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De-estabilishing the Maori Health Authority


The Te Ora report stated that the number of hospital admissions that could have been prevented by access to timely and competent general practice care (Ambulatory Sensitive Hospitalisation – the ASH figure) were 2171/100,000 for the non–Maori population, and 3686/100,000 for the Maori population between the years of 2007 and 2018.

Taking the population at 5,000,000 with Maori being 16.5%, and non-Maori 83.5%, then the number of possible preventable hospital admissions during that period were 30,409 for Maori, and 90,639 for non-Maori. The percentage for Maori is obviously higher than it should be based on the percentage of the population – it would be approximately 17,900 at the non- Maori ASH rate. However, the Te Ora report neglected to mention that the 2016 ASH rate for Pacific adults was 8787/100,000 – a figure over twice as high as Maori, and the figure for Pacific children aged 0- 4 was 12079/100,000. (Ref 10) As the Pacific population is only 9% of the total population, these figures are not seen when it is diluted with the 83.5% of the population comprising Pakeha, Asian and other non- Maori ethnicity groups.

There were also no ASH figures collected for the disadvantaged section of the Pakeha population. This is important as the poor health of the Pakeha in poverty is also “hidden” by the large bulk of the non-Maori population (83.5%) living above the poverty line. The size of this group of Pakeha living in poverty can be estimated to be to be 14.8% of the population according to Child Poverty figures for Stats New Zealand in 2020 (Ref 16), making this group the largest by far of any disadvantaged group of any ethnicity who have poorer access to health services. Because the ASH figures have not been collected for these Pakeha living in poverty, it is not possible to state that Maori have poorer health services than other New Zealanders. The necessary research has not been done. 3. That decolonising the health system will improve Maori health and Longevity.

The comment that “decolonising the Health Service is necessary to improve Maori health and longevity” is not supported by the Cook Island experience.

One way to estimate the impact of colonisation, and other factors argued to be responsible for shorter life expectancy in Maori is, as mentioned above, to compare New Zealand Maori demographic data to a genetically similar population, namely Cook Island Maori who are still resident in the Cook Islands. The latter have also been subject to a degree of colonisation but have been decolonised for 56 years.

When comparing the Cook Islands life expectancy figures for 2018 it can be seen that Cook Island females living in the Cook Islands have a life expectancy of 79.2 years, whereas Maori females living in New Zealand have a life expectancy of 78.2 years. For males, the relevant expectancies are 73.3years (Cook Island males living in the Cook Islands) and 74.2 years (Maori males living in New Zealand). These differences are not significant and taken together do not support an argument that a 56-year period of decolonisation has had neither a positive nor negative effect on the longevity for Cook Island Maori.

Perhaps more helpful to this consideration of colonisation and its effect on longevity is that all Pacific Islanders, irrespective of their origin, have significantly increased their life expectancy by migrating to New Zealand – despite living in lower socioeconomic areas in New Zealand, and despite having to use the allegedly “systemically racist” health system.

The average life expectancy for Pacific males (Fijians and Tongans) living in Fiji and Tonga is 8.7 years less than Pacific males living in New Zealand, and for Pacific females (Fijian and Tongans) living in Fiji and Tonga it is 9.6 years less that Pacific females living in New Zealand. These data showing a very significant increases in life expectancy for Samoans, Tongans and Fijians living in New Zealand also shows that the key social determinants of health – poverty, unemployment, low educational level, and poor housing - which presumably have been prevalent in the less economically developed Pacific nations - are the prime factors in determining good health and improved longevity, along with a health system that provides a more complete service than that available in the Islands.

The fact that the 77.2% of Pacific people who are choosing to use the NZ Health system is higher than any other ethnicity (76.5% or lower for Pakeha, Asian, and other non – Maori ethnicities) suggests that they do not perceive the system to be “systemically racist” or having an “unconscious bias” against Pacific peoples.

Thus, if shortened longevity for Maori is attributed to a “systemically racist” health system that Maori state discriminates against Maori, as claimed by the Waitangi Tribunal and Te Ora, how is this phenomenon of a higher utilisation of the health services by Pacific peoples as compared to Pakeha and other non-Maori ethnicities, explained? What also explains the significantly increased life expectancy of Maori living in the Marlborough region where Maori males have a life expectancy of 79.9 years (a 5.7-year increase) and Maori females have a life expectancy of 83.4years (a 5.2-year increase).

Is the health system not “systemically racist “down there? It does not make sense that the 80,000-health workers are racist for Maori but not racist for Tongans, Fijians and Samoans, or the health workers in Marlborough are not racist but the workers in the rest of New Zealand are. The logic in the Waitangi Tribunal and the Te Ora report regarding systemic racism is not rational. 4. That primary contributing factor for Maori ill health is “systemic racism,” “white privilege” and “unconscious bias” in the New Zealand Health system.

The third of the above core statements - that “systemic racism”, “white privilege” and “unconscious bias” in the health system are key contributors to reduced Maori longevity, is listed as the primary cause in the Te Ora report. What is “a systemically racist health system”? It is a system of health delivery in which services are separated, financed, and delivered on the basis of race.

This is what existed in South Africa under apartheid. To understand what these accusations mean, we must analyse each of the terms separately.

Under apartheid, the separate areas that had been the historical tribal homelands of the various tribes were allocated to each tribe. In these areas, the tribe governed itself and administered their own health systems including hospitals. In the remaining area of South Africa itself, the public health system was divided into two – one system for “whites” and one system for “non-whites.”

There were separate hospitals, separate ambulances, separate services, and separate funding provided for “white” and “non-white” patients who lived in South Africa. In the private health sector, separate waiting rooms and separate consulting rooms were required for the “white” and “non-white” racial groups. There was vastly different government funding per head of population in the health budgets for the various races as per government policy. The standard of medical care on offer varied significantly with the “white” and “non-white” groups.

These are the characteristics of a “systemically racist” health system. Until now, none of these basic criteria for a systemically racist system exists in the New Zealand Health Service.

Thus, for the Chairman of the New Zealand Medical Council, the two Associate Ministers of Health, and the CEO of the Ministry of Health, to state that we have “systemic racism” in the New Zealand health system, was just not factually correct.

The New Zealand system does not compare to the internationally criticised South African health system that was legislated to be completely systemically racist. Under the Code of Disability and Consumer Rights, we have a health system that legislates for equal services and access for all races, as also required by the UN Declaration of Principles on Human Rights, the Declaration of Commonwealth Principles, and the New Zealand Bill of Rights.

Had there been any discrimination on racial grounds, there would have been prosecutions. There have been none. Racism in the New Zealand medical context has been levelled at the health system when the cultural norms of the patient were not adhered to in primary practice or in the hospital environment.

However, a lack of cultural knowledge is not racism, and allowing for the inherent cultural competency problems that arise when the New Zealand health workforce is so dependent on immigrant health workers (44% are immigrants - NZMC and Nursing Council data,) accusations that the 80,000 workers of all ethnicities, who are the New Zealand health system, are collectively racist, is wrong, and has caused significant resentment amongst medical and nursing staff.

The phrase “white privilege” implies that there are fewer obstacles in the way of non -Maori people to access health than Maori people.

Where is the evidence? Pakeha, Polynesians, and other non- Maori races who are affected by unemployment, poverty, poor education, poor housing or living in rural areas, have as much difficulty in accessing health as Maori in the same socioeconomic or geographical situation. From 2018 figures, there were approximately 90,100 non-Maori unemployed compared to 40,300 Maori over a similar period. The claim that these Pakeha, Polynesian or other races have “white privilege “is not correct. All these people battle and need assistance irrespective of their ethnicity.

The statement “unconscious bias” - refers to a strongly held belief that exists in memory and influences decision making. These beliefs arise from childhood conditioning and because they seem so normal, we are unaware they are affecting our decisions.

All people, from all races, including Maori, have unconscious bias – it is part of being a human being, and some people in all races will have an unconscious bias against members of a different race - this is the racial bias that is referred to in Te Ora.

People in different races often believe that their culture is best or that their culture is not being treated fairly- this is the commonest unconscious bias that exists and is very much present in this discussion on health in New Zealand. As example of this, the current low vaccination rates amongst Maori, the lowest of any ethnicity, has been blamed on “systemic racism” and “government incompetence” by both Associated Ministers of Health. Their unconscious belief in the complete responsibility of the government and the racist Health Service for poor Maori health statics, stops them from considering that the same factors that are causing poor vaccination rates in other communities and countries, may be contributing to vaccine hesitancy in Maori – e.g.: anti vax sentiment, fear concerning genetic engineering, concern re the injection of foreign particles into the body, problems in getting off work, rumours of infertility, rumours of DNA issues, religious issues, needle phobia, tapu issues, concern re adverse long-term effects, other misinformation/side effects etc.

Why would these concerns not be affecting Maori in the same way as they affect a significant number of New Zealanders and millions worldwide? They are of course and even Derek Fox has commented that a significant minority of Maori refuse to take the vaccination for their own reasons.

The Medical Council chair has stated that doctors have an unconscious racial bias against Maori. The bias presumably means that doctors believe that Maori are somehow inferior and therefore they are not treated as well as patients from other non-Maori races. Where is the evidence for this? The fact that the highest utilisation by ethnicity of the health services is by Pacific peoples, suggests that they do not think that an unconscious bias exists for them. We have had a Health and Disability support system for patients for over 20 years.

If specific examples exist, where Maori have been treated with an inferior service due to their race, why have they not been prosecuted?

Throughout the reports, the poor Maori health outcomes documented in the Waitangi Report 2575 and the Te Ora report are statements only of poorer health outcomes. There is no documented, factual evidence presented regarding the causes.

For example, the Te Ora Report, states, without evidence, that the following are the causes of poor Maori health outcomes:

  • “Systemic racism,” “white privilege” and “unconscious bias” in the health system
  • The need for longer consultations
  • The doctor getting to know the patient better
  • Lack of Maori spiritual knowledge
  • Not having one doctor on an ongoing basis in Primary Health Clinics
  • Maori knowledge is not incorporated into the consultation and diagnosis
  • The effects of colonisation

Aside from colonisation contributing to poverty, which has the greatest impact on health, the other nominated causes are not consistent with international medical opinion that states that disease prevalence and presentation is strongly related to the range of social deprivation factors which exist external to the health system, and for which the health system is not responsible.

Because the ASH figures have not been collected for these Pakeha living in poverty, it is not possible to state that Maori have poorer health services than other New Zealanders. The necessary research has not been done.

The phrase “white privilege” implies that there are fewer obstacles in the way of non -Maori people to access health than Maori people.

The Medical Council chair has stated that doctors have an unconscious racial bias against Maori. The bias presumably means that doctors believe that Maori are somehow inferior and therefore they are not treated as well as patients from other non-Maori races.

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elocal Digital Edition – January 2024 (#273)

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