Tapu Misa: When ethnicity equals need

On the day last week that the Government was reported to be "in retreat" over so-called race-based funding, the PM and a number of her MPs were indulging in a bit of pre-election schmoozing at the Pacific business awards in Manukau (as were one or two Opposition MPs, including Winston Peters).

Earlier in the day they'd launched a Pacific youth development policy in Auckland. Yes, that's right - an ethnic policy.

I guess that's what National means when it accuses Labour of "pandering to minorities", though Trevor Mallard's review of policies as Minister of Race Relations might have fooled some into thinking that the Government seems more intent on pandering to the majority - or at least that section of mainstream New Zealand that agreed with Don Brash's Orewa 1 speech when it came to seemingly preferential treatment for Maori and Pacific Islanders.

You could hardly blame The Don for claiming a moral victory on that one, though as usual Labour was having it both ways. Not to be accused of racist policies, Mallard's review slashes $57 million from ethnically targeted health funding, and several million more from education programmes and scholarships. Need, not ethnicity, he says, will be the determining factor.

Which is all very well, except that ethnicity still seems to be the basis for quite a number of existing programmes.

The aforementioned business awards are a case in point. The awards are run by the Pacific Business Trust, which is allowed to keep on giving Pacific businesses a helping hand "to reduce barriers" (like the Samoan restaurateur who won the enterprise award for owning a couple of, um, Italian restaurants). But it is not allowed to fund scholarships for college students, despite a demonstrated need.

She's a hard row to hoe, pandering simultaneously to needy minorities and an unsympathetic majority - and one could be forgiven for thinking that the only unifying principle here is re-election.

To be fair, it isn't easy making the case for ethnically based funding, especially when you're sliding in the polls - but I wish they'd tried.

As with the tax cuts, half the problem is with perception. Middle New Zealand, whoever they are, might well have worn a Budget without tax cuts - which reason tells us will widen the gap between the comfortable and the afflicted - but not the insult of a 67c adjustment.

Similarly, and despite the policy contortions, Labour might have held the high ground on ethnically targeted policies, if it had just been more honest about them.

The truth is that race-based funding has always been needs-based - and disentangling ethnicity from need requires the kind of scalpel-like finesse that no one, anywhere in the world, has yet mastered.

Race and ethnicity matters in ways we're still discovering, and are more influential and complex than most politicians will concede.

That's why there continues to be an element of ethnicity in funding under Labour, and why I'm betting there will be under National, should it get the chance to confront the same sticky realities after election day.

Let's not forget that it was National that pushed through the first major treaty settlements, and which brought us kohanga reo, kura kaupapa, wananga, and a proliferation of Maori and Pacific health providers. All fine examples of what National, Act, New Zealand First et al would today describe as race-based initiatives.

But while mainstream New Zealand is understandably tetchy about anything that has the R-word attached, it's worth examining the needs-versus-race argument.

Take health, for example, and why Mallard's tinkering with the ethnicity component of the funding allocation was vigorously opposed by Ministry of Health officials. No doubt they've seen the mounting evidence from both overseas and here which shows that ethnicity has a significant bearing on health outcomes.

Dr Tony Blakely, an assistant professor at the Wellington School of Medicine and Health Sciences, and one of the authors of the Decades in Disparities report, says we're just fooling ourselves if we think ethnicity doesn't matter.

He says two facts support the case for continued funding on both need and ethnicity. One, that Maori and Pacific people have higher mortality rates than Pakeha people. And two, that Maori have higher death rates regardless of how much they earn.

Blakely's ongoing research shows that death rates for the most well-off Maori are 40 per cent higher than the death rates for the worst-off Pakeha.

So it isn't just about income, says Blakely. Neither is it just about lifestyle, contrary to popular opinion. Even accounting for those factors, there's still a significant ethnic gap, which suggests that something else is at work.

Blakely's research is starting to unearth a few clues - the most significant being differing access to health services. In a paper published in the American Journal of Health last month, Blakely and his fellow researchers showed that survival rates for invasive cancer was lowest for Maori, intermediate for Pacific Islanders, and highest for everyone else. They concluded that "ethnic inequalities might include access to specialised cancer services and the quality of care received".

Of course, we'd never know this if we insisted on colour-blind research and a one-size-fits-all approach to health funding.

Blakely argues that both income and ethnicity are critical in health funding. Target only low-income people and you miss the health needs of Maori and Pacific people. Target only Maori and Pacific people and you miss the needs of low-income Pakeha.

According to Blakely's calculations, Mallard's proposed tinkering misses both ethnicity and greatest need, though it still retains other drivers of funding, including sex and age. "Age is the biggest determinant of funding, but no one jumps up and down about that."

He's worried, too, that the gap in death rates, which had shown signs of narrowing as a result of those so-called "race-based" policies of both National and Labour, will start to widen again.

"It takes time for health statistics to turn the corner. Now is not the time for rocking the boat and pulling apart social and health policy that is helping to reduce inequalities in health. Now is the time for New Zealand to continue building a cohesive and inclusive society."