Claims of Structural Racism and Bias
In recent years we have heard repeated claims that the New Zealand Health System is systemically racist and that Māori health outcomes are compromised as a result. For example, Came et al (2021) argue that constitutional transformation and decolonization are potentially powerful ethical sources of disruption to whiteness and structural racism.
Evidence for such claims includes the fact that Māori live on average approximately seven years fewer than other New Zealanders (Ministry of Social Development, 2022). Knight (2022) discusses another assertion - that Māori experience poorer health services than non-Māori and that decolonising the health system will improve Māori health and longevity. Partly in response to such claims, the Māori Health Authority was established in 2021, ostensibly to work with the Ministry of Health and Health New Zealand in ensuring that the health system works well for Māori.
We also hear anecdotal claims that New Zealand's education system is inherently biased and that the proof of this bias lies in differences in educational performance and outcomes across demographic groups. Systemic bias and racism are supposed to exist in other domains as well. For example, rates of Māori representation in science are lower than those of other demographic groups and it is asserted that this lower representation arises from discrimination; for example, McAllister (2021). A previous article (Lillis and Schwerdtfeger, 2022) acknowledged anecdotal reporting of Māori experiences of racism in academia; for example, those of Ngata (2021). Systemic barriers are believed to exist for Māori and Pacific peoples within our academic institutions, and conscious and unconscious bias, and sexist and racist processes and notions of excellence, account for these disparities (Wiles, 2021).
It is possible that racist thinking, prejudice and misogyny persist within certain institutions. However, labels such as racism, systemic bias, conscious and unconscious bias and colonialism not only may be applied unfairly, but possibly distract well-intentioned people from focussing on the real causes and could detract from our efforts to address those causes.
In my own research, I have identified socioeconomics as the major predictor of disparities in educational performance and achievement, both in New Zealand and in other countries (e.g. the United Kingdom and Australia). For example, I have conducted multiple regression analysis of education performance at secondary level in different countries and found that ethnicity and other variables become non-significant when socioeconomic variables are included (controlled for) in the regression models. While such analytic approaches may not provide the last word in investigations of educational performance and cannot rule out systemic bias completely, nevertheless they are highly suggestive of economic circumstances as the primary agent of educational success.
Other New Zealand studies suggest that socioeconomics is the major predictor of educational performance. For example, Marie et al (2008) showed that including socioeconomic factors in analysis of education performance for Māori reduced associations between cultural identity and educational outcomes to statistical non-significance. Their findings are similar to my own and those of other studies, suggesting that educational underachievement among Māori can be explained by disparities in socioeconomic status during childhood. In my professional experience, the same is true for other demographic and ethnic groups, both here and in other countries.
Bias in the Health Sector?
Knight (2022) suggests that systemic bias and racism most probably do not exist in our health system. He reports what is already known among researchers and policy organisations; that disparities in health outcomes across demographic groups emerge largely from socioeconomic factors (especially in relation to housing), differences in genetics and lifestyle choices (e.g. exercise, consumption of alcohol and recreational drugs, and smoking).
Knight reports a commonly-held view that primary contributing factors toward Māori ill-health include systemic racism, white privilege and unconscious bias in New Zealand’s health system. He notes a related view that non-Māori are not affected by inequitable health provision and services. After due consideration of the available statistical evidence, Dr. Knight concludes that racism and bias are not present in our health system.
Of course, the existence of systemic racism (or sexism) in health policy and delivery, but also in education and science, is difficult to determine objectively. Racial bias today as a major cause of disparity in these critical domains may be real but is a perspective that lacks evidence other than anecdotal.
Here it is worth considering the World Health Organisation’s
perspective on the social factors that influence health - the social
determinants of health. They are defined as the conditions in which people are
born, grow, work, live and age, and the wider set of forces and systems shaping
the conditions of daily life (World Health Organisation, 2022). They exert
great influence on health inequities within and between nations. The World
Health Organisation provides the following list of social determinants of
1 Income and social protection
3. Unemployment and job insecurity
4. Working life conditions
5. Food insecurity
6. Housing, basic amenities and the environment
7. Early childhood development
8. Social inclusion and non-discrimination
9. Structural conflict
10. Access to affordable health services of decent quality.
The World Health Organisation suggests that the social determinants can influence health more greatly than healthcare or lifestyle choices and that they could account for between 30% and 55% of health outcomes. In addition, the contribution of sectors outside health to population health outcomes exceeds the contribution from the health sector (World Health Organisation, 2022). If these findings are true, then these are the factors that must be addressed, rather than invoking racism as the primary or exclusive cause.
An example: the Health of Pacific People
By way of example, here I focus on the health of another relatively disadvantaged group – Pacific people. Drawing on various prior studies and censuses, the Health Quality & Safety Commission report (2021) summarises a very significant study of the health and wellbeing of Pacific people in New Zealand. The report concludes that various socioeconomic issues experienced by Pacific people provide impediments to good health.
Examination of the statistics on health and wellbeing in New Zealand suggests that Pacific people are not much better off, and often even more disadvantaged than, Māori on certain indices (for example, Household Overcrowding and Home Ownership, Employment, Income and Deprivation, Life Expectancy, Medical Conditions such as diabetes, gout, cardiovascular disease, kidney disease, cancer and asthma, Mental and Emotional Health).
Of all ethnic groups in New Zealand, Pacific peoples are among those most affected by inequities in the socioeconomic determinants of health, including living in areas of high socioeconomic deprivation, unemployment, and low income. These factors can affect health directly (for example, through damp, cold and overcrowded conditions which increase the transmission of infectious diseases) and indirectly, by limiting opportunities to engage in health-promoting behaviours (Health and Disability System Review: Interim Report, 2019).
Two years ago the Ministry of Health published Ola Manuia: Pacific Health and Wellbeing Action Plan 2020–2025 (Ministry of Health, 2020). This plan recognises that health inequities are complex and interact with socioeconomic status. It highlights the factors that affect the health of Pacific people, including education, housing, income, employment and culture.
Another study, this time of the health of Pacific people and Māori in Queensland, indicated poorer health outcomes for those groups than the total Queensland population. Many of the social and economic determinants of health were found to be interrelated and complex and, most importantly, lay outside the jurisdiction of the health sector (Queensland Health, 2011). The key issues identified in that study included social exclusion, economic disadvantage, overcrowded and inadequate housing, parenting issues, low literacy and educational attainment, and overrepresentation in low paid employment.
The Health Quality & Safety Commission Report
The Health Quality & Safety Commission report suggests that New Zealand’s health system is fragmented; that current models of care are not working properly for Pacific people, often are hard to access for Pacific people, and that critical shortages exist within the Pacific health workforce. It states that we must ensure that care is holistic, integrated and comprehensive.
We may agree that resourcing should be made available to support Pacific providers in delivering models of care that address dynamic interactions between health, social circumstances and economic factors holistically. We can agree that New Zealand must build on and strengthen its models of care by facilitating rapid access to social, financial and housing support within the health system, recognising that good health cannot be achieved without addressing the context within which Pacific people live. However, the same thinking should apply to all demographic groups and, therefore, to all New Zealanders.
Finally, in the foreword to the Health Quality & Safety Commission report, it is suggested that shortcomings in Pacific health outcomes reflect systemic bias and racism in New Zealand’s health and disability system, as well as lack of diversity in the health workforce.
Perhaps a review is required in order to identify the presence or otherwise of systemic bias and racism in New Zealand’s health sector and, if present, its extent and how best to address bias and racism. However, quite possibly we will find no evidence of either bias or racism. Possibly, we would find no evidence of bias or racism in education either, nor in employment within the sciences. Surely, employment in the sciences is predicated mainly on subject matter choices at tertiary level, willingness and ability to engage in post-graduate studies (usually at the level of the Ph.D) and demonstrated track record in research.
I can only confirm that in my own professional life, which includes several years during the 1980s as a secondary teacher in schools with high Māori and Pacific enrolments, several years as an education researcher and statistician, and several further years as an academic manager in a tertiary, degree-granting institution, I detected no evidence whatsoever of either racism or bias in either education policy or delivery (though matters are taking an ominous turn lately, with the elevation of particular minorities and their traditional knowledge above others). Possibly these things were indeed present within the system and were obscure for me as a middle-class white male, but they most certainly were not evident to me. Surely, if they were indeed present within either policy ministries or secondary or tertiary institutions today, they would be identified and exposed very quickly. Of course, we do hear such assertions, as well as complaints of bias against females in our workplaces, and we must examine the more serious of them very carefully, simply because they could be true. However, explaining differential outcomes across demographic groups as resulting primarily, or to any significant extent, from bias or racism is no longer very convincing.
Many indigenous people lost their lands and their freedom to western colonisation and, nowadays, we recognise this fact. Undoubtedly, the lingering effects of historic oppression are felt today by many indigenous people and other minorities. We also recognise that indigenous people were not always kind to each other; that some were not always kind to their environments, and that many have gained a great deal from education, medical and health care and from legal structures that offer greater protections and ensure, for the most part, that we treat each other better than in former times. Today, we cannot undo past injustices, nor address discrimination or oppression in other societies. However, we can acknowledge inequality in the present within New Zealand and take steps to repair inequality. In New Zealand we recognise the historic negative experiences of Māori. That’s why we should assist them and other disadvantaged groups, such as Pacific people, to enjoy better outcomes - educationally, socioeconomically and in mental and physical health and wellbeing.
The key lesson from the available research is that factors other than racism and bias are sufficient to explain disparities in outcomes across demographic groups. We know that some white people are racist, xenpohobic and bigoted, but racism, prejudice and bigotry are characteristic of proportions of people within every ethnic, religious and cultural group.
It seems logical that New Zealand directs resources to achieve improvements in the health of the Pacific community and to all communities that experience significant health issues; not only to Māori. The same applies to education, employment and other domains. The question is how better outcomes can be achieved for all disadvantaged New Zealanders, regardless of ethnic, religious or social background. Each of us may have a different view, but surely there is a solid argument for proportioning resources into programmes that assist all disadvantaged groups and minorities, especially in relation to education and health and wellbeing. Many people, including myself, do not favour making one demographic group more special than others. Instead, we can make progress by doing largely what we already do now - by proportioning resources to areas of greatest need; in other words, to those whose present disadvantage can and should be addressed.
Enhancing Social Mobility
Protzer and Summerville (2022) argue that certain countries constitute role models in embodying the highest rates of social mobility (movement across social strata) in the world. These countries are Canada, Australia and the Nordics (Sweden, Denmark, Norway, Finland and Iceland). They combine state support for equal opportunity through public goods, such as education and healthcare, with competitive private markets, thereby enabling people to succeed on the basis of talent and hard work, irrespective of family origins. They suggest that such environments create best-in-class social mobility, the perception of a meritocratic system and high levels of trust.
Protzer and Summerville also argue that the notion of equity is problematic because it conveys the idea that equal outcomes are necessary for all groups within the population, rather than equal opportunities. They suggest that inequities do not necessarily reflect structural bigotry in the present and that the solution for inequality is equal opportunity from birth.
They concede that it would take great societal will and resources to eliminate inequality but that a just society would strive to make the necessary changes.
Conferring special privilege to one particular group will not repair inequality; nor will expending scarce resources to address structural racism and bias if these things are no longer significant and if the core structural and systemic problems lie elsewhere. Finally, convincing people of their victimhood when the world has made great progress toward equality of opportunity over the last half-century is rear-vision mentality. In the end, for Māori and Pacific people in New Zealand and, indeed, for all indigenous people, minorities and disadvantaged groups around the world, true social and economic progress is to be found in education, employment, good housing, ready access to high quality healthcare, respect for our fragile environment and positive connections to the wider society.
Came, H., Baker, M. and McCreanor, T. (2021). Addressing Structural Racism through Constitutional Transformation and Decolonization: Insights for the New Zealand Health Sector. Journal of Bioethical Inquiry volume 18, pages 59–70.
Health and Disability System Review: Interim Report (2019). Hauora Manaaki ki Aotearoa Whānui – Pūrongo mō Tēnei Wā. Wellington: Health and Disability System Review. URL: www.systemreview.health.govt.nz/assets/HDSR-interimreport/5b33db77f5/H-and-D-full-interim-report-August-2019.pdf.
Health Quality & Safety Commission (2021). Bula Sautu - A window on quality 2021: Pacific health in the year of COVID-19. Wellington: Health Quality & Safety Commission.
Knight, K. (2022). Fact checking the Māori Health claims that have led to The Futures Health Bill. https://www.nzcpr.com/fact-checking-the-maori-health-claims-that-have-led-to-the-healthy-futures-bill/
McAllister, T. (2021). The underserving and under-representation of Māori scientists in New Zealand’s science system. https://newzealandecology.org/underserving-and-under-representation-m%C4%81ori-scientists-new-zealand%E2%80%99s-science-system
Ministry of Health (2020). Ola Manuia: Pacific Health and Wellbeing Action Plan 2020–2025: https://www.health.govt.nz/system/files/documents/publications/ola_manuia-phwap-22june.pdf
Ministry of Social Development (2022). The Social Report 2016 - Te pūrongo oranga tangata https://socialreport.msd.govt.nz/health/life-expectancy-at-birth.html
Ngata, T. (2021). Defence of Colonial Racism. https://tinangata.com/2021/07/25/defending-colonial-racism/
Protzer, E. and Summerville, P. (2022). Reclaiming Populism: How Economic Fairness Can Win Back Disenchanted Voters. ISBN: 978-1-509-54812-5
Queensland Health (2011). Queensland Health’s response to Pacific Islander and Māori health needs assessment Published by the State of Queensland (Queensland Health), December, 2011 ISBN 978-1-921707-69-8
Wiles, S. (2021). Academics: Use your mana to aid colleagues, not fight them. https://www.stuff.co.nz/science/300480580/academics-use-your-mana-to-aid-colleagues-not-fight-them
World Health Organisation (2022). Social Determinants of Health. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1
Dr David Lillis trained in physics and mathematics at Victoria University and Curtin University in Perth, working as a teacher, researcher, statistician and lecturer for most of his career. He has published many articles and scientific papers, as well as a book on graphing and statistics.