20 H U M A N R I G H T S COMMISSION | A FAIR GO FOR ALL? Several examples of culturally-specific health initiatives Literature on health outcomes provides consistent provide evidence that shifting away from a universal health evidence that some doctors treat patients differently based provision focus has benefits for Mäori, Pacific and Asian on ethnicity. One study found that only two per cent of communities. Researchers Tony Blakely, Don Simmons Mäori diagnosed with clinical depression were offered and Norman Sharpe describe the benefits of health pharmaceutical intervention, compared with 45 per cent of promotion and screening programmes that include tailored non-Mäori patients with the same diagnosis.93 Additionally, components for Mäori and Pacific populations: doctors spend 17 per cent less time (2 minutes out of a Pacific health provider development has also progressed in leaps and bounds. Many – if not just about all – major health promotion programmes and screening programmes include tailored components for Mäori and Pacific audiences, for example Mäori language components of Quit campaigns. The One Heart Many Lives programme has been a particular success in heart health promotion focused primarily on Mäori men.91 12 minute consultation) interviewing Mäori than nonMäori patients.94 Pacific peoples are referred to specialists at lower rates (20 per cent versus the national average of 30 per cent) particularly involving access to surgical care.95 Once age is taken into account, Mäori attend GP appointments at the same rate as non-Mäori, but obtain fewer diagnostic tests, less effective treatment plans and are referred for secondary or tertiary procedures at lower rates than non-Mäori patients.96 Research following the Recent health literature outlines the importance of National Primary Medical Care Survey has shown that developing and applying culturally appropriate health general practitioners are less likely to have a high level of research and practice frameworks.92 Specifically, this rapport with their Pacific patients, ordered fewer tests and literature highlights the limited ability of Western investigations (17.8 per cent compared to 24.9 per cent) frameworks and philosophies to understand and effectively and referred Pacific patients to specialists at lower rates address non-Päkehä health concerns, a concern echoed (20 per cent versus the national average of 30 per cent) in the Waitangi Tribunal’s Ko Aotearoa Tënei report. than their Päkehä patients.97 Professor Mason Durie’s holistic health model of wellness – Te Whare Tapa Whä – employs a Mäori philosophy of health – one that moves beyond physical health as the sole determinant for wellbeing. Te Whare Tapa Whä describes four cornerstones of Mäori health: whänau (family health) tinana (physical health), hinengaro (mental health), and wairua (spiritual health). Professor Durie applies Mäori conceptual tools to understand and explain Mäori experiences. This research illustrates the potential of adopting culturally-specific frameworks and worldviews within existing health systems as a promising approach to addressing health inequities. These studies illustrate the manifestation of structural discrimination through the often unconscious and unspoken bias of health practitioners. Many health professionals may be unaware of biased attitudes and unaware that these attitudes can be translated into practice. Cultural misunderstandings, unconscious bias and uninformed beliefs about Mäori, Pacific and ethnic minority patients by health practitioners have contributed to health disparities. Health outcomes for Mäori, Pacific and ethnic minority communities can be improved when health professionals are supported to develop greater cultural competence and awareness of their own attitudes towards Promising initiatives to address structural discrimination people who are culturally different from themselves.98 The including the Whänau Hauora Village initiative are benefits of culturally-appropriate healthcare programmes discussed in the case-studies following this discussion. are discussed in the first case-study following this systemic Manifestations of structural discrimination There are many examples that point to manifestations of structural discrimination within the health system, some of which are highlighted in the text that follows. analysis. Although it is important to attend to the unconscious bias of health care practitioners, addressing individual attitudes (of doctors, nurses and so on) alone will not shift structurally discriminatory practices. A 2007 article about institutional racism and healthcare disparities, stressed the