Lowdecile student ratio a concern
‘‘THE benefits to society of having a socio-demographically diverse health workforce are well documented.’’ So began a paper in the June issue of the New Zealand Medical Journal, which Civis tracked down after reading about it in the ODT.
The paper describes the characteristics of students accepted into eight Health Science Professional Programmes (HSPPs) at the University of Otago in 2016, compared with 2010, to assess progress towards increasing diversity within the health professional student cohort. The programmes included dentistry, medicine, pharmacy, physiotherapy, radiation therapy, and related degrees.
An important tool for addressing health inequities in different populations, such as Maori, Pacific Island and rural, is ensuring that enough of those providing medical care are drawn from those populations.
So, after 2010, the university instituted its Mirror on Society selection programme, to increase diversity in the student intake. This has achieved substantial increases in
Maori and PI students, and a small increase in those from rural backgrounds, in the HSPPs overall, and in medical students.
But the picture is less encouraging regarding the socioeconomic category from which students come.
New Zealand has roughly equal numbers of people in each of the 10 categories of the NZDep Index of Deprivation. It’s known that deprivation affects academic achievement, and that’s reflected in the much higher, and growing, numbers of HSPP students from areas of least deprivation. In 2016, based on home addresses, there’s been an increase in the percentage of students from each of NZDep1 (best off) to NZDep4; percentages from NZDep5, NZDep8, and NZDep10 are, roughly, unchanged; and those from NZDep6, NZDep7, and NZDep 9 have dropped — there’s been a ‘‘drift to the rich’’.
Another measure of socioeconomic category is the decile rating of schools students attended (decile 1 is most disadvantaged, decile 10 least). This appears to show an increase, from 2010 to 2016, in medical students drawn from deciles 13, from 2.4% to 4.7%. But there’s a greater increase (26% to
30.7%) in those from deciles 47, and even greater (50.7% to 58.5%) in those from deciles 810.
The drop (20.8% to 6.2%) in ‘‘decile unknown’’ almost exactly matches the total of increases (the same is found for the combined HSPPs, and for all Otago University students), suggesting the ‘‘increases’’ are artefacts arising from better information.
But it’s clear that HSPP students, and al lOU students, are disproportionately, and perhaps increasingly, from welloff backgrounds.
That should concern the whole university. But it’s particularly worrying about medical students heading for general practice. That’s where practitioners drawn from the setting in which they’ll work are most vital.
It’s encouraging that, in 2017, the university added two further categories — low socioeconomic groups and refugees — as ‘‘affirmative pathways’’, hoping to increase enrolment in HSPPs by students from those groups.
But that won’t be enough — admission to courses is just the start.
When Civis attended university in the 1960s, thanks to bursaries for those who passed their exams, and easily obtained work in the Christmas vacation, students with no family help could undertake fulltime university study, debt free.
Not now. Even with parttime work (difficult, given the demands of the medical course) medical students from lowincome backgrounds struggle to survive on current student allowances and loans, and though there are some charitable trusts to help them, they can help very few students.
If more students from low socioeconomic groups enter HSPPs, and in particular the medical course, they’ll need more financial support. Whatever conditions might be applied (bonds, perhaps, like the studentships of the past for those intending to teach?) better government funding is essential.
Civis intended to inveigh against the previous government’s originally seven, then eight, years student loan cap, which affected some students coming to medicine after previous tertiary study — the eight years cap didn’t always allow them to complete the medical course.
But this week the Government beat me to it, increasing it to ten years. Common sense has won.