Sixteen health academics and researchers argue that New Zealand cannot risk stunting the gains made so far in countering historical and social inequities in the health workforce
Multiple student associations have declared their opposition to a discussion document which raised changes to the University of Otago’s Mirror on Society selection policy and the way Māori admissions to the university’s medical school are managed.
As Māori academics, researchers and doctoral scholars of Māori health, we endorse the opposition and have sent an open letter to the University of Otago to this effect.
Admissions selection policies are critical to counter the historical and social inequities that prevent many sectors of the population of Aotearoa from gaining access to educational opportunities like medical school. The MoS policy was designed to promote academic equity for under-represented groups such as Māori, Pacific peoples and those from rural communities, so that the health workforce not only better reflects society but is better equipped to meet society’s needs. This is all recognised in the university’s rationale document for the MoS policy.
Also recognised is the dual obligation that universities in Aotearoa, acting as agents of government, have to honour both their contractual obligations defined in Te Tiriti o Waitangi and their responsibility to correct the inequitable health outcomes experienced by Māori populations.
That the University of Otago could therefore consider imposing caps on the number of Māori admissions to its medical school through the Māori Entry Pathway defies logic and lacks foresight.
We are especially concerned about poor consultation with Māori leadership in the review of the MoS policy. This disregard of Māori expertise is all too familiar.
An independent review currently under way at the University of Waikato into allegations by respected Māori academics of structural and systemic racism includes claims of Māori expertise being ignored. These allegations come just weeks after advice from the Māori Expert Advisory Group for the Health and Disability System Review to establish a standalone Māori Health Authority was similarly ignored.
A policy that simply matches entry numbers to population proportions cannot deliver the representative medical workforce required to meet the future health needs of Aotearoa. The likely negative impact on Māori health outcomes, not only of the University of Otago limiting Māori student numbers to 56 to reflect population demographics, as proposed, but of other agents of government failing to recognise Māori rangatiratanga across these matters, represents failures to meet Tiriti obligations.
Had a cap been in place at the time of selecting the current 65 Māori students in their second-year programme at the medical school, nine of them would have been denied entry. Given the evidence that doctors with more in common with their patients are more empathetic, have more success in diagnosis and are more able to get patients to follow recommended treatments, an immeasurable number of Māori patients would then also have been denied optimal health care.
The disproportionate burden of racism experienced by Māori, including as patients, also cannot be disregarded here. We know, through the work of Māori researchers, that racism results in less positive primary care experiences, lower breast and cervical cancer screening coverage for wāhine Māori, and negative attitudes by health providers towards Māori.
Through their ability to relate, doctors with their own lived experience of racism play an important role in addressing the interpersonal and systemic racism that has been shown to contribute to health inequities.
Medical schools have historically operated as places of privilege, where academic excellence nurtured through expensive, private schooling, and parents already embedded in the profession, has assumed places as of right. It is no secret many of these predominantly Pākehā students now denied entry to medical school due to limited places harbour resentment towards Māori students with sometimes lower grades who are accepted through affirmative admissions pathways. Stuff has reported “at least one family has threatened legal action” as a result. Our concern is the weight of this privileged discontent as a contributor to the discussion document currently being considered.
We urge the University of Otago not to stunt potential gains in the creation of an equitable health workforce by undermining efforts to boost the number of medical professionals who come from traditionally under-represented groups. Do not pander to the powerful elite simply because their children may no longer be guaranteed a place in your medical school despite their educational achievements attained by virtue of a school system structured to benefit them without the stresses of poverty, discrimination and racism. Continue to recognise more than academic attributes and strive to deliver a medical workforce that reflects the communities being served.
Research published in the New Zealand Medical Journal in 2018 highlighted the success of Otago’s MoS policy in “increasing the sociodemographic diversity of its health professional students” between 2010 and 2016, and the importance of this increase, given international evidence indicating such diversity “is beneficial for meeting the health needs of diverse populations”.
As explained by one of the main architects of the MoS policy, Professor Peter Crampton: “We want the health workforce to broadly reflect the communities being served so that when you come into contact with [it] … there is some chance that system has been influenced by health professionals who share your worldview, your ethnic affiliation or your gender … you meet a health professional who you might identify with and [who] makes you feel at home within that system.”
In order to transform the predominantly Pākehā health workforce, proactive measures like the robust affirmative action policies implemented at medical schools for the best part of the past decade, which are supported by Prime Minister Jacinda Ardern and Director-General of Health Dr Ashley Bloomfield, remain crucial. With only 3.4 per cent of the current medical workforce being Māori, this is hard to argue against.
To address the poor health outcomes of Māori, more Māori doctors capable of meeting the needs of Māori – doctors who are culturally aware, humble, self-reflective, good communicators, honest, compassionate, altruistic, empathetic, committed to the service of others and able to relate to Māori – are needed. Not fewer.
Dr Lynne Russell, Professor Bev Lawton (ONZM), Adjunct Professor Amohia Boulton, Dr Clive Aspin, Dr Lisa Te Morenga, Dr Kirsten Smiler, Janet Collier-Taniela, Tina Bennett, Nora Parore, Anna Adcock, Paora Crawford Moyle, Ana Bidois, Aneta Cram, Kahurangi Dey, Michelle Mako and Shane Munn, Te Wāhanga Tātai Hauora—Wellington Faculty of Health, Te Herenga Waka—Victoria University of Wellington.