You say equality, I say inequity

Desmond Tutu once said: “My humanity is bound up in yours, for we can only be human together.”

In a bizarre and erroneous twist on this, Finance Minister Nicola Willis said this year’s Budget “delivers to Māori because when a New Zealander turns up to an emergency room or a school, they don’t turn up thinking about their ethnicity”.

Associate Professor Marama Muru-Lanning, director of the James Henare Research Centre, responded: “When a Māori turns up at a hospital, they know they are a Māori! They never forget that, and they’re only there because they absolutely have to be there.”

As a perpetually perplexed academic I can only agree. Just this week, I was reading the survival statistics for babies over the last two decades in Aotearoa New Zealand, and my heart broke. There has been no change in the unequal burden of baby deaths in Māori, Pacific and Indian families.

I would love to believe we all sit in the same waka as we propel everyone forward together – when it comes to participating in our national healthcare system, this clearly isn’t the case. One size does not fit all when it comes to health and healthcare in Aotearoa New Zealand.

Certainly, when it comes to accessing and participating in healthcare, equity is not the same as equality. Equality describes a situation where each individual or group is given the same, whether that be resources or opportunities. Comparatively, equity recognises that we come from different circumstances and histories, that we don’t have the same starting point, and that some need different resourcing to achieve the same outcome – to even the playing field.

Presenting the same healthcare to everyone does not equally meet the needs of all people. To illustrate, I have a son who was unexpectedly born with a ‘disability’, or with differential abilities to my firstborn child. It would not be fair or right for me to offer my children the same care. One of my children required seven specialist doctors at one stage to manage his medical needs, and my other didn’t need any. It wouldn’t have been appropriate or just to offer equal healthcare services while neglecting the clear differential needs of my two sons.

So it is with ethnicity and our current healthcare system in this country. The public health experts Dr Belinda Loring and Dr Elana Curtis, my colleagues at the university, have described the standard practices and behaviours of health professionals and institutions that propagate ethnic bias and, in turn, exacerbate health inequities. In their recent commentary, How racism plays out in contemporary public health practice, they argue:  

“… racism and colonisation [are] the fundamental causes of Indigenous health inequities, driving the appropriation of resources, loss of political power, and cultural subjugation which impact on the more downstream socioeconomic factors, health behaviours and health outcomes.”

Western/European priorities, influences and theories of care dominate our healthcare system and therefore funding choices. Those of European ethnicity are better matched culturally to how our services are used and delivered. This is not surprising because when systems are created by people like you, for people like you, it clearly would serve their needs best. For, as the adage says, you do not know what you do not know.

But is this detrimental to some people? Based on my interactions as a doctor on the wards and the evidence available, yes. Racism is an evidence-based health determinant; however difficult to swallow, that loaded word is. As the authors of a literature review published in the New Zealand Medical Journal, Racism and health in Aotearoa New Zealand, concluded: “Health research in New Zealand consistently finds that self-reported racial discrimination is associated with a range of poorer health outcomes and reduced access to and quality of healthcare.”

The solution to this ingrained matter needs a top-down approach. This was the hope of the health system reform with the establishment of Te Aka Whai Ora, a governing body of Māori health experts to oversee healthcare in Aotearoa. As this was recently dismantled, we can’t measure any positive effects this could have instilled in our hospitals and clinics. We have now lost any advancement globally in obtaining evidence of Indigenous-governed healthcare for post-colonial countries.

If only our Government would lead the way by redistributing resources to ethnic groups at risk of poor health, a risk that only those who come from backgrounds that have lived through the inequity and cultures can truly understand. We need non-European groups to inform and design their own healthcare services and interventions that can meet the needs of all families living in our country.

Cultural processes could potentially enhance wellbeing, healthcare engagement, and overall health; community-led healthcare services, incorporating cultural values such as karakia (prayer) and spiritual needs into care plans, for instance.

As a doctor and mother of mixed ethnic heritage, I know this – connecting to culture improves wellbeing. I returned recently from a family reunion in Samoa with an enhanced understanding of who I am and where I come from, which grounds me and enhances my general feeling of health.

Inequity affects us all, if not directly, but because we all live in this land of the long white cloud. If only we could all acknowledge that the current healthcare system is broken for Indigenous and minority ethnic groups in New Zealand, that it doesn’t meet everyone’s needs as well as it could and should. That would be a start. Only then can we all support our country taking accountability to change the agency, access, acceptability, and opportunity in our health system.  

To bring it back to the waka, we may not be able to control the current in the water, but we can adapt the waka’s design to align with the vision and needs of all New Zealanders. As a wise Samoan proverb says – we are from different parts of the forest but connected in one cause: O lupe sa vao ese’ese, ae ua fuifui faatasi.