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The BulletinJune 20, 2023

Debate about reality of health inequities shocked back to life


The surgical prioritisation score at the centre of a story yesterday was rolled out in February and there is evidence it is helping to eliminate inequities, writes Anna Rawhiti-Connell in this excerpt from The Bulletin, The Spinoff’s morning news round-up. To receive The Bulletin in full each weekday, sign up here.

Surgical prioritisation using ethnicity criteria first rolled out in 2020 

In June 2020, the Herald published a “Big Read” from Nicholas Jones (paywalled) on a plan from DHBs to prioritise Māori and Pacific patients for certain elective surgeries. It opened with the story of Paumea Ferris who discovered he had a 68mm abdominal aortic aneurysm (AAA) only because he had a free check that was being offered to Māori aged 55-74. Subsequent reporting on the surgical prioritisation plans followed Jones’ report. Both the Act and National parties voiced opposition with Act leader David Seymour saying the plan risked “fuelling an election campaign of racial bickering”. As we got further into the Covid pandemic, inequities present within the health system became something of a regular news beat as criticism of the government’s approach to the vaccination rollout grew. Most of us took an interest in its success and were, at the very least, accepting of the fact that a one-size-fits-all approach wasn’t going to work and that the different approaches required were explicitly framed based on needs determined by ethnicity. We all know what happened at the 2020 election but I’m not sure we would characterise it as one dominated by “racial bickering”.

Rollout of prioritisation tool completed in February

Flash forward to yesterday, and the issue of explicitly addressing surgical healthcare needs based on ethnicity was back in the news after a report from Jason Walls and Barry Soper in the Herald. Just a quick correction on this story as it appeared in The Bulletin yesterday here: Walls and Soper are both with NZME-owned radio station Newstalk ZB and not the Herald and Newshub as stated. The story relates to the addition of ethnicity as one of five criteria used to determine patient waitlist prioritisation. The rollout of the tool, the equity adjustor score, was completed in Auckland in February and as BusinessDesk’s Tamara Poi-Ngawhika reports, due to “positive evidence that it is helping to eliminate inequities in our system, it is now being rolled out across the other northern region districts.”

Royal Australasian College of Surgeons supports the new tool

As Newsroom’s Jo Moir writes (paywalled), evidenced by Jones’ reporting in 2020, the concept of adding ethnicity to this mix is not new. Māori and Pasifika people are less likely to be referred or accepted for treatment in the first place, and once in the system generally get less treatment. That was exacerbated by Covid which is why DHBs looked at the criteria in 2020. The new tool is a refinement of the original criteria which were deemed too blunt by clinicians. Speaking on behalf of the team that developed the algorithm for a new equity adjustor score, Duncan Bliss told Newsroom he can’t stress enough that clinical need “always takes precedence and the equity adjustor doesn’t interfere with that”. The Royal Australasian College of Surgeons supports the equity adjustor score with Associate Professor Andrew MacCormick saying “It’s not a zero-sum game. Elevating those groups that have been less well-served by the health system is a benefit to everyone. It means improved health across the population and the targeting of healthcare to those individuals who need it most.” Dr Vanessa Blair of the Association of General Surgeons said the tool is “a little bit simplistic for what is a very complex problem with many underlying contributing factors.”

Is it less controversial if we use life expectancy as the criteria?

Jo Moir posed an interesting question at the post-cabinet press conference yesterday asking whether it might be better for this criteria to be framed around life expectancy disparities because people get “triggered” when you talk about race. Based on some of the comments sections I read yesterday, she might have a point, but you’re still just sugar-coating a reality we seemed a little more comfortable accepting when vaccination targets were tied to alert-level step-downs. It’s an interesting hypothetical though. If we said the deaths of half of one group of people were potentially avoidable, compared to 23% in the rest of the population, would it be less controversial? That’s a finding from a Waitemata District Health Board study in 2019. A New Zealand Medical Journal editorial deemed the findings so alarming, it said should be on the computer screensavers of any planning staff working in health organisations. Madeleine Chapman cuts to chase on life expectancy with a bleak ranking of ethnicities in New Zealand, based on how likely they are to die first.

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