Ki te kahore he whakakitenga ka ngaro te iwi
Without foresight the people will be lost – King Tawhiao Potatau Te Wherowhero
The Royal Australasian College of Physicians’ (RACP) Māori Health Committee was deeply disturbed to hear of the University of Otago’s proposal to introduce caps on students entering medicine through equity pathways.
We write as Māori physicians and paediatricians who see the inequity of health outcomes on tangata whenua from inside the hospital system. We see whānau bewildered and overwhelmed by systems and structures, processes and people who are not culturally safe.
The impact of this is that Aotearoa NZ continues to accept a life expectancy gap that renders Māori lives shorter, and in poor health for longer, than non-Māori lives. We know from morbidity and mortality data that although whānau Māori are more likely to experience and die from several types of cancer, diabetes, heart disease, stroke and respiratory conditions they are less likely to receive a timely diagnosis or be referred for specialist treatment.
The third article of Te Tiriti o Waitangi makes an exacting commitment to Māori health equity, affording Māori all the rights and privileges of British citizens. The Waitangi Tribunal has found that the ōritetanga or equity principle not only protects Māori from discrimination, the Crown is obligated to actively promote equity for Māori. The approach we advocate for is twofold: action on the social determinants of health and increasing the Māori and Pasifika medical workforce.
There must be no cap on students accepted through equity pathways. We must grow the numbers of Māori and Pasifika in all parts of health workforce, but we must continue to give particular emphasis to the medical workforce.
More Māori and Pasifika doctors means whānau who feel comfortable to see their respiratory physician, or their tamariki’s paediatrician, because they know that the person in charge of their care will understand them in a way no one else can. Having a health workforce that is equitable gives whānau Māori and Pasifika an opportunity to see themselves. Going to a health practitioner who looks and sounds like you, thinks like you and has the same core beliefs as you is an experience we want to be the norm for whānau.
More Māori and Pasifika doctors also means more Māori and Pasifika in clinical leadership with significant opportunities to influence policy, strategy, and guideline development. It means more Māori and Pasifika medical specialists taking senior leadership roles in Colleges and specialty societies, in District Health Boards and the Ministry of Health.
A cap dulls the brilliance all equity pathway graduates bring to our health system. People and their whānau deserve to have clinicians with the skills, attitudes, and expertise that respond to their needs – including their needs as tangata whenua. Indigeneity is a skill in itself and the value Māori and Pasifika trainee interns bring to the hospital is incalculable. The increased numbers of graduate doctors in the last few years has already caused a tangible shift in hospitals, and our Committee believes this must continue to make a difference in health outcome inequities.
The “Mirror to Society” policy should itself only be a starting point for equity. Although the University of Otago is currently producing graduates sufficient for the current population, the two medical schools in Aotearoa should be making up for the traditionally lower numbers of Māori and Pasifika doctors in the overall system – currently 3.5 per cent and 1.8 per cent respectively. Furthermore, while Māori may make up 17 per cent of the population, using this as the target is inherently self-limiting. A truly equitable approach to medical school admissions would seek to match the disproportionate burden of disease demonstrated in the higher numbers for Māori, Pasifika and lower income whānau seen in acute hospital admission(s) and outpatient clinic appointment(s).
Finally, we note that it was a single legal challenge against the University of Otago that may have been the catalyst for the proposed cap on equity pathways. This suggests the admissions pathway – an internationally renowned and highly influential model – is itself precarious. The Māori Health Committee calls on the Division of Health Sciences and the University of Otago to actively protect the equity pathway, making it permanent with no cap on annual entry numbers.