title: The spatial equity and sustainability of general practitioner services: A mixed methods analysis of the Waikato DHB region

authors: Whitehead, Jesse

subjects: spatial equity

abstract: The New Zealand Primary Health Care Strategy states that quality primary health care is the first level of contact with the health system and should be universally accessible. Effective primary health care is an essential component of health systems, and is associated with more equitable distributions of health outcomes. However, not all New Zealanders have ready access to primary health care. For instance, adult residents of the Waikato region, and in particular Māori, have higher levels of unmet need for primay care than others. Improving the spatial equity of health services is a key step in achieving health equity. Health systems should contribute to achieving health equity and maintaining sustainable and equitable services into the future. 

This thesis research examines the spatial equity and sustainability of general practitioner (GP) services in the Waikato DHB region, using a mixed-methods approach to identify not only where inequities exist, but why they occur. A conceptual framework establishes a foundation for examining spatial equity and sustainability in New Zealand. Next, a systematic literature review identifies common definitions and measures of spatial equity. Primary Health Organisation (PHO) enrolment data is used to examine patterns of patient enrolment at GP services, and a range of health needs indicators were assessed for their suitability in the New Zealand primary care context. These findings inform the development of a Geographic Information Systems (GIS) model of spatial accessibility that is tailored to the Waikato District Health Board (DHB) context. The GIS model is then used, in combination with in-depth qualitative interviews, to examine the spatial equity and sustainability of GP services in the Waikato DHB region. 

Key findings include that spatial equity is commonly defined as a ‘need-based distribution of resources’, which can be quantified using a range of statistical and geospatial measures and techniques. PHO enrolment analysis revealed that most patients do not enrol with their closest service, and that the size of the ‘catchment area’ served by GP clinics varies with rurality. Analysis of indicators of health need suggest that ‘Ambulatory Sensitive Hospitalisations’ are a robust indicator; however, area-level socioeconomic deprivation is also strongly associated with other indicators of need and data is more widely available to researchers. Mixed-methods analysis suggests that GP services are not distributed equitably within the Waikato DHB region and that key barriers to access include the affordability, appropriateness, and availability of services. New Zealand’s history of colonisation and discrimination are identified as fundamental drivers of health inequity. Furthermore, population growth and ageing suggest that current levels of access to GP services are unlikely to be maintained in the future, while participants identify key economic, professional, organisation, and social dimensions that influence service sustainability in New Zealand.

text: The spatial equity and sustainability of general practitioner services: A mixed methods analysis of the Waikato DHB region The New Zealand Primary Health Care Strategy states that quality primary health care is the first level of contact with the health system and should be universally accessible. Effective primary health care is an essential component of health systems, and is associated with more equitable distributions of health outcomes. However, not all New Zealanders have ready access to primary health care. For instance, adult residents of the Waikato region, and in particular Māori, have higher levels of unmet need for primay care than others. Improving the spatial equity of health services is a key step in achieving health equity. Health systems should contribute to achieving health equity and maintaining sustainable and equitable services into the future. 

This thesis research examines the spatial equity and sustainability of general practitioner (GP) services in the Waikato DHB region, using a mixed-methods approach to identify not only where inequities exist, but why they occur. A conceptual framework establishes a foundation for examining spatial equity and sustainability in New Zealand. Next, a systematic literature review identifies common definitions and measures of spatial equity. Primary Health Organisation (PHO) enrolment data is used to examine patterns of patient enrolment at GP services, and a range of health needs indicators were assessed for their suitability in the New Zealand primary care context. These findings inform the development of a Geographic Information Systems (GIS) model of spatial accessibility that is tailored to the Waikato District Health Board (DHB) context. The GIS model is then used, in combination with in-depth qualitative interviews, to examine the spatial equity and sustainability of GP services in the Waikato DHB region. 

Key findings include that spatial equity is commonly defined as a ‘need-based distribution of resources’, which can be quantified using a range of statistical and geospatial measures and techniques. PHO enrolment analysis revealed that most patients do not enrol with their closest service, and that the size of the ‘catchment area’ served by GP clinics varies with rurality. Analysis of indicators of health need suggest that ‘Ambulatory Sensitive Hospitalisations’ are a robust indicator; however, area-level socioeconomic deprivation is also strongly associated with other indicators of need and data is more widely available to researchers. Mixed-methods analysis suggests that GP services are not distributed equitably within the Waikato DHB region and that key barriers to access include the affordability, appropriateness, and availability of services. New Zealand’s history of colonisation and discrimination are identified as fundamental drivers of health inequity. Furthermore, population growth and ageing suggest that current levels of access to GP services are unlikely to be maintained in the future, while participants identify key economic, professional, organisation, and social dimensions that influence service sustainability in New Zealand.

year: 2020

title: Providing space for indigenous knowledge

authors: Tangihaere, Tracey Mininoa

subjects: indigenous knowledge

abstract: Colonial influences have generally failed to respect indigenous knowledge, languages, and cultures. Determination to reclaim First Nations identity is visible in many jurisdictions. First Nations Peoples continue to call on governments to facilitate changes needed to revitalize their economic, social, cultural, and spiritual well-being. This article is a reflective article generated from our response to the situation of Mäori, the indigenous peoples of New Zealand. It provides a background on the historical attempts to weaken Mäori leadership and the resilience of Mäori in their resistance to such undermining. Using a description of a physical space, the Marae (the meetinghouse), the authors provide a glimpse into a distinctive Mäori psychology connected to Marae encounters and into Mäori ways of thinking, feeling, and behaving. Three examples of organizational practice at the incorporation of such values are provided. Four implications for management education are posited as relevant not only to the education of managers in Aotearoa but wherever engagement with indigenous people occurs.

text: Providing space for indigenous knowledge Colonial influences have generally failed to respect indigenous knowledge, languages, and cultures. Determination to reclaim First Nations identity is visible in many jurisdictions. First Nations Peoples continue to call on governments to facilitate changes needed to revitalize their economic, social, cultural, and spiritual well-being. This article is a reflective article generated from our response to the situation of Mäori, the indigenous peoples of New Zealand. It provides a background on the historical attempts to weaken Mäori leadership and the resilience of Mäori in their resistance to such undermining. Using a description of a physical space, the Marae (the meetinghouse), the authors provide a glimpse into a distinctive Mäori psychology connected to Marae encounters and into Mäori ways of thinking, feeling, and behaving. Three examples of organizational practice at the incorporation of such values are provided. Four implications for management education are posited as relevant not only to the education of managers in Aotearoa but wherever engagement with indigenous people occurs.

year: 2011

title: Crown and country: Negotiating the one space

authors: Kitson, Greg

abstract: The concept of ‘Country’ is central to Aboriginal culture and has sustained the Quandamooka Peoples (the Quandamooka) of South East Queensland (SEQ) for 40,000 years. On 4 July 2011, the Federal Court of Australia determined that 54,500ha of exclusive and non-exclusive Native Title rights over land and waters, occupied continuously and managed sustainably by the Quandamooka Peoples, be legally vested in these Peoples. This formal recognition, of tenure under Australian law, marked an important milestone for the Quandamooka, and offered the opportunity to re-assert Quandamooka lore, customs, culture and sovereignty, over these lands and water, which are pillars to the concept of ‘Country’. Today, two Indigenous Land Use Agreements (ILUAs) operate in Quandamooka lands and waters, assisting parties to negotiate future actions through a complex multi-layered planning system, all of which affect ‘Country’. Achieving these outcomes may require the incorporation of ‘Country’, as a traditional planning framework, into this Eurocentric planning system. Thus, embedding Quandamooka recognised title rights and interests into conventional local land use planning frameworks to align and maximise land use planning outcomes that benefits the local community, particularly Traditional Owner groups. In a narrative summary, this paper examines and reviews the major land title transitions of Quandamooka ‘Country’ and identifies a possible role that ‘Country’ can play in innovating a new way of addressing Indigenous values of ‘Country’ in the Australian planning system.

text: Crown and country: Negotiating the one space The concept of ‘Country’ is central to Aboriginal culture and has sustained the Quandamooka Peoples (the Quandamooka) of South East Queensland (SEQ) for 40,000 years. On 4 July 2011, the Federal Court of Australia determined that 54,500ha of exclusive and non-exclusive Native Title rights over land and waters, occupied continuously and managed sustainably by the Quandamooka Peoples, be legally vested in these Peoples. This formal recognition, of tenure under Australian law, marked an important milestone for the Quandamooka, and offered the opportunity to re-assert Quandamooka lore, customs, culture and sovereignty, over these lands and water, which are pillars to the concept of ‘Country’. Today, two Indigenous Land Use Agreements (ILUAs) operate in Quandamooka lands and waters, assisting parties to negotiate future actions through a complex multi-layered planning system, all of which affect ‘Country’. Achieving these outcomes may require the incorporation of ‘Country’, as a traditional planning framework, into this Eurocentric planning system. Thus, embedding Quandamooka recognised title rights and interests into conventional local land use planning frameworks to align and maximise land use planning outcomes that benefits the local community, particularly Traditional Owner groups. In a narrative summary, this paper examines and reviews the major land title transitions of Quandamooka ‘Country’ and identifies a possible role that ‘Country’ can play in innovating a new way of addressing Indigenous values of ‘Country’ in the Australian planning system.

year: 2018