Māori and Pasifika populations in New Zealand experience poorer health than other New Zealanders. Some of this inequity is due to health policies and uneven access to health care.
The New Zealand government often appoints committees and advisory groups, connected to government agencies, in an effort to reduce inequities in health. In our research, we explored the experiences of Māori and Pasifika members on advisory boards in influencing policy development.
We interviewed Māori and Pasifika public health leaders, with a century of collective experience between them, and found that their knowledge was often devalued. They experienced tokenistic engagement and racism. Some indicated that it took considerable effort to establish credibility, be heard and make an impact.
Here are five ways we found that racism manifests in health advisory groups.
1) Navigating the room
All participants acknowledged the strategic importance of advisory group work and the challenges of being a solitary or minority voice. They experienced not being heard, a lack of respect, and the absence of authentic consultation and support for Māori and Pasifika health. Several participants noted their contributions were often not recorded in minutes.
The leaders we interviewed developed their own strategies to navigate this challenge. They drew strength and solidarity from other minorities and spoke out or used official complaints channels when necessary. They were proactive in seeking better outcomes and used their seniority to ensure the group remained focused on reducing inequities of health.
2) The battle for evidence
Participants noted that Māori and Pasifika knowledge and research are considered less rigorous and perceived as anecdotal evidence. Government officials relied on research from overseas, usually North America and Europe, which was assumed to be “gold standard” and “best practice”, even though it might not have been tested locally.
The leaders observed how white participants in the advisory group assumed their knowledge was superior and were reluctant to examine the causes of health disparities in ways that would generate equitable health outcomes.
3) Working with government officials
Those interviewed for our research project found government officials had their own cultural and political biases. They were often subsumed in the “bureaucracy of government” and had to work within the politics of prevailing ministers. When combined with high staff turnover and a higher proportion of officials who are new migrants or not culturally competent or experts in the subject matter this led to the development of strategies that are likely to generate health inequity.
4) Suspicions of tokenism
Good policy building requires authentic engagement and functional relationships, yet this was not the experience of those we interviewed. They experienced being invited to advisory groups to create an impression of inclusiveness rather than having a substantive input into policy.
A specific example of this is engaging with Māori kaumatua (elders) as only a ceremonial presence. They are often there to open a meeting instead of being invited to bring their particular cultural expertise to ensure there is a stronger Māori voice.
5) Witnessing and experiencing racism
Most participants disclosed witnessing and experiencing behaviour consistent with racism – patterns and practices of disadvantage or marginalisation. Some named it “covert” or “sophisticated” racism.
Specific examples included a health equity champion who didn’t want anything to do with Māori health, and a proposed breast screening program that was going to target Māori women through a mosque, even though Māori make up a very small percentage of people attending mosques.
We consider that it is the government’s obligation to engage with Māori to fulfil obligations under the te Tiriti o Waitangi. But institutional racism within the policy process fails to create meaningful engagement and consultation.
In our research we observed the determination of Māori and Pasifika leaders to remain focused on health outcomes and to engage with government. More work is needed, but the possible solutions we identified include cultural and anti-racism training for white policymakers.