My View: Partnering for equitable gains

eHealthNews.nz: Sector

Monday, 31 October 2022

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VIEW - Kevin Ross, chief executive, Precision Driven Health

Kevin Ross Aotearoa New Zealand’s people stand to benefit greatly from advances in digital health technology. Preventing disease, managing chronic conditions and reducing healthcare costs are ubiquitous goals, and all of these can be progressed through digital technology.

Unfortunately, technology has a habit of benefiting those who already experience the best outcomes more than those with comparatively worse outcomes. Because of this, technology needs to be designed and deployed with equity as an explicit goal rather than a hopeful by-product.

One of the principles that’s underpinned all of the conversations around the health sector reforms is the goal of creating a more equitable system. The aspiration is to achieve health equity, reaching what the World Health Organisation (WHO) describes as the point “when everyone can attain their full potential for health and well-being.”

In New Zealand, there’s much work to be done to close the persistent gap in health equity between Māori and non-Māori. There has been some progress, and the formation of Te Aka Whai Ora - The Māori Health Authority has brought this goal into a much clearer focus.

But the inequities in Māori health outcomes are clear. Life expectancy for Māori remains significantly lower than that of non-Māori though, and overall mortality rates are higher for Māori than for non-Māori in nearly all age groups across a very high proportion of conditions.

In short, we have a lot more work to do if we’re to achieve health equity for Māori and for all New Zealanders. Central to this effort is ensuring that equity is front-of-mind when developing new health technologies and techniques.

The strength of partnerships
Strong partnerships bring organisations and people together, leveraging their collective experiences and backgrounds to create solutions to problems. Precision Driven Health (PDH) is one such partnership that is greater than the sum of its parts, with a goal of improving health outcomes through data science.

Partnering with Māori has been an increasing focus for PDH, recognising both our role as a Te Tiriti o Waitangi (Treaty of Waitangi) partner, and the inequities that Māori have experienced through New Zealand’s health and disability models of care. Through our work, we aim to help lessen these gaps until they eventually disappear.

To achieve equity improvements, health data research requires deliberate engagement with populations with poorer health outcomes, and PDH has focused on projects and developing capability that takes into account current and historical bias.

Our partnership, which has supported over 300 researchers on more than 100 research projects involving over 45 organisations, is focused on creating equitable solutions through our mahi.

The only way to do this is together. In his role as PDH’s Māori Health Director, Chad Paraone has noted in PDH’s soon-to-be-released Partnership Report: “Just like in any research, if you want to make sure that this works for a particular group, you have to involve that group. As the saying goes - ‘Nothing about us, without us.’”

What we’ve learned
Since we formed the PDH partnership in 2016, our approach has evolved to learn to listen more, and earlier.

The idea of ‘nothing about us, without us’ can move us from paternalistic perspectives to partnering to supporting. If we’re focusing on health outcomes for Māori, it’s vital that Māori are navigating the way towards this. We have adapted our model around this through the course of our partnership. We’ve also found that partnering allows other researchers to learn to acknowledge and see things through a Te Ao Māori lens.

Developing capability is key. There’s a shortage of Māori data scientists coming through our training and education system. The need to invest in pathways to identify talent and develop the skills needed to meet the rising demand for including Māori perspectives in health projects must be prioritised.

Partnership in action
The journey towards health equity will require many steps and a sharp focus on ensuring technology reduces inequity.

Some of the steps PDH has taken feature in Te Pū Waiora, a series of case studies reflecting Māori leadership and engagement in health data science. These shine a light on efforts like those of Auckland-based start-up Kāhu - a spinoff of MoleMap, a chain of clinics across Australia and New Zealand – partnering with PDH to build tools based on MoleMap’s initial research on skin lesions.

This project applies new techniques in data science to advance Māori health outcomes, with Kāhu highly prioritising working with Māori communities - such as partnering with Te Hau Ora O Ngāpuhi to provide free skin checks in Kaikohe. This will help further optimise their AI algorithm.

PDH has also supported Te Whānau o Waipareira and its subsidiary, Whānau Tahi, to develop an appropriate artificial intelligence (AI) solution to predict priority outcomes for new and existing whānau, and the best courses of action to achieve these, based on past experiences of whānau.

A PDH-supported research project co-designed by Te Hiku Hauora (Te Tai Tokerau’s most comprehensive health service provider), Te Whatu Ora - Waitematā, Orion Health and the University of Auckland also seeks to understand how patients engage and interact with existing and new technologies and tools. A pilot solution will be trialled in 2023 for patients identified by their doctor as pre-diabetic.

These are just some of the small steps the PDH partnership has taken. The road to health equity will be long, but the effort must not falter if we are to reach our goal. Māori are not the only disadvantaged group in Aotearoa, but they hold a sacred place as tangata whenua. Health equity for Māori will benefit us all and achieving this should be a collective goal that evokes our national pride.