Racism is a cause of ethnic health gaps

The reasons are difficult to disentangle, but the facts are black and white: Māori routinely receive worse healthcare and have poorer outcomes than everyone else.

A free public health system should mean the same treatment and outcomes for everyone, right? But what if one group is consistently getting worse care than everyone else?

In New Zealand, you don’t need to wonder. Across the health sector, Māori patients routinely have worse health outcomes than any other ethnic group.

The reasons are complex, but researchers have identified barriers dotted across the health sector that are preventing Māori from accessing the same standard of healthcare as the rest of the population.

AUT public health director Dr Heather Came says the health system is built around Western values for Pākehā patients. She says the inability or unwillingness for that system to change, to better serve Māori patients, is proof of ‘‘institutional racism’’.

The Waitangi Tribunal agrees. After stage one of its ongoing hearing into health, it reported that the ‘‘health inequity Māori continue to experience indicates that the health system is institutionally racist’’.

The tribunal added that there are many reasons, but there is ‘‘uncontested statistical evidence demonstrating that, despite reform and readjustments, Māori health inequities have persisted’’.

So what is that statistical evidence? Well – across different practice areas, there are startling and undeniable health gap between Māori and non-Māori.

This gap has been measured at every stage: social inequities that lead to more ill health and disease in the first place, greater barriers to access, and then differential treatment even when people do make it into the system.

This is seen in mental health, whereMāori inpatients are placed into the wards’ seclusion rooms, akin to solitary confinement, at rates five times higher than non-Māori inpatients.

It’s also seen in cancer care, where studies show Māori are more likely to die and have poorer access to treatment, information and diagnosis. For lung cancer, Māori mortality rates are 2.5 times higher than Pākehā.

The mortality rate for rheumatic fever is five times higher for Māori than non-Māori. The illness, which predominantly affects children, is known as a ‘‘disease of poverty’’ and is rare in most developed nations. Those who survive often face ongoing heart issues into adulthood. The Royal NZ College of GPs says it affects tamariki Māori at a rate 25 times higher than Pākehā children.

A recent Health Ministry report also identified:

■ Māori men are twice as likely than non-Māori men to have depression or anxiety disorders.

■ The stroke mortality is nearly 1.5 times higher in Māori than in non-Māori.

■ Rangatahi Māori are twice as likely as non-Māori young people to be hospitalised due to asthma.

Researchers such as Dr Donna Cormack have highlighted barriers for Māori patients accessing healthcare. These include financial, physical and cultural difficulties for Māori accessing primary healthcare services, and differential treatment at higher levels of healthcare, meaning it’s harder to get specialist care, even when Māori patients are diagnosed at the same stage as others.

All of these disparities in healthcare for Māori contribute to the most disturbing evidence of inequity in the health system: a Māori pēpi born today is currently expected to die 7.5 years earlier than a non-Māori peer.

While the disparities are clear, there is debate about how best to fix them.

The Government has just established the Māori Health Authority. Its job is to make sure the health system addresses these differences. But removing all of these barriers and mending every disparity will take time and deliberate effort, across many different services. It will also require attention to social factors that lead to poor health.

Health workers and researchers say these broader issues, such as the prevalence of cold, damp homes, aren’t considered ‘‘health’’ related in government – but will continue to create unequal health outcomes as long as they exist.

❚

Reporting disclosure statement: This story was reviewed by The Whole Truth: Te Māramatanga expert advisory panel member Dr Rawiri Jansen (Ngāti Raukawa) before publication.