Bob Edlin: Is the right medicine for NZ Pharmac’s ethnic mix or their pharmaceutical expertise?

 

Stuff delivered another woke-up call to its readers this morning with a report which presses Pharmac to hire more Maori.

There’s nothing in the article to convincingly explain how current staff ratios adversely affect Pharmac’s job of buying medicines or how they actually undermine the nation’s health.

The drug-purchasing agency’s “appalling” shortcomings instead relate to concerns about cultural inadequacies, systemic racism and a failure to meet Treaty of Waitangi obligations.

The on-line report is accompanied by a video of the PM facing questions about the government’s healthcare policy and its funding of Pharmac.

She will be used to such questioning.  Pharmac is the constant target of grievances about its medicine-buying priorities and of petitioners who quickly muster popular support for demands that certain drugs be bought (typically at great cost) to deal with one life-sapping illness or another.

This time Stuff’s Katarina Williams has discovered –

Just three of Pharmac’s 130 staff members identified as Māori last year, despite the country’s drug-buying agency vowing to prioritise Māori leadership and uphold the Treaty of Waitangi as a way to ensure better health outcomes for Māori.

Readers are left to puzzle about how Pharmac’s drug purchases and the policies underpinning them are adversely affecting the health of people who identify as Maori.  Or how they might unfairly advantage the health of other people.

Williams goes on:

There were more staff members who identified their whakapapa as ‘British/Irish’ and Chinese – five staff members apiece – than Māori, according to the agency’s annual report.

We obviously are expected to be disquieted, if not dismayed, by the ethnic mix on Pharmac’s staff.

The lack of Māori representation, particularly within its senior leadership team, was “unacceptable on every level,” said Leanne Te Karu, associate dean (Māori) at Otago University’s School of Pharmacy. 

Patient Voice Aotearoa chairman Malcolm Mulholland described it as “absolutely appalling”.

University of Otago School of Pharmacy associate dean (Māori) and founder of the Māori Pharmacists Association Leanne Te Karu says Pharmac’s low rates of Māori staff is “unacceptable on every level”.

Williams has been mining Pharmac’s latest annual report for ethnicity data and has delved into a briefing to incoming health minister Andrew Little “that highlighted evidence that Māori received medicines at lower rates than non-Māori”.

But how does Pharmac’s policies and purchasing decisions influence the rate at which medicines are dispensed among the many ethnic groups that make up the country’s population?

Good question.

Never mind.  A problem has been identified:

“We consider inequitable outcomes for Māori unfair, unjust and avoidable, and we are actively working to eliminate them,” ministerial staff said in the briefing to Little last month.

We may struggle to fathom how those outcomes relate to the numbers of Māori on the Pharmac team.   Williams is fixed on staff diversification data nevertheless.

Te Karu is quoted as saying the numbers of Māori staff [said to have increased to five since the report’s publication last month] remained woefully disproportionate.

A total of 16.5 per cent of the population identified as Māori during the 2018 Census.

“It’s great that they have got a Māori senior leader, but he is a single person with a team of nobody,” she said. “Until we see some really big changes across the board, it’s going to be a lot of swimming upstream.”

But Pharmac does not prescribe medicines.  Nor does it determine who will seek medical treatment (and therefore be prescribed medicines) and who won’t.

Mulholland nevertheless questions how the agency can meet its aims without greater Māori representation and contends that Māori should be advising Pharmac “every step of the way” given the medicine inequity problems facing Māori.

He references his successful campaign for cancer drug Ibrance to be publicly funded, including for his wife, Wiki, who has advanced breast cancer.

Her struggle to access the drugs she needed was a problem affecting countless other Māori, further enforcing the need for more Māori in the agency.

But surely it was a problem for countless women of all ethnic persuasions. If one minority group should be better represented numerically, others should be, too.

Ah – but it’s here that Mulholland plays the Treaty card:

“Being a government agency, there should be a high Māori representation as part of their staff due to their Treaty obligations,” he said.

“Second to that, because there are such a huge number of issues regarding Māori and medicines, it comes as no great surprise that Māori are high-end users when it comes to medications,” he said.

“It’s vitally important that throughout Pharmac’s processes, they have Māori staff advising them every step of the way,” Mulholland said.

Trevor Simpson, the recently appointed inaugural chief advisor (Maori) at Pharmac, tells us the agency is committed to hiring staff to balance the ethnicity mix and aims to improve cultural competence (whatever that might be) rather than competence with medicines.

Described in Williams’ report as the only Māori voice at the agency’s top table, he said the organisation had already recognised his appointment wasn’t enough and the number of Māori staff members had risen to five since last month.

“We’re going to be actively recruiting to increase that capacity over the next six months to a year, and that’s largely connected to Te Whaioranga,” Simpson said, referring to Pharmac’s Māori strategy released in December, which sets out five key priorities including developing a plan to recruit more Māori for the board.

Pharmac was also focused on developing cultural competency across the organisation and ridding itself of “unconscious bias” recognising “systemic racism” was a key determinant of Māori health, Simpson said.

Social commentator Lindsay Mitchell has noted the mention of racism and commented that Stuff ‘s editorial stance now is to inspect every institution from a grievance angle. She contends:

In the process their journalists are actually practising racism.

Her reasoning is that the critics quoted in the Stuff report are saying the inequitable access by Maori to medicines is implicitly, at least partly,  the fault of Pharmac decisions. Therefore the existing Pharmac workforce doesn’t care about Maori.

That’s racist thinking right there.

Pharmac is an agency tasked with making impartial and objective decisions about medicine funding as their very core task, Mitchell points out.

The “representation argument”, if taken further

… would require that Pharmac address why only 32% of their staff are male. And less than 4 percent are Asian.

But nobody is jumping up and down about those realities. (I note that one in five staff does not disclose their ethnicity which leads me to suspect they don’t see the relevance. There may be Maori among them.)

As to Pharmac joining other branches of the public service in succumbing to the demand to address cultural competency, “unconscious bias”, “systemic racism” and so on, this points to substantial sums from Pharmac’s budget being spent for training when they should be used for medicines.

Medicines for Maori and anybody else who needs them, Mitchell tartly observes .

Bob Edlin is a veteran journalist and editor for the Point of Order blog HERE.