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Institutional Racism and the Dynamics of Privilege in Public Health

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Institutional Racism and the Dynamics of Privilege in Public Health Institutional Racism and the Dynamics of Privilege in Public Health A thesis submitted in fulfilment of the requirement for the degree of Doctor of Philosophy in Management at The University of Waikato by HEATHER ANNE CAME _____________________________________ 2012 ABSTRACT 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,1 the indigenous peoples of this land, in the conceptualisation, structure, content, and processes of health policies, despite Te Tiriti o Waitangi2 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 Pākehā3 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 1Māori is the collective term for the indigenous peoples of Aotearoa who more commonly identify as distinct tribal groupings. 2 Te Tiriti o Waitangi in this context refers to the Māori text of the Treaty of Waitangi see a more detailed explanation of the use of this term in chapter three and four. 3 Pākehā is the term for settlers who came from a variety of cultural backgrounds after Māori settlement of Aotearoa. ii | P a g e ethical bicultural practice. Greater transparency could enable more effective monitoring of Crown behaviour and support transformed practice. iii | P a g e Dedication To the stroppy Pākehā Tiriti workers of Aotearoa who daily fight for honourable kāwanatanga and the pursuit of tino rangatiratanga, moreover, to the generations of women who were denied an education because they lived in a society where men were valued more than women. iv | P a g e Acknowledgements Firstly, I acknowledged the dynamic Māori Health Providers of the North: Whakawhiti Ora Pai, Te Runanga o Te Rarawa, Te Hauora o Te Hiku o Te Ika, Ngāti Hine Health Trust and Ki a Ora Ngatiwai and the brave wāhine of Te Tai Tokerau MAPO Trust for your political and cultural guidance, inspiration and ongoing support. Thanks to the hardworking members of my research whānau who painstakingly read every word of this thesis, sat through many vegetarian lunches and now know more than they ever wanted to know about research methodology and Crown procurement policies. To the staunch Māori leaders who shared their experiences and insights about the dynamics of Crown policy and funding behaviour named and unnamed in this work. May the evidence collected in this study be useful and inform your ongoing engagement with Crown officials. May you see institutional racism transformed within the public health sector and beyond. Thanks to Maria Humphries and Suzanne Grant for your steadfast support and academic direction. It was always a source of comfort to know you were only an email away. Thanks for your patience with my rage and investment in me as an emerging scholar. I look forward to our ongoing collaboration. Special mention goes to my partner in crime Susan da Silva for going above and beyond the call of duty in her support. For opening up her home, sharing Missy the cat, learning to cook vegetarian, doing laundry, sharing Leonard Cohen, proof-reading, co-authoring, becoming a transient with me, caddying and for fabulous social and political collaboration. Thanks to University of Waikato, Tindall Foundation and the Public Health Association for scholarships, which enabled me to access the prerequisites of health. Thanks also to the members of Network Waitangi Whangarei for your ongoing interest and support of this project including access to our most interesting archives. Thanks to the many individuals that supported me during this thesis through providing shelter, food, air-points, alcoholic beverages, baking, ice cream, chocolate bars, emotional support, political insights, access to the internet, golf games, theatre tickets, car-pools, proof-reading, editing, petrol vouchers, groceries, contract work, outings etc. Thanks Mum and Dad, Dr Helen Wihongi, Ani Pitman, Sharron Came, Edwina Hughes, Jan Marie, Clare Bear, Anj Oxborough, Marjorie Phillips, Andrew Preston, Dan Cassidy, Joan and Russ Cook, Bronwyn Ward, Agnes Hermans and Pete Maguire, Sheryl Daniel, Brenda Archer and Kath Forde, Julianne Krebs, Kathryn McKenzie and Mike Kake, Charles Rollo, Murray McKenzie, Kathleen and Keith Rowe, Kevin Wensor and Chris Paul, Carolyn Rodler, Andre Ducrot, Les and Selina Robinson, Alex Barnes, Megan Ingle, Jennie Moore, Don Lemieux, Anthea Raven and Julie Glamuzina, John Knight and Sally MacLean, Dr Helen Warren, Penny Neave, Linda Dowsett, Andrew South and assorted cats, dogs and chooks who all contributed in some way to the construction of this thesis. v | P a g e Table of Contents ABSTRACT ....................................................................................................... ii Dedication .......................................................................................................... iv Acknowledgements ............................................................................................ v Table of Contents .............................................................................................. vi Table of Figures ................................................................................................ xi List of Tables .................................................................................................... xii Glossary ........................................................................................................... xiii CHAPTER ONE: INTRODUCTION ............................................................................. 1 1.0 Introduction ................................................................................................. 1 1.1 Statement of Research Question ................................................................ 2 1.2 Personal Background .................................................................................. 2 Professional Involvements ........................................................................................................ 4 1.3 Local and International Significance ......................................................... 5 Anti-Racism Praxis ................................................................................................................... 6 Activist Scholarship.................................................................................................................. 7 Public Policy............................................................................................................................. 8 Public Health Practice .............................................................................................................. 8 Rights Based Discourses .......................................................................................................... 9 Indigenous Peoples’ Rights .................................................................................................... 10 Te Tiriti o Waitangi ................................................................................................................ 11 1.4 Guide to the Thesis .................................................................................... 11 Use of Te Reo Māori .............................................................................................................. 14 CHAPTER TWO: METHODOLOGY
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