HUMAN RIGHTS COMMISSION | A FAIR GO FOR A L L ? importance of focusing on policies, and practices within systems, not just on individual attitudinal changes: The history of racism in medicine and healthcare ... illustrates that the problem of healthcare disparities is not simply one of individual behaviour. It is a problem that is rooted in organisational and institutional structures and • in 2010, there were 60 active Mäori psychologists representing 4 percent of all active psychologists (1346). Forty two (or 70 per cent of) active Mäori psychologists were female. The main employers of active Mäori psychologists were DHBs (15) and self employed practices (15).103 practices. Given how embedded racism is in institutions In 2010, the Ministry of Health published research on such as healthcare, a significant shift in the system’s Shifting Mäori Health Needs to enable the health workforce policies, practices and procedures is required to address to more appropriately meet the health needs of the growing institutional racism and create organisational and Mäori population. The report found that, given the projected institutional change to reduce healthcare disparities.99 increase in the Mäori population over the next 10-20 years, Health workforce diversity it would be necessary to recruit over 150 Mäori students into medical education each year for the next 10 years. Another manifestation of structural discrimination is the In addition, Mäori secondary school students needed to under-representation of Mäori and Pacific peoples in the be encouraged to study science and then be supported to health workforce. A study of New Zealand’s District Health successfully do so (at personal and curriculum levels). Mäori Boards (DHBs) shows that only three per cent of the nearly students in tertiary medical education also needed personal, 60,000 people employed by DHBs are Pacific peoples. In pedagogical and curriculum support. Curriculum changes the Auckland region, Pacific peoples are under-represented in medical education are also being endorsed by health in this sector, seven per cent of the workforce, despite workforce and system planners here and internationally. making up around 12 per cent of the regional population.100 Workplaces need to support Mäori doctors to be Mäori and Additionally, most Mäori and Pacific DHB employees are to practice within Mäori models of health care delivery. concentrated in administrative and nursing roles.101 Achieving these targets requires a cross-government Ministry of Health monitoring also offers data on the Mäori approach.104 health workforce. According to their research: A 2011 study on Future Directions for a Mäori Dental Health • In 2009, active Mäori medical practitioners represented 3 Workforce, for example, highlighted the need to expand the per cent of the medical practitioner workforce (330 out of 11,164).102 Between 2006 and 2009, the number of active Mäori medical practitioners increased from 240 to 330, an increase of 90 or 38 per cent (all active medical practitioners increased from 9547 to 11,164, an increase of 1617 or 17 per cent) • between 2006 and 2010, the proportion of active Mäori dental health workforce to optimise the oral health needs of Mäori 0-17 year-olds. The study recommended structural changes to the workforce including: raising the proportions of Mäori dental health practitioners via incentives in the education system (e.g. changes to the secondary curriculum and recruitment into university); introducing cultural competency training for non-Mäori oral health professionals; the purchasing of more Mäori oral health services; and the midwives was between 6 and 8 percent of the total provision of oral health services at times and in places that active midwife workforce. During this time, the number are most accessible for Mäori whänau.105 of active Mäori midwives increased by 45 or 29 per cent (2006, 153; 2010, 198), while the number of all active midwives increased from 2303 to 2639, an increase of 336 or 15 per cent • in 2008, there were 156 active Mäori dentists Better representation of Mäori and Pacific peoples in the health workforce would have significant benefits. Mäori patients have higher rates of visits and increased engagement with Mäori healthcare providers and likewise for Pacific patients and Pacific providers.106 A report representing 5 percent of all active dentists (3419). Of the commissioned by the Ministry of Health shows that where active Mäori dentists, 113 (or 72 per cent) were female patients and healthcare professionals are of the same ethnicity, there are better health outcomes for patients.107 21