Informing Anti-Racism Health Policy in Aotearoa New Zealand

Abstract

Racism is firmly established as a determinant of health and an underlying cause of ethnic health inequities. As an organised system, racism operates at multiple levels (including structurally and interpersonally). Racism and its many manifestations are breaches of international human rights obligations and, in the Aotearoa New Zealand context, te Tiriti o Waitangi. This article considers approaches to anti-racism in health and disability policy in the 30 years following the foundational publication Pūao-te-Ata-Tū (Ministerial Advisory Committee on a Māori Perspective for the Department of Social Welfare, 1988), which was one of the first government publications to name and call out the harmful impacts of institutional racism. The article then examines the ways in which government health and disability sector organisations have talked about and responded to racism at a national level since 1980. The results of this research urge a stronger organisational-level approach to antiracism in the health and disability system for more tangible results, requiring multi-level solutions, and transforming what is considered ‘business as usual’ in health and disability sector institutions.

The adverse impacts of racism and whiteness on indigenous health

“…10, p.14 A study examining anti-racist interventions in New Zealand's health and disability sectors, however, cautions the limitation of anti-racist actions to educational training curricula. 11 The authors found that, in alignment with international literature, the majority of anti-racist interventions appeared to be one-off training for professionals or organisations. They highlight the urgent need to "enact real actions for anti-racism change".…”

“…They highlight the urgent need to “enact real actions for anti-racism change”. 11, p.55 Williams and Cooper 12 report evidenced tangible actions for anti-racist change including creating ‘communities of opportunity’ to mitigate systemic racism impacts, guaranteeing high-quality health care for all and building political will to eliminate inequities and “implement large scale efforts to reduce racial prejudice, ideologies, and stereotypes in the larger culture that undergird policy preferences that initiate and sustain inequities”. 12, p.1 These actions may be drawn upon to support those Indigenous-led anti-racist actions outlined in Reid et al’s ‘Twelve projects to improve Indigenous health’.…”

Co-design for indigenous and other children and young people from priority social groups: A systematic review

“… Talamaivao et al (2021) highlight that enduring change in health and disability systems “can only occur when power imbalances are examined and addressed – for example, by reorienting funding structures, services, access and representation for and partnerships with Indigenous peoples” (pp.54–55). Co-design has been touted as a means by which power imbalances can be addressed ( Chauhan et al, 2021 ; Mark & Hagen, 2020 ; Moll et al, 2020 ), however Mark and Hagen (2020) caution that the term ‘co-design’ has been used on occasion to “infer a degree of power sharing, participation and partnership that never really existed” (p.5).…”

Working in value‐discrepant environments inhibits clinicians’ ability to provide compassion and reduces well‐being: A cross‐sectional study

“…Discrepancies in values are also likely to be exacerbated by variations in resource allocation [100] and increasing resource scarcity [45]. In fact, this dynamic was already clearly seen in evidence during the rationalization of healthcare resourcing that occurred during the COVID-19 pandemic where values informing important decisions have often shown to be process-orientated and tokenistic, exacerbating existing inequities and likely worsening the pre-existing tensions between organizational values and those of the healthcare workforce [127][128][129][130][131][132]. Given that the experience of value discrepancies can have significant costs for clinicians, patients and, indirectly, for healthcare systems, such dynamics must be addressed.…”