Health outcomes, real-world consequences of what people say

There as of right. But will some think they jumped the queue for their operation? PHOTO: GETTY...
There as of right. But will some think they jumped the queue for their operation? PHOTO: GETTY IMAGES
Sometimes statements made in public have unintended consequences.

Years ago when I worked as a hospital social worker, a Māori woman told me about a visit to her GP. The doctor came into the waiting room, pointed at a waiting patient and said "I want you to go down to the money machine, get the money you owe me, and then, I’ll see you".

We cannot know for certain what the facts were. However, our minds immediately assume it is a patient who has not paid past medical bills and a doctor who refused to see a patient because they believed they had the ability to pay their debt.

Whatever the circumstances, the outcome was a message that flew around the Māori community that "if you don’t have the money, don’t bother turning up to the doctors".

Medicine is one of the most caring of professions and usually doctors let people pay off debts gradually if needed.

However, the interpretation of the people who were there was that if you didn’t have the money, you wouldn’t be seen. We will never know the unintended damage that this message caused because people delayed or did not seek healthcare.

It is these unintended consequences, caused by statements made in the public by those with power, that can have real-life consequences.

Last week the Broadcasting Standards Authority fined a radio host for "materially misleading" the public in June 2023 about the implementation of the Equity Adjustor Score in hospitals in the Auckland Region.

The algorithm was used to sort out the order of who went first on surgical waiting lists. The waiting list was firstly based on clinical need.

However, when there were a group of people with the same level of need a further way of organising the list was required to ensure equal access across different groups.

With the clinical needs being equal, the most important criteria was the number of days on the waiting list. Other factors were then added including ethnicity, deprivation (based on decile ratings of your street) and whether you lived in a rural area.

However the claims made by the broadcaster were unquestionably misleading. They made statements such as "it’s going to rank patients, putting Māori and Pasifika at the top of the list." And "push Māori and Pasifika to the top of waiting lists based on ethnicity, basically, not on urgency or illness".

People will make their own decisions about whether these statements were uninformed, taken out of context, or a cynical ratings grab.

What is often forgotten is the impact these negative headlines have on Māori people. How it can make us even less comfortable in the health system and less inclined to get the services we need.

Once spoken, the "lie", and I consider it a lie, remained and became embedded as something that people still believe is real. I wouldn’t be surprised if there are still people who are suspicious when a Māori person gets surgery and assumes that they must have gamed the system in some way.

The idea that Māori have an advantage over every other New Zealander in the health system is farcical. Study after study has shown that Māori are more likely to be diagnosed later, treated less, operated on less and are more likely to have negative outcomes at every stage.

Māori have been classified as a "priority group" but this sends a false message. The statistics show that, even though our health system has its problems, that it is really Pākehā who are the priority group. They tend on average to get better outcomes, are more likely to get surgery and have lower waiting times, unless of course you live in a rural area. While Māori were targeted and criticised with the furore over the Equity Adjustor Score, those prioritised by the same system in rural communities were not.

We saw similar stunts during Covid where at one stage Māori vaccination rates were 25% lower than Pākehā rates. Yet some politicians undermined attempts to reach out to the Māori community by insinuating that communications taking into account cultural values were somehow meaning that Māori were having unfair access. Yes they were having unfair access, an unfair lack of access.

The problem is that these forms of negative grandstanding does have an effect. It can make Māori who need these services less likely to access them because you feel you are under even more scrutiny. With yet another unintended consequence of poorer outcomes.

— Dr Anaru Eketone is a senior lecturer at the University of Otago’s social and community work programme.