Auckland surgeons are now being required to consider a patient’s ethnicity alongside other factors when deciding who should get an operation first.
Several surgeons say they are upset by the policy, which was introduced in Auckland in February and gave priority to Māori and Pacific Island patients – on the grounds that they have historically had unequal access to healthcare.
Health officials stress that ethnicity is just one of five factors considered in deciding when a person gets surgery, and that it is an important step in addressing poor health outcomes within Māori and Pacific populations.
Te Whatu Ora – Health New Zealand has introduced an Equity Adjustor Score, which aims to reduce inequity in the system by using an algorithm to prioritise patients according to clinical priority, time spent on the waitlist, geographic location (isolated areas), ethnicity, and deprivation level.
Honestly, sometimes NZ feels like you’ve woken up at a Klan Rally wearing a Culture Club T-shirt singing “Do you really want to hurt me“.
I’ve never seen so many people correctly spell apartheid without understanding how stupid the comparison is.
Ok, at first blush this announcement that ethnicity is a determinant in health resource allocation is the end of western civilisation, every negative suspicion of co-governance proved and the cooker meatsack rage directed at the Māorifictation of road signs all at a time when first time home buyers are crippled by Orr’s Monetarism and 12.1% food inflation burns everyone else.
We are all so raw and hurt by the experience of a post-Covid reality, the uneven sacrifice of which is exploding in a million different ways as Kiwis face the blunt reality that for the majority, life is far more grim and downgraded than what we had before and with far less hope on the horizon.
Into such a febrile psychological landscape 4 months out from an election drops news that the blunt category of ethnicity has to be added to the rationalisation equations of the health dollar.
Is such an equation ugly?
Fuck yes it is ugly, but it is also bone crunchingly honest you pearl clutching muppets!
Our health spend and public health assets have been so egregiously underfunded for such a long time that the people held responsible for considering all the elements of public health expenditure have concluded that in the interests of recognising State obligation to minority groups with terrible health outcomes embedded within an unjust system, that the blunt inclusion of ethnicity into the determinants of health provision are a cruel but necessary health spend rationalisation!
Don’t like the brutality of the equation? PUT MORE MONEY IN THEN!
And don’t even at me with ‘where are we going to find the money’, the IRD clearly stated the rich were gaming a rigged capitalism.
Tax. The. Rich.
We don’t just need more drs and nurses, we need new hospitals, we need new technology, we need new drugs, we need our own basic pharmaceutical industry.
We need a vast injection of new money for new Health assets and we need it now by taxing the richest and creating new taxes that capture their speculation.
What this inclusion of ethnicity as a determinant truly represents is an under-funded public health system forced into making this brutal equation because of grotesque and systemic underfunding.
To have ACT and National, who would privatise our existing health system if given half the chance, to hold up this example of what underfunding health really looks like as apartheid is intellectually fucking bankrupt in the most obscene way.
We are a better people than where the Trolls amongst us will want to drag the carcass of this news story into the dark echo chambers they wish to defile.
This is a symptom of an underfunded health system using blunt tools like ethnicity to attempt more equitable outcomes. It is an ugly treatment to a much more malicious disease, which is the underfunding of the public health system by starving the State of tax revenue from the wealthiest amongst us.
Don’t allow the manufacture of this into a culture war Klan Carnival make you miss what is really going on Comrades.
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Every New Zealander knows someone who has been stuck on a waiting list.
But now under Labour it’s not a simple list, it’s an equity adjustment calculation.
Yeah. Your categories suck.
This is not a good look for the government at all. First the total abolition of hospital board elections without any kind of vote, and now the claim that racialist death panels are the ‘solution’ to poverty (the ‘postcode lottery’ sounds a lot better now!)
There are apparently no plans to reopen all the hospitals that were shut down. Are they even interested in building new hospitals? Perhaps it is really all going to plan, as a build up to announcing the same policy as Sir Keir Starmer — this ‘old’ model has ‘failed’, and to ‘save’ the national health service, it must all be sold off (the corporate political donors cannot wait!)
The racial selection category assumes that Labour are right, that health outcomes vary because Maori and Pacific people are too stupid to work out their own health, which are course is a patronising load of insulting shit! Plus the impossible to quantify “subconscious racism” etc, etc.
But Labour are almost always wrong because their assumptions, based from their insular middle class backgrounds, are always so wide of the mark they couldn’t hit a barn with a frying pan. And who shut the country down North Korea styles, so needlessly in the end for covid? Labour! Not that it makes much difference except to starve the country of medical people, who were throwing themselves at us but Labour didn’t want them.
When a human gets crook, the very last thing ever ever to be considered to seek help is fucking race!
You’re right, the health system is badly underfunded. And thanks to Labour, appallingly run too.
Fuck Labour, the election cannot come fast enough!
Like all of the neo-liberal parties, they have to deal with rising dissent using misdirection and demagogy. They couldn’t possibly admit that their policies caused all poor people — including poor whites — to be in worse health (class must be buried, replaced by racialistic nationalism). They can’t allow anyone to start asking why primary care is no longer fully funded via bulk-billing to Social Security, or why there aren’t enough beds and specialist physicians any more.
Nobody voted for any of this. They didn’t vote for the sudden abolition of health board elections, or the earlier closure of regional hospitals, nor that the revived Central Health Board should be inexplicably renamed “The Living Eye (H.N.Z.)”
Ethnicity is one consideration, not the only one, for certain categories/conditions . Why don’t you actually read about it before giving yourself a hernia leaping to conclusions.
In addition what are you talking about in terms of “being too stupid to work out their own health”? These people are on waiting lists. Clearly they have worked out their own health, they consulted a doctor. How do you think they ended up on a waiting list?
Hopkins is a primary school teacher from Lower Hutt with the same lousy advisors as Ardern. On behalf of New Zealand he presented sausage rolls to Charles3 to mark his coronation. Verrall another well paid public servant escaping the cut and thrust of the real world, IMO, and now cruelly trying to compromise the health of undeserving health challenged persons, because government lacks the gumption, integrity, and fortitude to address taxation rorts.
Well said
I’ve just gone into my health records and changed my priority/ethnicity from NZ European to Maori. Job done!
Great Ada. Suggest you cancel some of your longer term plans. Allow for about seven years less time in terms of availability
Oh Ada you are pathetic. Walk in your own shoes. You have absolutely no control of other’s health issues and be glad you don’t. Oh by the way as tou are now a Maori, do you also identify with being Pacifica, low socioeconomic or rural, take your pick because they all qualify.
It’s an ifey new category that should be funded separately.
Are there boxes I can tick for those as well? I’ll go back and look…
I don’t know. Prefer medical insurance myself
Look for the box that says ‘idiot’. Go no further
Queeny No. Hipkins and Verrall are the pathetic persons here, making racist decisions and thinking that the punters will applaud them for it.
Queeny. Perhaps you may care to say why history would judge Sepuloni, Verrall and Davidson any more kindly than Shipley, Richardson and Bennett,
in terms of their services to the persons most in need of them?
Well Snow White, Shipley has been to the high court ( just recently ) and she just loved trickle down . Paula Bennet threw people out of their homes on a false premise in a housing crisis, outed people publicly because she didn’t agree with them, Paula Bennett denied a housing crisis. Oh my god Ruth Richardson condemned people to a life of poverty, instead of a hand up she stamped them into the ground never to recover. All 3 women are despicable.
I changed mine to rural red neck – same result .
What’s really going on? 1.8billion pissed away on ‘mental health’ without anything decent results…that’s what’s going on just as an example! That’s a fuck load of our hard-earned money down the drain. So don’t tell us there’s not enough money. There’s not enough Labour politicians and Wellington bureaucrats being tarred and feathered and hung out to dry in public for squandering public money. That’s what needs to happen before anything else.
How has the money been wasted? Budget spend is not the same as actual spend.
Kraut What needs to happen is striking Verrall from the register of medical practitioners for wanting New Zealand surgeons to discriminate again persons with white skins and reasonable addresses.
So this is good news for New Zealand Indian descendants of the three million Bengalis deliberately starved to death, and forced into malnutrition, thanks to Churchill et al, to provide food for Brit and American troops, having this factored into their medical treatment. Good news for New Zealanders of Irish descent who not only suffered through the Great Famine, but were were subjected to generation after generation of deprivation and exploitation by colonialist England, and then further discriminated against when they came to this country which they helped to build, through hard physical labour. Good news for Scots descendants of the Highland Clearances, turfed out of their homes, like the Irish, forcibly relocated, who colonised cold Otago and Southland, and established the first university at Otago, with the Scots prioritising education, unlike current governments. Factoring in historical disadvantage and alleged discrimination when addressing current health problems of New Zealand citizens will be a complex exercise, but let’s do this.
couldn’t agree more!
Blah blah blah. Are they overly represented in our statistics with the poorest outcomes? Furthermore we are talking a subset of particular cases not all patients. Jesus do you actually read?
Hollyhock of the Valley, this is not about historical grievances, foreign or local, it’s about the here-and-now inequities faced by these groups in health system.
It’s policy that determines hospital waiting lists, and changing policy to deliberately disadvantage persons because of their ethnicity and other sociological factors, is medically indefensible and morally reprehensible.
Until hospitals are provided with adequate resources that enable limiting waiting lists to clinically acceptable levels, prioritising is a fact of life. This excellent article provides an insight into how we got here: https://www.newsroom.co.nz/ethnicity-a-factor-in-surgery-waitlists-for-years
Ethnicity has been a factor in outcomes for many years, which is also indefensible and reprehensible. Under the system Máori and Pacifica may get up to 2 points extra out of 100; and clinical assessment always overide all the other factors.
What exactly are these “inequities” faced by Maaori in the NZ health system? Do you mean inequalities of outcome? Inequalities of outcome do not necessarily mean inequalities of opportunity.
Agreed P+P+II, but expecting the health system to solve the other contributing factors would be like expecting the police to resolve the growth in gang numbers. The health system can only work with what they have available and control of.
The 18th Royal Irish Regiment were raping and murdering Maori woman children when they arrived on our shores, hardly a saintly bunch of victims.
The 18th Royal Irish Regiment 2nd Battalion, nicknamed Paddy’s Blackguards, came to New Zealand on two ships; the Elizabeth Ann Bright which arrived at Port of Auckland on the 2 July 1863 with 28 Officers and 688 Rank and File soldiers while the remainder of this Regiment arrived at Auckland on the Norwood 2 August 1863. They were formed mainly of Volunteers from the Irish Militia and were soon involved in skirmishes in Drury and surrounding areas of the North Waikato.
interesting history stephen can’t see the relevence to the issue in hand
Yawn, Nothing to see here, just another tokenistic memo put out by the ministry of silly rules, most GPs (medical) doctors will file the memo in the far queue pile and carry on business as usual prioritising (triage) there patients from those most in need, regardless of race etc.
An ACT National government will do more to harm Maori and Pacifica and these sort of announcements are just propelling the electorate towards that outcome despite the obvious merits in considering ethnicity to improve outcomes. You’d think health officials would know where their bread is buttered.
After watching an interview on this topic some of the people reporting on it need a kick up the arse. It almost gets lost that it’s not in an emergency setting of even across all conditions. Ultimately it’s probably saving money. As for some of the sanctimonious surgeons looking all upset I don’t see why people look them like pillars of society that would be above any bias.
We’ve got to understand that once Nixon got rid of the gold standard money has basically become so worthless that both parents had to go and work and a lot of politicians have used rates as an excuse for some theory like Neoliberalism or even transhumanism. Now we are being asked to swallow this theory that Maori are racist.
It is by definition racist
Here are 2 articles where they don’t think it is racist, going on your logic the sun is racist since white people are more likely to get sunburn.
https://www.nzherald.co.nz/nz/surgeon-organisation-backs-surgical-ranking-policy-says-it-reduces-institutional-biases/EOV33GU5XJCKDGNIVVQRKIRYLY/
https://www.nzherald.co.nz/kahu/rob-campbell-its-sickening-how-right-minded-kiwis-react-to-poor-maori-and-pasifika-health-outcomes/ZEVOXVIZUNHJDPTP2H4CPQHJBA/
ra·cist
[ˈreɪsɪst]
ADJECTIVE
characterized by or showing prejudice, discrimination, or antagonism against a person or people on the basis of their membership of a particular racial or ethnic group, typically one that is a minority or marginalized:
Nonsense – read the last sentence, are Maori a minority have they been marganlised.
YES YES YES
prejudice, discrimination, or antagonism by an individual, community, or institution against a person or people on the basis of their membership of a particular racial or ethnic group, typically one that is a minority or marginalized.
Yeti How could a talking walking sausage roll possibly be racist? Sausages don’t think outside the plastic shrink, or in this case, the puff pastry.
I used to be on a surgery waiting list and now I am on the equity adjustment mechanism.
I was on a list waiting to see a specialist.
My friend, a white farmer got his knee replacement before I got my specialist appointment. We went to the GP one week apart. Same problem. I was on a walking stick he wasn’t. I was on an ethnicity list, he wasn’t. He’s white, I’m white to look at but have a Maori surname. Don’t fucking tell me the system is not racist. It is but not in the way you people of European ancestry would have us believe. I’m still waiting and still using sticks. He’s back driving tractors.
Who gets to surgery depends on the patient being willing to change their lifestyles that led to them needing surgery in the first place.
Did the white farmer lose the extra kilos that caused him to need a knee replacement in the first place? Did you lose the weight that means the surgery will be a quick and successful intervention – in an over-stretched health system?
How would this be relevant to getting a specialist appointment? Maybe the specialist is uncomfortable dealing with Maori and put it off for as long as he could or the GP was doing Farmer Joe a favour so he could get back to his debt slavery. I’d like to think it was just down to timing and how the cards were dealt but who would know..
Uncle Tom Cobbley. I don’t want to belittle what happened to you, but there are often differences between patients with similar medical problems which can cause them to be treated differently, or prioritised differently. Best thing is to raise it with your GP; raising it with the hospital service does mean that you’re likely to be fobbed off with a meaningless standard reply about not meeting their criteria, and signed by a non-medical ‘team leader.’ Your family doctor may be fobbed off too, but hopefully some are still able to phone through and have a chat with an appropriate person, and good luck to you.
Well said Snowy.
Are you working? I imagine the farmer has quite a strenuous job, and an entire business relies on him him working.
If you’re an employee you may not be as critical to a business.
Let’s hear all the facts.
Don’t talk shit!
A lobotomy perhaps?
Ada. You can ID as any race or gender you want, to get preferential treatment.
If you don’t live in a majorly deprived area, you could use your car as your home address, and don’t steal anyone else’s address. A Green MP did that, and it ended badly. Capital Coast Health customer service reps are trained to rebuff GP referrals, but severe pain should score highly, and arriving at hospital by ambulance forces them to at least admit you.
Good tips, thanks Gentle Annie.
Normally this type of story would result in a 2-3% drop in support of a government.
However this is 2023 New Zimbabwe. We come to expect it now.
That is the sad but entirely accurate truth Frank.
Martyn – Gee, here I was thinking the Health System waiting list were based on need.
All things being equal, it’s about time Maori got first suck of the sav in this country. For all the the calls of racism, it has been glaringly obvious that Maori were on the butt end of these types of decision in the past because -err- racism.
Equality of opportunity vs equality of outcome. The first should be a given in any decent society and I believe it is in NZ, the second involves so many variables that simplistic cries of ‘racism’ are just wrong.
you “believe” it is? I’m sure every medical professional would “believe” themselves free of bias too but it would seem ministry of health data doesn’t back this up.
Of course it could all be a bunch of woke political twaddle based on woo woo interpretations but it seems the arguements have been made.
Maybe we could put more effort in to ensuring equality of opportunity for all groups in society by equal representation in the professional fields, obviously to a point. I guess it’s up to those groups to attain this representation for themselves. Alas, for Maori it’s a slow trickle but hopefully we will see more studying and working into professional positions, and that they are free of bias too.
Are there any data that conclusively indicate that racial prejudice influences medical decisions in this country? I mean real data, not “living experience” anecdotes.
maybe obesity, drinking and smoking effect clinical decisions not neccesaryly ethnicity
On the AM show this morning it is reported Verrall has informed Reti that this racial equity device will be extended to waiting lists for specialist appointments in due course.
JohnO. Verrall extending racial inequity looks like payback time for what Gt Britain did to India, and utterly disgraceful using the sick and the poor as political pawns; an irresponsible, unethical, evil, and unprofessional way to assess and act upon medical conditions.
The bottom line is that neoliberalism has deliberately underfunded the whole health system. If the brutish little Dipton Double Dipper had had his way, the remnants of our free national health service wouldn’t exist, with everything privatised. That’s where the Bowen Street barbarians are heading now.
+ 1 Holly.
+ 2
If only we had a Race Relations Conciliator to sort this out is some even-handed way…..
We do not need a race relations conciliator to sort this out at all.
Racism is a live and well in Aotearoa and Maori are marginalized on a daily basis.
prejudice, discrimination, or antagonism by an individual, community, or institution against a person or people on the basis of their membership of a particular racial or ethnic group, typically one that is a minority or marginalized
It was a joke reference to Meng Foon ‘resignation / non-resignation’
Personal racism is everywhere and in everyone, you deal with it by reason not by force or by passing draconian laws. Institutional racism should be sorted with sensible legislation, not with racist legislation. This “me victim you oppressor” thing is not helpful and invites a destructive backlash – eg ACT on 15%.
The crime of apartheid is defined by the 2002 Rome Statute of the International Criminal Court as inhumane acts of a character similar to other crimes against humanity “committed in the context of an institutionalized regime of systematic oppression and domination by one racial group over any other racial group or groups and committed with the intention of maintaining that regime”.
Tell me if Maori or more importantly this NZ govt is practicing the crimes of apartheid?
Please leave a detailed explanation.
This country was founded on racism colonising and assimilating the then colonised is racism and discrimination. Why do you think past governments had to get the Ministry of Maori Affairs to help Maori whanau into housing as we didn’t get homes, such was the extent of the racism. We also didn’t get many state jobs they preferred to give them mainly to Pakeha many coming over from the UK being white and looking like the colonisers they got many of the welfares state jobs setting themselves up to become the middle classes of NZ.
I took the Hippocratic Oath 45 years ago . Part of it was to treat all patients equally regardless of colour, race or creed.
If you want to treat on need and deprivation the data is on file. Use it on an individual basis , don’t use ethnicity.
Tribal+Scot. 100%. Well said. And thank you for your good work.
All things being equal there has to be a judgement call at some stage where an inherent bias could have a determining factor? No? Is every case and need so easily determined?
I think this entire thing is political DD re: Maori Health Authority, Pharmac priority to MPac and now surgical priority.
Labour and the Health Industry know that MPAc health has been studied in detail and that various ‘determinants of health’ have been identified. They rank Health Care provision at something like No 5 or 6 on the list. So whilst the issue of MPac Health does absolutely need sorting, Labour knows what it is doing is ideological and politically it plays well to MPac and middle class virtue signallers. It will no doubt deliver some improvement but it is unlikely to be ‘value for money’ or really significant in closing the Gap.
From memory the first 2 determinants that must be dealt with are Poverty and Housing but you see actually fixing those, takes a lot more money and complexity so they will waste money and tilt at windmills because it suits their purposes.
As part of the study on determinants, it was found that where Maori live a ‘middle class life’ their ‘health gap’ shrinks down to very comparable to Pakeha. And this is without any special Healthcare’ intervention.
So does institutional racism exist yes but it is probably far less significant than a number of other factors. I could give you various examples of why this is but generally it is because the Hippocratic oath really does require Drs to treat people equally and most Drs do take this seriously. Ease of access and level of comfort with the system by MPac is also probably a big part of the problem and this is what needs to be focussed on rather than assuming it means Drs are racist.
Tribal+Scot, there is a difference between you personally treating a patient and the ‘system’ having to prioritise limited resources.
I totally agree with Martyn. The underfunding of the health system for decades puts us in this position. In the NZ Herald article https://www.nzherald.co.nz/nz/surgery-wait-lists-maori-pacific-prioritised-why-ethnicity-is-a-factor/EDUXXOWQ4NFPRFV5FLCVZRRQ5M/ Dr Mike Shepherd is quoted as saying “Māori and Pacific patients might get perhaps one or two extra points out of about 100 because of their ethnicity.” Hardly grounds for all the drum-beating and dog-whistling going on – as it can be shown statistically Māori and Pacific are already disadvantaged by our health system, why aren’t people labelling this racist. Two percentage points would seem a small contribution towards equity.
Also, in the NZ Herald https://www.nzherald.co.nz/nz/surgeon-organisation-backs-surgical-ranking-policy-says-it-reduces-institutional-biases/EOV33GU5XJCKDGNIVVQRKIRYLY/ “The Royal Australasian College of Surgeons has spoken out about the new surgery wait-list rank system, explaining this isn’t about putting Māori and Pacific health above the health of other people, rather it’s about reducing existing health institutional bias.”
National and ACT need to front up and explain how they are going to give the health system back its ‘mojo’. Given that National underfunded the health system to balance the books during their last 9 years in government I will take some convincing that they have any intention of providing any ‘mojo’ next time around.
Listen to this The Front Page podcast .
https://www.nzherald.co.nz/nz/the-front-page-ethnicity-in-healthcare-is-te-whatu-oras-new-policy-ethical/ICUSVYKJAVDGPPNUIEM6WVOL5Q/
Thank you Geoff, excellent discussion.
I hate how these stories are covered giving the impression that Maori get specially privileges from pundits that aren’t Maori. Maori people like most other peoples would at a heartbeat give their place in the que if they saw someone that wasn’t Maori needed the help urgently, this is basic humanity that get lost in this conversation.
Remembering we have a historically illiterate society that doesn’t realize the sacrifices Maori have made? ‘What not quite understood that in the very early years of contact how reliant pakeha were on Maori to feed and protect them!!
‘European colonisation in NZ is founded on maori willingness, to engage with pakeha, to welcome them to this country, and to look after them, that lasted into the 19th century until pakeha became stronger and their numbers became ever large’
Maori asked the British for protection. There is ample historical evidence in Paul Moon’s historical accounts of pre- treaty NZ (Edges of Empire, A Savage Country, The Newest Country in t he World, and This Horrid Practice)that Britain had to be heavily persuaded by Maori to colonise NZ. Britain did not accept there was any economic advantage in colonising NZ.Britain did not have the financial means to colonise such a far flung country. The erroneous notion held by 21st Century Maori that NZ was some great prize is not borne out by the historical facts. And far from welcoming the colonisers that too is factually incorrect. Maori needed to recover from the slaughter of the Musket Wars and they desperately needed trade.Most did not want settlers at all.
Shona, the problem with your historic analysis is that it usually concentrate on the lurid and exaggerate the extreme.
And Paul Moon has an opinion that can and needs to be challenged. Sure he makes the argument of NZ didn’t have any financial benefits for Britain but I can assure you that he is wrong!!
Firstly the Whales and seals that were hunted by the whalers were in a significant abundance in the NZ waters also the gigantic Rimu, Totara, Kauri etc where used for ship mast and repairs. Remember the british ships were in the Aboriginal lands raping and murdering those poor souls.
And there’s the land which is why in 1791 the colonial Governor of New South Wales Philip Gidley King kidnapped two Maori boys from a prominent Ngapuhi chief and held them captive for 8 months on Norfolk Island wanting information about there country.
There other examples but I’m not your fucken history teacher so I’ll leave a link so you can use whateva you have left for a brain to come up with a comprehensive argument than quoting someone else opinion.
http://www.enzb.auckland.ac.nz/
Shona , Maori asked for legal protection because the traders we’re becoming more unlawful . Land was being sold in Britain illegally that did not belong to the seller. Maori chiefs went to see Queen Victoria because of their concerns. Now it’s debatable that the crown saw no value in NZ of old, however they waged a war against the Maori tribes so NZ must have been worth fighting over. Shona you can’t change history to justify today’s happenings. The indisputable fact is NZ was colonized there was a treaty signed by the crown and certain Maori tribes in 1840. There was a war, land was confiscated, the Maori people were not allowed to speak their own language. The colonizers brought western diseases. This was the 1800’s . We are now in 2023. Maori are still classified as second class citizens by certain members of our not so nice society. For a change let’s agree to a hands up mentality not a constant put down because it not only costs people their peace of mind but their health and safety. Racism unfortunately is still alive and well in Aotearoa while we pakeha mostly believe that we are the superior race.
Ironic the cutters are complaining about prioritisation when they kicked it off when establishing the private hospital system.
Along with Private GP clinic’s .
A large chunk of whom are now owned by two Australian corporate’s one of whom also owns two of the chemist chains as well. As I have said before we have a SEMI PRIVATISED HEALTH SYSTEM .
The right wing set this in motion in 1938 when they ensured all GP clinic’s would be privately owned.
Now we have a flood of Medical insurance policies.
The Right wing and the anti anyone but white crowd have the health system on it’s knee’s.
Right where they wanted it at ripe for privatisation.
Along with Medicines rationing that is the worst in the western OECD.
This country was founded on racism colonising and assimilating the then colonised is racism and discrimination. Why do you think past governments had to get the Ministry of Maori Affairs to help Maori whanau into housing as we didn’t get homes, such was the extent of the racism. We also didn’t get many state jobs they preferred to give them mainly to Pakeha many coming over from the UK being white and looking like the colonisers they got many of the welfares state jobs setting themselves up to become the middle classes of NZ.
sounds like you’re ok with collective punishment
the fact that someones ancestor stole someones land doesn’t make their decendants CLINICAL need less
“Tax. The. Rich.”
Fuck that. Investigate the rich. Taxing the rich would merely legitimise the dodgy bastards. Taxing the rich would effectively launder them to all squeaky clean.
How did we get 14 multi-billionaires, 3118 multi-millionaires and four now foreign owned banks who steal $180.00 a second from us in net profits annually anyway. When the country they burgle has only 5.2 million people and of that 5.2 million there are only about 3 million voters and also of that 5.2 million there are only about 50 thousand farmers and farming is our primary industry but wait, there’s more, our primary industry manufactures food, wool, timber etc which is mostly exported. And if you think there’s tourism what pays them bills then what you’re doing when you get that glazed, cross-eyed look on your face? The same look as when you’re on the toilet after two codeine tabs and a three meats dinner? Yeah, that one. That’s called denial”. Duh, here I am prayin’ ta Jesus for a laxative and a wee lie down.”
During the two year lock-down, when tourists weren’t touring, our GDP went up! Yep. Look it up.
So don’t you think there’s something fishy going on?
Before we must engage with our witless and the unimaginative, poor dears, and don’t worry, every family has at least one, we must first beg for a royal commission of inquiry to sort out our criminals before they distance us from the Crown then sell us to the Israeli’s while the aforementioned witless and unimaginative are beering it up down at the pisser while cheering on the heavily sponsored All Bought and Paid For’s. “Go the ABaPF’er’sess an’ that! “
Enjoy reading your stuff countryboy always enlightening
Bring back Susan Devoy.
Yes, at least she was merely useless.
The insolence and arrogance of LP oafs telling highly trained medical professionals how to do their job will inevitably drive more sorely needed specialists out of the profession, and out of the country.
why? Because they have to finally face up to their inherent bias?
D Doom. The medical profession does not formulate the policy. That’s what the politicians are meant to be doing, and it is they who are responsible, they, and nobody else, who are responsible for our once world class national health service being deliberately trashed.
The politicians now trying to directly interfere in how medicine is practised in New Zealand is a Nth Korea -type dynamic, based on penny-pinching, plus their need to create social division. It’s called, ‘ divide and rule.’
doom “ Inherit bias “? I don’t think so. It’s because they have a moral and professional obligation to themselves to do their job with integrity, and to the best of their ability, to get the best possible outcome. This is compromised if politicians start interfering. The years of hard grift, self-discipline, honing of skill, self-sacrifice, and expense it takes to become a trained surgeon, are unknown to most politicians who nowadays tend to be shallow self-interested opportunists and the last sort of persons who should be interfering in how their betters do their jobs. You wouldn’t want them telling pilots how to fly planes in stormy weather either, or instructing vintners about producing fine wines.
This latest Labour policy will be an epic election loser. No one likes racism, and this policy can only effectively function with racism. Nail in the coffin.
Nitrium I hope you’re right. Politicians interfering in the work of doctors is worse than scarey. They already ignore medical and biological knowledge as a basis for their sick Gender ID agenda in schools.
Yes indeed Nitrium!
This is yet another nail in Labour’s coffin. The leadership must have tin ears not to know this will go down like a cup of cold sick with the majority of the electorate.
Yup – it is as if Labeen are trying to throw the election.
James. Politics is so dirty now that there could be a fifth columnist at work within the Parliamentary advisory army to help throw the election. That’s a reasonably civilised way of doing things, but when it impacts against innocent health- challenged people it’s bad.
Yet another Human Rights issue. If the Commissioner’s not MIA demonstrating against biological women being empowered to speak, then he should get it addressed, but preferably not with more numskull whiny victims from W. University.
Try telling voters that granny has to wait for her life saving surgery due to “historic, systemic, injustices”.
For the right wingers on the Daily blog.
Some articles to read;
Facts are the underfunding and this policy is not new.
The blame for it can be laid right at you right wingers door.
https://thespinoff.co.nz/society/19-06-2023/ethnicities-in-new-zealand-ranked-by-how-likely-they-are-to-die-first
https://www.nzherald.co.nz/nz/surgeon-organisation-backs-surgical-ranking-policy-says-it-reduces-institutional-biases/EOV33GU5XJCKDGNIVVQRKIRYLY/
https://www.nzherald.co.nz/kahu/rob-campbell-its-sickening-how-right-minded-kiwis-react-to-poor-maori-and-pasifika-health-outcomes/ZEVOXVIZUNHJDPTP2H4CPQHJBA/
Surgery wait lists: Māori, Pacific prioritised – why ethnicity is a factor
By
Nicholas Jones
19 Jun, 2023 02:25 PM9 mins to read
Comments
Who gets surgery first is now a political issue.
This morning Newstalk ZB and the Herald revealed Te Whatu Ora – Health NZ has introduced an “Equity Adjustor Score”, which uses an algorithm to prioritise patients according to clinical priority, time spent on the waitlist, geographic location (isolated areas), deprivation level and ethnicity.
In the ethnicity category, Māori and Pacific are top of the list, while European New Zealanders and other ethnicities are lower-ranked.
That’s riled some surgeons, who in anonymous comments to Newstalk ZB slammed the policy as medically indefensible. However, the change has support among others as a vital step to finally reduce health gaps.
How long has this happened?
Using ethnicity to help decide which patients should be prioritised isn’t new – some DHBs did so when working through wait lists that were swollen by Covid-19 disruption.
That change was spearheaded by Auckland DHB, whose former chairman Pat Snedden said the disruption from Covid-19 represented a once-in-a-lifetime opportunity to reset an unfair health system.
“Our current system privileges some groups already. Māori and Pasifika are not in that group usually. It is important to be explicit about this. Covid gives us a big-bang opportunity to reset,” Snedden wrote in a document put to the board in May 2020.
He acknowledged how controversial the step would be, but said the fact our health system is designed to advantage the Pākehā majority is also a trade-off, but one most people aren’t aware of.
“Making a trade-off in another direction explicit is important, and this is where the discomfort lies. Framing it as a zero-sum game however makes it unnecessarily a binary situation,” he wrote.
“The waiting list work is about prioritisation, it isn’t that people will miss out, but it does change who gets up the queue earlier to address known inequities and improve outcomes.
“Our data shows Māori and Pasifika patients take longer to move from referral to listing for procedure and often have to present multiple times…we want our clinical assessment process to be intrinsically evidence-based and fair to our population within the resources available. But it hasn’t been, and we can’t avoid that.”
The paper had broad support, but some board members were opposed.
“I absolutely, completely disagree with having a prioritisation system into electives, or indeed anything that we do that is race-based. That is just anathema to me,” board member Doug Armstrong told the meeting.
“I am all for clinicians adopting a more holistic view when they do prioritise people [and] we can advance things by support. The majority of the national population would not support any racial-based prioritisation for elective surgery, or indeed any of the health provision that we make.”
Many of the country’s other DHBs investigated or committed to using ethnicity as a factor when prioritising patients, the Herald later revealed, and that change was embedded into the system after DHBs were replaced by Te Whatu Ora, on July 1 last year.
What’s driven the reform
A growing number of studies and reports – including hospitals’ own data analysis – show Māori and Pacific people can be less likely to be referred or accepted for treatment in the first place, and once in the system generally get less treatment.
Health authorities attribute part of the problem to institutional racism, which is a term that describes how procedures or practices result in some groups being disadvantaged.
A landmark report by the Health Quality & Safety Commission (one of the country’s health watchdogs) in 2019 challenged services to stamp out institutional racism that it said severely harms and kills Māori.
Its review gave a range of examples, including:
* Specialist appointments have unacceptably long wait times and happen less often for Māori.
* Inappropriate prescribing happens much more often for Māori, and Māori consistently rate the communication with hospital staff and doctors lower than other groups.
* The percentage of Māori getting an operation for a hip fracture on the day of or after admission steadily decreased since 2013, whereas the percentage for non-Māori steadily improved.
The commission’s chairman, Professor Alan Merry, said of the report that, while broader social factors influence a person’s health, the findings suggested seeking healthcare doesn’t reduce inequities: “In fact, the results suggest the health system creates further disadvantage for Māori.”
Other research includes a 2019 study that found about half of Māori and Pacific deaths are potentially avoidable, compared to 23 per cent for non-Māori and non-Pacific.
Those findings prompted an extraordinary editorial from the NZ Medical Journal, which said they should be on the computer screensavers of all planning staff in health organisations.
“The 7.0-7.4 year shortened life expectancy for Māori and 5.9-6.0 year for Pacific is a travesty and a lost opportunity within families, communities and Aotearoa,” the editorial authors said.
The Herald has reported on numerous other examples where Māori and Pacific suffer worse health outcomes, including in maternity and diabetes care. For example, researchers have found Māori are at much greater risk of losing a leg to diabetes, even after factors such as deprivation are taken into account.
Controversy grows along with wait lists
National and the Act Party are opposed to prioritisation by ethnicity, and spoke out against the changes when they were first made by DHBs.
However, the issue is now back in the headlines, in election year and amid community concern about worsening hospital delays.
Backlogs have hit record lengths, with over 90,000 people overdue for treatment or a specialist appointment.
The current position of health officials is that while improvements could happen earlier, dramatic reductions in wait list times won’t occur until “at least” 2025.
The situation has deteriorated since in May last year then-Health Minister Andrew Little announced a “high-powered” planned care taskforce, which delivered a report outlining how backlogs could be cleared.
The report – which was accepted by the Government – supported Te Whatu Ora’s approach that “once high clinical priority cases have been addressed, priority must be given to excessively long-waiting patients, with emphasis on the longest waiting Māori and Pacific patients.”
The taskforce found data that showed a disproportionate number of Māori and Pacific patients “waiting excessively long” for imaging scans (used to check for serious conditions including cancer) in some regions.
Another example: Māori and Pacific children suffered the most because current capacity in the paediatric oral health service can’t match demand, including for dentistry requiring sedation or general anaesthetic.
“There are numerous examples of inequities in many planned care services,” the taskforce concluded. “Initiatives must be put in place to resolve this.”
Postcode ‘lottery’
Another factor in what treatment somebody gets can be their address – so-called “postcode healthcare lottery”, where thresholds for treatment and surgeries can vary greatly by region.
For example, an ongoing Herald investigation has exposed how Southlanders are declined life-changing cataract surgery, which they would easily qualify for if they lived in greater Auckland or other regions.
This month Health Minister Dr Ayesha Verrall announced new groups of expert clinicians would be formed, and tasked with identifying regional variations, and then recommending how these can be reduced and eliminated.
The groups, called national clinical networks, would help bring in national standards of care, Verrall said, and would also be expected to close equity gaps, including by ethnicity.
In response, Act Party leader David Seymour said if Labour wanted to eliminate inequities “it would also get rid of the racial lottery, where patients face unfair differences in access to treatment based on their ethnicity.
“That means a needy patient can miss out due to their race, and a less needy patient can overtake them,” Seymour said.
“Pharmac [also] uses ethnicity criteria for some medicines and they’ve adopted a lower age threshold for Māori and Pasifika to get the flu vaccine.
“Labour’s changed the way GPs are subsidised to mean Māori and Pacific patients receive a larger subsidy than other people. Universities are using Māori and Pasifika quotas to allocate limited places in medical schools.”
National vows to scrap scheme
Te Whatu Ora Auckland interim district lead Dr Mike Shepherd this morning told Newstalk ZB’s Mike Hosking that Māori and Pacific patients might get perhaps one or two extra points out of about 100 because of their ethnicity. Clinical need was the main driver of a patient’s score, he said.
“Our people want to get out of bed every day and ensure that all of our population is getting the best health care possible and this is the part of that solution,” Shepherd said.
However, Seymour continued his attack on the policy, saying the other factors taken into account – clinical priority, time waiting, geographic location (isolated areas), and deprivation level – should be sufficient.
“The only possible effect of racial discrimination is to make sure a person in greater need waits longer for an operation and may die on a waiting list because they had the wrong ancestors,” Seymour said.
“A person who is in great clinical need, has waited a long time, lives far from major medical facilities, and is poor could be Māori, European, Pacific, Indian or Chinese, and they should all be treated equally.”
National health spokesperson Dr Shane Reti also reiterated his party’s opposition, saying prioritisation by ethnicity “is offensive, wrong and should halt immediately.
“The way to improve Māori and Pasifika health is through better housing, education and addressing the cost of living, not by disadvantaging others.”
That opposition was foreseen by Dr David Tipene-Leach, chair of Te Ora, the Māori Medical Practitioners Association.
In 2020 he told the Herald that using ethnicity to help prioritise patients was justified given “terrible” health inequities, but factoring in deprivation could make the reforms more palatable to some New Zealanders.
“People who live in decile 9, 10 communities [the most socio-economically deprived] also have inequitable health outcomes. There is this aphorism in the Māori health field – if you get it right for Māori, you get it right for everybody.”
Nicholas Jones is an investigative reporter at the New Zealand Herald. He won the best individual investigation and best social issues reporter categories at the 2023 Voyager Media Awards.
The fundamental mistake that the Labour Government, its policy advisers in the Ministry, the medical establishment, and the te tiriti advocates all make is to assume that ethnic disparities in health are all entirely due to the health system’s treatment and the Social Determinants Of Health – income, education, housing, etc.
It is based on the erroneous assumption that there are no cultural differences between the ethnicities, such as none puts a higher value on pro-health behaviors and choices.
To say health disparities is all down to the health system being racist, you must deliberately ignore the very large differences in obesity rate between ethnicities, for example. Or smoking rates, or high-risk drinking.
I’m sure they have better data at their disposal than a few reckons but you could be right – just woo woo interpretations based on privileged angst and guilt.
https://twitter.com/drkiwicj/status/1671235195058663427
Here is what a gp has to say.
Did you read that graphic the onclology professor tweeted?
top left, first factor discussed – Co-morbidity – higher in Māori, adds to the overall disease load, makes treatment more complex, more likely to be declined treatment
Front page podcast on this topic.
https://www.nzherald.co.nz/nz/the-front-page-ethnicity-in-healthcare-is-te-whatu-oras-new-policy-ethical/ICUSVYKJAVDGPPNUIEM6WVOL5Q/
Front page podcast on this topic.
https://www.nzherald.co.nz/nz/the-front-page-ethnicity-in-healthcare-is-te-whatu-oras-new-policy-ethical/ICUSVYKJAVDGPPNUIEM6WVOL5Q/
https://twitter.com/benmackey/status/1670944628009467906?s=20
Re kid’s teeth. There used to be school dental clinics where children had regular routine checks and any necessary treatment, during school hours. In rural areas an out- of- town dental nurse regularly visited the existing clinic; this could be attached to an existing District High School. These were all abolished. In Willis St, Wellington, a large clinic, known as, The Murder House, trained school dental nurses. Annette King trained there. It got closed down. I think it became student accommodation, could be anything now. A similar outfit existed at Holly Lea, Colombo St, Christchurch, where established dentists helped to train school dental nurses. Children who went to school, had their teeth monitored via the school system, for free, from age 4-5.
Ah yes, I remember the “Murder House”? When were dental nurses abolished? I lived out of the country during the 90s and noughties, so I’m a bit vague about history during that period.
Pope Punctilious 11. I was overseas a long time too, so don’t know how and when a lot of bad happened. Reading intelligent autobiographies like eg Sam Neill’s, can provide a useful sort of social context, but reading official political biographies can be a masochistic exercise, and historians may miss out on non-political issues, I’m not sure. The downgrading of the education system must be among the most destructive of dynamics inflicted upon people and it’s an ongoing shocker, and painful holes in kiddies’ teeth shouldn’t be happening, now.
Hat tip Martyn .
This is the best blog you have done yet on our health system.
Oh I am not surprised the rightee’s are out in force opposing it.
Fact of the matter is they created the problem and now the health model they created and the BLATANT under funding of the TOTAL health system is coming back to bite them fair square in their butts.
I say tough shit.
Many of you accused me of being a liar ten years ago when I started posting on our 3rd world status health system.
So Martyn thanks again for this blog post.
It is time this right wingers health model was called out for what it is .
Blatantly discriminatory against anyone not white and those who cant afford medical insurance or private hospital care .
Hell Canterbury still has not got the new hospital wing to replace the parkside block that was meant to open 7 years ago .
Then look at the bullshit went through getting the riverside block replaced due to earthquake damage.
So you rightee’s should just shut the hell up.
You created this mess NOW GOD DAMN OWN IT.
Typical middle class fury from the I am okay jack crowd screw anyone else.
Eagerly awaiting a blog post from Ian Powell on this.
https://twitter.com/drkiwicj/status/1671235195058663427
‘Gee sorry we were racist in the past. Unfortunately we can’t fix anything because it would racist to do so’…..what a bunch of f’ing muppets.
You are so right Wheel all the flappers are flapping, no one is concerned that a farmer may be prioritized over a towny, because that does not fit the narrative . There are so many right wing ill informed opinions on this page that it makes me want to cry. The fact of the matter is Maori will be here long after David Seymour and his ilk has gone. Maori won’t disappear whoever wins the election in October. The right wing so called anti racists are in fact the real racists . They highlight jealousy and discrimination every step of the way. Luxon is worse than Seymour, he’s becoming more racist to keep up with his counterpart just for votes.
Stupid never sleeps.
All you muppets who are crying because inequality is being addressed make me sick.
The usual suspects of ideological hacks from the right – to stupid to read a whole proposition and parroting fubar talking points from people who dwell in dirty politics.
Then the fearful muppets who think because someone is getting a hand up, they are missing out.
Stop smoking or drinking what ever you are on, it’s making you paranoid and stupid.
There’s no money left for health now, it was all spent on the ridiculous covid pantomime. What we need here is a smirking, out of touch race relations commissioner to make a bit of cash on the side.
Martyn I don’t agree with you on this one.
Good thing is every time the left keep pushing this CRT anti white racism they lose more votes 🙂
no one likes racism apart from racists
Well according to Chippy the accidental PM we can just Self ID as Maori, and voila we are Maori. Self ID the gift that will take care of all inequality.
RB wasn’t Bill English an accidental PM. but hey let’s not nitpick
Bill English was an accident full stop.
For perspective there are 5 factors being accessed for elective surgery (ie non-emergency) including clinical priority, time on waiting list, geographic location (isolated areas), and deprivation. Ethnicity appears to have a minimal weighting in that list.
I’m generally anti-woke but this appears to be affirmative action for empirical reasons (rather than ideological) and it is certainly not apartheid. Factors such as deprivation and location typically have far bigger effect than race, and there is an attempt to account for them.
The success (or otherwise) of this policy should be monitored over whether it has any benefit (does it address the poor health outcomes for Māori and PI?, have reasons for those poor outcomes been accurately identified?) or does it have any detriment (would a poor non-māori get cue jumped by a wealthy māori? or does a non-māori with a higher clinical priority get cue jumped by a māori with a lower clinical priority?).
Finally under what conditions would the approach be declared successful or failed and retired and how to prevent special interest groups, political or financial, leveraging off this policy. (For example title IX was brought in partly due to the imbalance between men and women going to US colleges. The imbalance is now even bigger in the opposite direction but title IX shows no sign of being amended or repealed).
A cynical take that chimes with Martyn’s take on underfunding. Since the PMC status quo is neoliberalism with a taste for identity based virtue signalling, one would expect a public service to be left to wither while increasing the market for private heathcare and private medical insurance. Boosting or slowing the decline in service for those with the worst outcomes could mask that outcomes decline as a whole for everyone that cannot afford to go private.
A sensible comment Tui as always. Nothing wrong with trying to fix things as long as they are reasonably empirical and measured and reviewed. But you really hit the nail on the head with your comment “How to stop the special interest groups leveraging off the policy”. We seem to have that part of the equation down pat and once some group gets a whiff of power they go for gold trying to take over the whole system to funnel wealth and power in a particular direction (And I am not inferring Maori here, thinking more of the Trans Lobby in this instance)
In this debate, something that seems to get forgotten is that we have for Maori by Maori primary health provision covering large chunks of the Maori population and this has been happening for up to 20 years. Has anyone done vigorous empirical research into whether outcomes have improved at this level or which particular outcomes and which havent and whether they represent value for money re: Spend over outcomes.
I dont know if the Govt has looked at this because if it was an overwhelming success what better way to justify improved healthcare by ethnicity and if so why arent we hearing about it?
I think the ‘feelings’ aspect of this debate has dominated what should be a long hard evaluation of what is working and what isnt and whether the solution offered is the best approach. I absolutely stand by the research that shows the social determinants of health are by and large where you want to put your money. Reti is being accused of racist thinking but in his blurb, he nails it by saying the focus has to be on the social determinants.
And at some stage there needs to be some honest talking about culture and the part it plays. Again, I am not thinking poor lifestyle choices but something else that is becoming a growing issue that no-one is talking about. Maori who attend Maori schools and maybe access primary care given by Maori are increasiingly becoming ‘functionally illiterate’ in the Mainstream Eurocentric world. And it is creating quite big barriers for Maori accessing health, housing and other services.
As an example, a Maori lady named Corinna wrote about her own family. In quite common Maori fashion, Corinna’s siblings were born over a longish period. She and her sister went through the public school system, her younger siblings went through the Kohanga Reo etc system. What she notes is a marked divide between their ability to function in the mainstream world. They all come to her to get their issues sorted out with government agencies because they just do not understand the system or what to say and do to get the results they need. They jokingly refer to her as their white Maori.
I cant help wondering how these issues are impacting Maori health outcomes in particular. Again probably as a result of an ideological decision that hasnt had its outcomes monitored.
Should we have Maori schools etc and all the good stuff that comes from that (increased Te Reo, culture etc etc) – yes. But what outcomes arent they achieving? Are we measuring and tweaking because at the moment I think we could be adding to the perception/reality that things arent working for Maori.
We need better evaluation and long term understanding of political choices and more focus on genuine problem solving and measurement of outcomes.
Exactly.
https://pubmed.ncbi.nlm.nih.gov/?term=inequities+Maori+cancer
https://anaesthesia.nz/news/considering-ethnicity-during-the-prioritisation-of-surgical-waitlists/
These sorts of policies are more trouble than they’re worth especially given the countries fragile social cohesion.
Does Verall et al really think that 2 extra points on a waiting list is going to move the dial especially given the fact that cultural factors are much more impactful in determining poor health outcomes.
Side affects people side affects !!!
What happens now is the middle class starts buying up medical insurance because this sort of policy scares people. The end result is further division and frankly people who have medical insurance don’t care about funding a public health system – they will however want lower taxes to pay for their health insurance!
Exactly why the health system is where it is now. The push by the right wing by deprivation of the health system over the last 35 years . To force the population on to health insurance. This also lead to the split age group policies . Which were started by Southern cross back in the 90s during the Crown Health business model Era that are still in place today . These lead to the multiple types of health insurance policies and companies we have today all charging through the nose and by the time you reach 65 plus when you need them most are unaffordable. Then you find out the really serious stuff can only be done in public hospitals anyway and you have spent good money which achieves bugger all.
https://www.rnz.co.nz/national/programmes/focusonpolitics/audio/2018895430/ethnicity-in-health-debate-gets-under-mps-skin
Disparities in healthcare re Maori and Pacifica according to a October 22 article cost the health system $863 million a year in additional costs.
https://www.rnz.co.nz/national/programmes/focusonpolitics/audio/2018895430/ethnicity-in-health-debate-gets-under-mps-skin
Disparities in healthcare re Maori and Pacifica according to a October 22 article cost the health system $863 million a year in additional costs.