Dialogue: Sick Maori face of subtle racism

By TAPU MISA

Researchers looking into racial gaps in health have tended to frame their studies in a manner that somehow puts the blame on those unfortunates on the wrong end of the health statistics.

The focus has been not on finding out what it is about New Zealand society that disadvantages Maori but what Maori were doing wrong to make them so sick.

Was it their genes? Their behaviour or culture?

Whatever the explanation, the fault seemed always to lie with the patient.

Maori, it was implied, were clearly deficient compared with Pakeha. Hopefully, they would get their act together and stop draining the health budget.

The possibility that the effects of colonisation and racism might be involved just didn't figure.

In latter years, the blame has shifted to income disparities. No end of studies here, and overseas, show that being poor is bad for your health. The poorer you are, the sooner you will die, even of the most preventable diseases.

But recent studies tell us being poor is not the whole picture. They show that just being Maori, or any kind of ethnic minority, is a health risk.

A study released last week by researchers from Otago University and the Christchurch School of Medicine indicates Maori men die at more than twice the rate of non-Maori (five times more for treatable conditions like asthma, hypertension and bronchitis).

Not only that but death rates for Maori in the top occupational group are higher than for non-Maori in the bottom group.

Those findings are backed up by a more comprehensive study by Wellington School of Medicine researchers, who used the New Zealand Deprivation Index to look at the link between deprivation and health.

Using Census data to rate the level of deprivation of neighbourhoods of about 100, it shows - as do overseas studies - that people in the least-deprived neighbourhoods are healthier than those in the worst-off neighbourhoods.

No great surprise there.

More worrying is that no matter what the level of deprivation, the health outcomes for Maori are always worse than for Pakeha. Even Maori in the most affluent neighbourhoods have, on average, worse health outcomes than Pakeha in the poorest neighbourhood.

The researchers suggest Maori deprivation might be the result of the long-standing and continuing effects of colonisation.

An American study released last week by the Institute of Medicine suggests racism is part of the equation, too.

It shows racial and ethnic minorities in the United States receive lower-quality healthcare than whites even when insurance and income are the same.

It says the subtle, even unconscious, racial prejudice of doctors, 91 per cent of whom are white, is part of the problem.

The report says minorities are less likely to get appropriate medications for heart disease or bypass surgery; in 90 per cent of cases their doctor does not even recommend it. They are less likely to receive kidney dialysis or transplants than whites.

Minorities, the survey shows, are much more likely to get the less-desirable procedures.

Diabetic Blacks are nearly four times as likely as whites to have their lower limbs lopped off.

The result is higher death rates from cancer, heart disease, diabetes and HIV infection

Most health providers are well-intentioned, said researchers, but they also found doctors who assumed that black patients would be less likely to participate in follow-up care.

We have had similar examples of unconscious institutional racism.

A 1980s study found that Maori and Pacific children in hospital for asthma for the first time were more likely than Pakeha kids to be prescribed a reliever than a preventative inhaler to take home.

It was not so much that the house surgeons were racist. Rather, busy and under pressure, they were prone to making wrong assumptions about the children's families. As a result, many children missed out on treatment that might have prevented their return to hospital.

In the US, the Institute of Medicine has called for a closer look at the problem, and more ethnically diverse doctors. It wants doctors to examine their attitudes and the treatment they give minorities.

Maori and Pacific health researchers hope the system here will come under similar scrutiny.

If the data is screaming at you, said one, it's time to make changes.