Marginalisation on health policy groups

08 Mar, 2019
Marginalisation on health policy groups

A new study, which explores Māori and Pasifika leaders’ experiences on government advisory groups, indicates ongoing inequities in the development of New Zealand’s health policy.

The leaders had variable success in navigating advisory groups or being able to influence health policy and funding decisions. They noted that their knowledge and interests were often devalued, and they experienced tokenistic engagement and racism. Some indicated that it took considerable effort to establish credibility, be heard and make an impact – but, even then, their input was marginalised.

Dr Heather Came is a senior lecturer in Māori Health at the School of Public Health and Psychosocial Studies at Auckland University of Technology (AUT). She is the lead author of the paper, “Māori and Pasifika leaders’ experiences of government health advisory groups in New Zealand,” recently published in the New Zealand Journal of Social Sciences.

“Health policy advisory groups need deeper engagement and more genuine recognition of Māori and Pasifika knowledge. These leaders have constructive solutions for eliminating health inequities that could benefit all New Zealanders,” she says.

“All of the participants acknowledged the strategic importance of advisory groups. However, despite some of them being decades into advisory roles, they found that the work was frequently difficult and frustrating.”

Dr Came estimates that there are as many as 120 government health advisory groups operating at any given time, ranging from semi-permanent committees connected to central government and district health boards, to short-term committees called to develop a particular health policy or strategy. These advisory groups frequently draw from a limited pool of Māori and Pasifika leaders.

The six Māori and Pasifika leaders interviewed had more than 100 years of collective experience in public health. They were knowledgeable in their respective fields, with clinical, cultural and community expertise, and all had participated in a multiplicity of central and district health board advisory and steering groups for at least 10 years.

Sometimes they were the only Māori or Pasifika member of the group. At other times, Māori and Pasifika representatives were 20-50 percent of the membership. Some leaders had also been on dedicated Māori or Pasifika advisory boards.

The key themes that emerged from interviews included difficulty ‘navigating the room’ and ‘working with officials’. The environment was not always experienced as supportive and leaders were sometimes emotionally distressed by the content of process of meetings. In addition to a lack of respect in some meetings, such as arrogance from peers and people talking over them, several participants noted that their contributions were often not recorded in the minutes.

Leaders also drew attention to the constant turnover of staff within government agencies and the high proportion of government officials who were new migrants to New Zealand. This lack of cultural context and background was considered a barrier, disenabling to both processes and outcomes.

The scarcity of Māori policymakers was also viewed as a challenge by several participants – further compounded by the absence of effective leadership in influential positions within the health sector.

Another theme was ‘the battle of evidence’. Several leaders voiced their concern about government officials’ strong reliance on evidence from the Global North, stressing that these Western approaches have consistently delivered inequitable outcomes. One participant was disappointed by the quality of Māori and Pasifika evidence used in strategies, stating that policy analysts did not know about key studies and seemed unable to provide a comprehensive literature review inclusive of Māori and Pasifika research.

“Overall, the participants felt that the knowledge of policymakers was biased, incomplete and inadequate to inform the development of policy that could eliminate disparities,” says Dr Came.

“Māori and Pasifika knowledge and expertise was frequently ignored, debated, contested or perceived as unworthy or invalid. And, this neglect of Māori knowledge is in direct contrast to government policy that affirms the importance of Māori and Pasifika led solutions.”

Leaders were also ‘suspicious of tokenism’ and had either ‘witnessed or experienced racism’. One participant noted that good policy building requires authentic engagement and functional relationships, but this was not her experience. Another participant was concerned that advisory groups were there to create the impression of inclusivity rather than substantive input into policy.

Behaviour consistent with racism, that is patterns and practices of disadvantage or marginalisation, was described by leaders as ‘covert’, ‘sophisticated’ and ‘institutional’.

“Participants in advisory groups should not be witnessing or experiencing racism or unconscious bias from colleagues. And, the onus should not fall exclusively on Māori and Pasifika leaders to prepare for those cultural exchanges,” says Dr Came.

The study suggests that there may be merit in a dual approach, having ethnic-specific advisory groups as well as integrated advisory groups that represent all stakeholders.

“It seems that more could be done by government officials and agencies to ensure that Māori and Pasifika leaders are respected, so they can fully engage in government health advisory groups,” says Dr Came.

Taupua Waiora Centre for Māori Health Research

The Taupua Waiora Centre for Māori Health Research at AUT South Campus promotes Whānau Ora and positive health experiences for Māori. It aims to reduce inequities in health by improving evidence and knowledge that will enhance access and the use of health services, and promote positive outcomes and hauora for Māori whānau, hapū, iwi and communities.