Education And Debate

Ethnicity, equity, and quality: lessons from New Zealand

BMJ 2003; 327 doi: (Published 21 August 2003) Cite this as: BMJ 2003;327:443
  1. K M McPherson, reader in rehabilitation (,
  2. M Harwood, research fellow1,
  3. H K McNaughton, consultant in rehabilitation medicine2
  1. 1Wellington School of Medicine and Health Sciences, Wellington, New Zealand
  2. 2Medical Research Institute of New Zealand, Wellington
  1. Correspondence to: K McPherson, School of Health Professions and Rehabilitation Sciences, University of Southampton, Southampton SO17 1BJ

    Life expectancy and poorer outcomes associated with ethnicity are important issues for many countries. National and local developments are making a difference in New Zealand

    Life expectancy for indigenous people in colonised countries is shorter than it should be. In New Zealand, Maori die on average 10 years younger than people of Anglo-European descent.1 The usual suspects of poverty and poor socioeconomic opportunities contribute to inequity, but failures in service organisation and delivery are part of the picture. New Zealand is not the only colonised nation with higher rates of illness and premature death, but it is making concerted efforts to address the disparity.

    Enhancing responsiveness to cultural needs

    The starting point in identifying inequality in health outcomes is ensuring accuracy of data. The 2001 census indicates that 14.1% of New Zealand's population is Maori, 6.2% Pacific people, and 6.4% Asian.2 Each of these groups is actually growing at a faster rate than pakeha (the white descendants of colonial settlers). Until recently, documentation of ethnic origin in relation to health was not routinely collected. Even when ethnic group was recorded, it tended to be based on health workers' assessments of the appearance of the service user. Addressing health needs and planning appropriate …

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