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- A fair go for all?
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Key Focus Areas
A fair go in Health
Inequalities persist in health. For non-Pākehā death rates for diseases such as cancer and diabetes are higher, and life expectancies are shorter. GPs often spend less time with non-Pākehā patients and offer fewer specialist referrals.
There are several possible reasons for this inequity.
Failure of “universal health” system
New Zealand’s policy of “universal health provision”, where everyone gets the same service no matter what their socio-economic status or ethnicity, is clearly not working. It ignores the obstacles faced by ethnic groups in accessing services and “both legitimates the non-recognition of ethnic disparities and privileges Pākehā.”
Providing culturally-specific health initiatives has been successful in several cases with Māori and Pacific communities, such as the Māori language elements for the Quit anti-smoking campaigns and the One Heart Many Lives programme, which focused mainly on Māori men. Professor Mason Durie’s holistic health model of wellness – Te Whare Tapa Whā – employs a Māori philosophy of health—one that moves beyond physical health as the sole determinant for wellbeing. Te Whare Tapa Whā describes four cornerstones of Māori health: whānau (family health) tinana (physical health) hinengaro (mental health) and wairua (spiritual health).
Increasingly, research is finding that racism – either individual or institutional, – is a major factor in poorer health for non-Pākeha ethnic groups. A 2012 study of secondary school students found that those who had experienced racial discrimination were more likely to report poor health, experience depressive symptoms, and smoke cigarettes. Studies consistently show doctors treat patients differently based on ethnicity because of cultural misunderstandings, unconscious bias or uninformed beliefs. For example, 2002 research found only 2 per cent of Māori diagnosed with clinical depression were offered medication, compared with 45 per cent of non-Māori patients with the same diagnosis. Another study found doctors spend 17 per cent less time (2 minutes out of a 12 minute consultation) interviewing Māori than non-Māori patients. General practitioners were also less likely to have a high level of rapport with their Pacific patients, ordered fewer tests (17.8 per cent compared to 24.9 per cent) and referred Pacific patients to specialists less often (20 per cent versus the national average of 30 per cent).)
While it is important to address the (often unconscious) bias of medical professionals, a significant shift in the policies, practices and procedures of the health system needs to be implemented.
The number of Pacific and Māori peoples working in health is low compared to the percentage they make of the population. Only 3 per cent of the nearly 60,000 people employed by district health boards are Pacific peoples. Even in Auckland, only 7 per cent of the health workforce are Pacific peoples, although they make up around 12 per cent of the population. Active Māori medical practitioners represented only 3 per cent of the New Zealand medical practitioner workforce (330 out of 11,164). In addition, most Māori and Pacific DHB employees are concentrated in administrative and nursing roles.
Research has shown that patients experience better outcomes when they are the same ethnicity as their health provider, although this in itself will not necessarily shift discriminatory practices.
Māori and Iwi health workers earn up to 25 per cent less than their colleagues in hospital settings. This funding inequity is an important barrier to recruitment and retention of Māori health workers. In 2009, the Health Select Committee recommended that the Government establish a working group to address this issue. This was rejected and no further progress has yet been made.
Kerri Nuku of New Zealand Nurses Organisation argues that Māori health professionals are the key to improving the Māori health, whether it be quit smoking programmes or a whānau-based approach to Māori wellbeing. “Unless we achieve pay equity, our highly prized and overworked ‘Māori for Māori’ workforce will continue to be a limited resource, and any new initiatives will continue to struggle and fail,” she said.
In July 2011, the NZ Medical Association released a statement identifying structural barriers in health and set out a programme of action to address them. The NZMA said that improving health was everyone’s responsibility. Health agencies will need to work with other agencies to improve health outcomes for everyone.