Māori and Pasifika health experts have spoken of racism, feeling "token" and ignored after being selected to take part in health advisory groups.
A study surveyed six Māori and Pasifika with more than 100 years of collective experience in public health about their experiences on government health advisory groups.
They reported their knowledge and interests were often devalued, they felt marginalised and experienced tokenistic engagement and racism.
Māori and Pasifika in New Zealand experience poorer health outcomes than other New Zealanders, and carry the highest burden of disease.
On average, Māori die seven years earlier than non-Māori. They are twice as likely to die from cardiovascular disease or heart failure, and one and a half times more likely to die from stroke or cancer than non-Māori. Rheumatic heart disease rates are five times higher and twice as high for diabetes.
Lead researcher Auckland University of Technology (AUT) senior lecturer Dr Heather Came said due to many of these issues it was important Māori and Pasifika were not only represented in boards and committees established to tackle them, but were listened to.
While she had researched institutional racism in the health sector, her latest paper, Māori and Pasifika leaders' experiences of government health advisory groups in New Zealand, was the first time they had learned about what happened within the advisory groups.
"We found it was a bit of an ideological battlefield. The very few invited into the room found they needed to assert themselves against the default western position, and be disruptive in order to be heard."
One participant said she altered the tone and volume of her voice to be heard more effectively.
"When I say something, I don't know if it's me and the way that I speak or my accent or something. I look around the room and often people … have this kind of stunned mullet look. Like, what is she going on about?"
Came said participants reported feeling their places on the boards were "token", and they often had to make a point of establishing their credentials, while their Pākehā colleagues did not.
"I do speak up about my experience because I don't want them to think I've just been plucked in as a brown girl or woman," one participant said.
There were as many as 120 government health advisory groups operating at any given time, ranging from semi-permanent committees connected to central government and district health boards, to short-term committees called to develop a particular health policy or strategy.
These appointed advisory groups frequently drew from a limited pool of Māori and Pasifika leaders, Came said. The survey participants had been involved in groups where they were the only Māori or Pasifika, while others were 20-50 per cent.
The leaders surveyed were knowledgeable in their fields, with clinical, cultural and community expertise, and all had participated in various central and district health board advisory and steering groups for at least 10 years.
Came said despite this, they often found they were not being listened to. Some even reported their comments not being recorded in the minutes.
"They would write a whole lot more based on what the Pākehā [white] researchers were saying," one participant said. "And because they probably were not understanding what Māori were saying, they didn't write it down, so it didn't get heard."
One participant said a committee she was on depicted a (white heterosexual) nuclear family as with a mother, father and two children.
"It was myself and one of the Māori people who raised the idea that for Pacific people that can be quite different. You can have 10 plus people living in the same household. You could have your parents and your other parents who are [actually] an aunty and uncle … they really struggled with that concept and how to fit it into their [Western] framework."
The participants also said there was a lack of cultural context and background, partly driven by constant staff turnover and a high proportion of government officials who were new migrants to New Zealand.
The scarcity of Māori policymakers was also viewed as a challenge by several participants who felt they were misunderstood.
"When you do talk, you almost have to, with everything you say, you have to give them a little bit of a picture," one participant said.
Came said participants felt government officials placed a predominance on western science.
"Participants felt that the knowledge of policymakers was biased, incomplete and inadequate to inform the development of policy that could eliminate disparities.
"Māori and Pasifika knowledge and expertise was frequently ignored, debated, contested or perceived as unworthy or invalid. And, this neglect of Māori knowledge is in direct contrast to government policy that affirms the importance of Māori and Pasifika led solutions."
Came said more needed to be done by government officials and agencies to ensure Māori and Pasifika leaders were respected and listened to.
"Health policy advisory groups need deeper engagement and more genuine recognition of Māori and Pasifika knowledge.
"Participants in advisory groups should not be witnessing or experiencing racism or unconscious bias from colleagues. And, the onus should not fall exclusively on Māori and Pasifika leaders to prepare for those cultural exchanges.
"There needs to be more cultural and political training, so people don't bring their racism into the room."