LEARNING OBJECTIVES
After studying this chapter you should be able to:
• describe the Australian and New Zealand health care systems
• identify and describe the health care challenges faced by rural communities in Australia and New Zealand, including Aboriginal and Torres Strait Islander and Māori rural communities
• identify the national health priorities and strategies for achieving improved health outcomes in Australia and New Zealand
• critically analyse health differentials and health inequality and their interaction on individuals, groups and communities
• discuss the impact that vulnerability has on individuals and populations, and the importance of resilience.
Introduction
This chapter describes the Australian and New Zealand health care systems, which are both predominantly publically funded and aim to provide equity in access to health care for all citizens. In Australia, there is also a private market model that provides a significant amount of funding for health care services. In New Zealand, the Treaty of Waitangi is most important in underpinning all health and social policies, assuring partnership, participation and protection of Māori (NZMOH, 2014b). As in many countries around the world, the Australian and New Zealand governments and health care systems face the significant challenges of an increasing burden of chronic disease among ageing populations. Another challenge in both Australia and New Zealand is that some people live in rural and remote locations where morbidity and mortality are higher than in metropolitan areas. Rurality is classified in Australia according to three systems that determine the level of remoteness and funding available (AIHW, 2004). The impact of rurality is greater in Aboriginal and Torres Strait Islander and Māori peoples and is reflected in their overall poorer health status compared to the non-Indigenous populations (AIHW, 2014; NZMOH, 2014a).
The Integrated Care for Chronic Conditions Framework (ICCCF) provides a model for change to address these challenges. National health priorities, developed in response to the World Health Organization (WHO) ‘Health for All’ global strategy (WHO, 1981), provide guidance for governments in promoting the health of their citizens and addressing the needs of the most vulnerable groups. Health differentials and inequalities are caused by a range of complex factors including social and economic factors, health behaviours, physical factors, environmental issues, and access to health services and their utilisation.