There's been a fight brewing in our southernmost university, also home to the country's oldest medical school. The University of Otago is reviewing its targeted entry pathways for Māori and Pasifika medical students. The official reason: the scheme, known as "Mirror on Society", is doing well. That is, it is achieving what it was supposed to do when it was first implemented in 2012.
Numbers of Māori and Pasifika medical students at the university have increased. Of the 282 students who were accepted into the second-year programme last year, 65 were Māori and 25 were Pasifika. There has also been an increase in students from rural backgrounds - another targeted demographic - as well as the creation of targeted pathways for students from refugee and low socioeconomic backgrounds. Notably, while significant progress has been made, workforce parity for these groups is still a long way off. For example, 2018 figures show Māori doctors made up 3.5 per cent of the workforce, and Pasifika 1.8 per cent. Nationally, Māori comprise 16.5 per cent of the population and Pasifika about 8 per cent.
At a university level, the Mirror on Society policy rationale document outlines the practical importance of prioritising these student groups. It is grounded in the current inability of the health system to meet the needs of the communities they are from.
"The purpose of health professional education is to produce a health workforce equipped to meet the needs of society," the document states.
"There is international evidence that health professional graduates from rural, ethnic minority and low socioeconomic backgrounds are more likely to make career choices to serve similar communities. The [Health Sciences] Division is thus committed to attracting and supporting the most academically able students from a wide variety of backgrounds. The gender, ethnic, socioeconomic and rural/urban composition of graduates should reflect the diverse communities in Aotearoa."
The document also references the university's obligations to Māori under Te Tiriti and notes its responsibility to the health of Pasifika communities as an institution in a Pacific nation.
Seems sensible, right?
Perhaps that question, and the logic underpinning the construction and implementation of the Mirror on Society policy, is why it is so difficult to understand the university's choice to "review" it. At the weekend, one of its own medical students penned a piece in E-tangata looking at whether too much equity is possible in an area where so much inequity exists. Indeed, a cap on the number of Māori and Pasifika medical students - reportedly proposed as part of the current Mirror on Society policy review - would indicate that in New Zealand it is.
Professor Peter Crampton, a former pro-vice chancellor Health Sciences and former dean of the medical school at the University of Otago, was one of the architects of the policy. When discussing the current review, Crampton touches on his own experience with the policy, and universities, over the years.
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"One of the dynamics we're experiencing right now is reaction to a policy which has been very successful.
"The system's reacting to being successful in pro-equity changes. It's an interesting sociological phenomenon."
Crampton highlights the pace of the policy's success in addressing under representation of Māori and Pasifika medical students as a particularly important learning point.
"I observe this frequently, problems which are put in the 'too hard to solve category' by Pākehā-led institutions, he said.
"Personally, I have experienced and witnessed literally decades of expressions of regret around how difficult it is to change anything in the health workforce, particularly the medical workforce, and expressions of regret that everyone is trying as hard as they can and that these are very difficult issues and we can't move any faster.
"[With the Mirror on Society policy] we turned it around on a dime, and, it turns out it's not a very hard problem to crack at all."
The "we" Crampton is referring to included his associate deans in the Health Sciences division, Professor Jo Baxter (Māori) and Associate Professor Fa'afetai Sopoaga (Pacific). In the current round of discussions on possible changes to the Mirror on Society policy, Pacific and Māori leadership have not been present.
It seems the University of Otago's Mirror on Society policy has become a victim of its own success. Less than a decade after it was implemented, its progress towards bringing the make-up of the medical workforce closer to the communities it serves has prompted an official review of it – with Māori and Pasifika student numbers under the spotlight. It is a glaring reminder that despite the goodwill and oft-loud rhetoric we hear about creating a fairer New Zealand and more equitable health system, there are still those who fail to understand what that actually means and looks like.