The Seventy-Thirty Problem, And The Māori Health Authority

Friday, 21 May 2021, 4:27 pm
Article: Keith Rankin

When policymakers try to fix things, they often mess up because of the way the problem is formulated and the ways that subsequent policies are targeted. A classic example was the Closing the Gaps initiative in the early 2000s.

The problem – albeit simplified – is that some people are 'advantaged' and others are 'disadvantaged'. In New Zealand, one of the groups that were (and presumably still are) disproportionately disadvantaged are Māori. (Another such group was, and is, Pasifika.)

One useful way of approaching the problem is that we can say as stylised facts:

• Seventy percent of non-Māori are advantaged, and thirty percent are disadvantaged.
• Thirty percent of Māori are advantaged, and seventy percent are disadvantaged.
• The socio-economic circumstances of advantaged Māori are comparable with the circumstances of advantaged non-Māori. And the socio-economic circumstances of disadvantaged Māori are comparable with the circumstances of disadvantaged non-Māori.

Closing the Gaps was meant to be about making the disadvantaged less-disadvantaged; or – better still – not disadvantaged at all. But the policymaking didn't target the disadvantaged as such; rather it targeted Māori as the most prominent disadvantaged group. And it is true that if the median circumstance of Māori could be raised, given that the median Māori is disadvantaged, then the gap between a median disadvantaged person and a median advantaged person would close. Though many disadvantaged people – indeed the majority of disadvantaged people, who in New Zealand are not Māori – would not benefit

Today's more modest equivalent of Closing the Gaps is the proposed creation of a Māori Health Authority. And, as in 2004, the National Party passionately opposes this as racially targeted policymaking. (I might note that Māori versus Pakeha constitutional issues have no more to do with 'race' than do issues in Northern Ireland between 'Catholic' and 'Protestant'. In New Zealand's case, the point of difference is that Māori are tangata whenua, not that Māori are 'brown'; of course that doesn't preclude the possibility that some people may be prejudiced against dark-skinned ethnicities, and thereby – knowingly or unknowingly – hold racist views towards Māori.)

Unintended Consequences

The problem with racially targeted policymaking of this sort is that it doesn't address the actual problem ('disadvantage'); instead such policies use 'Māori' as a proxy for 'disadvantage'. (Other groups use other demographic proxies for disadvantage, such as 'female' or 'working-class' or 'Muslim'.)

We are not yet clear as to the purpose of the Māori Health Authority.

Some believe that its purpose will be positive discrimination in favour of people with proven indigenous ancestry, especially in their ability to access health services. (Much as a Community Services Card discriminates in favour of cardholders.) If this is intended, it would be clearly problematic. Should a Māori family in Flaxmere or Kaikohe have more favourable access to services than their circumstantially identical Pakeha neighbours? Or should the community of Kaikohe be more favourably resourced than the community of Bluff?

The alternative interpretation is that the Māori Health Authority is an addition to the Health bureaucracy, that could only be justified – like other government bureaucracies – as a means to an overall improvement of health outcomes for all disadvantaged New Zealanders.

This is particularly problematic in today's zero-sum fiscal environment. In a zero-sum fiscal environment, funding is from a fixed 'pot of money'. This means that funding for one purpose comes at the expense of funding for other purposes (such as cancer treatment, or research on infectious diseases); and the policy issue becomes the 'marginal health benefit' that arises from this use of the money, as opposed to that use.

One of the most important refrains today is that Health is already over-bureaucratised, with far too great a proportion of funding going into 'prioritisation services'; this being a euphemism for gate-keeping. Is an addition to the bureaucracy a more beneficial use of scarce resources than direct funding to train nurses, or to subsidise a greater range of life-enhancing drugs?

The concern that follows from this is the possibility that the principal benefit of the Māori Health Authority will be to provide enhanced career opportunities for the thirty percent of Māori who are not disadvantaged. And that the main people who will bear the opportunity cost of this benefit will be the presently disadvantaged, the majority of whom are the thirty percent of non-Māori who are disadvantaged.

The irony of this would be an opening of the gaps between the advantaged and the disadvantaged. Indeed, a dispassionate look at socio-economic outcomes in Aotearoa New Zealand since 2017 would be that it has been a period that could be described as an 'opening of the gaps'.

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Keith Rankin, trained as an economic historian, is a retired lecturer in Economics and Statistics. He lives in Auckland, New Zealand.

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Keith Rankin

Political Economist, Scoop Columnist

Keith Rankin taught economics at Unitec in Mt Albert since 1999. An economic historian by training, his research has included an analysis of labour supply in the Great Depression of the 1930s, and has included estimates of New Zealand's GNP going back to the 1850s.

Keith believes that many of the economic issues that beguile us cannot be understood by relying on the orthodox interpretations of our social science disciplines. Keith favours a critical approach that emphasises new perspectives rather than simply opposing those practices and policies that we don't like.

Keith retired in 2020 and lives with his family in Glen Eden, Auckland.

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