As background, most readers will recall that it was revealed in the New Zealand Herald of 19 June that Health New Zealand (or Te Whatu Ora as they prefer to be known) has introduced “an Equity Adjustor Score” intended to “reduce inequity in the system by using an algorithm to prioritise patients according to clinical priority, time spent on the waitlist, geographic location (isolated areas), ethnicity, and deprivation level”.
In the “ethnicity category”, Maori and Pasifika are top of the list, with all other ethnicities lower-ranked.
There has been strong push-back against using ethnicity as the basis for determining priority for surgery, from at least some surgeons, and from both the National Party and ACT.
Mr Trafford offers four arguments in defence of the system.
First, he argues that “Maori experience poorer health outcomes than non-Maori, for no fault of their own”. He notes that “Maori have higher rates of chronic conditions such as cardiovascular disease, diabetes and respiratory diseases.”
Second, he notes that “Maori have a lower life expectancy than non-Maori”.
Third, he argues that “Maori face barriers in accessing healthcare services, leading to delays in receiving appropriate treatment”.
And finally, he argues that “the New Zealand government has a commitment to equitable participation in healthcare for Maori through Te Tiriti o Waitangi”.
The first three of those arguments don’t carry water at all. If, as he asserts, probably correctly, Maori have poorer outcomes than other New Zealanders, they will by definition be getting more access to surgery given that clinical priority, time spent on the waitlist, geographic location (isolated areas) and deprivation are already key criteria in determining who gets priority access to surgery. There is absolutely no reason to add ethnicity on those three grounds.
David Seymour asked the Prime Minister in Parliament on Tuesday this week whether he would be considered Maori for the purposes of receiving healthcare, and was told that that was up to him. (Mr Seymour has some Ngapuhi ancestry.) As Mr Seymour commented: “That settles the question of how Te Whatu Ora determines whether someone is Maori, Pasifika, or another ethnicity for the purposes of prioritizing people on the surgical waitlist. You can just self-identify.”
It is Mr Trafford’s fourth argument for prioritizing Maori and Pasifika which is the weakest. He argues that Te Tiriti requires the government to provide “equitable participation in healthcare for Maori”. (Te Tiriti said nothing about Pasifika of course.) And he is surely right that Article III of Te Tiriti made it clear that all New Zealanders were to have equal rights and responsibilities, but equal rights cannot be interpreted to mean superior rights for those who chance to have one or more Maori ancestors.
If clinical priority, time spent on the waiting list, living in a remote area and deprivation level are used as criteria in ordering the waiting list, those with a Maori or Pasifika ancestor may on average get a degree of priority, but that should have nothing whatsoever to do with who their ancestors were.
There has been strong push-back against using ethnicity as the basis for determining priority for surgery, from at least some surgeons, and from both the National Party and ACT.
Mr Trafford offers four arguments in defence of the system.
First, he argues that “Maori experience poorer health outcomes than non-Maori, for no fault of their own”. He notes that “Maori have higher rates of chronic conditions such as cardiovascular disease, diabetes and respiratory diseases.”
Second, he notes that “Maori have a lower life expectancy than non-Maori”.
Third, he argues that “Maori face barriers in accessing healthcare services, leading to delays in receiving appropriate treatment”.
And finally, he argues that “the New Zealand government has a commitment to equitable participation in healthcare for Maori through Te Tiriti o Waitangi”.
The first three of those arguments don’t carry water at all. If, as he asserts, probably correctly, Maori have poorer outcomes than other New Zealanders, they will by definition be getting more access to surgery given that clinical priority, time spent on the waitlist, geographic location (isolated areas) and deprivation are already key criteria in determining who gets priority access to surgery. There is absolutely no reason to add ethnicity on those three grounds.
David Seymour asked the Prime Minister in Parliament on Tuesday this week whether he would be considered Maori for the purposes of receiving healthcare, and was told that that was up to him. (Mr Seymour has some Ngapuhi ancestry.) As Mr Seymour commented: “That settles the question of how Te Whatu Ora determines whether someone is Maori, Pasifika, or another ethnicity for the purposes of prioritizing people on the surgical waitlist. You can just self-identify.”
It is Mr Trafford’s fourth argument for prioritizing Maori and Pasifika which is the weakest. He argues that Te Tiriti requires the government to provide “equitable participation in healthcare for Maori”. (Te Tiriti said nothing about Pasifika of course.) And he is surely right that Article III of Te Tiriti made it clear that all New Zealanders were to have equal rights and responsibilities, but equal rights cannot be interpreted to mean superior rights for those who chance to have one or more Maori ancestors.
If clinical priority, time spent on the waiting list, living in a remote area and deprivation level are used as criteria in ordering the waiting list, those with a Maori or Pasifika ancestor may on average get a degree of priority, but that should have nothing whatsoever to do with who their ancestors were.
Dr Don Brash, Former Governor of the Reserve Bank and Leader of the New Zealand National Party from 2003 to 2006 and ACT in 2011.
5 comments:
Don, the ‘equity’ argument used to justify interventions such as this, must be challenged.
Equity means equality of outcome. The contributors to outcomes in relation to medical interventions are vast, complex and not amenable to simplistic, societally destructive (non)solutions.
There is ZERO evidence to suggest this approach will work.
Take obesity surgery for instance; prior to being finally approved for surgery, it is best practice to support patients in an intensive trial of self-directed limited eating and weight loss. This is because it is known that lack of success here increases significantly the chance that the patient will fail to realise the benefits of the surgery and may in fact be further harmed.
Obesity surgery requires a huge and sustained post-operative commitment from the individual.
There is NO way around this.
In the mental world of Woke equity however, this is a perfect example of equity equalising downward.
By focussing simplistically on ‘more surgery equals more equity’ it is being suggested that because Maori ‘fail’ the pre op trial requirements more frequently, then for them, that requirement should be dropped.
That’s like saying of a maori in need of a blood transfusion that we should drop the requirement for cross matching so they have better access to the available blood. (Giving un-crossmatched blood is fatal).
A few years ago i heard a health ‘professional’ seriously agonise over whether it was (woke) right to tell parents that they could pay to get access to an unfunded, but provably more effective, vaccine than that on the (government funded) schedule for their children. Her dilemma? - If she gave parents this information it risked those with more money going off and paying for this superior treatment and this, by definition, would INCREASE the difference in health outcomes between these ‘wealthy’ children and those with lesser means whose only ‘choice’ was to take the routine vaccine. That is, it would INCREASE ‘inequity’ and therefore, was morally wrong.
If any one needs an illustration of both the stupidity of chasing equity at at expense of sanity, and of the truism that Equity Equalises Down then this is it.
‘Equity of outcomes’ is being conflated with ‘Equality of rights’.
In essence, defenders of the “Equity Adjustor Score” argue that the end justifies the means.
The unequal health outcomes for Maori and Pacific people has been a persistent problem and it is possible, as Sir Collin Tukuitonga argues, that this is in part due to an institutional bias and racism.
But to conclude from this that ethnic discrimination is an appropriate means to achieve more equitable health outcomes is “to repudiate morality while laying claim to it.”
To claim that critics of the Equity Adjustor Score are race-baiting is the textbook definition of what George Orwell in his dystopian novel Nineteen Eighty-Four refers to as ‘doublethink’.
Well said Mr Brash. Common sense and a dash of old fashioned Kiwi decency applied here.
The Labour Party and its minions are sadly lacking in these qualities.
DO NOT VOTE LABOUR GREEN OR MAORI.
It`s time kick these dropkicks out of government and all the way to Texas!!!!
As a believer in naturopathy , which is the relationship between health and diet , exercise, positive attitudes and lifestyles, I have always been interested in epidemiology. For me much of Maori ill health can be attributed to poor choices in the above mentioned factors. This unfortunately is related to Maori concentrated in the lower SES group which notoriously self destruct.
My father-in-law, solidly in the working class observed that unlike him most people who had heart surgery did not follow the dietary and other guidelines they were given, and therefore did not benefit much from the operation with extended life span.
My point is, obviously that bad health can be because of bad choices and therefore self inflicted. But education is needed.
In Finland, with a superior education system, they recognize the connection between diet and health and preschoolers on wards are given one free healthy meal a day as part of the education system.
We as a society have failed badly in this area with junk food being so cheap and readily available.
anyone born in NZ is a Pacific Islander ...
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