Henry Armstrong: Racism in the New Zealand Health System

I begin this article with the conclusion I have reached on the above subject, which I would normally reserve for the final paragraph. My conclusion is quite simple. Our health system in New Zealand is NOT racist, as a host of academic, political and cultural activists so vociferously claim. 

Claims that our health system deliberately withholds treatment from our Maori people, are dishonest, untruthful and alarmist. What these activists claim as “systemic racism” can be easily illustrated, and dismissed, as failures in  socio-economic outcomes, NOT failures in our health system. Anyone, including myself, would understandably be outraged if our health system deliberately withheld appropriate treatment for ANY person in our New Zealand society, on the basis of their ethnicity, age, gender, sexual orientation, religion, disability, or any other political identity so favoured by these politicised activists.

This article is designed to illustrate just how dishonest these people (academics, cultural activists, politicians- and some highly-honoured New Zealanders) are, in their facetious claims.

   

If you have recently had the need to avail yourself of the public (as opposed to the private) health care system in New Zealand you will have experienced a professional, efficient and caring system focused on you and your immediate health priorities. Firstly, if an emergency, you may have called 111 to request an ambulance, staffed by highly competent paramedics of St John- you know, that always available, but horrendously unfunded (by the Ardern government), emergency service which depends upon charitable donations and fundraising for its survival - unlike those many other lesser projects in the community for which there appears to be unlimited government funding designed to ensure political, rather than medical and health outcomes.

Arriving at an A and E department in one of our regional or metropolitan hospitals, you will have been made comfortable, then assessed by trained, competent, A and E staff. Large numbers of these very competent people originate in countries far away from New Zealand - UK, USA, Asia, South Asia, South Africa, Sri Lanka, and the Philippines, to name but a few. Indeed, a large proportion of our health professionals are from countries other than New Zealand.

Once assessed and treated, you will be assigned to a ward where again, most of the staff originate from overseas.

Regardless of your personal identity-ethnicity, gender, age, sexual orientation, religion, or disability, etc - you will receive expert and professional care of the highest order, depending upon your specific needs and the nature of your illness. There is no cost involved.

And in a modern society such as New Zealand, that is as it should be, right?

Not so. Groups of academics, media celebrities, politicians, cultural activists, and bureaucrats, claim that the health system outlined above is not available to all New Zealanders; is racist; and denies equal health outcomes to those in the community who identify as Maori.

Really? Only Maori? Not Asian and Pasifika people too? Not the elderly, beneficiaries, or those living in remote country areas, who are not Maori?

This claim is frequently made by a group of academic Public Health “experts” at Auckland University’s Public Health Department, and gleefully repeated ad nauseam by a biased, politicised media.

See for example, an article in the NZ Herald of July 2019 in which a prominent academic claims our health system” is killing and harming Maori”. The academic is commenting upon a report by the Health Quality and Safety Commission into Maori health, with claims of “systemic racism”.

Ref: A Window on the Quality of Aotearoa New Zealand Health Care 2019, Health Quality and Safety Commission, Wellington 2019 .

This group’s alarmist and outrageous demands are not limited to claims of “systemic racism” in our health system. They also claim that the academic editorial process is racist. In an article on this subject in E-Tangata of12 September 2020, this group was academically challenged on an article they had submitted to the NZ Medical Journal on cardiovascular disease amongst different ethnic groups across New Zealand, based purely on statistical variations. Their peers, in reviewing the article, pointed out that there are many different clinical causes of heart attacks and strokes, including lifestyles. This infuriated the academics who immediately claimed racism, when clearly those expert clinicians pointed out that socio-economic factors are mainly responsible for health outcomes, not failings in our health system. 

It is important to define what these people mean by the term “racism” in the context of our health system. Indeed, this offensive and insulting term is increasingly used by social, political, and cultural activists to claim similar negative outcomes for Maori in our education, welfare, and justice systems.

A whole new typology of racism has been developed to ensure that a constant, continuous, and increasing level of offensive accusations of racism can be directed at the majority of New Zealanders who are of European descent, because their ancestors “colonised” New Zealand some 200 years ago and in so doing caused the Maori people to be in the situation they are in today. This is yet another modern-day political construct which is trotted out whenever these activists are challenged to present evidence to support their outrageous claims. It is purely an opinion, but like many other opinions, is fast becoming regarded as fact.

It is apparently lost on these activists too,  that virtually every person of Maori descent also has shared European ancestry;  that there are large ethnic groups other than Maori, such as Asian and  Pasifika,  integral to New Zealand society, who also fit the criteria  claimed by the activists of “systemic racism” in regard to minorities.   

The new racism typology includes, but is not limited to:

Overt; covert (or subtle); personal; systemic; institutional; asymptomatic; unconscious bias; stereo-typical; intergenerational; internalized; unintentional; structural; individual; “everyday”; micro-aggressions or jokes; akratic (or knowingly); colourism - the list goes on. More versions of racism are being “discovered” as we speak. Some of these terms are used synonymously as well. The type of racism most preferred by these academics and others is “systemic” racism.

Using this descriptor, these academics condemn whole or total systems, even an entire society, as racist, thereby extending the insult even wider. Claims that our health system is “systemically racist” are predicated solely on statistics derived from social and economic census data and DHB records. These data are claimed by these academics to show conclusively that inequities invariably and inevitably exist between the majority of New Zealanders and Maori. Not any other ethnic minority such as Asian or Pasifika, nor indeed any other minority of any description.

Such claims are of course highly selective and purposely politically focused. In virtually every case provided in the report, no clinical or other research evidence is presented-just statistics. But that, they claim, is sufficient.

It is important to differentiate between inequality and inequity, even though theses terms are used synonymously by these academic and cultural activists. Inequality refers to unequal outcomes, whereas inequity refers to issues of fairness and justice.

What these academic and cultural activists deliberately and conveniently ignore is that socio-economic inequities have always existed across a whole range of factors, which describe various bands of difference, and which are constantly dynamic or changing. All societies have and will always have, varying degrees of socio-economic variance. Even Communism found this to its cost.

(See for example, “Intellectuals and Society”, Thomas Sowell, Basic Books, 2011)

These academic and cultural activists claim that if it can be shown statistically that a particular ethnic group (in this case, Maori) have a lower life-expectancy than everyone else, then any system which influences or affects life expectancy (ie the health system, amongst others) must be racist and discriminatory. Right?

Wrong! Life expectancy can be affected by a whole host of factors including lifestyle choices, amongst others.  

The problem with this invalid and disingenuous assumption is not what the statistics claim, but why there are differences. To claim that any statistical difference between such groups is “racist” ignores the possibility that such differences could be, (and almost certainly are), due to a whole range of factors including clinical factors; genetic issues; socio-economic status; age; gender; disability; geographic location; cultural factors such as communalistic and co-generational living; housing; personal choices; and lifestyle factors, to name but a few possible reasons for statistical differences.

To illustrate how dishonest these people are in using selective statistics as the only indicator of Maori ill-health, the report by the Health Quality and Safety Commission of 2019 makes major claims of racism as the cause of Maori ill-health and premature death, based on statistical differences of life-expectancy between Maori and other New Zealanders, not clinical evidence or field research. They conveniently exclude similar data which apply to Pasifika, Asian, European, and African citizens. In it, the authors claim a range of negative outcomes, all based on these generalised, selective, statistics.

The report makes no attempt whatsoever to explain WHY these differences exist, except that they are due to racism, and absolutely no attempt to provide solutions to deal with these so-called inequities. The report also contains a comprehensive list of references purportedly designed to support their claims, but in virtually every case, these references are in turn based on the same statistics used in the report, ie census and DHB data. Three examples illustrate the abject paucity of academic and clinically-valid, reliable evidence to support their claims:

1.Maori are genetically more susceptible to various stomach cancers than European New Zealanders.

In their reasoning, according to these activists, this genetic factor is an indicator of racism. Work that one out! If however they are claiming that Maori patients  with stomach cancer receive less treatment than the rest of the population, then there would have to be both evidence of and reasons for , this apparent lack of treatment. Surely such an august body would be demanding to know the reasons? But no, the statistics alone are sufficient for them to claim “systemic racism”.

2. Maori, and especially elderly Maori patients do not have equal access to certain types of medical services including equipment. Could it be that many elderly Maori are not aware of such equipment; or live in rural or remote areas where such services are not usually available? Non-Maori people living in such remote areas also do not have such access either, but their statistics are not of course provided-only and solely those of Maori. If the analysis included ALL people in such remote or rural areas, common sense tells us that “Pakeha” would also exhibit similar outcomes. But no, we have to accept that the cause is racism. Are these activists not aware that most rural areas of New Zealand struggle to attract and maintain sufficient GPs and other medical specialists? Surely they must be aware of such shortages? Are not “rural” students, along with Maori and Pasifika, now accorded preferential entry into Medical School, to the exclusion of more academically - qualified applicants?

 3.Asthmatic Maori children are prescribed more relievers than preventers. No clinical reason is given to explain this outcome - it is simply racism. Really? Could it be that Maori children suffer more asthmatic episodes than other children and if so, why? Could it be that all children suffer more episodes than adults, not just Maori children? Could it be housing? Genetics? Smoking? Other factors? All of these?

No, it’s racism.

But hold on, the Mayo Clinic states that the causes of asthma are many and varied, including: airborne allergens such as pollen particles; dust mites; mould spores; sulphites and preservatives in food; second-hand smoke(!); certain medications; and yes, genetic factors too. Ethnicity is not mentioned, either as a contributor, nor as a variant, in regard to different treatments, including inhalers, both preventers and relievers. How then can this outcome possibly be racist?

The major fault with this flawed “research” is that, besides basing all claims of racism on purely statistical variations, with no attempt to analyse WHY these differences exist, these activists imply that these statistical data are causal, (that is, racism is the cause of these inequities) when it is clear even to the most humble scientific researcher that these data reflect at best, a correlation between ethnicity or indeed any other minority identity, (for example, age) and health outcomes. No attempt is made to interpret and analyse this correlation - if it exists, it has to be racist.

The worst aspect of these claims is that the proponents not only offer no research evidence (clinical; field research; trials, etc) for these inequities, but also, and more seriously, no solutions, when there are obviously solutions to be had. They also provide no suggestions for any ongoing research, which should now be instituted to establish just why such claimed inequities exist.

For example, if access to medical services is because people live in remote or rural areas where it has in the past not been practical to extend all medical services (an inequity?), a simple solution is to provide mobile clinics and clinicians to provide such needed services to such areas on a regular basis, as proposed by New Zealander Of The Year, Dr Lance O’Sullivan, an experienced and highly regarded Maori health professional.

Another solution, in the case of Maori, is to provide marae-based clinics. Most Maori have access to their local marae, so why not base a medical facility at marae?

The fundamental issue at stake then, is not the provision of health services when someone is in dire need, but more the delivery of preventative health programmes designed to head off the need to access health services in the first place.

Most of us applaud our health system developing comprehensive preventative programmes for all members of our communities-and in fact, one must seriously question if and why such preventative programmes are not already being more widely- provided by our health system? In many instances, preventative health programmes are up and running-including Whanau Ora and other Maori-focused health initiatives.

 Whanau Ora was established in 2010 with the goal of improving well-being amongst Maori, including health outcomes. It has a multi-million dollar annual budget funded by taxpayers. It is difficult to determine from published reports if Whanau Ora has had any measurable impact on Maori health outcomes since its inception. What has it been doing with its funding for the past 10 years?

In the end however, we are all responsible to a large extent for our own health, particularly in making life-style choices which impact adversely on our well-being. It is high time these academic charlatans and cultural activists stop blaming everyone else for poor health outcomes and start applauding the fact that we have a health system in New Zealand available to all, irrespective of one’s political and ethnic identity.

Henry Armstrong is retired, follows politics, researches and writes.