Māori are 50 per cent more likely to die from Covid-19 than Pākehā, a groundbreaking new study has found - and institutional racism is partly to blame.
Researchers - including sociology, statistics, physics and cultural history experts - linked existing demographic and health data for ethnic groups in New Zealand with international Covid-19 data to reach the findings.
International data was used was because the number of cases in New Zealand alone is too small to provide a sufficient sample size.
The alarming results, published in today's New Zealand Medical Journal, come as the current Auckland cluster disproportionately affects Pacific NZers (more than 60 per cent of cases) and Māori (about 20 per cent of cases).
Factors that researchers say can explain the difference in risk by ethnicity include:
• More Māori live with multiple underlying health conditions (comorbidities) compared to New Zealand Europeans. Those with comorbidities are at greater risk of dying from Covid-19.
• Hospitalisation and fatality rates for Māori and Pacific from the H1N1 influenza pandemic in 2009 were significantly higher than for New Zealand Europeans.
• Avoidable hospitalisations are higher for Māori and Pacific populations due to structural disadvantages.
• Māori are at greater risk of exposure to the disease due to higher involvement in high-risk occupations and environments and larger social networks.
Risk factors for accelerated transmission included crowded housing, which affects about 25 per cent of Māori and 45 per cent Pacific.
Rapid spread of Covid-19 would "place unprecedented stress on the healthcare system" and almost certainly amplify existing racism, the researchers concluded.
Mike Plank - one of the authors of the paper and a professor in the School of Mathematics and Statistics at the University of Canterbury - said, overseas there were already horrible reports of doctors faced with the awful decision of choosing which Covid-19 patient to save.
"If a patient has a pre-existing health condition then they have less chance of surviving, so the doctor would more likely prioritise the healthier patient," he said.
Plank said the worse health outcomes for Māori and Pacific people "stem from widespread inequities in the healthcare system and the ongoing impacts of systemic racism and colonisation".
Given the speed at which Covid-19 could spread, there was an urgent need to prepare healthcare services and establish measures to protect at risk groups.
The researchers said better transparency was needed in the risk factors and weightings used to guide decision-making about healthcare service provision - and more work was needed to incorporate these findings into the Ministry of Health disease transmission models that are used to inform New Zealand's Covid-19 response.
The New Zealand data showed the level of pre-existing health conditions in Māori and the international data revealed that pre-existing health conditions meant greater risk of dying from Covid-19.
Researchers adjusted the age-specific infection fatality rates (IFR) from international data for differences in unmet healthcare need, and comorbidities by ethnicity.
They also altered the life expectancy rate for each ethnicity due to evidence that Covid-19 amplifies existing death rates.
The research comes as additional studies, conducted by separate researchers, have revealed major ethnic inequalities within our country across the board, including mental health, heart attacks and prostate cancer.
READ MORE: The key issues behind racism within our healthcare system.
About the study's authors:
• Professor Shaun Hendy is Director of Te Pūnaha Matatini, a research centre focused on the study of complex systems and networks, based at the University of Auckland.
• University of Canterbury Professor Michael Plank and Associate Professor Alex James work in the department of mathematics and statistics, including on all the Covid-19 modelling. They also work for Te Pūnaha Matatini.
• Kate Hannah, Research Fellow in Physics at University of Auckland, and Deputy Director, Equity and Inclusion at Te Pūnaha Matatini.
• Tahu Kukutai specialises in Māori and Indigenous population research. She is affiliated with the University of Waikato and the National Institute of Demographic and Economic Analysis.
• Melissa McLeod (Ngāi Tahu) is a public health physician and senior research fellow working at Te Rōpū Rangahau Hauora a Eru Pōmare, University of Otago, Wellington.
• Audrey Lustig and Rachelle Binny are affiliated with Manaaki Whenua Landcare Research.
• Andrew Sporle is affiliated with Statistics Department at the University of Auckland. He has more than two decades experience developing initiatives in social and health research as well as Māori research workforce development.
• Kannan Ridings is a researcher at Department of Physics, University of Auckland.