Disabled People Recognised as an Equity Group in NZ’s Interim Health Plan, Te Pae Tata

By Rebecca Park, CCS Disability Action National Marketing, Communications & Fundraising Advisor. This article was published in our Summer 2023 newsletter, Reflections | Ngā whakaaroaro.

Despite making up a quarter of the population, disabled people in Aotearoa face discrimination around health and accessing health services. More than 40% of disabled people rated their health as poor in the 2020/2021 New Zealand Health Survey, compared to just 9% of non-disabled people. The inequities are even greater for disabled people from other minority groups, including Māori and Pacific people, who also live with other forms of marginalisation.

While not all disabled people have additional medical needs, there is a range of physical and attitudinal barriers that can prevent them from accessing good healthcare. This is an issue that the recently released interim health plan, Te Pae Tata, looks to address over the next two years as part of its five-year plan.

Te Pae Tata is designed to begin establishing the foundations of a healthcare system that is more unified, affordable, sustainable and better serves all New Zealand’s communities. In what is a historic move, the plan recognises disabled people as a priority group – the first time this has formally occurred in our health system.

A broken system

According to the New Zealand Health Survey, disabled people have notably higher unmet healthcare needs than non-disabled people across several indicators.

• 42% of disabled people had an unmet need for primary healthcare, vs 27% of non-disabled people.

• 11% had an unmet need for a GP as a result of the pandemic, vs 6% of non-disabled people.

• 51% had an unmet need for dental care owing to the expense, vs 39% of non-disabled people.

Covid-19 served to further exacerbate the disparities in access and quality of healthcare, with a survey from the Health Quality & Safety Commission finding that during levels 3 and 4 of Covid-19 restrictions, 60% of disabled people were not able to access the healthcare they needed, compared to 45% of non-disabled people.

Similarly, the report revealed that the fear of contracting the virus prevented almost a third of disabled people from seeking the care they normally would, while just 21% of non-disabled people were affected by the same concern.

Debbie Ward, National Disability Leadership Coordinator at CCS Disability Action, says that many disabled people fail to receive the care they need because too much emphasis is placed on their impairment and not enough on their holistic health.

Physical barriers, such as inaccessible treatment rooms, are another key concern.

“If you look at women's healthcare, for example, a lot of disabled women miss out on the opportunity to have those regular screenings like cervical screenings and breast mammograms,” she says.

“This can lead to disabled people passing away early due to late diagnosis or undiagnosed conditions that are unrelated to their impairment.”

Taking the first steps towards change

Disabled people have the same healthcare requirements at each stage of their lives as non-disabled people, but it’s clear that the current system is not working for everyone.

By recognising disabled people as a priority population, Te Whatu Ora in partnership with Te Aka Whai Ora, will work with Whaikaha the Ministry of Disabled people to lay the groundwork for reforms to create a more accessible and appropriate health system.

The disability community is calling for an intersectional approach to healthcare that sees, celebrates, listens to and treats disabled people with dignity. But to get there, we need to challenge our internalised ableism and the outmoded paradigms that underpin our current practices.

Te Pae Tata is built on the following core principles:

• The human rights model of disability

• Nothing about us without us (and Enabling Good Lives principles)

• Connected, holistic models of care

A key aspect of this action plan is supporting disabled people to lead the conversation by increasing disability leadership in the development of health services and implementing a data ecosystem to understand the inequities the community faces.

Yet while the framework appears promising, Debbie questions how it will be made a reality.

“Prioritising disabled people as an equity group means that we have to bring disabled people around the table,” she says. “But who’s going to be that voice? Will it be the disabled people themselves, those that work for service providers, or non-disabled people?”

“There are many non-disabled people that are great allies for the disabled community, but at the end of the day, they go home without an impairment, while disabled individuals live and breathe theirs.”

She also emphasises the need for those representatives to look past their own experiences, negative or otherwise and consider what will have the greatest benefit for the disability community.

Te Pae Tata is not the first attempt at making the health system more equitable, with historical efforts such as the introduction of disability advisory committees across regional DHBs proving ineffective. Nevertheless, there is hope that with the right accountability and follow-through, the more structured and unified approach laid out in this interim plan could be different.

But will Te Pae Tata lead to a real impact on the health of disabled New Zealanders? Only time will tell.