with executive decision-making authority address these differently than the status quo?

Without wanting to sound negative: It likely won’t—although there is one way the MHA might be able to help. You’re absolutely correct that disparities in health are powerfully determined at a societal level, but one has to look a bit deeper.

Specifically, you need to think of non-communicable diseases as the product of flow of commodities: things like nicotine, salt, high-energy-density foods rich in simple sugars, and alcohol (and other drugs of abuse). Entire communities are dosed with rubbish.

What determines this flow? Three things:

  1. availability;
  2. price;
  3. advertising.

It is vanishingly unlikely that any intervention by health care professionals and their allies will substantially influence this flow, because we have almost no influence on bulk availability, price and even on advertising (apart from the gains we’ve made with nicotine, now being reversed by vaping). Take advertising: even with hundreds of millions of dollars intelligently deployed at ‘counter-advertising’, you’d still likely fail in the face of the billions that are spent.

There is however one thing we can do: point out the above, and advocate ceaselessly and powerfully to Control the Flow. Get the message into the grass roots, and rip up the astroturf that has already been put down by those making a profit from the vascular disease, kidney failure, heart failure, strokes, cancer, diabetes and death caused by vast volumes of these commodities.

You may also have more luck with our current government. They will likely listen; they may even act!

My 2c. Dr Jo.


Thanks @jvanschalkwyk , yes. And, a Māori Health Authority can advocate very strongly about this and all social determinants of health, as these elements are core to Mātatauranga Māori:

Thanks Emily if we are able to develop a true Whanau Ora outcomes based framework that focuses on wellness paradigm this would provide the foundation for success. There has already been some significant work done by Sharon Shea and her team with Balancedd Scorecard type activity and also MBIE with multi provider funder outcomes contracting. Just seemed to go all quiet on that front . Aligning the current concept of Allianz ing with outcomes based contracting within a locality based commissioning environment is a good start. Essential to success will be ensuring hospital services being a contracted service no different to all other services and completely separated from health funding governance

Tena koe @emily.gill .thanks for starting this korero. The opportunities will arise if a maori commissioning approach with a holistic outcome framework can be universally applied and marauded usefully to drive what matters to Whanau interventions. MSD and other Government enterprises must bring there $ associated with broader well being into the mix under a Whanau Ora framework. MBIE did some great work around collective multiparty Whanau Ora contracting back in 2012-2014. Whanau Ora collectives used a standardised Whanau Ora maori outcomes scorecard that accumulated outcome benefit at provider , regional and national level. With modern analytic software we can leverage this for targeted Whanau led interventions