Health Minister Dr Shane Reti challenged to restore ethnicity variable for equitable healthcare

Thursday, 3 October 2024

A collective of Māori primary health care providers is calling on the Minister of Health to restore ethnicity as a variable in equitable healthcare.

The Government recently advised the public service it would need to prioritise on the basis of “need, not race”.

That advice contradicted decades of clinical evidence and research which showed ethnicity impacts health outcomes for patients in Aotearoa, the collective said.

Te Kāhui Hauora Māori, a collective of Māori primary health care providers, is calling on Health Minister Dr Shane Reti to issue a counter-directive instructing the health sector to consider ethnicity, as a variable, in equitable healthcare.

Ora Toa director of health Michael Rongo said a directive to include ethnicity would ensure “fair and robust” needs-based provisions for individual care, services and health contracts.

“It will meet the Government’s objectives, and continue decades of work already undertaken to improve equitable health outcomes for Māori, Pasifika people, and all other ethnicities which suffer from certain health conditions, of which ethnicity, is one of the determining factors.”

The wero, or challenge, to Reti, was laid down following the Government directive from Public Services Minister Nicola Willis to remove, or justify using, ethnicity in needs-based service provisions in every public agency, including health.

“Ethnicity is a need,” said Hauraki PHO chief executive Taima Campbell. “It is a determinant of health and therefore a need which impacts outcomes for patients.

“If the Crown does not recognise ethnicity in public services we run the risk of blowing out inequities, which will again, disproportionately harm Māori people, their children and whānau, our communities, and Aotearoa in general,” Campbell said.

“It is unfair, and unjust. It is also not the behaviour of fair-minded Kiwis. This is not who we are as a nation.”

Māori die younger and prematurely, more than any other ethnic group in New Zealand, the collective said, and Māori children are disproportionately represented in social situations such as poverty, in greater numbers than any other ethnicity, leading to higher rates of preventable health conditions and death.

That was why Te Kāhui Hauora Māori (TKHM) was challenging the Health Minister to “do what is right by providing a fair and just counter-directive to the policy set down by the Minister of Public Services”.

TKHM includes the Hauraki PHO, National Hauora Coalition, Ngā Mataapuna Oranga, Ngāti Porou Oranga and Ora Toa.

“We also challenge Dr Reti to consider the decades of clinical evidence and overwhelming research to continue using ethnicity, as one of many variables, to determine equitable healthcare initiatives and services,” Rongo said.

“Equity guardrails against higher taxpayer costs, more sickness, and premature deaths. Why would the Government conceive that taxpayers would agree to widening inequity gaps by removing ethnicity as a factor?”

While ethnicity was not a proxy for need, it was a marker of need, equal to all needs-based factors, the collective said.

“A holistic approach to healthcare is important because it targets and considers everything in a person’s life which could be impacting their health, such as the environment, family dynamics, socioeconomic status, etc.”

The collective questioned Willis’s “perception of discrimination” reasoning for removing ethnicity from contractual services.

“Trying to improve equity isn’t a form of discrimination,” Campbell said. “The Government seems determined to conflate needs and rights to justify its many policies to remove race-based, evidence-based initiatives, particularly focused on Māori. It’s unconscionable.”

For the past 24 years, much has been done to ameliorate health inequities for all New Zealanders. Although Māori health statistics are dire, they have improved over time but more can be done, TKHM said.

In the Government Policy Statement on Health 2024-27, the Health Minister prioritises improving outcomes for all New Zealanders and high-need populations such as Māori, Pacific peoples, disabled people, women, and people living rurally.

He has also set out how those priorities will be achieved in Māori health by shifting decision-making closer to people and communities, and involving them in the design and delivery of services.

The collective has proposed a hui for Māori primary healthcare representatives and Minister Reti to discuss the future of Māori health.

“We look forward to engaging with Hon Dr Reti in the future to discuss our challenge to him further, kanohi ki te kanohi, face to face, and to support his efforts to improve outcomes for everyone,” Campbell said.

“Let us work together, the Crown and Māori, to remove barriers so all New Zealanders are equal.”

A spokesperson for Reti did not respond when asked whether the Health Minister would accept the hui invitation.

In a statement to Stuff, the spokesperson said: “The Government Policy Statement on Health clearly sets out the Minister's direction that healthcare should be provided based on clinical need, not ethnicity.

“This is reinforced by the recent Cabinet Circular, which sets out the Government’s expectations for how the targeting, commissioning, and design of public services should be based on the needs of all New Zealanders.”