From the Research
Unconscious bias is a significant issue in New Zealand's healthcare system, with substantial evidence supporting its presence and impact on health outcomes, particularly for Māori and Pacific peoples. Research shows that these groups experience poorer health outcomes compared to New Zealand Europeans, with studies documenting disparities in treatment decisions, pain management, and access to specialized services 1, 2, 3, 4. For example, Māori patients are less likely to receive certain cardiac procedures despite similar clinical indications, and Pacific peoples face longer wait times for elective surgeries. Healthcare professionals have demonstrated implicit biases in clinical decision-making through testing with tools like the Implicit Association Test, which appear in prescription patterns, with ethnic minorities receiving fewer pain medications and mental health referrals 5. Patient surveys reveal experiences of discrimination, with Māori and Pacific patients reporting they receive less time, attention, and respect from healthcare providers.
Some key findings from the studies include:
- A nationally representative cross-sectional survey of admissions to general public hospitals found that Māori patients were more likely to experience adverse events compared to non-Māori/non-Pacific patients 1
- A mixed methods approach identified five specific sites of institutional racism in public health policy making in New Zealand, including majoritarian decision making, the misuse of evidence, deficiencies in cultural competencies and consultation processes, and the impact of Crown filters 2
- A national survey of district health boards found that measuring, monitoring, and targeting equity is not systematically undertaken, and that equity is not addressed systematically below strategic levels 3
- A study on conscious and unconscious bias in healthcare found that COVID-19 exacerbated many pre-existing disparities, and that older people, Black people, uninsured people, rural communities, and people with lower education levels have been disproportionately affected in both morbidity and mortality 5
- A nationwide survey of public health providers found that there are inconsistencies and bias in government-funded contracting processes for Māori public health providers compared to generic providers, with statistically significant variations in length of contracts, intensity of monitoring, compliance costs, and frequency of auditing 4
These biases persist despite healthcare professionals' conscious commitment to equitable care, highlighting the unconscious nature of many discriminatory practices in the system. Addressing unconscious bias in New Zealand's healthcare system is crucial to improving health outcomes and reducing health inequities, particularly for Māori and Pacific peoples. This can be achieved through strategies such as cultural competency training, implicit bias testing, and policy changes that address institutional racism and promote health equity.