The idea that Māori have advantages over New Zealanders in health is farcical - Anaru Eketone


Sometimes statements made in public have unintended consequences.

Years ago when I worked as a hospital social worker, a Māori women told me about a visit to her GP. The doctor came into the waiting room, pointed at a waiting patient and said “I want you to go down to the money machine, get the money you owe me, and then, I’ll see you.”

We cannot know for certain what the facts were. It could have been an incomplete Trade Me auction, a car sale, or a dinner date gone wrong. However, our minds immediately assume it is a patient who has not paid past medical bills and a doctor who refused to see a patient because they believed they had the ability to pay their debt.

Whatever the true circumstances, the actual outcome was a message that flew around the Māori community that “if you don’t have the money, don’t bother turning up to the doctors”.

Medicine is one of the most caring of professions, and usually lets people pay off debts gradually if needed. However, the interpretation of the people who were there was that if you didn’t have the money, you wouldn’t be seen. We will never know the unintended damage that this message caused because people delayed or did not seek healthcare.

It is these unintended consequences, caused by statements made in the public by those with power, that can have real life consequences. Last week the Broadcasting Standards Authority fined a radio host for “materially misleading” the public in June 2023 about the implementation of the Equity Adjustor Score in hospitals in the Auckland Region.

The algorithm was used to sort out the order of who went first on surgical waiting lists. The waiting list was firstly based on clinical need. However, when there were a group of people with the same level of need, a further way of organising the list was required to ensure equal access across different groups.

With the clinical needs being equal, the most important criteria was the number of days on the waiting list. Other factors were then added including ethnicity, deprivation (based on decile ratings of your street) and whether you lived in a rural area.

However, the claims made by the broadcaster were unquestionably misleading. They made statements such as “it’s going to rank patients, putting Māori and Pasifika at the top of the list”. And “push Māori and Pasifika to the top of waiting lists based on ethnicity, basically, not on urgency or illness”. People will make their own decisions about whether these statements were uninformed, taken out of context, or a cynical ratings grab.

What is often forgotten is the impact these negative headlines have on Māori people. How it can make us even less comfortable in the health system and less inclined to get the services we need.

Once spoken, this exaggeration and distortion, remained and became embedded as something that people still believe is real. I wouldn’t be surprised if there are still people who are suspicious when a Māori person gets surgery and assumes that they must have gamed the system in some way.

The idea that Māori have an advantage over every other New Zealander in the health system is farcical. Study after study has shown Māori are more likely to be diagnosed later, treated less, operated on less and more likely to have negative outcomes at every stage. Studies have also shown we are also less likely to have doctors as part of our social networks and so often miss out on the “coaching” some patients get to exaggerate symptoms to get priority.

Māori have been classified as “priority group” but this sends a false message. The statistics show that, even though our health system has its problems, that it is really Pākehā who are the priority group. They tend on average to get better outcomes, more likely to get surgery and have lower waiting times, unless of course you live in a rural area. While Māori were targeted and criticised with the furore over the Equity Adjustor Score, those prioritised by the same system in rural communities were not.

We saw similar stunts during the Covid pandemic where at one stage Māori vaccination rates were 25 per cent lower than Pākehā rates. Yet some politicians undermined attempts to reach out to the Māori community by insinuating that communications taking into account cultural values were somehow meaning that Māori were having unfair access. Yes they were having unfair access, but an unfair lack of access.

The problem is that these forms of negative grandstanding do have an effect. It can make Māori who need these services less likely to access them because you feel you are under even more scrutinyi wth ,yet another unintended consequence of poorer outcomes.

Anaru Eketone is an associate professor in social and community work at the University of Otago and a columnist for the Otago Daily Times