Good intentions can all too often founder on the rocks of practical difficulties. Such is the case with the pro-Maori health policies proposed as part of the Government's Closing the Gaps initiative. Nobody can doubt that social cohesion will be endangered if steps are not taken to bridge the divide between Maori and other New Zealanders in health, life expectancy, education and income. But, as the Race Relations Conciliator has pointed out, affirmative-action health policies targeting Maori, such as hepatitis B and smoking cessation programmes, invite racial division, resentment and anger.
Dr Rajen Prasad provides good examples of how such sentiment is being stirred. People, he says, are being turned away from hepatitis B testing caravans because they are not Maori. And he has received a complaint from a Pakeha forced to travel 30 or 40km for treatment while a Maori neighbour received the same service from a mobile clinic down the street. Such incidents promote only discord, the very opposite of the cohesive urge at the heart of Closing the Gaps.
Health should not be administered in a discriminatory fashion. International conventions to which New Zealand is a signatory say as much. Dr Prasad recommends that the Government should act in the first instance by dropping the clauses in proposed legislation that say health treatment should be interpreted in light of the Treaty of Waitangi.
The Government, for its part, says no preferential treatment is intended. According to the Prime Minister, the intent of the treaty clause was "to signal that Maori must be involved in the planning and providing of services, which seems perfectly reasonable."
Yesterday, Helen Clark reiterated that Maori would not get favourable health treatment. Whatever the intention, this, of course, overlooked the stark examples of preference outlined by Dr Prasad the previous day. Instead, the Prime Minister accused Dr Prasad of failing to take account of Government utterances since the Health and Disability Bill was first proposed. There would be changes to the legislation, she said, without being specific.
In fact, the Government has been given good reason to reassess its Closing the Gaps policy.
Dr Prasad's criticism goes to the heart of the planned programme, which envisages responsibility for delivering social services to Maori devolved through iwi and other Maori structures. Assistance for Maori would be delivered by Maori in a Maori way. Such a process is always open to claims of discrimination if other races are excluded. Only if such services treat all people fairly and equally will they ensure that they avoid such criticism.
More fundamentally, however, the Government is being prodded to recognise that Maori deprivation has more to do with socio-economic factors than ethnicity. This was the conclusion of a report by the Labour Department's senior research analyst, Simon Chapple. Helen Clark might well have had that finding partly in mind when she referred to a lot of water having gone under the bridge since the Government first formulated legislation.
Mr Chapple said, in essence, that place of residence, age, education and skills had more to do with poverty than race. In areas such as South Auckland, Northland and the central North Island, there were poor Maori, but there were also poor Pakeha and poor Pacific Islanders.
Now, the Plunket Society has chimed in, saying it is aware of an increasing link between poor health and lower incomes, rather than ethnicity.
Recognising that this is a problem of poverty as well as ethnicity in fact provides the Government with the path out of its predicament. The way becomes open for the targeting of risk areas, rather than an at-risk race. If there is a prevalence of teenage pregnancy in, say, Northland, that district would be selected for a special programme of free contraceptive advice.
Maori, who are obviously over-represented as an at-risk group in many areas of health, are concentrated in such regions. Thus, they would automatically become one of the major recipients of such community assistance. However, other people, equally needy but of a different race, would not be denied such services.
If need, not ethnicity, is the basis of such programmes, issues of Maori health will still be tackled.