Photo: RNZ / Reece Baker
Public services must now be determined on need, not race. But in the health sector, experts say the biggest determination of need is ethnicity.
It's a dogma labelled in some sectors as 'colourblind ideology' - the idea that everyone should be treated the same when it comes to public services.
Now the instruction to prioritise on the basis of need, not race, is enshrined by a Cabinet Office circular setting out the government's expectations when it comes to who gets what.
But internationally, the approach has been criticised as something that allows us to deny uncomfortable cultural differences, and suggests it is a form of modern racism.
Writing for the New Zealand Medical Journal, a group of University of Auckland medical academics have argued that ethnicity is an evidence-based marker of need, and that taking that categorisation out of decision-making is actually a case of removing data from calculations.
The Detail talks to the lead author of that editorial, Belinda Loring, a public health physician in the area of looking at disease at a population level, who has researched health inequities.
"It certainly feels like this directive is a particular attack on science and public health advice," she says.
"It seems to be based on a false and unsubstantiated assumption that any previous ethnicity-based targeting in our health system has not been based on a robust analysis of need."
Loring says we have a duty to allocate health resources in the best way possible, and authorities are trying to use all of the available data sources to assess constantly who is going to get the most benefit, and how we minimise the risks of unintended harms to people.
She says the directive makes no scientific sense whatsoever.
"From all of our research, ethnicity is not just an evidence-based marker of health need, but consistent, overwhelming evidence tells us that ethnicity is a stronger marker of need than the other characteristics that we have at our disposal like deprivation, or age or rurality.
"It would seem that it's completely contrary to showing a regard for evidence and science."
Why is it a stronger marker?
"It's important to note that it's not ethnicity itself that leads to poor health. It's because racism and marginalisation are so strongly distributed along ethnic lines in New Zealand, which makes ethnicity such a strong predictor of need."
Loring points out the statistics are there no matter where we look - lower Māori life expectancy, higher health need, lower access to services, lower immunisation and poorer health outcomes.
"For example, ethnicity is the strongest marker of avoidable death, even after adjusting for deprivation or rurality. And if we look at those people living in high deprivation areas, Māori will have poorer outcomes than non-Māori.
"People are not turning up to health services with equal levels of need. And they're not being treated equally. And they're certainly not receiving equal outcomes, based on ethnicity.
"I think we all want to be treated fairly, and we all like the idea that we have a system that is fair and will give us all an equal chance. I think the problem is that there's a misunderstanding ... the current system is not equitable. The good outcomes and high level of high quality service that Pākehā receive isn't the same for other ethnic groups. So it's that inequity that continually needs to be adjusted."
Loring also fears that the directive, while not an outright ban on using ethnicity data, requires strong justification and analysis to be presented before it can be used.
The directive states that agencies should "engage responsible ministers early" about why they're doing it ... and "provide a strong analytical case for targeted investment, based on empirical evidence".
Loring says the directive sends a strong message to public service officials.
"They're imposing additional requirements on agencies to consult with their ministers earlier on any time that they're thinking of targeting services to a particular population group. They need to provide robust analysis and justification for why ethnicity targeting should happen.
"So I think the risk is how it's understood and interpreted and implemented by these agencies. The risk is that officials will take this as a shorthand for 'no more ethnicity-based anything'. Which is completely the opposite of what is required."
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