The fact half of Māori and Pacific deaths in New Zealand are potentially avoidable has been called a national travesty. Now, a health board is set to declare racism as one reason for the health chasm.
Northland DHB turned the mirror on itself and, in a briefing endorsed by its chief executive, concluded, "as an institution we fitted the definitions which described racism, inequity and inequality". Nicholas Jones reports.
Another DHB is set to declare racism as a reason for poor health suffered by Māori - adding momentum to a major shift in the health sector.
Northland DHB will sign-off a position statement on institutional racism, a term that describes how procedures or practices result in some groups being disadvantaged.
An internal briefing bluntly states: "Northland DHB has been aware that as an institution we fitted the definitions which described racism, inequity and inequality."
The development comes after the Herald on Sunday revealed Auckland DHB had concluded racism a "basic, underlying" reason for the health chasm between Māori and Pacific New Zealanders and Pākehā.
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In response, Harold Wereta, general manager for Māori health at Northland DHB, drafted a position statement on institutional racism, in a wider briefing to the board that was also endorsed by chief executive Dr Nick Chamberlain.
"Institutional (and systemic) racism contributes to inequalities and poorer health outcomes in our communities," the draft position states.
"It is the collective responsibility of the Northland health system to rid itself of this practice. We are committed to this within NDHB working together with people, whānau/families, communities, hapū, iwi, health agencies and other partners to influence this change and improve access to healthcare to Northland Māori."
A spokeswoman for the DHB confirmed the board approved of the statement in principle but "subject to a couple of changes". It will be discussed at a board meeting this month.
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 over others.
Within 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.
In his report, Wereta stressed that a statement on institutional racism was meaningless unless backed by action.
Programmes already happening included putting more than 2000 staff through compulsory training designed to "confront bias, prejudice and racism" by hearing from Māori communities about their experience of health services. Staff are also educated about Tiriti o Waitangi and the lasting effects of colonisation.
Te Reo courses are also run, Wereta stated, because "one of the most significant barriers identified by Māori, Pacific and other ethnicities is the mispronunciation of a person's Christian or surname". Proposed initiatives include an annual Māori health plan and public reporting of progress, and overhauling funding policy.
Māori make up about a third of Northland DHB's population, and suffer shorter life-expectancy and a greater burden of ill-health. Services have struggled to make headway in some areas, including growing numbers of diabetes-related amputations.
Auckland DHB executives were recently briefed on an internal "equity deep dive" report by the HR department. Racism was a "basic, underlying" reason for poorer health suffered by Māori and Pacific New Zealanders, concluded the report, which was hailed as courageous and groundbreaking by Te Ora, the Māori Medical Practitioners Association.
In July the Health Quality & Safety Commission challenged health services to stamp out institutional racism that it says severely harms and kills Māori. Examples found by the commission included specialist appointments having unacceptably long wait times and happening less often for Māori, and inappropriate prescribing occurring more often for Māori.
"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," said HQSC chairman, Professor Alan Merry.
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.