Rob Campbell says we must act now to reverse poor Māori and Pasifika health Outcomes. Photo / NZME
OPINION
The noise and anxiety being created by guidelines for surgery within Te Whatu Ora may be serving some political interests. But it is not serving health outcomes.
Let us start from the uncontroversial observation that, across a wide range of health outcomes, Māori and Pasifika people's experience is poorer relative to other populations.
There is a wide range of reasons for this but research consistently backs the view that even when, as a result of that wide range of reasons, Māori and Pasifika patients are in our hospitals, they get worse treatment outcomes as a group.
It is not always the case. There are other groups or individuals that face such outcomes which are inequitable. But the balance of research shows a persistent pattern.
I do not think that many working within the hospitals would argue that this was not so, nor that taking steps to rectify that made social and moral sense. Improving the way our hospitals provide clinical treatment and care is a cause dear to the heart of every hospital staff member I have ever discussed such issues with.
We should never lose sight of the fact that health outcomes overall are not determined solely or even mostly in hospitals. The social and commercial determinants of health are the essential base for us all, and even more so in their impact on inequity for Māori and Pasifika.
The solutions here are partly universal (incomes, public health measures, housing etc) and partly specific (cultural, colonisation, physical and mental differences).
But back to the hospital, where such factors have already played out and the person is under clinical treatment. No one I have seen, or heard has argued that clinical judgments must not dominate here. (Noting that differences in access and nature of facilities also play a role in different outcomes and need to be addressed in design and operational process as many are).
If there are persistent and widespread imbalances in waiting lists between different populations, then anything but the most narrow of clinical judgments would regard that as something to be taken into account in prioritising.
Remember that the private hospitals are not, shall we say to be generous, weighted in their services towards Māori and Pasifika patients.
So the “social queue” for surgery has often enough been jumped already.
Clinical judgment is not a value-free exercise. A high degree of objective assesment is core, but global research and policy does not ignore the role of culture, background and experience in this.
The initial and ongoing professional training of clinicians rightly recognises this.
So when the policy guidelines are being drawn up (in Te Whatu Ora and/or in Manatu Hauora), it is scarcely surprising that such matters are included. After all, clinicians are involved at this level as well as at the sharp end of surgical decisions. There is not a bureaucrat at the bedside checking for bias. Guidelines are just that. Things to be taken into account.
It would be a very poor outcome if, in addressing surgery lists, decisions were consistently made about priority such that Māori and Pasifika remained disproportionately at the wrong end of the queue.
I think the stirrers know that, and know that they are making an issue of something that is simply a rational and caring and equitable approach to queues which we must reduce for all.