Institutional Racism and the Dynamics of Privilege in Public Health

Institutional racism, a pattern of differential access to material resources and power determined by race, advantages one sector of the population while disadvantaging another. Such racism is not only about conspicuous acts of violence but can be carried in the hold of mono-cultural perspectives. Overt state violation of principles contributes to the backdrop against which much less overt yet insidious violations occur. New Zealand health policy is one such mono-cultural domain. It is dominated by western bio-medical discourses that preclude and under-value Māori, the indigenous peoples of this land, in the conceptualisation, structure, content, and processes of health policies, despite Te Tiriti o Waitangi guarantees to protect Māori interests. Since the 1980s, the Department of Health has committed to honouring the Treaty of Waitangi as the founding document of Māori-settler relationships and governance arrangements. Subsequent Waitangi Tribunal reports, produced by an independent Commission of Inquiry have documented the often-illegal actions of successive governments advancing the interests of Pākehā at the expense of Māori. Institutional controls have not prevented inequities between Māori and non-Māori across a plethora of social and economic indicators. Activist scholars work to expose and transform perceived inequities. My research interest lies in how Crown Ministers and officials within the public health sector practice institutional racism and privilege and how it can be transformed. Through dialogue with Māori working within the health sector, fuelled by critical analysis and strategic advice from a research whānau (family) of Māori health leaders and a Pākehā Tiriti worker, and embracing the traditions of feminist and critical race theory I provide evidence of racism that can invoke strong emotional reactions. More disturbing is its normalisation to nigh imperceptibility within ones personal and professional life. The exposure of racism as a socially created phenomenon is a strength of the research presented here. My action orientation is my ethical response. Honouring Te Tiriti o Waitangi is a pathway to transforming racism. Such change is likely to be resisted by the Pākehā majority. This anticipated resistance is not a credible reason to weaken responsibility for such necessary change. Transforming institutional racism needs to be driven by senior managers, professional bodies, unions, and by communities. Policies, practices and leadership that enable institutional racism need to be systematically eliminated from the health sector. Crown officials must be supported to strengthen their professional accountabilities and to embrace ethical bicultural practice. Greater transparency could enable more effective monitoring of Crown behaviour and support transformed practice