Expert opinion from University of Auckland - Waipapa Taumata Rau
Opinion: Equity means delivering justice and fairness. Disestablishing an equity intervention programme, such as the University of Auckland’s Māori and Pacific Admission Scheme, for access to our medical schools will do harm. I know this because I am an Afakasi Samoan doctor, specialising in paediatrics and equity. And I am a product of this programme.
Qualifying as a doctor in 2011 was made possible only through this scheme, a targeted equity initiative.
I am now in my final year of a PhD looking at why the outcomes of critical congenital heart disease in Aotearoa New Zealand are worse for Māori and Pacific children than for Pākehā kids.
I am proud to be a part of something essential advancing equitable health outcomes for our most vulnerable and at-risk population groups.
But this programme is now at risk.
In their coalition agreement, Act and National committed to examine the Māori and Pacific Admission Scheme at Auckland, and similar schemes at the University of Otago.
Politicians argue we need to “determine the effectiveness” of these programmes.
The Māori and Pacific Admission Scheme sees 30 percent of entries into the Faculty of Medical and Health Sciences allocated to Māori and Pasifika students. It also provides extra tutorials and other academic and pastoral support.
I remember a ‘Mapas house’ during my time at the university, where we came together as a community of students from similar cultural backgrounds to support one another, study and share meals. (There was free food in the kitchen!) There were also camps and marae trips where we had a chance to learn more about Māori and Pacific culture and connect on a deeper level with each other (Whakawhanaungatanga).
One memorable evening around a fire pit, older students passed tips and stories of encouragement down to us. This peer support was integral to my success within an innately competitive and high-achieving study environment. Medical school can be tough for Māori and Pasifika.
The vision of the scheme is simple: to train medical students of Māori and Pacific heritage, and through that to enhance how these groups are represented in the health workforce; to create doctors who better mirror the diversity of the population in Aotearoa.
Disestablishing a successful intervention such as Mapas will almost certainly harm Māori and Pacific population groups. My experience working with children and families in hospital confirm commonly reported statistics – Māori and Pacific children disproportionately suffer ill health.
The benefits of a programme like Mapas extend beyond increasing the number of Māori and Pacific people qualifying as doctors.
Being part of the scheme gave me an advocacy and equity lens. By and large, I found a like-minded community that became like family. The doctors I know who went through Mapas during my time at medical school are now qualified consultant professionals and are huge advocates for their communities – investigating and promoting the best ways to deliver equitable care and health outcomes for our people.
One of my friends from Mapas is now a general practitioner, and part of his practice involves being a social media health advocate for Pacific people on TikTok.
Without training and supporting future health leaders and advocates, I worry the voiceless and invisible populations in our society will continue to bear the unfair and unjust burden of an inequitable system.
The knock-on effects of even ‘reviewing’ the programme are hurtful and upsetting.
What will happen to the Māori and Pacific children I advocate for and treat in the future, when I retire? How will people like me feel when traversing a health system that doesn’t reflect their culture, health beliefs and background? Do we as a society think it is fair for our at-risk population groups to become further marginalised?
In many ways, Aotearoa New Zealand leads the world in indigenous healthcare initiatives, and targeted medical school entry pathways are an important part of that.
My message to Christopher Luxon and David Seymour: programmes such as Mapas are a success; touch them at your – our – peril.
Equity is “The quality of being equal or fair; fairness, impartiality; even-handed dealing “(OED). Equity cannot justify a discriminatory policy. Discriminatory policies are not equitable. If this issue is approached in a rational way, discrimination and inequity needs to be accepted as an outcome and then be justified by demonstrating that in the particular case, there is another value which is more important than equity. And the details ought to be examined to ensure that the way that value is achieved is no more inequitable than is necessary.
I think the NZ public would be appalled and outraged, as I just was, to learn that 30% of all medical places are reserved for Maori and Pasifika students.
30%! How is this massive percentage of med student entries ever justified? Did someone add Maori and Pasifika percentage of populations to 30% and then assume this was justified?
And how does a Pasifika student get racial priority in New Zealand over any other kiwi kid? They are a recent immigrant class just like Asian and Indians. Are they forced to then pay a debt of working in their culture for a number of years? Remember this is a zero-sum game, even kid given an exclusive place, means someone, more deserving, misses out.
This ‘equity’ stuff is out-of-control.
Side note. My family are Pasifika medical. Grandfather Sir Ed Sayers, Dean Medicine Otago and was the Pacific Islands expert. Father [orthopeadics] and sister [oncology] are part-Pasifika. All my kids could have claimed special status yet didn’t because we do not its fair to other kiwis. My grandfather must be rolling in his grave.