When we talk about healing health inequities, we often only think within the U.S. context. But what about the challenges other countries’ healthcare systems face in providing equitable care? And what can we learn in this nation from discussing these issues?
Amio Matenga Ikihele, a 2023 Winston Churchill Fellowship recipient and former nurse, reached out to Memora Health earlier this year to explore how digital health equity is being addressed in underserved communities in the United States. Our team was excited to meet with her to learn more about her work at Moana Connect — a New Zealand-based non-profit focused on supporting health equity among at-risk Pacific Islanders — and to dive deeper into our approach to using digital health as a tool to support health equity. Here are some themes from our conversation.
Health equity challenges pervade different nations’ healthcare systems
Financial barriers. Lack of transportation. Limited health literacy. These notable and persistent issues block many U.S. citizens from accessing high-quality and often-necessary care. Some New Zealanders face similar hurdles.
Roughly a quarter of all New Zealand citizens are on private insurance. That means, theoretically, the other three quarters of the population have access to publicly available healthcare. But the story gets complex when we consider at-risk demographics — like Pacific groups.
Comprising a blend of immigrants from surrounding lands (such as Samoa and Tonga), automatic citizenship-holders from associated countries (like Cook Islands and Niue), and communities that have resided in New Zealand for generations, this ethnic group makes up about 8% of the island nation’s population. Although some of these subsections are covered through publicly available health programs, others who lack the proper documentation are either invoiced at full price for services or — in some cases — actually have to return to their country of origin to receive care.
Naturally, this complex reality has led to workarounds that are often inefficient and can end up putting more strain on New Zealand’s healthcare system at large. Ikihele says, “What we have in New Zealand is a health ID number — a unique identifier for each person who is born in New Zealand. People have been using other people’s national health index numbers, and if you have allergies or other complex health issues, that’s when people usually find out [that] you’re somebody else.”
Beyond national regulations that might make accessing care more difficult for Pacific communities, broader society-based health disparities also play a significant role. Ikihele explains, “Pacific communities experience lots of divides … Our life expectancy is about 10 years lower than [non-Pacific groups]. One in five Pacific people experience a digital divide with no internet access.”
Key cultural differences can present barriers to equitable care
Pacific communities in New Zealand have significantly different cultural outlooks than other groups. Ikihele expands on how these viewpoints can present challenges in the care context, remarking, “Similar to other collective groups, there’s a big emphasis on physical connection and being in the same spaces with people … One thing we’re finding difficult in New Zealand is that there’s still an individualistic — instead of a collective — approach to care.”
That’s why Moana Connect has a specific strategy for including a wide array of Pacific cultures into New Zealand’s greater healthcare system. Moana Connect laser-focuses on healing disparities in technology use to ensure these communities can take full advantage of the latest healthtech advancements. “Even though we acknowledge — within the Pacific health strategy — that digital health is so important, we have to also acknowledge the digital divide,” Ikihele adds.
“Even though we acknowledge — within the Pacific health strategy — that digital health is so important, we have to also acknowledge the digital divide.”
Addressing these gaps means understanding what platforms will work for at-risk populations. Reaching people with the right technology helps enhance care for those without access to advanced mobile technologies — like smartphones or tablets — or the internet. Ikihele says, “We want people on patient portals, but they have no connection to what it is. This is our struggle with wanting our communities to be more self-determining and having autonomy over their healthcare.”
The first step in addressing the digital divide is expanding access to technology
For Moana Connect, a critical aspect of healing this divide is expanding access and competency with using effective digital health interfaces. And a key part of accomplishing that is to work with the right people within at-risk groups.
Moana Connect launched the DIGIFALE initiative to do exactly that. Ikihele explains, “We go back into people’s ethnic-specific communities — they could be Samoan, Tongan, Cook Islander — and we work with their church groups, community groups, or youth groups. And it’s our young people who teach our elders … If elders don’t trust the people coming in to teach them how to use technology, they’re not going to be receptive to learning.”
Furthermore, the type of technology makes a big difference in earning trust with communities. “We first scaffold their learning by saying, ‘Let’s learn how to turn your phone on, let’s learn how it ticks. Let’s go onto Zoom.’ It became a bit more complex with patient portals. It wasn’t because of the individual. It was because of the user interface of patient portals in New Zealand … If you’re new to using a digital tool, it becomes too difficult and people end up not using it.”
That’s why Ikihele suggests SMS-based digital health tools — like Memora Health — are ideal for giving everyone a seat at the technology table and expanding equitable care. “What [elders] love … is the SMS component. They love appointment reminders … When a doctor sends a prescription to the pharmacy, they get an [SMS] notification … The patient portal was too difficult. It was just too complex for them.”
“What [elders] love … is the SMS component… The patient portal was too difficult. It was just too complex for them.”
Ikihele proposes that the operational friction people — especially aging populations — encounter can lead to further inefficiencies across New Zealand’s healthcare system. “We have to remember, our elders have multiple health conditions and take multiple medications. If we don’t make it easy for them to navigate, they’re just going to say, ‘I’ll just go visit the doctor.’ That adds strain to our healthcare system, because our doctors are burned out.”
Healing the digital divide demands collaboration between innovators and community groups
Addressing persistent health tech inequities will take more than just educating at-risk groups. It also takes a sincere effort from digital health developers to understand how their technologies help heal gaps and include a diverse user base.
Moana Connect launched a program to foster these conversations called Medtech-iQ. This project’s goal is to advise and connect with both innovators and venture capital groups to create effective approaches to cross-cultural communication in the healthcare context. Ikihele explains, “One project involves implanting a device into the brain [for hydrocephalus] that can help drain excess fluid. As an example, if this is going to be introduced to Pacific communities … have they got the right people to engage with communities? They might be skeptical.” Medtech-iQ can help stakeholders better scale their solution with specific populations by advising them in situations like these.
Memora Health partners with healthcare organizations across the care continuum to ensure its intelligent care enablement platform continues to support every patient in navigating their care journeys — including those who might face barriers to access or hold specific cultural viewpoints.
Transforming care delivery won’t happen overnight. And it certainly won’t happen without having critical discussions about how we can best help at-risk communities and provide them with the tools they actually need — instead of the solutions we think they need. It’s conversations like the one we had with Moana Connect that can foster collaboration, spawn better practices for including every demographic in digital health development, and support addressing long-standing barriers to care.
Want to find out more about how Memora Health’s platform helps support health equity? Speak with one of our experts!