18 H U M A N R I G H T S COMMISSION | A FAIR GO FOR ALL? Structural discrimination in the health system Everyone has the right to enjoy the highest attainable standard of physical and mental health. International Covenant on Economic, Social and Cultural Rights, Article 12 is delayed, it can cause damage to the heart and have a long-term serious impact on a person’s health. According to the Medical Director of the National Heart Foundation of New Zealand, Professor Norman Sharpe, the persistence of rheumatic fever in New Zealand “represents one aspect of our failure to achieve a fair society and health equity Significant and deep-seated ethnic disparities in health and for Mäori and Pacific peoples.”78 In March 2012, the well-being continue to afflict New Zealand and there is a Government specifically singled out reducing rheumatic good amount of research examining these disparities in fever rates as a priority target.79 relation to structural discrimination. In this section, health is examined broadly, looking at access to health care, quality of care received and the diversity of the health workforce. There is a notable absence of comprehensive data available on the health status of Asian communities when compared to Mäori and Pacific communities. According to Ruth DeSouza of the Centre for Asian and Migrant Health Mäori have the poorest health of any New Zealand group, Research, Asian ethnic groups “have been largely neglected with higher mortality rates than non-Mäori and higher rates by New Zealand health policies and research, despite of illness. Avoidable death rates for Mäori are two and a their long history in New Zealand and recent population half times the rate of other New Zealanders69 and Mäori growth.”80 However, growing evidence concerning health die on average 7 – 8 years earlier.70 Mäori babies are more disparities amongst Asian ethnic groups has led to an than five times more likely to die of Sudden Infant Death increasing recognition and focus on Asian-specific research. Syndrome than non-Mäori babies. Mäori adult all-cancer Recent research shows notable disparities for Asian peoples mortality rates are almost twice that of non-Mäori.72 There in access to health services. Asian people are less likely to are wide disparities too between Mäori and non-Mäori in have a primary health care provider and exhibit high levels complications from diabetes: renal failure is more than of chronic disease, including diabetes and cardiovascular eight and a half times higher for Mäori than non-Mäori and disease, particularly in some Asian ethnic groups such as lower limb amputation is more than four and a half times Indians.81 According to an Auckland District Health Board higher.73 These gaps in health disparities between Mäori report on the status of Asian health in New Zealand “the and non-Mäori persist even after controlling for socio- percentage of adult Chinese and other Asians who have a economic deprivation. regular health care provider (82 per cent and 81 per cent, 71 Pacific peoples also have disproportionately poor health outcomes with nearly twice the rate of avoidable mortality as other New Zealanders and have experienced the least respectively) is so much lower than for Europeans (95 per cent) that it warrants further research to rectify this inequity in access to basic health care services.”82 improvement in life expectancy over the past 20 years.74 The links between racism and health Pacific peoples are three times more likely to die of a A growing body of New Zealand research has found links stroke than the general New Zealand population and have between racism and health, which show, among other higher rates of lung, liver and breast cancers.75 Pacific things, that negative health outcomes are not solely related peoples turn up for GP appointments at higher rates than to socio-economic status. Racism is also a key determinant the general New Zealander population, but experience of people’s experience of health services. Taken together, worse outcomes and receive fewer referrals, despite having these studies provide compelling evidence of racism as a a higher burden of disease.76 major determinant of negative health outcomes and ethnic Rheumatic fever – a preventable disease that is close to inequalities. non-existent in other OECD countries – is a specific area A 2006 study (Harris et al) found that racism, both that disproportionately impacts Mäori and Pacific children. interpersonal and institutional, contributes to Mäori health Mäori are 20 times more likely and Pacific peoples 37 times losses and leads to inequalities in health between Mäori more likely to be hospitalised with acute rheumatic fever, and Europeans in New Zealand.83 Their findings suggest compared to non-Mäori. Left untreated, or if treatment 77