As a national campaign addressing New Zealand’s attitude towards casual racism gets underway, newly-published research highlights another national shame: institutional racism in our public health sector. Teuila Fuatai reports.
Working in public health can be a tough slog – just ask Dr Heather Came, senior lecturer in Māori Health at the Auckland University of Technology (AUT). Came, who refers to herself as a seventh-generation Pākeha New Zealander, has spent 25 years working in the sector, both as an academic and as a health promotion worker.
Her latest research, published earlier this month in the Social Science and Medicine Journal, involved taking a meticulous comb through the world of public health contractors in New Zealand – examining whether Māori service providers are treated differently from their mainstream counterparts by those with the purse strings (Ministry of Health and District Health Boards).
Disappointingly, the research – which included both qualitative and quantitative analysis – showed they were.
“There’s Māori health providers, there’s public health units that are attached to DHBs, there’s primary health care organisations, and there’s non-governmental organisations, Came said from her office at AUT’s Taupua Waiora Centre for Māori Health Research. “We compared Māori with the other folk.”
Over a six-month recruitment period, Came and her team approached New Zealand’s 214 public health providers via telephone and email, of which 75 percent responded and took part in the study. Of those providers, 60 were Māori and 90 were mainstream. No Pacific providers were included in the analysis to ensure a clear comparison between Māori and mainstream providers.
According to the quantitative analysis, significant variations were identified in four key areas: Māori providers received shorter contracts, were monitored more intensely, struggled more with compliance costs and were audited more often than their mainstream counterparts.
Came, who prefers qualitative research methods to hard number crunching, said conversations with providers uncovered a broad range of examples that backed up what the numbers highlighted.
“There’s no reason why Māori providers should have shorter contracts than other providers. There’s no rationale for it in … the procurement policy. So, there’s something about them not being trusted, which is why they seem to get scrutinised more intensely and they get audited more frequently and they have these shorter contracts,” Came said.
Relationships between Māori providers and contract fund managers was another key point of contention.
Māori providers received shorter contracts, were monitored more intensely, struggled more with compliance costs and were audited more often than their mainstream counterparts.
“There’s diverse Māori providers, they’re not all the same. Some of them are very big and very strong, and some of them are small and more vulnerable, so they’ve got different amounts of power in negotiating with the [contract funder].
“[Furthermore], when it comes time to speaking out, not everyone is in a position to do that,” Came noted.
“I’m not contracted to the Ministry of Health and I’ll probably never be contracted with the Ministry of Health so I can say different things than the people in the survey.
“This was a way of doing the survey so you could look across and see the racism. These are very assertive people, but this is their bread and money, this is people’s livelihoods,” Came said of the surveyed Māori providers.
Strong-arm politics from the Government this year, including threats to pull funding from NGOs refusing to share personal client information, and Alfred Ngaro’s comments around “people taking with one hand and throwing with the other”, are public examples of the behaviour and attitudes that prevent and discourage Māori public health providers from calling out discrepancies in the way they are treated by contract funders, Came said.
“It is about how the Government chooses to contract with Māori health providers. They are treated differently, and that pattern of behaviour … disadvantages them, and that is what institutional racism is. It’s the pattern of behaviour over time.”
Antony Thompson, manager of Te Rūnanga o Ngāti Whātua Maori public health unit, agreed with the study findings.
Just this week, Thompson’s team had been awarded its first three-year public health contract. Previously, the unit – which delivers services to about 3000 people from Hokianga to Auckland – was “negotiating” contracts on a 12-month basis.
“It’s huge,” Thompson said of the longer contract. “As a result of that, we’re able to plan ahead and put some long-term planning in place, rather than the very short, very quick policy directives and initiatives we normally do.”
While “institutionalised racism” and “unconscious bias” in the treatment of Māori health providers was unlikely to be eradicated anytime soon, there had been significant improvements in the past two years in relationships between his own organisation and Crown agencies like DHBs, Thompson said.
“In the past, there have been managers who didn’t actually meet their contract funders – it was all by email. Funders are now coming out and meeting our community and seeing how things are going,” he said.
“They’re not doing it as part of their scope, they’re doing it because they want to know more.”
“We’re also seeing a bit more of an open dialogue where we’re able to negotiate or talk to funders … and see what their thinking is around what we do – that’s been one of the biggest eye-openers,” Thompson said.
Came emphasised the importance of Te Rūnanga o Ngāti Whātua’s experience in the past few years, labelling it a “little breakthrough” in her work around anti-racism and public health.
“It is about how the government chooses to contract with Māori health providers. They are treated differently, and that pattern of behaviour … disadvantages them – and that is what institutional racism is. It’s the pattern of behaviour over time.”
“This is racism that can be changed. The Ministry of Health need to strengthen their quality assurance processes so they can detect and prevent and minimise racism.”
More transparency around the length of contracts awarded to providers, and the type of criteria needed for multi-year contracts would be one of the first ways to address this, Came said.
When asked for comment on Came’s research, the Ministry of Health refused an interview, instead sending through written comments from Deputy Director, Service Commissioning, Keriana Brooking.
Brooking would not acknowledge the existence of institutional racism in public health sector contract funding processes.
“The Ministry believes there are alternative and more plausible explanations for the results shown in the survey,” Brooking stated.
“If the Ministry is made aware of specific examples of Māori health providers being disadvantaged, it will act.”
Initially, when contacted by Newsroom, a spokesman from the Ministry of Health referred to articles from last year and 2013 on institutional racism in the public health sector, and said he would “look for the comments we provided at the time”.
Health Minister Jonathan Coleman also declined an interview.