“There is a false perception that the health sector has been using ethnicity to target health services because of an ideological basis or some spurious, lazy default,” she told the Herald.
“When actually we use it because it is the most scientifically precise way of targeting things that we have at this moment.”
Furthermore, ethnicity was a stronger marker of need than many other factors, like deprivation or rurality, she said. The editorial noted that New Zealand’s bowel screening programme was initially based on age, which failed to recognise that more than half of Māori cancers occurred before the screening threshold of 60 years.
“Suggesting that these ‘colour-blind’ variables may be better proxies for health need than ethnicity is blatantly untrue and misleading, and encourages weak analytical science and will likely lead to greater waste of public resources due to less effective targeting of resources towards groups with highest need,” the editorial said.
The bowel-screening age has since been lowered to 50 years old for Māori and Pacific people.
The Government’s directive was not only unscientific but would undermine the targeting of resources to those most in need, the researchers said.
“For the same reason, it would be an irresponsible use of public funds to allow males to receive funded breast cancer screening, it is fiscally and ethically unjustifiable to enable anyone to access services that have been specifically targeted to meet a particular health need for a high-risk group.”
Health Minister Dr Shane Reti said he had seen the editorial. He reiterated that healthcare should be based on clinical need, not ethnicity, and noted that this was also set out in the Government Policy Statement on Health. The Cabinet directive reinforced this approach, he said.
Last month, Reti said he supported Health New Zealand Te Whatu Ora’s decision to get rid of a tool which prioritised patients for elective surgery and used ethnicity as one of its criteria.
The previous Labour-led Government reviewed the equity adjuster tool out of concern that it was “replacing one form of discrimination with another”. Some surgeons had also expressed discomfort with the ranking system.
The review found it was legally and ethically justifiable to keep using the equity adjuster but that it did not follow best practice.
The tool prioritised patients based on clinical need and how long they had been waiting for surgery. For patients who had the same clinical need and had been waiting the same amount of time, the tool weighed a range of factors (ethnicity, social deprivation, rurality) to determine the booking order, with final sign-off from a doctor.
Surgeon Dr John Mutu-Grigg, a member of the Royal Australasian College of Surgeons’ Māori Health Advisory Group, said that by scrapping the surgery ranking system the coalition Government had decided to maintain the “significant white privilege” within the health system.
“For instance, in the most recent New Zealand joint registry, which is all the joint surgeries done in New Zealand … New Zealand Europeans receive 87.6% of total hip replacements and 86.9% of total knee joint replacements despite only being 67.8% of the population. There is a massive discrepancy there … and the ethnicity adjusted tool was specifically designed to address these well-known inequities.”
The tool was an attempt to compensate for all the various disadvantages Māori faced before they entered the health system, such as poorer access to healthcare and delayed diagnosis, he said.
Isaac Davison is an Auckland-based reporter who covers health issues. He joined the Herald in 2008 and has previously covered the environment, politics and social issues.
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