Undercounting of Māori in health data a breach of treaty, report finds

The undercounting of Māori in the health and disability care sectors is prevalent, and a breach of Te Tiriti o Waitangi, according to a new paper published in the New Zealand Medical Journal.

The study, carried out by health experts around Aotearoa, found when a Māori individual’s self-identified ethnicity on the 2018 Census was compared with their ethnicity on primary care enrolment data, 21% of people who identified as Māori on the Census were not recorded as Māori on their health data.

It found the large undercount of Māori in health data and datasets could also be having a large impact on targeted health system support for Māori.

“Longstanding and significant inequities exist between Māori and non-Māori across most health indicators including life expectancy, health determinants, outcomes and healthcare,” the report read.

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“Furthermore, the lack of urgency towards their elimination, particularly by Crown agencies, further reflects the disregard with which Māori and Māori health are held.”

The report found while many health providers used ethnicity data to deliver services proportionate to risk, the researchers emphasised that many Māori may miss out due to being left out of data sets.

This comes as the starting age for bowel cancer screening is set to be lowered for Māori and Pasifika, based off of NHI ethnicity data, according to the Ministry of Health website.

A “worrying” number of Māori and Pasifika are diagnosed with cancer only once it is quite advanced, in stages 3 or 4, significantly lowering their chances of long-term survival.

Currently, just over half of bowel cancers in Māori are detected before the age of 60 (58% in wāhine and 52% in tāne), whereas just under a third of bowel cancers in non-Māori are diagnosed before 60 (27% in women and 29% in males).

Māori public health physician Dr Paula King, who co-authored the paper, said while there was a lack of official information from the Government, it was also part of a wider issue.

“The lack of data sits within a broader context of a lack of priority of hauora Māori (Māori wellbeing) … this plays across in terms of barriers in access to services, and the ideological driving forces like racism, colonisation, white supremacy and ableism,” she said.

This comes as the Waitangi Tribunal is also looking into the lack of official government information on tangata whaikaha, or Māori with disabilities.

The Waitangi Tribunal’s Health Services and Outcomes Kaupapa Inquiry began hearings on May 2 into the historical and contemporary treatment of Māori within New Zealand’s healthcare system.

The tribunal has so far heard evidence of inequities faced by Māori in regard to injury, care and rehabilitation within the healthcare system, and is set to continue in 2023.

Te Whatu Ora was approached for comment.