The Medical Council of New Zealand, in partnership with Te Ohu Rata O Aotearoa (Te ORA), has recently released an independent report outlining findings of the current state of cultural safety and health equity delivered by doctors practising in Aotearoa New Zealand and experienced by patients and whānau.
Cultural Safety Baseline Data Report Release and Recommendations
The Medical Council of New Zealand, in partnership with Te Ohu Rata O Aotearoa (Te ORA), has recently released an independent report outlining findings of the current state of cultural safety and health equity delivered by doctors practising in Aotearoa New Zealand and experienced by patients and whānau:
Māori patients’ experiences are the focus of the report, however many of the challenges and solutions will be applicable to other ethnic groups and populations who experience inequitable healthcare.
The report forms the baseline from which a wider evaluation will be undertaken on a range of initiatives in a joint work programme between the Council and Te ORA. The programme aims to contribute to achieving equity in healthcare through developing the practise of doctors and improving how patients experience their care.
The initiatives look at how to embed practices such as self-reflection, create an understanding of a doctor’s own conscious and unconscious biases, and consider how these impact on the doctor-patient relationship. Other initiatives include increasing the number of, and support for, Māori doctors, and ensuring Māori are in governance and decision-making roles in health organisations. The aim is to transform the workforce and the profession, as well as the systems we work within, to contribute to achieving health equity
While this report offers an insight into current practice, it is only the first step on this long journey. It sets a baseline for ourselves and other health organisations to use when developing programmes, strategy and policy that supports the aim of achieving health equity.
We strongly encourage those working across the health and disability sector to draw on the following general suggestions, gathered from the key themes in the report’s findings, for their own journey of change and improvement.
Findings and Recommendations:
Acknowledging systemic racism
The report found that while most doctors were aware of the health context for Māori, including colonisation and how it impacted on health outcomes, some described difficulty in addressing this in their practice and the system they worked in. Doctors who worked in settings where they dealt with large numbers of Māori patients living in high deprivation were particularly aware of the impacts of colonisation and described an awareness of the deep-seated nature of inequity, its complexity and how this may impact patient choices. Some doctors had an awareness that patients may come from a context that does not help them to engage with health professionals or with the treatment prescribed, and that there were systemic issues underpinning this.
It is important to firstly acknowledge that systemic racism and privilege exists in the health sector in order to meaningfully address this problem. Thought must be given as to what needs to change and how this can be supported across organisations and within communities. Doctors can reflect on their own cultural views and biases as a first step, then work to influence and support the places they work in and those they interact with, to make positive change.
Structural barriers exist in the medical system
There is a need to reconsider short consultation and appointment times, and the focus on only the immediate presenting needs, which limits the ability to build relationships and partner with Māori and can create situations where biases are more likely to be expressed. This results in a relationship which is largely transactional and does not incorporate principles of whanaungatanga, te whare tapa whā and whānau ora.
Getting to know the person and their context
Many whānau feel disempowered, that their knowledge is underestimated and that they are not involved in decision making. This leads to whānau feeling distanced from both the doctor and healthcare and distanced from their own health. Tailoring the consultation to the individual can help, while also ensuring their input is respected and valued.
Including wairuatanga in health care
It was strongly expressed that health care providers need to consider the specific practices, values and beliefs associated with an individual’s connection to people and place, and include this in the caring of whānau Māori.
Recognise the additional cultural loading on doctors who identify as Māori
The report confirms that many Māori doctors experience additional cultural demands on top of their day to day work, as well as responsibilities from their own whānau, hapū or iwi or advisory roles in the wider community. There is little evidence of cultural activities and training of others being acknowledged and recognised in job descriptions or as a key element of professional development.
Workforce recruitment strategies
Recruitment strategies in some District Health Boards and Primary Healthcare Organisations aim to increase the number of Māori doctors, many with set targets to achieve parity with their local population. Some DHBs have specific strategies to ensure that Māori values are at the centre of the recruitment process. This is encouraged across the health sector.
Partnerships with Māori
Low Māori representation in governance requires those in governance to be bold and courageous about highlighting issues for Māori. There have been some successes, but these require considerable effort and assertiveness on the part of individuals, and risks Māori perspectives being overlooked and ignored. There was a strong feeling of the need for strengthening Māori participation in decision making, and in support of such partnerships as an expression of the Treaty of Waitangi.
Collection and use of robust ethnicity data for equity monitoring
Organisations and individual practitioners need accurate data to identify inequities and address the structures and processes that limit Māori health development. We recommend that the collection of these data are prioritised and available to doctors and health organisations responsible for service provision.
Prompting doctors to focus on self-reflection and culturally-safe practice
The extent to which doctors engage in self-reflection, consider how their own cultural view and biases impact on how their patients receive their care, and then adjust their practice, depends heavily on doctor self-motivation to make change. Initiatives to embed cultural safety into all aspects of practice, professional development activities, policies and processes are essential.
Support your team to acknowledge the privilege Pākehā receive in their healthcare and consider what they can do to address underprivilege for Māori as vital to achieve health equity
On almost all indicators, non-Māori (predominantly Pākehā) experience significantly better health outcomes than Māori. Achieving equity of health outcomes in Aotearoa New Zealand requires first that we acknowledge that current inequities are not acceptable, that we understand better what is contributing to that inequity, and the health and disability system becomes more determined to operate differently so that inequities are addressed.
It is a professional obligation to deliver health care equitably to all. We encourage you and your organisation to use these recommendations as a basis for achieving long term, positive change for the benefit of all patients and whānau.