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Health advisory boards rife with racism

A study driven by the desire to get behind the closed doors of government health advisory boards has painted a picture where Māori and Pasifika board members experience racism.

Study participants reported having their contributions not recorded from meeting minutes, feeling a need to stress their credentials, and being talked over in the room.

Māori and Pasifika carry the highest burden of disease in New Zealand. For Māori, mortality rates are higher than for non-Māori at nearly all ages. Māori are also less likely to be sent for diagnostic tests than non-Māori.

Auckland University of Technology senior lecturer and lead author Dr Heather Came researches institutional racism and has previously written on racism in health policy. She said a part of it stemmed from what happened in health advisory boards.

“I do speak up about my experience because I don’t want them to think I’ve just been plucked in as a brown girl or woman.”

Health advisory boards are appointed to central government and district health boards and often help inform policy. Unless the board is specifically an ethnic group, there are normally one to two Māori or Pasifika board members.

“We don't know much about what happens in those rooms. So, it was nice to get a little insight and it's not all good,” said Came.

Came’s research published in Kōtuitui: New Zealand Journal of Social Sciences Online consisted of interviews with six Māori and Pasifika health leaders with over 100 years’ experience between them. Pseudonyms were used as participants feared they may not be included in future boards if they spoke openly.

Among the themes which emerged were having to prove their right to be in the room, struggling to be heard, and having their contributions and knowledge ignored.

“I do speak up about my experience because I don’t want them to think I’ve just been plucked in as a brown girl or woman,” said one participant.

This feeling was shared by other participants who felt it was important to share their credentials at the beginning of meetings to be taken seriously.

“You don't normally you have to stand up in a meeting to be heard, but such was the difficulty in being heard from a seated position. That’s not how a meeting should be run.”

During meetings the participants said being heard was a challenge. One study participant shared the advice to do whatever it took to be “loud and proud and brown”. She said she deliberately altered the tone and volume of her voice in meetings in order to be heard. Others said they had at times needed to raise their hands, or even stand up while others remain seated.

Came found this to be one of the more shocking stories she heard:

“You don't normally have to stand up in a meeting to be heard, but such was the difficulty in being heard from a seated position. That’s not how a meeting should be run.”

Two of the participants told Came they had raised the poor behaviour with the meeting chair in discussion, or via a complaint.

If they got a chance to speak the problems weren’t over according to one participant:

“When I say something, I don’t know if it’s me and the way that I speak or my accent or something. I look around the room and often people … have this kind of stunned mullet look. Like, what is she going on about?”

Several participants said their contributions were not recorded in meeting minutes.

Evidence was often ignored said the participants who said Māori academic contributions were questioned more rigorously than other academic work. Sometimes it was glossed over or omitted.

“… they would write a whole lot more based on what the Pākehā (white) researchers were saying. And because they probably were not understanding what Māori were saying, they didn’t write it down, so it didn’t get heard.”

This lack of understanding played out in even simple things such as depictions of family which consisted of two parents and two children.

“It was myself actually and one of the Māori people who raised the idea that for Pacific people that can be quite different. You can have ten plus people living in the same household … they really struggled with that concept and how to fit it into their [Western] framework.”

Came’s study notes: “Overall there was a view that the knowledge of policy-makers was biased, incomplete and inadequate to inform the development of policy that could eliminate disparities.”

Fixing the issues within advisory boards will come from listening, according to Came.

“If we want to improve health outcomes from Māori, we need to listen to Māori and I believe they have the answers about what's going to work best...”

In 10 years of New Zealand’s health policy Came said only 12 Māori academics were cited.

“We need to see Māori academics cited in policy documents. We need way more Māori in the room and advisory groups and we need to have Māori-centred policy.”

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