The Government loves to tell us that they always listen to the opinion of experts. I seriously doubt though that they will listen to the opinion of Dr Bryce Wilkinson, who has a background in public policy analysis, and comments on fiscal issues, poverty, inequality and welfare research.
In 2020, my report, Pharmac: The right prescription? for the New Zealand Initiative found much to compliment in Pharmac’s pursuit of its statutory duty to obtain the best reasonably achievable health outcomes for eligible people from pharmaceuticals within the subsidy budget.
No race-based preferences are implicit in that concept. So, I was surprised last year to see the Pharmac Review Panel recommend that Pharmac bias its subsidy and employment decisions in favour of “priority populations”, notably Maori.
Investigating further, I found that a race-based focus has invaded health policy more generally.
Which should come as no surprise to The BFD readers.
[…] In her Waitangi Day Speech this year the Prime Minister told Maori that they die younger than everyone else because they are Maori.
What evidence did the prime minister and the Director-General have for making such unequivocal causative assertions?
Separate Official Information Act requests for the most authoritative empirical analyses supporting the respective statements were answered earlier this year by the Ministry of Health.
I examined this material looking for two things: evidence of causation (as distinct from correlation) and evidence that the adverse causative effect was of material significance.
[…] Shockingly, the best empirical analyses the Ministry could supply proved to be silent as to both causation and materiality. They did not establish that racism is a material cause of the relatively poor health outcomes for Maori. [emphasis added]
Two articles in the same issue of The New Zealand Medical Journal in 2020 sum up the inconclusive state of empirical research.
The first article was a “systematic review” of quantitative studies in racism and health in New Zealand. The review’s opening sentence roundly declares that “Racism has been firmly established as an important determinant of health and an underlying cause of ethnic health inequities in Aotearoa New Zealand and internationally.”
In contrast, the body of the review article makes it clear that the studies it reviews establish correlations. It did not identify any empirical research that establishes causation, let alone materiality.
The correlation arises because those who self-report a higher experience of racism also tend to self-report a poorer state of health status. Perhaps the former causes the latter, perhaps those feeling poorly about their health take more notice of prejudice or discrimination, or perhaps causation works in both directions. Or something else could be behind the dual experiences.
Or it’s easier for some to blame whitey for their poor state of health instead of taking responsibility for their own bad choices.
And even if we assume one-way causation, how material is its effect, and through what channels does it mostly work? The Ministry of Health routinely presents health outcomes as being 40 per cent determined by socioeconomic factors (e.g. education and income), 10 per cent by the physical environment (e.g. housing quality), 30 per cent by personal lifestyle choices and 20 per cent by the quality of the health care sector. Pharmac’s contribution to the 20 per cent could be quite small. There are too many unanswered questions.
The MOH has a point here. Thanks to this Government, it’s cheaper to eat unhealthily than healthily. Still that doesn’t excuse the gross obesity, and health problems caused by heavy smoking, prevalent amongst Maori.
The second article was an editorial. To its credit it did not assert that the review article established causation. To fill that gap, it baldly asserted that large and enduring group average differences “is evidence of the fact that institutional racism occurs in New Zealand”. What sort of fact is that? If it is a fact, how material is it? Are Maori helpless in its face?
When you want to argue “racism” but can’t quite prove it, just say “institutional racism”.
The editorial thus essentially accuses the hospital boards and practising medical professionals en masse of institutional racism. In 2018 the then Director-General of Health had done much the same.
[…] To return to the role of Pharmac, requiring it to bias its decisions in favour of a “population priority” must reduce the health outcomes for eligible people overall. It could even make those in the priority population worse off.
[…] Officials defend race-based preferences on the grounds of equity and the Treaty. Yet to favour a well-off person in a ‘priority group’ over a less well-off person in another group violates vertical equity. To favour someone in a ‘priority’ group over someone in the same state in another group violates horizonal equity. Yet, the documents I reviewed largely ignore the ‘fair process’ concept of equity.
In other words no one should have to put up with inferior health service just because they’re rich, and no one should have to put up with inferior health service just because they don’t belong to a certain group.
On top of all this, much international evidence on the results of race-based affirmative action aimed at “‘closing the gaps” is discouraging. Official documents seem to be uninformed by this evidence.
By simply blaming racism, this Labour Government does no one any favours. By ignoring the real reasons for the state of Maori health Ardern’s Government virtually guarantees that things will stay as bad as they are and more the likely get even worse.
