Moving Beyond Institutional Racism Within the Primary Healthcare Sector in Aotearoa

Abstract

There are various forms of racism; they are interconnected and have a whakapapa (genealogy). Structural racism is the scaffolding that normalises historical, cultural and institutional practices that benefit white people. Systemic racism stems from this system through the way institutions, structures, and policies work together to perpetuate inequity. This includes whole organisations (political, legal, economic, healthcare) working together to include structures that uphold the system. This then flows through to institutions that further enable the racism within an institution’s structures, filtering into interpersonal and internalised racism, where people act and behave in racist ways. In Aotearoa, institutional racism contributes to health inequities between Māori and non-Māori, resulting in poorer health outcomes for Māori and undermining equitable service delivery.

This research is premised on a kaupapa Māori methodology that utilised Māori knowledge and perspectives through pūrākau (story) to understand, (a) how institutional racism manifests in policy and practice within the primary healthcare sector; and (b) how the primary healthcare sector can move beyond institutional racism at a strategic level.

Thirteen manukura Māori (leaders) who had recently/currently worked for health providers in Aotearoa were purposely recruited. Each participant was invited to a wānanga (meeting) to share their pūrākau of experiences and perspectives on solutions. Hui (meetings) were held with individual participants who were unable to attend the wānanga. Data collection used pūrākau and was thematically analysed to communicate three of them.

Three key themes emerged: firstly, the inequity in contracting and resource allocation, where manukura Māori described the Crown's varying contracting processes. Secondly, looking under the hood, where institutional racism is embedded within legislation, policy, strategy, and processes, alongside how people operate and make decisions within organisations. Lastly, the Crown holds the power and control where decisions are made for Māori by non-Māori.

This research demonstrates that the Crown and other non-Māori organisations need to firstly, accept that they hold an imbalance of power, and secondly, be willing to relinquish their power for a true collaborative partnership to exist with Māori. Kaupapa Māori/iwi providers need to be trusted and valued by the Crown, as Māori people have a role to play in reducing inequities for Māori.

Solutions include involving Māori at every level and phase of decision-making- within Crown and other non-Māori organisations, to ensure mātauranga Māori and te ao Māori are recognised and valued. The creation of equal partnerships between Māori and the Crown is required to enable shared governance and decision-making. A form of veto right for Māori is agreed at the establishment of partnerships between Pākehā and Māori to ensure Pākehā do not have the absolute power in decision-making. That the Crown and other non-Māori organisations enable organisations’ systems and structures to apply a pro-equity and pro-Tiriti lens to decision-making to support the change of mindsets and behaviours of Pākehā within organisations. To commission kaupapa Māori/iwi providers through long-term, high-trust contracts focused on outcomes; and to support the collective approach of Māori through the Crown organisations, removing competitive tendering and instead implement collective commissioning across localities.