Racial compatibility is central to affirmative-action entry programmes.
The news early this month that a Pakeha patient asked not to be treated by Asian staff at Auckland’s North Shore Hospital and that the hospital complied was quickly and roundly condemned by the Association of Salaried Medical Specialists and health-worker unions. Many of the public, too, criticised the patient’s request as blatant racism.
While the code of consumers’ rights states, “Every consumer has the right to express a preference as to who will provide services and have that preference met where practicable”, the clause is presumably intended to resolve individual personality clashes between patients and the nurses and doctors looking after them, not a blanket refusal to be treated by a swathe of ethnic groups coming under the umbrella term of “Asian”.
What went unremarked in the furore, however, is that the idea that patients might want to have medical staff who look like them and whom they feel comfortable with is officially sanctioned at the highest levels of the health system. Both Auckland and Otago medical schools run extensive race-based, affirmative-action programmes to do exactly that.
Both consider such personal congruence to be so important they are willing to dramatically drop their academic entry standards to allow more Māori and Pasifika students to study medicine — thereby boosting the likelihood that a Māori or Pasifika patient might be attended to by someone who shares their ethnic background. In short, they happily give possible racial compatibility precedence over merit.
And it’s not a trivial programme. This year, of the 287 available places for domestic students, Auckland University’s Medical School set aside 115 places for MAPAS (Māori and Pacific Admission Scheme) students.
That is to say, a full 40 per cent of available places were earmarked for Māori and Pasifika students.
And the relaxed academic standards for Māori and Pasifika students are not trivial either. An OIA showed that while an academic grade of at least 93 was required in the general category to be granted an interview to study first-year health sciences at Otago Medical School in 2022, Māori students required only 69.14.
For graduates, the minimum GPA score to receive an offer in the general category was 8.59 while Māori required only 4.51 — or roughly half.
The mantra offered to justify this race-based discrepancy is that all students have to pass the same exams once they are admitted. However, a low B-grade student doesn’t become a strong A-grade student simply by virtue of studying at med school.
The most extraordinary justification offered for this racial discrimination is that Māori and Pasifika patients not only prefer to be treated by someone of their own ethnicity but that such a match leads to better clinical outcomes.
Last December, Professor Warwick Bagg, Dean of the University of Auckland’s faculty of Medical and Health Sciences, told RNZ, “There’s no question about it, that when you have cultural concordance between your provider and your patient, then you’re much more likely to get a better health outcome.”
The question immediately arises: is a Pakeha patient justified in mounting a similar argument for the good of their health, or is it one reserved solely for Māori and Pasifika?
Interviewed on TVNZ’s Breakfast alongside Professor Bagg, Auckland University’s Associate Professor of Public Health Sir Collin Tukuitonga similarly opined: “International research shows that when you have the health care provider — the doctor, or the nurse or the pharmacist — [from] the same ethnic language, social, cultural groups with the patient, you have better outcomes.”
It is a view shared by Dr Emma Wehipeihana (formerly Emma Espiner, wife of RNZ’s Guyon Espiner). A MAPAS graduate herself, she told Re: News: “It benefits our patients enormously in terms of the therapeutic relationship to be looked after by a doctor who looks like them, who understands what’s important to them and their whānau.”
Asked what she would say to those who claim race doesn’t matter when it comes to medical care, she replied: “I would love it if ethnicity didn’t matter when it comes to medical care. Unfortunately, the evidence — the mountains and mountains of scientific evidence — tells us that it does.”
It’s difficult then to argue that a Pakeha patient who doesn’t see any “concordance” between themselves and Asian hospital staff should be castigated for making their preference known. After all, if senior doctors and academics tell us that ethnic compatibility achieves the best health outcomes for Māori and Pasifika, why shouldn’t a Pakeha patient believe their prospects are best served by at least not having staff of totally different ethnicities caring for them?
The fact is that the arguments about the extensive benefits of having a doctor who looks like you are exceedingly weak — amply illustrated by Bagg’s example offered on Breakfast: “If you are a Māori woman with a breast lump and the only doctor in town is a Pakeha male, you might be reluctant to go and see that person. You might not, but you might be reluctant. Whereas if you have the option to see a Māori doctor, you may well present earlier and get the treatment you need.”
Of course, the hypothetical Māori woman might actually decide to go to the doctor who has a reputation for being the most competent rather than deciding that their race was the most important factor. And, unfortunately, she might assume that the Māori doctor is likely to be less competent given the lower academic standards required for entry to med school.
Professor Bagg and Sir Collin Tukuitonga were being interviewed because the effectiveness of the MAPAS scheme and its Otago equivalent is due to be reviewed by the government this term as part of National’s coalition agreement with Act. David Seymour makes no secret of the fact that he believes “MAPAS is a scheme that openly practises racial discrimination, that treats people differently based on their ethnic background”. Act’s antipathy to any race-based policy is well known.
It’s a safe bet that the arguments predicting much better clinical outcomes will not stand up to close scrutiny in any review and that the true justification for the affirmative-action programmes will be revealed to be ideological. That is to say they are part of the relentless push to “indigenise” the university as a consequence of a particular interpretation of the Treaty of Waitangi as a “partnership”.
So far, that push has included inserting matauranga Māori with its vitalism and spiritual components into science courses and the introduction of a compulsory paper covering the Treaty of Waitangi and traditional Māori knowledge systems that all students in every faculty — including overseas students — will have to complete before being able to move on to second-year studies at Auckland University.
In an article in a BMJ journal last year, a team of researchers, led by Professor Bagg, made it clear they see training more Māori and Pasifika doctors not as an end in itself but as a stepping stone towards true indigenisation. “Although these equity-targeted policies [like MAPAS] have met with a degree of success through greater inclusion, more needs to be done. The work is part of the larger project of Indigenising academic institutions. While our institutions have sought to focus on Indigenous inclusion, this is not adequate as the goal, as on its own it is inadequate for achieving a properly productive relationship with Māori. Rather, the journey towards Indigenisation of the institutions, leading to the normalisation of Indigenous ways of being and knowing is required for medicine to truly mirror NZ society.
“In a broad sense, the reorientation of all government educational institutions (preschools, schools and universities) is required, focused on good relationships between Māori and non-Māori, to ultimately achieve health workforce and health outcomes, as envisaged in Te Tiriti o Waitangi.” The affirmative-action programmes are therefore most accurately viewed as just one aspect of the long and relentless march of progressive policies through the nation’s institutions that aim to effectively turn all our taxpayer-funded educational organisations — whether catering for children or medical students — into wānanga, imbued with Māori cultural values.
Graham Adams is a freelance editor, journalist and columnist. He lives on Auckland’s North Shore. This article was first published at The Platform.