AFFIRMATIVE PATHWAYS
A DOCTOR and senior academic who was one of only two Maori men to get into the Otago Medical School’s 1959 intake wonders if recent action to boost admissions from minority groups has been a little too successful.
A scheme that gives priority to sectors such as Maori and Pasifika has been starting to make headway in attracting more of those students into medicine, but that means some who are not from minority groups are missing out.
‘‘I like the concept of Mirror on Society,’’ Prof Colin Mantell (80) said, referring to the University of Otago’s policy of generating a health workforce more reflective of New Zealand’s ethnic and socioeconomic makeup.
However, such efforts could generate ill feeling, especially if they were effective.
In 2020, more than half the secondyear medical placements at Otago went to students who gained entry through affirmative pathways — Maori, Pasifika, rural, low socioeconomic and refugee.
The university is considering adjusting the way students are selected for the medical school and one idea is to bring in caps on those pathways.
Prof Mantell, of Wanaka and from the Ngai Tahu iwi, said that idea disappointed him.
He was in charge of the Vision 20:20 programme that started at Auckland University 23 years ago. The aim was to get the proportion of Maori and Pasifika doctors in New Zealand up to 10% by 2020.
Senior high school pupils were told if they had an interest in healthcare, the university had a place for them. The university promoted bridging courses and provided general support for Maori and Pacific students.
New Zealand remains well short of Prof Mantell’s target.
Maori make up 3.4% and Pacific people 1.8% of the medical workforce. The proportion of the total population who identify as Maori or Pasifika is about 15% and 8%, respectively.
However, recent numbers indicate a shift. In 2018, almost 16% of Otago’s graduates and 14% of Auckland’s graduates were Maori.
Prof Mantell and influential Maori health leader and Massey University academic Sir Mason Durie were the only two Maori in his 1959 class.
Prof Mantell had ‘‘reasonable but not wonderful grades’’ and assumed he entered the school through a targeted admissions scheme.
‘‘It was a great break for me.’’ He went on to study the impact of smoking on unborn babies, study at Oxford University, chair a Maori and Pacific Island health committee at Auckland University and work as a clinician and lecture in obstetrics and gynaecology.
His PhD was about the physiology of the foetus.
Prof Mantell said factors such as whether a student attended one of the best schools, family circumstances and cultural expectations could affect equality of opportunity.
People became grumpy when their ambitions were thwarted, he said. Some tended not to get grumpy about generations of Maori or rural children missing out ‘‘because of the circumstances of their birth’’.
He was encouraged by progress made in promoting female judges and saw a parallel in that.
AN RNZ National news item on Friday last week referred to a paper published in the New Zealand Medical Journal that day. The Auckland University study had found that a year after a first myocardial infarct (heart attack) the death rate in Maori and Pasifika was three times that in Pakeha (the first infarct occurred at a younger age too). Looking online for that article Civis found that the relevant issue of the NZMJ (Vol 133 No 1521: September 4, 2020) is dedicated to: “Acknowledging and acting on racism in the health sector in Aotearoa”.
This issue of the NZMJ underlines what’s been known for years, that Maori and Pasifika have worse health outcomes than Pakeha New Zealanders. Obvious examples include their shorter lifespan (averaging seven years shorter for Maori, 5.5 for Pasifika), and the high incidence of rheumatic fever (long eliminated from other OECD countries) among Maori and Pasifika.
There are many factors causing this difference. Poverty’s one. Another is medical care.
Medical care is most effective when providers and recipients share a common kaupapa, and so can best understand and relate to each other, and work together to improve health.
When Civis was a student, in the 1960s, entry to medical school, apart from a few individuals admitted after gaining degrees, and a very few under a Maori admission policy (the class which included a number of Civis’ friends had perhaps two Maori), was by competition: marks in the medical intermediate subjects, zoology, physics and chemistry.
Concern over the low numbers of Maori and Pasifika doctors led to the introduction of the ‘‘Mirror on Society’’ admissions policy, which, under the leadership of Prof Peter Crampton, previous medical school dean and provicechancellor for the division of health sciences, has aimed, over the past decade, to increase the numbers of doctors coming from a variety of backgrounds (Maori, Pacific Island, rural and, recently, lowincome and refugee) to match their strength in the general population.
Domestic students from those groups, providing they achieve 70% in every firstyear health sciences subject (in 1962 Civis’ upper sixth form biology teacher kept reminding those aspiring to study medicine that they’d need to get 70% in medical intermediate), can gain entry to medical school without having to score more than other applicants.
The policy is showing results. Between 2010 and 2016 there was a 124% increase in Maori students, a 121% increase in Pasifika and the proportion of students from rural areas grew from 19% to 22%.
There’s a way to go, though, before there are adequate numbers of Maori and Pasifika doctors to care for their people. Of the present medical workforce only 3.4% are Maori (population 16.5%) and 1.8% Pasifika (population 9%).
Now a university discussion paper has suggested capping the numbers of students admitted under the “affirmative pathways”. And the university has acknowledged it’s facing a legal challenge against aspects of its admission policy.
The legal challenge (is it initiated and funded by wellheeled vaguely pinkish parents of students who’ve failed to gain entry to medical school despite high marks, which in many cases will reflect ‘‘vaguely pinkish privilege’’ in their schooling and firstyear health sciences, or who anticipate that happening?) is unlikely to succeed. An academic lawyer has pointed out that neither section 19 (2) of the New Zealand Bill of Rights Act, nor section 224 (6) of the Education Act, which allow preference to advance disadvantaged people or groups of people, limit such preference to numbers that reflect the country’s population mix.
And what’s so special about getting the highest marks in firstyear health sciences? That doesn’t necessarily make for good doctors.
There’s disquiet among Otago medical students about possible capping of numbers admitted through “affirmative pathways”. So there should be. As student leader Isaac Smiler, tumuaki of Te Oranga ki Otakou, says: “Our people need us.”
It would be disastrous (and racist) to limit “affirmative pathway” numbers, before Maori and Pasifika have enough doctors to meet their peoples’ needs.