The Herald uncovers some of the key issues behind "horrible" institutional racism within New Zealand's healthcare system.
An iwi health leader has called for urgent action to put an end to racism within our country's healthcare system, saying "it's killing our people".
It follows a new study in the New Zealand Medical Journal, which shows Māori are 50 per cent more likely to die from Covid-19 than non-Māori.
Another study, also published in NZMJ, showed Māori and Pacific people experience a greater risk of heart disease than Pakeha due to a higher prevalence of smoking, obesity and heart failure.
And a third study in the NZMJ found Māori who are diagnosed with prostate cancer are much more likely to die of the disease than non-Māori. Researchers of the study were calling for more culturally appropriate care to be available to Māori men.
The background health statistics for Māori are even more disturbing. 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.
Interim CEO of Hāpai Te Hauora, Jason Alexander said the recent findings were just the tip of the iceberg.
"[Racism] is deeply embedded in our system, it's not individual racism but it's systematic issues that's having a horrible affect on Māori and Pacific in particular."
He said the issue was so bad it was killing our people.
"Even that word 'inequalities' rolls of the tongue now and I think people have become immune to it but we have to keep in mind what that means at a community level.
"At a community level it's seven years less Māori have with their grandkids."
What are the key issues?
Institutional racism means the procedures or practices of particular organisations result in some groups being advantaged.
In the health context, this could mean Māori health organisations being made to jump through more hoops for less funding, for example, or medical advice being delivered in a culturally insensitive way, making the patient feel talked down to.
Access to care
Alexander said access to healthcare was a major problem for Māori and Pacific and one of the many issues that attributed to the institutional racism.
"I'm based up in Northland, and we had people setting up road blocks (during Auckland's Covid-19 outbreak) because we were so scared for our vulnerable, because we know if it gets up here we are in serious trouble as they don't have access to our health system like they do in the cities."
He said for rural Māori whanau the big issue was travel, in the city it was poverty.
"If you have a crappy car and can't afford to put gas in or if you are working in a low skill job, you don't have the flexibility in your workplace to take a day off to see a doctor or you might not be able to afford to pay the doctor for the appointment, let alone the prescriptions."
Barriers within healthcare services
Even after services are accessed, Māori do not experience the same benefits, a 2019 Landmark report showed.
Health Quality & Safety Commission chairman Professor Alan Merry told the Herald last year after the report came out that problems went much deeper than Māori not being able to access health services as easily. In fact, access can make things worse.
"While broader social factors influence a person's health, the patterns of inequities shown in this report suggest engagement with health services does not reduce inequity. In fact, the results suggest the health system creates further disadvantage for Māori."
Examples given by the commission include:
• Specialist appointments have unacceptably long wait times and happen less often for Māori.
• Inappropriate prescribing happens much more often for Māori, increasing the risk of severe kidney injury.
• Māori children with asthma have more prescriptions for reliever medications without any preventer prescribed. This "may contribute to the 30 per cent higher rate of hospitalisation".
• The percentage of Māori getting an operation for a hip fracture on the day of or after admission has steadily decreased since 2013, whereas the percentage for non-Māori has steadily improved.
• Māori consistently rate the communication with hospital staff and doctors lower than other groups.
• In old age, disabled Māori are less likely to secure specialist equipment.
Lack of Māori and Pacific workforce
Alexander said it was crucial for New Zealand to have a strong Māori and Pacific health workforce, who don't have to be taught how to deal with Māori and Pacific patients.
"It's removing one of the barriers - and that's what it all comes down to getting rid of as many of these barriers as we can and that's certainly one of them."
A 2017 report by the Medical Council of New Zealand found Māori doctors were under-represented in the medical workforce, but there were positive changes at graduate level.
The proportion of Māori doctors increased to 3.6 percent in 2017 but is still well below their proportion of the New Zealand population.
However, almost 16 per cent of Otago's graduates in 2017 were Māori, and in 2016, Māori and Pasifika doctors made up a fifth of Auckland's graduating doctors, the report found.
Auckland DHB told the Herald in July last year it had started a hiring policy that automatically fast-tracks all eligible Māori and Pacific job candidates straight to the interview stage.
"Our people want to learn and understand how to play their role in health outcomes for Māori but they would like tools and guidance to help them do so," a spokeswoman said. "We are also rolling out programmes to improve equity and health outcomes for people from the Pacific nations," they said at the time.
What needs to change?
The major Health and Disability System Review, drafted by Helen Clark's former chief of staff Heather Simpson and NZTA chair Brian Roche, recommended the creation of a Māori health agency but backed away from giving it extensive powers.
Some Māori health professionals raised concerns at the pair's appointment with one saying they "have shown little understanding of equity or Māori health".
Other members of the advisory group and the Expert Māori Advisor Group said the agency should have far more decision-making powers.
Alexander said it was crucial for the proposed agency to have the power to tackle these issues - "it needs teeth and authority otherwise nothing will change".
National's health spokesperson Shane Reti said ethnic inequalities in New Zealand was a serious concern and he promised that he would prioritise the issue if elected.
He said clear Māori specific targets at a DHB level were needed and accountability to ensure those targets were met was crucial.
Health Minister Chris Hipkins said the Government was well aware that any widespread outbreak of Covid-19 here would likely take a heavier toll on Māori and Pacific communities.
"As this paper underlines, this is in large part because of the existing health inequities among these groups.
"Tackling these inequities has always been one of this Government's overriding priorities in health.
"It is why we conducted the recently completed Health and Disability System Review and it will be one of the key drivers of our response to the review.
"It is also why the Government is investing in a range of new initiatives to improve equity in health and wellbeing, with a real focus on growing the Māori and Pacific workforce."
The Government had also been very clear that its pandemic response must be designed and implemented to minimise the impact of the disease on Māori and Pacific communities.