Accurate diagnosis is critical for effective public policy, for the same reason. All too often it is not sought. A misdiagnosis that supports a politically preferred end can be a tragic mistake.
In her Waitangi Day Speech this year, the Prime Minister told Māori that they die younger than everyone else because they are Māori.
In 2018, the then Director-General of Health informed a Treaty of Waitangi Tribunal hearing that “the impact of personal and institutional racism is significant on both the determinants of health and access to and outcomes from health care itself”.
These are assertions of racist causation with a material effect on health outcomes. What evidence supports them?
Earlier this year, the Ministry of Health responded to my twin requests for the most authoritative empirical evidence it had in support of the above statements.
I examine those responses in my report, Every Life is Worth the Same: The Case for Equal Treatment, that The New Zealand Initiative published this week. Des Gorman, professor of medicine at Auckland University, wrote the foreword.
Regrettably and disturbingly, I found obfuscation on a grand scale. Unequal group average outcomes are conflated with inequity and racism. Correlation is taken to be causation. Materiality is merely asserted.
What about the remedy? The Pharmac Review Panel proposed that Pharmac’s spending be skewed to favour the needs of “priority populations”, notably Māori.
That approach treats Māori lives as being of higher value than those not in a priority population. The report illustrates how this might be quantified. It also shows how even Māori might end up worse off.
Official documents justify this racially polarising approach for health care generally. Their main grounds are relatively poor average health outcomes for Māori, ‘equity’, and the Treaty.
Non-Māori outnumber Māori by 40% in the bottom decile of according to New Zealand’s Deprivation Index. To favour Māori over others in this decile violates horizontal equity. To favour Māori in better-off deciles over non-Māori in the lower deciles violates vertical equity.
Nor is the international empirical evidence on such “affirmative action” policies encouraging.
People who do not care for accurate diagnosis cannot care much if their remedy does not work.
Finding remedies that work for all is critical. The previous government’s social investment approach had that focus. The current racially polarising approach does not.
I examine those responses in my report, Every Life is Worth the Same: The Case for Equal Treatment, that The New Zealand Initiative published this week. Des Gorman, professor of medicine at Auckland University, wrote the foreword.
Regrettably and disturbingly, I found obfuscation on a grand scale. Unequal group average outcomes are conflated with inequity and racism. Correlation is taken to be causation. Materiality is merely asserted.
What about the remedy? The Pharmac Review Panel proposed that Pharmac’s spending be skewed to favour the needs of “priority populations”, notably Māori.
That approach treats Māori lives as being of higher value than those not in a priority population. The report illustrates how this might be quantified. It also shows how even Māori might end up worse off.
Official documents justify this racially polarising approach for health care generally. Their main grounds are relatively poor average health outcomes for Māori, ‘equity’, and the Treaty.
Non-Māori outnumber Māori by 40% in the bottom decile of according to New Zealand’s Deprivation Index. To favour Māori over others in this decile violates horizontal equity. To favour Māori in better-off deciles over non-Māori in the lower deciles violates vertical equity.
Nor is the international empirical evidence on such “affirmative action” policies encouraging.
People who do not care for accurate diagnosis cannot care much if their remedy does not work.
Finding remedies that work for all is critical. The previous government’s social investment approach had that focus. The current racially polarising approach does not.
Dr Bryce Wilkinson is a Senior Fellow at The New Zealand Initiative, Director of Capital Economics, and former Director of the New Zealand Treasury. His articles can be seen HERE.
3 comments:
I agree with Bryce Wilkinson. Below I quote from an article of my own, published on Breaking Views on 2 May.
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 focusing on the real causes and could detract from our efforts to address those causes.
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.
For example, 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.
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.
David Lillis
For anyone who is interested, here is the reference to Marie et al.
Marie, D., Fergusson, D. M. and Boden, J. M. (2008). Educational Achievement in Maori: The Roles of Cultural Identity and Social Disadvantage. Australian Journal of Education. Volume: 52, issue: 2, page(s): 183-196. Article first published online: August 1, 2008; Issue published August 1, 2008.
Interesting that Maori pushing for preferential treatment on grounds of systemic racism and inequality are the very ones who seem to have done very nicely for themselves under the existing system.
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