The Government, especially Jacinda Ardern and Chris Hipkins, has strongly pushed back on any criticism that the Covid response has lacked an equity focus. Photo / Mark Mitchell
The Government, especially Jacinda Ardern and Chris Hipkins, has strongly pushed back on any criticism that the Covid response has lacked an equity focus. Photo / Mark Mitchell
ANALYSIS
The Government takes particular umbrage when its Covid-19 response is criticised as lacking enough of an equity focus.
But fresh hospital data from the Health Ministry lays bare how much more severely the virus has hit Māori and Pasifika compared to the rest of the population.
Public health expertshave been warning since the start of the pandemic that such populations will suffer more, unless policies were sufficiently weighted towards them to achieve equitable outcomes.
Of the 13,062 Covid cases who have been in hospital, "European/Other" make up 40.1 per cent, much lower than their 69.2 per cent of the total population. Similarly, the "Asian" group is 17.4 per cent of the population, and only 11.4 per cent of hospitalisations.
However Māori are 17.2 per cent of the population but 22 per cent of hospitalisations, while Pasifika are 8.7 per cent of the population but 26.4 per cent of hospitalisations.
The differences are wider for those younger than 60: European/Other make up two-thirds of the population but only one-third of the hospitalisations. Māori are one in five of this age group's population but more than a quarter of the hospitalisations, while Pasifika make up 10 per cent of the population but 30 per cent of the hospitalisations.
Māori and Pasifika are similarly overrepresented in the Covid-19 death statistics, as the Herald revealed earlier this month.
The Ministry of Health also broke down the ethnic data for the number of those hospitalised compared to the total number of cases: 7.2 out of every 1000 European/Other who test positive have ended up in hospital. This almost doubles for Māori (13.5), and more than triples for Pasifika (26.8).
Unsurprisingly, the likelihood of needing hospital care rises with age, with a third of Pasifika cases who were at least 90 years old ending up in hospital - much higher than the 16.2 per cent for Māori, and 9.5 per cent for European/Other.
The data, which includes those in hospital where the underlying cause was something other than Covid-19, must be viewed with caution as it doesn't account for several variables. Those include vaccination status and access to the vaccine, access to healthcare, pre-existing conditions or people's living conditions.
But the data broadly aligns with Te Punaha Matatini research, published in December 2020, that said Māori were two and a half times more likely to need hospital care than non-Māori, while the risk for Pacific people was three times higher.
That research controlled for age as well as pre-existing conditions.
The Health Ministry concedes that the new hospital data "does suggest some inequities in the number of people hospitalised with Covid-19, as well as reflecting wider health inequities in New Zealand".
The ministry "strongly supports an equity-first approach and continues to actively engage and build partnerships with whānau Māori and Pacific peoples to influence and implement Covid-19 initiatives".
Ministry of Health data showing Covid-19 hospitalisations for ethnic groups and age bands. The number in brackets is how many have been hospitalised for every 1000 person in each ethnic group.
Not enough focus on equity?
The Government, and in particular Prime Minister Jacinda Ardern and previous Covid-19 Response Minister Chris Hipkins, have pushed back strongly on any criticism of how equitable the Covid response has been.
Questioned at select committee last month, Hipkins said: "I would argue that the first 18 months to two years for the Covid response have been some of the most pro-equity responses a New Zealand government has ever taken to any issue, and I think the overall outcomes clearly demonstrate that."
Later questioned by media on the same day, he added: "The fact that we have had such a low mortality rate from Covid-19, the fact that our vulnerable communities have been protected from the worst ravages of Covid-19, I think that's something we can all be proud of as New Zealanders."
There are currently between five and 23 deaths a day in New Zealand associated with Covid-19, and 1308 deaths since the start of the pandemic.
New Zealand had the lowest per capita number of deaths in the OECD until recently, but Japan has now taken this position.
This week the ministry released a review, by research group dovetail, that found there wasn't enough focus on equity.
"The overall design of the Delta response was seen by many as not based on a pro-equity perspective," said the report, which interviewed 39 senior stakeholders at the Health Ministry and across the health sector.
"Existing barriers in the health system were seen to further exacerbate inequity."
The review found that the successes in making the response more equitable were largely due to the efforts of Māori and Pacific health providers who know their communities best.
The equity aspect of the Covid response has been scrutinised since the beginning of the vaccine rollout, when the Government rejected expert advice to prioritise 160,000-odd Māori and Pasifika aged between 50 to 64 at the same time as the 65-plus age bracket.
Dr Rawiri Jansen quit the Government's expert immunisation advisory group after its advice was rejected on which Māori and Pasifika should be prioritised in the vaccine rollout. Photo / Dean Purcell
Instead the Government provided 40,000 vaccine doses to Māori and Pacific health providers, which the expert group had recommended alongside prioritising younger Māori and Pasifika. The success of this is unclear, as the ministry has been unable to say where those vaccines were delivered and whether there were any delays.
This followed the Government's attempts to provide funding to Māori and Pacific providers through DHBs, but ministers said this was problematic because of poor relationships - or no relationships, in some instances - between the DHBs and providers.
In December the Waitangi Tribunal found that the Covid-19 response breached the Treaty of Waitangi as it failed to prioritise Māori - despite the known inequitable health outcomes - because of "political convenience" and "fear of a racist backlash".
The Government is currently passing legislation to enable the rollout of a second booster.
It has done a u-turn on its earlier position: the second booster will be available to vulnerable people including those aged 65 and over, as well as Māori and Pasifika aged 50 and over.
Proportion of hospitalisations by age band and ethnicity v population proportion
0-9
• European/Other: 27.5 per cent of hospitalisations (64.7 per cent of population, according to Stats NZ projections) • Asian: 11.7 per cent (21.4 per cent) • Māori: 34.8 per cent (27.6 per cent) • Pasifika: 25.9 per cent (14.9 per cent)
10-19
• European/Other: 37.5 per cent (68.4 per cent) • Asian: 7.6 per cent (15.9 per cent) • Māori: 28.6 per cent (26.5 per cent) • Pasifika: 26.2 per cent (14 per cent)
20-29
• European/Other: 30.4 per cent (63 per cent) • Asian: 9.8 per cent (22.1 per cent) • Māori: 26.4 per cent (20.9 per cent) • Pasifika: 33.1 per cent (11.4 per cent)
30-39
• European/Other: 31.4 per cent (59.6 per cent) • Asian: 19.4 per cent (19.7 per cent) • Māori: 22.1 per cent (15.7 per cent) • Pasifika: 27 per cent (7.9 per cent)
40-49
• European/Other 32.2 per cent (65.6 per cent) • Asian: 13.2 per cent (19.7 per cent) • Māori: 24.7 per cent (14.6 per cent) • Pasifika: 29.5 per cent (7 per cent)
50-59
• European/Other: 36.3 per cent (73.2 per cent) • Asian: 8.3 per cent (12.8 per cent) • Māori: 24.4 per cent (13.6 per cent) • Pasifika: 30.1 per cent (6 per cent)
60-69
• European/Other: 40.2 per cent (77.5 per cent) • Asian: 9.3 per cent (11 per cent) • Māori: 22.2 per cent (11 per cent) • Pasifika: 27.8 per cent (4.4 per cent)
70-79
• European/Other: 52.7 per cent (84 per cent) • Asian: 10.5 per cent (8 per cent) • Māori: 13.9 per cent (7.2 per cent) • Pasifika: 22.9 per cent (3.1 per cent)
80-89
• European/Other: 67.8 per cent (88 per cent) • Asian: 7.8 per cent (6.5 per cent) • Māori: 8.5 per cent (5 per cent) • Pasifika: 15.5 per cent (2.3 per cent)
90 plus
• European/Other: 78.3 per cent (93.1 per cent) • Asian: 7.6 per cent (4.4 per cent) • Māori: 4.4 per cent (3 per cent) • Pasifika: 9.1 per cent (1.6 per cent)
