Urgent need for action: Institutional racism killing and harming Māori, says Health Quality & Safety Commission

A powerful health watchdog has challenged health services to stamp out racism that it says severely harms and kills Māori.

A landmark report examining why Māori suffer poorer health than other New Zealanders has been released this morning by the Health Quality & Safety Commission.

The commission's chairman, Professor Alan Merry, was blunt when describing what was found, and the urgent need for action.

"The report lays down a challenge for the health and disability sector to identify and remove institutional racism.

"From before birth through to old age we see inequity. Services are not as accessible for Māori, and even after services are accessed, Māori do not experience the same benefits."

Racism can be both explicit (intentional) and implicit or unconscious (automatic and outside awareness).

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.

"It occurs and continues because people at all levels of the system make decisions that disadvantage one group in relation to another. In this way, personal racism can be a contributing factor to institutional racism," the commission stated in its report.

Merry said today's major report found 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.

Māori die on average seven years earlier than non-Māori, and are two-and-a-half times more likely to die from diseases that are potentially avoidable with good healthcare.

Merry said the challenge was moving from identifying such inequities, as today's report does, to fixing them.

"Creating an awareness that institutional racism has severe effects - from psychological ill-health to physical harm to early death - is an important focus for improving health services.

"The articles of Te Tiriti o Waitangi provide a framework to build and maintain appropriate long-term improvement. Māori knowledge and worldviews, including Māori data and analysis approaches, can strengthen and broaden evidence bases for health care."

Merry said today's report was meant to start a conversation with Māori and those working in and leading health services.

The report's release comes a day after the Herald revealed Auckland DHB had identified institutional racism as a "basic, underlying" reason for poor health suffered by Māori and Pacific New Zealanders. The DHB will put managers through training on institutional racism, and already has a hiring policy to fast-track eligible Māori and Pacific job candidates straight to interview.

The Waitangi Tribunal has recently investigated the health system's treatment of Māori. And last year the Perinatal and Maternal Mortality Review Committee - run by the Health Quality & Safety Commission - called for compulsory cultural competency training for everyone working in maternity and neonatal care, after finding very premature babies were less likely to receive a resuscitation attempt if Māori, Pacific or Indian.

New Zealand research has found final-year medical students reacting to hypothetical patients differentiated only by surnames — Wiremu/Williams or Tipene/Stephens — had, on average, implicit bias, including thinking "Māori" patients were less likely to take prescribed antidepressants.

In March, a special edition of the New Zealand Medical Journal highlighted the fact half of Māori and Pacific deaths in New Zealand are potentially avoidable, compared to 23 per cent for non-Māori and non-Pacific people.

While there were multiple factors in the avoidable death statistics, the journal said racism was the "ethnic health inequities elephant in the room": "It is a term that causes quiet discomfort - or at times not quiet. Yet, if we do not talk about racism and call it by name, its ubiquitous hold on health cannot be challenged."