Some of us are more equal than others

Let’s imagine I’m Pākehā and you’re Māori. We’ve got a semi-regular arrangement to play nine holes at the Awhitu Golf Club on a Sunday morning, unless life gets in the way.

We’ve both been getting chest pain when we walk up the hill on the fourth hole. You’re years younger than me, but even though we both have similar habits, your ethnicity is working against you on this one. We’ve both got angina.

I head off to my doctor and get referred to the hospital for an angiogram test. Two of the coronary arteries that supply blood to my heart muscle have narrowed sections. The best treatment is to take a vein from my leg and sew it onto my coronary arteries to bypass the narrow parts. I get put on the waiting list for surgery.

Let’s say you hold off on going to the doctor about that chest pain because of the way you’ve been treated in the past. When you go, the doctor doesn’t refer you to the hospital, because they have some racial bias they’re not even aware of. It takes another couple of visits before the letter gets sent. You wait longer for your angiogram than I did.

This is turning population research into a story, but it is not made up. This is really happening in our country.

In the end, you find out that you too need a coronary artery bypass graft. Like mine, your place on the waiting list is mostly based on clinical need – how bad the narrowing is and how urgently you need your surgery. But ethnicity also plays a part in the prioritisation process. The equity adjustor score used in Auckland also newly includes geographical location, social deprivation and time on the waiting list. If our clinical need is the same, this might mean you get your surgery before me.

Every step of the way you have been behind me. So, yes, your ethnicity should be taken into account. You’re not jumping the queue. I’m not graciously letting you in. It was your place all along.

You’re not even catching up completely. You’re still more likely to get complications from the surgery than I am. You’ll still die younger than me.

Your worse health and early death have many causes and a wide impact. Not only on your family, but also on mine.

I don’t just lose my golf buddy too soon. Inequity impacts government costs and reduces gross domestic product. It impacts social and political stability, which impacts quality of life. I might have the sorrow of observing that my kids really do believe, just quietly, that they’re a bit better than your kids. Inequity increases division.

Systems work better when the people who work in them and the people they serve are involved in developing and maintaining them. Because those people really know what does and doesn’t work.

If our health system had more Māori involved in design and governance, those systemic barriers that stood between you and the treatment for your coronary artery disease could have been identified and dealt with earlier. Which is both more efficient and more effective.

“End Division by Race” implies that Māori are being unfairly advantaged. This perspective suggests we all have equal opportunities and, if we work hard, we will be rewarded equally. In other words, those who have power have achieved it through their own merit.

In an equal system, everyone gets treated the same. That sounds fair.

But, like Orwell’s Animal Farm, while in theory we are all equal, in practice some of us are more equal than others. Systems designed and maintained by one set of people will always work best for those people. In New Zealand, that’s New Zealand Europeans or Pākehā. It’s not Māori who are unfairly advantaged. It’s people like me.

“End Division by Race”. The key word here is division. We don’t end division by treating everyone as if they are the same. We end division by respecting one another. Respecting one another enough to let go of some of that power, to trust Māori to make decisions for Māori to the benefit of all of us.

There will be a learning process. Trust in the immortal words of Rachel Hunter: “It won’t happen overnight, but it will happen.”

Our health system isn’t working now, and it wasn’t working before. The playing field was never level. Let’s not go back. Let’s aim for something better than equality, let’s aim for equity. As Bruce Springsteen reminded us on his Born to Run tour back in ’84: “Nobody wins unless everybody wins.”

Emma Dunning is a health communicator and former Wellington GP