More than a life is worth?

"When it came to COVID, we completely blew out what the value of a life was, completely, I’ve never seen such a high value on life.” That’s a quote from ACT health spokesperson Brooke van Velden speaking during a political panel discussion at the recent HealthTech Week.

The question asked was along the lines of, how do we value life? The issue of the different values placed by ACC, Waka Kotahi and other organisations was batted about and, before making the above comment, Ms van Velden noted that valuing life was quite a technical process. She told the audience she would not want to put a value on their lives.

Nevertheless, she held a strong opinion on the value of the lives of those who found themselves infected with COVID-19 and presumably also the families, caregivers and health workers at risk.

"Few politicians would be willing to spell out exactly who is not worth saving"

Ms van Velden is not alone in thinking the Government over-invested in containing the worst (as far as we know) of the epidemic. But it is far too easy to forget the many unknowns of those early days. Our television screens showed torrid scenes in Italian hospitals of COVID proving deadly to patients and health workers, of a desperate shortage of ventilators, of bodies being stored in refrigerated trucks.

No one knew whether the virus would become more or less virulent. No one knew there would be such a thing as long COVID. Steps were taken on the information available. As a country, we were pretty much on board with saving as many lives as possible.

To suggest now that New Zealand completely overspent on saving lives leads to the question, who was not worth trying to save? Few politicians would be willing to spell out exactly who among our populace is not worth saving. Yet they are absolutely willing to tie the hands of those looking to save the lives of Māori and Pacific patients.

The issue of using ethnicity as a tool to help improve health outcomes for Māori and Pacific patients came under fire recently following mainstream news coverage of an equity adjuster tool being applied to some elective surgery patients.

The tool uses an algorithm that weighs a number of factors – ethnicity, time spent on the waiting list, geographic location and deprivation level – after the primary factor, clinical need, has been considered.

People working in the health sector should already be aware that ethnicity is a factor in a number of health initiatives, including screening programmes and access to medicines.

Opposition leaders Christopher Luxon and David Seymour latched on to this latest initiative as evidence of a system giving preference to people based on race. Which is true. The system as it stands gives preference to Pākehā, providing them with longer life expectancy and better health outcomes across most measures.

But, sadly, that was not the point Mr Luxon and Mr Seymour were making.

Mr Luxon decried the use of ethnicity to assist in prioritising surgery waiting lists, saying decisions about surgery should be made solely on health need; taking into account clinical need, deprivation and time on a waiting list is enough, he says.

Mr Seymour describes the ethnicity component of the adjuster as racial discrimination and “fundamentally un-Kiwi”. Personally, I think a chunk of the population dying on average seven years younger is fundamentally un-Kiwi, but I digress.

Prime minister Chris Hipkins defended the ethnicity criterion in Parliament, saying the evidence for its use is clear and applying the adjuster deals to the disadvantage Māori, Pasifika, rural people and those from low-income backgrounds experienced on elective surgery waiting lists.

But then he sort of backtracked by asking the health minister to check that “everyone is being treated equally” – an aspiration contrary to the whole point of the adjuster, which is that not everyone is treated the same. Patients are treated according to need, and need is ascertained by viewing patients through those different criteria.

I have seen some of our own online commenters draw a parallel between use of ethnicity adjusters and apartheid. I am not arrogant enough to assume I have any sense of what it is like to live under apartheid, but I believe that is not a fair comparison.

On the one hand, you have a political system predicated on the separation of ethnic groups to the benefit of one group. On the other, a prioritisation tool aiming to bring the health outcomes of Māori and Pacific people up to the level experienced by Pākehā and others.

The adjuster is a new approach to an old problem. But the biggest problem remains communicating to the general public why such tools need to be part of achieving equity in health outcomes; how it is that our health system has failed, and continues to fail, many of the people it is supposed to help.

The Government has backed an equity approach to healthcare services. Now is not the time for speed wobbles. The price is too high.