Five enduring racist beliefs about health research

“I think New Zealand is the best place on the planet, but it’s a racist place.” Movie director Taika Waititi’s quote kicks off a New Zealand Medical Journal editorial today where four University of Auckland academics name “false beliefs” that fuel racism in the health sector.

The latest issue of the NZMJ highlights dismal Māori health statistics from cancer mortality to estimated Covid-19 infection fatality rates. The editorial starts with a personal reflection by a Pākehā, Vanessa Selak, a Senior Lecturer in epidemiology and biostatistics in the Faculty of Medicine and Health Sciences.

“I grew up believing that New Zealand was a country with limitless opportunities. Success was there for those who worked hard, and was therefore deserved by those who achieved it,” she says.
She believed herself to be a 'colour blind' medical professional, treating everyone the same regardless of ethnicity.

If patients “chose not to attend or follow my instructions, that was their choice and outside of my responsibility as a clinician,” she writes. “It wasn’t until I embarked upon training in public health medicine that I began to realise (and am continuing to realise) how mistaken I have been about many of my core beliefs, and about how, through my ignorance, I have contributed to racism in New Zealand.”

The editorial, co-authored by Professor Rod Jackson, Associate Professor Matire Harwood and Fellow in Medical Education, Jamie-Lee Rahiri, goes on to name five “incorrect and racist” beliefs that they say were expressed by anonymous peers reviewing the group’s research into differences in cardiovascular disease risk factors and outcomes by ethnicity. The “false beliefs” were:

1. Māori are immigrants, like other immigrant groups, as there are no indigenous people of New Zealand
2. Māori experienced development, not colonisation
3. Health differences between Māori and non- Māori are inequalities, not inequities
4. Behavioural risk factors wholly reflect individual choice. The editorial warns that a lack of understanding of the effect of social determinants of health may lead to healthcare professionals inappropriately blaming individuals.
5. Institutional racism is an opinion, not a fact, in the New Zealand health sector. The editorial says that there are large and enduring differences between Māori and non- Māori in most health outcomes is evidence that institutional racism occurs in New Zealand.

The editorial ends with recommendations based on an American journal article entitled, Eradicating racial injustice in medicine – if not now, when?

The authors call for Pākehā health professionals and researchers to review and understand the history of racism in New Zealand, undertake training to counter racism and implicit bias, and recognize that differences in health outcomes according to ethnicity are avoidable and unjust.
They urge the NZMJ to set up a code of practice on racism in the peer review process, end anonymity for peer reviewers, and assign a Māori co-editor.

Note from the Editor, NZMJ:The New Zealand Medical Association publishes the NZ Medical Journal (NZMJ), however the NZMJ has full editorial independence via its Editor-in-Chief. The NZMJ is the principal scientific journal for the profession in New Zealand. The NZMJ has had a Māori/Pasifika associate editor for the past ten years.