A leading Māori public health advocate says understanding the difference between equality and equity is critical if Aotearoa is serious about improving health outcomes for Māori and addressing long-standing disparities.
Jasmine Graham, Māori Public Health Manager at Hāpai Te Hauora, says the two concepts are often confused, yet they produce very different outcomes when applied to healthcare policy and service delivery.
Equality focuses on giving everyone the same resources, services or opportunities regardless of their circumstances. Equity, by contrast, recognises that different communities face different challenges and may require different levels of support to achieve the same outcomes.
In healthcare, this distinction can be the difference between a policy that appears fair on paper and one that actually improves people’s lives.
Māori communities continue to experience higher rates of chronic illness, lower life expectancy and poorer access to healthcare than many other population groups. Health experts say treating everyone exactly the same often fails to account for the barriers that contribute to these inequities.
Examples can be seen in screening programmes, primary healthcare access and preventative services. A universal approach may provide the same service to everyone, but if Māori are more likely to develop certain conditions earlier, face greater access barriers or experience poorer outcomes, equal treatment does not necessarily result in equitable outcomes.
Advocates point to bowel cancer screening as one example where debates have centred on whether different eligibility ages are needed to reflect differing levels of risk among population groups.
The challenge for the health system is ensuring policies are designed around need rather than simply applying the same approach to everyone.
Graham says embedding equity into health policy requires a deliberate focus on outcomes. That includes collecting and analysing data, investing in kaupapa Māori providers, strengthening the Māori health workforce and ensuring services are designed alongside the communities they serve.
Health leaders also argue that decision-makers must consider the wider social factors influencing health, including housing, education, employment, transport and access to healthy food.
Without addressing those broader determinants, disparities are likely to persist regardless of improvements within the healthcare system itself.
Education and public awareness also play an important role in shifting public understanding. While equality is often viewed as fairness, health experts say true fairness requires recognising that some communities start from very different positions.
Building greater understanding of equity can help people appreciate why targeted investment and culturally responsive services are often necessary to achieve better outcomes.
For Māori health advocates, the goal is not special treatment but ensuring everyone has a genuine opportunity to achieve good health.
As Aotearoa continues to grapple with persistent health inequities, the conversation around equity is becoming increasingly central to how healthcare is planned, funded and delivered.
Supporters say a stronger focus on equity offers the best chance of closing health gaps and creating a system that works for all communities.
