Read on Twitter
The story of Māori health over recent decades is a story of persistent inequities due to inaction by the health system and successive governments. (Thread) https://twitter.com/taramcallister4/status/1278776745282297856
I remember when I started my specialty training in Public Health Medicine ~20 years ago, our Māori Health lecturer @DavidTipene reflected on how Māori health had been a priority throughout his career (on paper at least), yet stark inequities had persisted.
Twenty years later, my reflections would be depressingly similar. Yes, there have been some gains, but often these have been temporary - and meanwhile things have been getting worse in other areas. Fundamentally nothing has changed.
The only conclusion one can draw is that Māori health is not actually a priority - it only exists as a priority in Ministry of Health and DHB documents. If it had truly been a priority we would have seen genuine commitment to achieving equity.
But the sad truth is that the govt, Ministry and health system have no intention of achieving equity. Like all settler colonial institutions and systems they are designed to maintain structural racism and perpetuate Indigenous disadvantage. Inequity is a feature, not a bug.
That’s why we might see some marginal and temporary wins, but overall the pattern is maintenance of the status quo. If we start making gains in a particular area, the system adapts to maintain the racist equilibrium.
There is clearly a tolerance of inequity in our health sector, from the top all the way down. If this weren’t the case we would have eliminated the inequity years ago. We wouldn’t see a continuing acceptance of ‘reducing inequities’ as a goal.
A goal of ‘reducing inequities’ means people accept a level of inequity, as long as it’s not as bad as it used to be, or not as bad as another DHB (for example).
Just to be clear, ANY inequity is unacceptable and racist. Let’s not celebrate unacceptable and racist outcomes.
Just to be clear, ANY inequity is unacceptable and racist. Let’s not celebrate unacceptable and racist outcomes.
The goal has to be equity, there has to be a deadline (otherwise we continue to accept illusory ‘improvements’ as satisfactory outcomes) and there has to be a clear pathway to get there. With intermediate targets and an intolerance of any departure from that trajectory.
This requires all health providers and organisations to be held accountable for achieving equity. Any departure from the pathway towards equity needs corrective action. Failure cannot be an option.
That’s what ‘priority’ looks like. Unless the govt and Ministry of Health are willing to take Māori health equity seriously, they should just be honest that it isn’t a priority - that they’re comfortable with the persistent inequities and unwilling to disrupt the status quo.
