A BETTER WAY TO EQUAL HEALTH
A lot of people think New Zealand is in trouble. This morning a very prominent New Zealander told us “I now think an economic and social crisis is already happening in NZ, it just isn’t recognised as such.” We don’t disagree but it’s worse than that and here’s why.
Emeritus Professor Peter Davis, a sociologist also known as the husband of former Prime Minister Helen Clark, is sounding like the most sensible person in New Zealand. His devastating op-ed on the Waitlest Equity Adjuster Tool from last month is well worth the read. He recalls his time with the Auckland District Health Board where he opposed the Waitlist Equity Adjuster Tool.
His basic point, abridged, is: “The data did not seem to support the need… [on nearly every wait lists] Māori and Pacific patients had waiting times somewhere between 20% below and 20% above other patients… You don’t want to mess with objective clinical criteria… If you wanted to pick up on disadvantage, more inclusive than ethnicity would be socio-economic position… health inequalities start well outside the health system, and we need to tackle those head-on as well.”
Davis’s op-ed goes on to suggest it would be better to have the nanny state back in full force to stop us all consuming fish and chips, proving nobody’s perfect. He does say that many people show up to hospital because primary care failed, that’s one reason ACT proposed an extra 13 per cent boost to GP funding in their alternative budget. In both cases he politely makes the case that adjusting waitlists based on race was and is nuts.
He came to the same conclusions as the New Zealand Initiative’s Bryce Wilkinson. Wilkinson went on a mission to find out what Jacinda Ardern meant when she said “…we have an obligation to make sure everyone has access to the healthcare they need, and that you don’t die younger than everyone else in New Zealand because you are Māori… And yet that is not the case.”
Surely she meant that being Māori is in itself a cause of early death? She figures that Māori life expectancy is seven years shorter than non-Māori, and she assumes that’s the case because of being Māori. But what if there are other causes?
For example, let’s say smoking takes ten years off your life and more Māori smoke. Let’s say living in a mouldy house causes respiratory disease and more Māori live in poor housing. Let’s say that being overweight makes you more likely to develop diabetes or die young, and more Māori are overweight.
The would all mean that Māori don’t live as long on average, but… there are also overweight non-Māori who smoke in poor houses, and they don’t live as long either. There are also fit non smokers in nice healthy homes who are Māori, and they do live longer. Racial profiling misses the unhealthy non-Māori and patronises the healthy Māori.
That’s what Peter Davis was saying in his piece, but back to Bryce. Bryce Wilkinson went on a mission, using the Official Information Act, to find out what evidence the Prime Minister had for her statements. Long story short, his analysis in Chapter Two here shows that the Prime Minister of New Zealand went to Waitangi and claimed Māori don’t live as long because of being Māori without a shred of evidence whatsoever.
All of which takes us to the question of what ACT would do about this. The party’s paper Democracy or Co-Government? answers that question. On the use of targeting it says: “In order to focus on citizens’ need, the Government requires more sophisticated ways of measuring need. ACT in government would orientate the Public Service towards sophisticated use of data to identify need rather than crude race based targeting.”
On devolution, it says: “ACT believes that decentralised systems close to their communities allow for greater innovation and responsiveness. ACT advocates moving from an ethnicity-based, centralised system to a more equitable and socially responsible one where the actual needs of individual people underpin decision-making. One example of successful devolution was the creation of Partnership Schools Kura Hourua (aka ‘Charter Schools’).”
In other words, the kind of better targeting and better service delivery that Peter Davis advocates. It’s a mixed up muddled up shook up world under this Labour Government, thankfully it’s only 103 days to Real Change.