Reducing inequality in health through evidence-based clinical guidance: is it feasible? The New Zealand experience.

Evidence-based guidance and guidelines need to include the voices of the most disadvantaged groups in society; doing so is a significant challenge, but one which is critical to a responsive and healthcare system. Addressing ethnic disparity (and other types of disparity) in health via evidence-based guidance is likely to be less effective if approaches are singular and do not address issues of participation by those groups who have the greatest stake in improved health outcomes. This paper presents a multifaceted framework, which has been developed in New Zealand to ensure health inequalities experienced by Māori (the indigenous population within New Zealand) are addressed when developing evidence-based guidance. The framework has two overarching goals. These are: (i) to ensure the explicit identification of Māori health needs occurs during each formal stage of guideline development; and (ii) to ensure there is full Māori participation in the guidance development process. The steps to achieving these two goals are described in detail. The framework presented is evolving and intended to be flexible dependent upon healthcare environments and resourcing. This paper is intended to provide some focus and discussion for the role of evidence-based guidance in both addressing and entrenching health inequalities in vulnerable groups. [ABSTRACT FROM AUTHOR]