Ethnicity is a useful shortcut for identifying needs – without it, targeting public services will become more arduous

Latest government news directive prioritizing public services “on the basis of need, not race” will make it harder and more time-consuming to reach Novel Zealanders with greater needs.

The directive’s focus on ethnicity fails to recognize that many ‘surrogate’ needs – such as age, gender, rural location and income – are routinely used in New Zealand and elsewhere allocate resources.

And this policy is contradictory relevant evidence that ethnicity is in fact an appropriate way to identify needs.

As well as making it more arduous to identify and reach Novel Zealanders most in need, these policies are likely to exacerbate existing inequalities. There is also concern that it will put providers at risk of financial failure because they do not receive enough funding to cover patients with the greatest needs.

Effective shortcuts

Proxies such as ethnicity, age, gender and location are effective shortcuts to where the money is going. The purpose of their exploit is to provide the right resources at the right place and time.

Take, for example, the main funding formula for primary care.

To ensure adequate funding for populations with higher needs, the basic services formula is as follows weighted to ensure a higher level of funding to specific population groups. These include children and older people, women, people using multiple services and people living in rural areas.

From which the specific features used as proxies are taken tests which recognizes that certain groups exploit or need health services more than others.

Blunt instruments

Frankly, powers of attorney are relatively blunt instruments. However, given the challenges of pinpointing needs, they are the best we have.

To determine population health needs without proxies, a nationwide survey of people’s health would need to be conducted, taking into account a wide range of conditions and risk factors.

Such a study would also need to identify which health needs people consider most vital to determine which services could be prioritized. Collecting such information would be pricey and its validity period would be very miniature.

Mortality rates (by state) can also provide data on health needs, but with some limitations – not every health condition causes death.

Other data may focus on the exploit of services (different proxy server). But this approach also has disadvantages. For example, it does not reveal unmet needs for people who do not have or cannot access services.

There are stern gaps in our data sets. We have quite good data on hospital services, including diagnoses. However, data is not as readily available for other services, including the exploit of primary care and mental health services.

And the data is virtually non-existent when it comes to understanding the needs of key population groups, such as people with disabilities and the rainbow community.

Providing a solid analytical case for any resource allocation target will be arduous in the current environment, particularly given recent public sector cuts.

Are all proxies problematic or just one?

The government has chosen ethnicity as an aspect of personal identity that public sector agencies should exploit with the greatest caution as a proxy.

However, when all other factors were taken into account (for example, age and rural location), Māori, Pacific Islanders and other ethnic groups worse health outcomes and access to health care.

In primary care, however, ethnicity is used only as a proxy measure when allocating a diminutive pool of funding to improve access to services.

In particular, Māori and Pacific peoples continue to face barriers to accessing health care that could be removed – if ethnicity determined greater resource allocation, not less.

The issue of human rights

The coalition government formulates its aversion to “racial policy” around human rights – in particular Art. 1.4 of the Act International Convention on the Elimination of All Forms of Racial Discrimination.

This allows states to take special measures (only) when necessary to adequately protect the rights of specific ethnic groups. This means that the measures taken in Aotearoa have gone beyond what was necessary.

However, the UN Committee on the Elimination of Racial Discrimination said Novel Zealand’s health policy was insufficient to meet Māori needs. The commission found there was a structural bias against Māori, which meant it was arduous for Māori to access health care on an equal footing with other Novel Zealanders.

It also found that Māori service providers are marginalized and are not paid for their work at the same level as other service providers. She also expressed concern about the poorer health outcomes that Māori and Pasifika continue to face.

In a context of persistent, well-documented inequality and discrimination, the coalition government wants to pretend that ethnicity is not associated with need.

If agencies are forced to overlook the role that ethnicity plays in health needs, we can expect a lot of wasted work by back-office workers trying to gather evidence about what we already know to justify targeted services. Or a lot of wasted money, making certain services widely available and targeting much more profitable.

Proxies, including those based on ethnicity, play an vital role in a fair and equitable resource allocation system. They are not random, slothful, or the result of prejudice. They are based on available evidence of demand at population level.

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This article was written in collaboration with independent health researcher Dr. Jacqueline Cumming.

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