Introduction:
As a retired medical research scientist with nearly 30 years of experience working in close collaboration with consultant clinicians and teaching clinical training fellows, I wish to provide feedback on the Medical Council’s draft statements. While my career was spent overseas at the intersection of research and clinical practice (Queensland Institute of Medical Research, Queen’s Medical Centre, Queen’s Medical Research Institute) after graduating from Otago (Chemistry), I have observed first-hand the dedication of medics to patient-centred care based on medical need and evidence.
Let me start by stating I support the Council’s goal of promoting culturally responsive care and addressing health disparities. New Zealand’s healthcare system must evolve to meet the needs of our diverse population, and I acknowledge the well-documented inequities in health outcomes for Maori, such as lower life expectancy (7–8 years below non-Maori), higher rates of preventable deaths, and unmet primary care needs (44% for Maori). These gaps are real and demand action.
My core concern with the drafts, however, is their tendency to conflate socioeconomic status (SES) with systemic racism as a primary causal explanation for these disparities. While the draft documents do not explicitly state “systemic racism” it is evident from the use of terms like “systemic bias,” “unfair systems,” “institutional structures,” “power imbalances,” and “colonial histories”. This attribution of systemic racism remains unproven on rigorous scientific grounds and risks embedding socially and scientifically contested interpretations into professional standards, potentially at the expense of more practical, evidence-based solutions focused on prevention, education, and individual responsibility.
Acknowledging Disparities and Inequities:
The drafts rightly highlight inequities in access, treatment, and outcomes, but frames them as rooted in historical colonization and ongoing structural issues. For instance, the Hauora Maori draft states: “Historical and ongoing colonization means that Maori are prevented from accessing resources that promote good health and experience much higher exposure to health harms compared to non-Maori.” Similarly, the Cultural Competence draft notes: “The values and worldviews of settler traditions... continue to privilege or advantage people who align with the ‘norms’ of that time, and disadvantage others.”
I do not dispute the existence of these disparities. Data from the Ministry of Health and studies like the 2019 Waitangi Tribunal inquiry show Maori face higher burdens of chronic conditions (e.g., diabetes prevalence 8–10% for Maori vs. 5% for Europeans), respiratory illnesses, and barriers to care, often amplified by SES factors like poverty, housing overcrowding, and rural isolation which manifests in higher emergency department visits and lower preventive care uptake. I can also appreciate that cultural mismatches can also exacerbate distrust and reduce engagement with services but this issue is not unique to Maori, especially when we have a predominance of internationally trained and migrant medical doctors, nurses, midwives and allied health professionals.
However, the drafts’ mandatory requirements for medical doctors to “actively acknowledge and address your own power, privilege, biases” and “use your professional influence to work in partnership with Maori to identify and dismantle unfair systems and power imbalances” imply acceptance of “systemic racism” as a settled fact. This goes beyond encouraging respect and self-reflection; it mandates endorsement of a causal framework that conflates SES-driven problems with racism, without sufficient causal evidence.
The Conflation of SES with Systemic Racism: An Unproven Attribution:
From my reading of the epidemiological literature, the link between systemic racism and health disparities is suggestive at best, not proven. Studies like Steyn et al. (2021) in the New Zealand Medical Journal show residual ethnic differences in COVID-19 hospitalization odds (2.5x for Māori, 3x for Pacific peoples) after adjusting for age and comorbidities. However, these models often fail to fully account for unmeasured SES confounders, such as household crowding, occupational exposure, or nutritional factors like vitamin D deficiency [as explored in Robert Scragg’s work (UoAkl), which highlights lower levels in Maori and Pacific populations due to biological and environmental reasons].
Researchers like Michael Baker repeatedly attribute these residuals to “structural inequities and systemic racism,” but this is interpretive, presumptive and unproven. Self-reported racism (e.g., 13.8% of Maori citing ethnicity-based discrimination in healthcare) correlates with worse outcomes, but causation has not been established—correlations could reflect SES overlaps or recall bias. Critiques from sources like the New Zealand Initiative argue that SES explains 30–50% of disparities, with racism claims lacking robust empirical isolation. As a scientist, I expect causal proof through methods like mediation analysis or quasi-experimental designs; without it, labelling residuals expressed in increased odds as racism risks confirmation bias and ideological subjectivism in modelling and policy.
This conflation concerns me because it diverts focus from actionable SES interventions. For example, access barriers where practices are often “maxed out” which stem from workforce shortages and capacity issues, not selective turning away based on race. Framing them as “prevented from accessing resources” due to colonization implies racism where logistics and deprivation may dominate. Similarly, obesity and smoking—major risk factors disproportionately affecting Maori and Pacific peoples—are often targeted by clinicians as modifiable behaviours, not ethnic traits. In my experience, any expressed frustration from medical colleagues was directed at these risks, not ethnicity, though critics might call this de facto racism due to demographic patterns. I argue otherwise: it is evidence-based risk stratification.
I would also add that despite historic and targeted preferential entry pathways for Maori students at both Otago and Auckland medical schools (~15-20% of recent intakes) the proportion of practising Maori doctors remains at ~5.5% of the workforce (Medical Council of New Zealand, 2025). This suggests that even with equity mechanisms in training, broader SES, educational, and distributional challenges continue to limit the impact on community service, rather than a lack of opportunity rooted solely in “systemic racism.”
The Role of Individual Responsibility and Education in Prevention:
The drafts emphasize treatment equity (e.g., “equitable outcomes” and “different approaches and resources to get equitable health outcomes”), but underplay prevention. A recent casual observation in nearby Hastings—a city with high Maori and Pacific populations—illustrates this: a McDonald’s packed with Maori/Pacific families and schoolchildren mid-afternoon, with fast food as an affordable social hub. This scene underscores how SES (time poverty, food insecurity) drives dietary patterns contributing to obesity (47% for Maori, 63% for Pacific vs. 32% for Europeans) and related conditions, yet the narrative often defaults to colonial legacies rather than immediate prevention strategies (see post-script).
At what point does individual responsibility enter? Prevention requires education on nutrition, exercise, and health-seeking behaviours, but discussing this risks accusations of victim-blaming, especially from non-Maori voices. Maori-led programs like Whanau Ora show promise in culturally tailored education, yet the drafts focus more on doctors challenging “systemic bias” than advocating upstream interventions. The Ministry of Health’s Equity Adjustor for elective surgeries—prioritizing Maori and Pacific peoples via points systems—addresses treatment gaps but feels like “reverse discrimination” to some, conflating race with need when SES targeting might suffice. Are disparities truly race-based, or SES proxies? The drafts’ language supports the former, potentially embedding it into standards without proof, and that I find unacceptable and unprofessional.
Recommendations and Conclusion:
To strengthen the statements, I would recommend:
Yours faithfully, Simon B Brown (PhD)
PS: Why fast food can look affordable when households are food-insecure:
Food insecurity is not about having literally no food or not knowing when the next meal will arrive. The MoH defines food insecurity as “limited or uncertain availability of nutritionally adequate and safe foods” or “limited ability to acquire acceptable foods in a socially acceptable way.” This often means families can eat regularly but must compromise on quality, variety, or nutrition because of money, time, or access constraints.
Fast food (e.g., McDonald’s) can appear inconsistent with poverty, yet it frequently fits the pattern because:
Ministry of Health. New Zealand Health Survey: Annual Data Explorer (2022/23). https://minhealthnz.shinyapps.io/nz-health-survey-2022-23-annual-data-explorer/
Carter et al. (2010). Aust N Z J Public Health. DOI: https://doi.org/10.1111/j.1753-6405.2010.00615.x
Simon Brown is a retired medical research scientist with nearly 30 years of experience. This article was sourced HERE
My core concern with the drafts, however, is their tendency to conflate socioeconomic status (SES) with systemic racism as a primary causal explanation for these disparities. While the draft documents do not explicitly state “systemic racism” it is evident from the use of terms like “systemic bias,” “unfair systems,” “institutional structures,” “power imbalances,” and “colonial histories”. This attribution of systemic racism remains unproven on rigorous scientific grounds and risks embedding socially and scientifically contested interpretations into professional standards, potentially at the expense of more practical, evidence-based solutions focused on prevention, education, and individual responsibility.
Acknowledging Disparities and Inequities:
The drafts rightly highlight inequities in access, treatment, and outcomes, but frames them as rooted in historical colonization and ongoing structural issues. For instance, the Hauora Maori draft states: “Historical and ongoing colonization means that Maori are prevented from accessing resources that promote good health and experience much higher exposure to health harms compared to non-Maori.” Similarly, the Cultural Competence draft notes: “The values and worldviews of settler traditions... continue to privilege or advantage people who align with the ‘norms’ of that time, and disadvantage others.”
I do not dispute the existence of these disparities. Data from the Ministry of Health and studies like the 2019 Waitangi Tribunal inquiry show Maori face higher burdens of chronic conditions (e.g., diabetes prevalence 8–10% for Maori vs. 5% for Europeans), respiratory illnesses, and barriers to care, often amplified by SES factors like poverty, housing overcrowding, and rural isolation which manifests in higher emergency department visits and lower preventive care uptake. I can also appreciate that cultural mismatches can also exacerbate distrust and reduce engagement with services but this issue is not unique to Maori, especially when we have a predominance of internationally trained and migrant medical doctors, nurses, midwives and allied health professionals.
However, the drafts’ mandatory requirements for medical doctors to “actively acknowledge and address your own power, privilege, biases” and “use your professional influence to work in partnership with Maori to identify and dismantle unfair systems and power imbalances” imply acceptance of “systemic racism” as a settled fact. This goes beyond encouraging respect and self-reflection; it mandates endorsement of a causal framework that conflates SES-driven problems with racism, without sufficient causal evidence.
The Conflation of SES with Systemic Racism: An Unproven Attribution:
From my reading of the epidemiological literature, the link between systemic racism and health disparities is suggestive at best, not proven. Studies like Steyn et al. (2021) in the New Zealand Medical Journal show residual ethnic differences in COVID-19 hospitalization odds (2.5x for Māori, 3x for Pacific peoples) after adjusting for age and comorbidities. However, these models often fail to fully account for unmeasured SES confounders, such as household crowding, occupational exposure, or nutritional factors like vitamin D deficiency [as explored in Robert Scragg’s work (UoAkl), which highlights lower levels in Maori and Pacific populations due to biological and environmental reasons].
Researchers like Michael Baker repeatedly attribute these residuals to “structural inequities and systemic racism,” but this is interpretive, presumptive and unproven. Self-reported racism (e.g., 13.8% of Maori citing ethnicity-based discrimination in healthcare) correlates with worse outcomes, but causation has not been established—correlations could reflect SES overlaps or recall bias. Critiques from sources like the New Zealand Initiative argue that SES explains 30–50% of disparities, with racism claims lacking robust empirical isolation. As a scientist, I expect causal proof through methods like mediation analysis or quasi-experimental designs; without it, labelling residuals expressed in increased odds as racism risks confirmation bias and ideological subjectivism in modelling and policy.
This conflation concerns me because it diverts focus from actionable SES interventions. For example, access barriers where practices are often “maxed out” which stem from workforce shortages and capacity issues, not selective turning away based on race. Framing them as “prevented from accessing resources” due to colonization implies racism where logistics and deprivation may dominate. Similarly, obesity and smoking—major risk factors disproportionately affecting Maori and Pacific peoples—are often targeted by clinicians as modifiable behaviours, not ethnic traits. In my experience, any expressed frustration from medical colleagues was directed at these risks, not ethnicity, though critics might call this de facto racism due to demographic patterns. I argue otherwise: it is evidence-based risk stratification.
I would also add that despite historic and targeted preferential entry pathways for Maori students at both Otago and Auckland medical schools (~15-20% of recent intakes) the proportion of practising Maori doctors remains at ~5.5% of the workforce (Medical Council of New Zealand, 2025). This suggests that even with equity mechanisms in training, broader SES, educational, and distributional challenges continue to limit the impact on community service, rather than a lack of opportunity rooted solely in “systemic racism.”
The Role of Individual Responsibility and Education in Prevention:
The drafts emphasize treatment equity (e.g., “equitable outcomes” and “different approaches and resources to get equitable health outcomes”), but underplay prevention. A recent casual observation in nearby Hastings—a city with high Maori and Pacific populations—illustrates this: a McDonald’s packed with Maori/Pacific families and schoolchildren mid-afternoon, with fast food as an affordable social hub. This scene underscores how SES (time poverty, food insecurity) drives dietary patterns contributing to obesity (47% for Maori, 63% for Pacific vs. 32% for Europeans) and related conditions, yet the narrative often defaults to colonial legacies rather than immediate prevention strategies (see post-script).
At what point does individual responsibility enter? Prevention requires education on nutrition, exercise, and health-seeking behaviours, but discussing this risks accusations of victim-blaming, especially from non-Maori voices. Maori-led programs like Whanau Ora show promise in culturally tailored education, yet the drafts focus more on doctors challenging “systemic bias” than advocating upstream interventions. The Ministry of Health’s Equity Adjustor for elective surgeries—prioritizing Maori and Pacific peoples via points systems—addresses treatment gaps but feels like “reverse discrimination” to some, conflating race with need when SES targeting might suffice. Are disparities truly race-based, or SES proxies? The drafts’ language supports the former, potentially embedding it into standards without proof, and that I find unacceptable and unprofessional.
Recommendations and Conclusion:
To strengthen the statements, I would recommend:
- Emphasizing universal respect, bias self-reflection, and evidence-based equity actions without mandating acceptance of systemic racism as causal.
- Focusing on SES-driven prevention: Encourage doctors to advocate for education, nutrition programs, and community-led initiatives over treatment prioritization alone.
- Tying requirements to proven evidence: Require ongoing research to disentangle SES from racism, ensuring standards evolve with data.
- Avoiding compelled belief: Reflection on privilege and power should be voluntary tools for improvement, not threats to re-certification.
Yours faithfully, Simon B Brown (PhD)
PS: Why fast food can look affordable when households are food-insecure:
Food insecurity is not about having literally no food or not knowing when the next meal will arrive. The MoH defines food insecurity as “limited or uncertain availability of nutritionally adequate and safe foods” or “limited ability to acquire acceptable foods in a socially acceptable way.” This often means families can eat regularly but must compromise on quality, variety, or nutrition because of money, time, or access constraints.
Fast food (e.g., McDonald’s) can appear inconsistent with poverty, yet it frequently fits the pattern because:
- It delivers immediate calories and satiety at a low upfront cost per meal (high fat/sugar/salt makes it filling quickly).
- Healthy home-cooked meals often require more cash at once (buying multiple ingredients), more time (shopping, preparation, clean-up), and reliable access to a kitchen and fresh produce that doesn’t spoil.
- In deprived areas, fast-food outlets are denser and more convenient than supermarkets; transport or time to reach better options may not be available.
- For exhausted parents juggling shift work or large families, “quick and filling now” often trumps “healthy but effortful.”
Ministry of Health. New Zealand Health Survey: Annual Data Explorer (2022/23). https://minhealthnz.shinyapps.io/nz-health-survey-2022-23-annual-data-explorer/
Carter et al. (2010). Aust N Z J Public Health. DOI: https://doi.org/10.1111/j.1753-6405.2010.00615.x
Simon Brown is a retired medical research scientist with nearly 30 years of experience. This article was sourced HERE
6 comments:
How about the systematic sexism in our health system. NZ men die younger than women (I understand by four years on average). Men have higher rates of terminal cancer, heart disease, death by accidents as well as suicide and mental health problems. So where are the efforts by the Medical Council and Health System to address the "systemic bias,” “unfair systems,” “institutional structures,” “power imbalances,” and “colonial histories”.
Also, funny how the name Michael Baker comes up when idealogy becomes a part of medicine. I seem to remember him from a previous time when we were all supposed to follow his expertise and everything he said was unquestionably accepted by the media.
Believers in dogmas such as 'systemic racism' (I am using quasi-religious terms quite deliberately) tend to shun scientific epistemology. Empirical science is associated (as their deluded minds see it) with the Great White Male Conspiracy to Rule the World. It is therefore evil and must be sidelined. Their case is faith-based - faith in marxofascist doctrine. So there is no point at all in arguing that their position does not stand up to rigorous scientific scrutiny.
Thank you for this. You explain the situation very well.
Dear Mr. Brown: Re your well-reasoned and researched piece:
The Maori elite/radicals and their woke enablers (who are infected with the suicidal urge to destroy the very Enlightenment-based civilization they benefit from) will NEVER accept your reasoning and proofs about Maori health because
1) These people do not operate from a rational basis. For them, its all emotion and mythology.
2) It is in the self interest of Maori elites and radicals to perpetuate the myth that ALL Maori health problems/outcomes are Never the fault of Maori culture or Maori as individuals.
3) Maori culture is tribal; that means:
A)Distrust of all "out" groups (my tribe above all). Maori with this basic cultural belief, coming into a non-Maori doctor's surgery, are always going to have a predisposed distrustful victim "attitude" which they will subjectively express as "experiencing racism".
B) Tribal culture ALWAYS puts the group first and the individual last. With this basic belief, trying to talk with Maori about their individual responsibility for their own health is ALWAYS going to be like pushing shit uphill. It is always about the group. This is why we hear so much about the "whanau" being involved in the medical treatment. This is NOT the same as the doctor taking into account of the wider family context of an individual Maori who is his patient, but actually saying that the family must be "consulted" about the treatment plan and approve of it. How could any doctor operate effectively under these conditions where his/her every move is under the critical scrutiny of a bunch of non-medical people, each with their own agenda?
C) Tribal culture is inherently based on top-down authority. To sustain their position as top dog in the tribal hierarchy, it is in the interests of the Maori tribal elite and radicals to always have an under-class in the tribe. The underclass takes orders from the elite and does the heavy lifting. Given this cultural set up, it is obviously in the interest of the elite tribal leaders to do all they can to maintain the status quo of Maori as perpetual underdog and victim of the non-Maori "others". Tribal elite will then use all these statistics about the travails of the Maori underclass to justify their rorts of the "unfair" system.
The idea there are Maori people is patiently ridiculous. Anyone claiming special dispensation because of selective ancestry need to be ignored.
This commentary is flawed as it buys into the false narrative that sustains the idea that actual Maori still exist when infact only human people exist.
We are all the same, but also different, in incalculable ways.
.
This is just more evidence of what the perpetually deranged left think is “good racism”
Racism is never good or helpful, it’s intellectually bankrupt wherever it occurs
When can we stop with all of our racist laws/rules/guidelines etc ?? 🤷🏻♂️
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