NewstalkZB reports surgeons must consider ethnicity when prioritising lists; Philanthropists campaign to get $10b of Covid cash given back; Queues at after-hours medical centre in Lower Hutt
I am a retired anaesthetist who worked in the NZ public health system for 25 years. Racism in health care is real, due to implicit bias. The degree of ignorance of this fact among well meaning doctors and nurses is depressing.
There is plenty of published evidence to validate the fact that there is gross inequity in our health care system. The most striking statistic is that a Maori child should know from day one that he or she has a lifespan which is on average 10 years less than that of a Pakeha child born on the same day.
Anybody who tries to spin this is guilty of wilful ignorance or deliberately spreading misinformation.
To me prioritizing certain patients over others due to race or ethnicity is the real racism and should be addressed wherever it is found. I very much doubt your ten years statistic once class and social background is considered. Around the same time Jacinda Ardern had her baby Neve Simon Bridges' wife Natalie gave birth to her baby Jemima. I have a very hard time believing that Jemima Bridges' Maoriness means she should expect to die 10 years younger than Neve Ardern-Gayford
In the status quo a māori or pasifika patient receives worse treatment, and poorer outcomes than a pakeha ceteris paribus.
That is what the data tells us so your hot takes here are just showing you haven't engaged with the 40 years of research telling us this. This government doesn't have the privilege of making policy from a place of ignorance.
You can think of it as a market which is facing a distortion. The addition of ethnicity as a factor to consider is a way of mitigating the current distortion in the supply of medical treatment to move us to a new equilibrium where people recieve treatment and outcomes that do not vary based on race ceteris paribus.
Do either of the two major players have an actual plan regarding the state of health care? And if health care is this dire, what is the state of mental health care? Because by sounds of it, they’re not even using magical thinking.
Also, please keep us updated on those Antarctic sea ice anomalies as we head into winter. The fact that the numbers are going in the wrong direction as we head into winter is more than a little disconcerting.
Thankyou Carolyn. Great question on what both parties plan. We sort of know the Labour ‘plan’, which is to buy itself some more lid sinking time by cutting out admin cost duplication by combining the DHBs into Te Whatu Ora and Te Aka Whai Ora. Jury well out on that. National’s ‘plan’ is to shut down Te Aka Whai Ora and…we don’t know it’s full health policy yet. But no indication at this stage of properly funding health for both opex and capex. National haven’t detailed their formal fiscal policy yet, which everything else derives from. That policy will have to include how fast National wants to get the debt track down and what its ceiling will be. I’ll also try to find out what National’s funding committment to health might be, including around per-capita and real growth, remembering that a lot of health costs (devices and drugs in particular) rise faster than inflation (even with Pharmac’s own contribution to the sinking lid). I welcome other suggestions for questions on health policy.
It would be lovely if you could pick some calmer colours like forest-green or baby-blue for your climate related chart themes Bernard... All the alert-red all the time now is giving me real "monsters on the world" vibes...
Ha! Know the feeling. I’ve been reading a lot more lately about these very fast rises in termperatures in the last couple of months. It’s not making me sleep well. Partly because I’m now in Paris in a 25 square metre apartment. Near 30 degrees.
Morning thanks for doing this Bernard. The words racism and disgusting comes to mind with the proposals. Everyone is familiar with the concept of triaging when in a mass casualty event like an earthquake doctors have to decide who to save and let die like lifeboats in the Titanic. Such are the ugly realities of life and people may have different opinions on who gets triaged (say should a mother with young children get prioritized over a childless women) but I think very few would say in a big earthquake in Wellington and David Seymour and Ibrahim Omer (a Labour MP who came to NZ from Eritrea as a refugee and is currently their Wellington Central candidate) were both equally injured David Seymour should get priority because he is Maori and Ibrahim Omer not. Likewise I find it hard to reason why David Seymour should get priority for any other surgery and think candidates on the campaign trail should be asked their view on a triage between David Seymour and Ibrahim Omer and justify their choices. To me this should be a major election issue and I really hope it becomes one
The requirement are "to prioritise patients according to clinical priority, time spent on the waitlist, geographic location, ethnicity, and deprivation level." Not just ethnicity. So I think in your example, Seymour will be lower on the list as though he is of Māori decent he is swimming in privilege.
Writing in support of your comments, Merav. If someone reads the Herald article carefully they'll see it's written using a form of the journalism triangle, with the sensationalist pieces that are designed to generate most outrage up the top, knowing that most don't read beyond that. The other side of the explanation, or the more balanced part of it, depending on one's point of view, comes from Dr Mike Smith's comments near the end:
“It’s important to note that ethnicity is not the only element considered in the scoring system,” Shepherd said.
He said the equity adjuster waitlist score helps reduce barriers and inequities in the healthcare system, to ensure that people have equitable outcomes, regardless of their ethnicity, socio-economic circumstances or where they live.
“These adjustments are based on evidence which shows these groups often have inequitable health outcomes, which often begin at the start of their healthcare journey. Early analysis shows the tool is effective at helping to eliminate the existing inequities.”
You seem knowledgeable, Merav, do you know if there is any ‘valid’ or positive clinical reason why ethnicity would be included on the list.? I would like to know more before going straight to the seemingly racist conclusion.
I don't have much problem with those other factors. I don't know too much about Seymours background but he is swimming in privilege today. But Omer while having a lot of disadvantage early in life is well of now. Suppose Omer got into cabinet (a real possibility) and became as well off as Seymour and both got the same cancer at the same time and the cancer had progressed equally. I strongly oppose prioritizing Seymour over Omer for ethnic or racial factors. And while this may seem an extreme case there will no doubt be plenty of pakeha in Auckland who do face real disadvantage in life (unlike Omer and Seymour today) being disadvantaged over their Maori and Pacific neighbours due to anti non-Maori or Pasifika racism.
Triage. Tri = 3. So you scan the mayhem. Group 1 is going to die anyway. Leave them. Group 2 is noisy, complaining, so will live for a short while. Leave them for now. Group 3 is quiet but signs of life, attend to them first as they are the most salvageable, i.e. they will die without immediate assistance such as rolling into the recovery position or removing bodily from danger. These snap decisions are based on long experience at assessment and also (very importantly) on ethics. The most good to the most people. Ethics takes no consideration of "ethnics" so no prejudice (political nor personal) should EVER enter an ethical decision.
Medical professionals prioritising a surgery list can apply the triage rule to their immediate problem which (as correctly pointed out by one commentator) is actually a result of inequities at source. But dealing with inequities of access to primary care, safe housing, etc is not their present problem. They need to apply ethical prioritisation to a list of people who have got to the "needing surgery" part of their health journey. Politicians should stick to providing help much further back in the health tsunami, and leave tertiary health professionals to do their job unhindered by dopey band-aid, blame-shifting "solutions".
I was one of those providers and I agree with you totally but bias kicks in while making those triage decisions. Research done at Auckland University clearly shows that morbidity and mortality are higher for Maori and Pacific Island populations, controlling for all other variables. I’ll try to dig out the relevant papers.
Thank you Mathew. It's a shame that bias exists at all, but we are all human. Regarding the NZ Medical Journal article above: The figures are clear that Māori and Pacifica are, per head of population, greater at risk of post operative mortality. The interesting statistic in the Table is in the Elective/Waiting List category, where the strongest ethnic disparities* occur, compared to the Acute setting. In this Elective/Waiting List category, under Valve Repair/Replacement, the death rates of Māori and European are the same: 3.2 n/100.
Rheumatic Fever public health programmes in Māori communities (e.g. Mōerewa), have been running for years, and I think this figure shows that preventative health in a targeted population does work. (Cardiac valve repair being a common later-life necessity in cases of childhood Rheumatic Fever, my own brother, included).
(*In both Māori and Pacifica communities, there is a generalised reluctance to present to a GP. Cost, lack of trust, lack of access, chaotic lives due to poverty - many reasons. This is where The State must intervene to work with both communities to improve uptake of early intervention in emerging health problems. This is the end of the health journey [the beginning!] where decisions based on ethnicity is most relevant.)
Yep. Thanks Nicholas. It is a really gnarly one. You could argue there always have to be funding limits, which means there will always have to be choices made. I’d much prefer the funding limits were less about meeting a notional and pointless debt target and more about actual limits. But even then, priorities have to set and choices made. I don’t know health economists sleep well at night. There is a fundamental unfairness in how our health system is set up for the majority, and how the combined effects of repeated unfairness and discrimination in health, education, housing, etc have meant there is a case to redress the balance for Maori and Pasifika. But why just health. Why not other areas?
You're upset at a system which provides unequal treatment based on race.
That is what the current system does despite being de jure race blind until now.
You're right that a racist healthcare system should be an election issue. The fact is that the health care system provides poorer treatment and poorer outcomes for maori and pasifika.
What is your proposal to fix a system which produces racist outcomes despite not factoring in race. How do you adjust a system acting in this way without considering race?
I'll take a wild bet (no, not wild at all) that this new requirement to also consider ethnicity will be blown out of proportion as is the usual modus operandi of National & ACT whenever white NZ needs to acknowledge the systemic racism and deprivation of Māori and Pacifica population. This will yet again divert the conversation away from having to discuss decades of underfunding, our built in reluctance to pay more tax and out tendency to magical thinking we can have Scandinavian level of public services while having yet another tax cut because of the beloved corporations buzz words.
Like Glenys I agree with you 100% too, and am glad you could put words to all the thoughts racing round in my head..
Politics seems now like flying around on roller skates leaping from one hopeful headline to the next. Are many of them genuinely ignorant of all the well-researched knowledge that is so readily available?
I remember as early as standard 4 in 1991 learning about how antarctic ice sheets could melt in our lifetimes. Pretty mad that is appears to be happening now.
I wonder how MPs would treat health spending if they, and their immediate family, were forbidden to have private health insurance. Yeah, they could still pay cash for private health care, but make it a disclosable requirement.
People could just as easily jump on the irony of "geographic location" being used to prioritise access to health care when "post code lottery" was such a prominent part of the political messaging for why we needed reform.
> forcing doctors to make the ugliest choices
This is bang on. Health care is a scarce resource so there's always going to be some level of prioritisation. But the scarcity is now so extreme that we have to resort to this level of prioritisation!
Public healthcare has degraded as private healthcare has expanded. The poor suffer with deteriorating health and prolonged suffering while the wealthy maintain and extend their privilege using the private system to bypass the poor masses. We have "Americanized" our healthcare system with all the associated inequities and this will continue while the well off have no need to use the public (system of the poor). Ethnicity arguments will simply distract from examining the now entrenched system disparities.
I have friends recently who have had hip or knee surgery at both public and private hospitals. The public system has provided far better all over service - assessing from physio, home support , and OT.
The social media discourse I’ve read this morning on this has been nothing short of disgraceful. Irresponsible rage bait framing by media outlets driving superficial and frankly lazy narratives.
Hurray for the clicks and engagement metrics. Everyone loses.
"There’s decades worth of clinical evidence documenting inequitable outcomes for Māori and Pacific people at diagnosis, referral, and treatment which literally results in premature death. But as soon as you do something, anything, to help close those inequities it’s racist."
An acquaintance of mine just did an amazing thing to celebrate his 60th birthday. He walked the length of Aotearoa. It was important to him because in his whanau they mostly die before they turn 60. Do Māori have some defect that causes them to die younger at greater numbers than other ethnicities? Or maybe it is the systemic problems we have in this country that are having an effect?
Let's say a certain ethnicity has a genetic predisposition to certain illnesses. Should ethnicity be included in determining who should get priority screening/treatment? If not, why not?
They die because they are too lazy to look after themselves. They drink, they eat too much fat, they don’t do any exercise, they smoke too much or it must be in their genes. All of the above are true but the fact remains that controlling for all of the above the evidence shows that they die mainly because the standard of care they get is worse than their European brothers and sisters.
It takes a brave man to say this Mathew. I concur with both of your statements, based on my career. During which I saw lives that were part joy, part immense sadness, and I nursed both sides of those people. I had to do things that were cultural, that I didn't think were beneficial, but that were asked of me by relatives, and who am I to argue? From my modest position, I think that one political decision does need to have a highly ethnic basis: Universal Superannuation for Māori and Pacifica should be granted at least 10 years earlier than the rest of us. Individuals can opt out, but many won't and I for one am happy about that.
I am a retired anaesthetist who worked in the NZ public health system for 25 years. Racism in health care is real, due to implicit bias. The degree of ignorance of this fact among well meaning doctors and nurses is depressing.
There is plenty of published evidence to validate the fact that there is gross inequity in our health care system. The most striking statistic is that a Maori child should know from day one that he or she has a lifespan which is on average 10 years less than that of a Pakeha child born on the same day.
Anybody who tries to spin this is guilty of wilful ignorance or deliberately spreading misinformation.
To me prioritizing certain patients over others due to race or ethnicity is the real racism and should be addressed wherever it is found. I very much doubt your ten years statistic once class and social background is considered. Around the same time Jacinda Ardern had her baby Neve Simon Bridges' wife Natalie gave birth to her baby Jemima. I have a very hard time believing that Jemima Bridges' Maoriness means she should expect to die 10 years younger than Neve Ardern-Gayford
The evidence is out there. You’ll find it if you care to look.
In the status quo a māori or pasifika patient receives worse treatment, and poorer outcomes than a pakeha ceteris paribus.
That is what the data tells us so your hot takes here are just showing you haven't engaged with the 40 years of research telling us this. This government doesn't have the privilege of making policy from a place of ignorance.
You can think of it as a market which is facing a distortion. The addition of ethnicity as a factor to consider is a way of mitigating the current distortion in the supply of medical treatment to move us to a new equilibrium where people recieve treatment and outcomes that do not vary based on race ceteris paribus.
Love The Kaka! My go to morning read.
Do either of the two major players have an actual plan regarding the state of health care? And if health care is this dire, what is the state of mental health care? Because by sounds of it, they’re not even using magical thinking.
Also, please keep us updated on those Antarctic sea ice anomalies as we head into winter. The fact that the numbers are going in the wrong direction as we head into winter is more than a little disconcerting.
Thankyou Carolyn. Great question on what both parties plan. We sort of know the Labour ‘plan’, which is to buy itself some more lid sinking time by cutting out admin cost duplication by combining the DHBs into Te Whatu Ora and Te Aka Whai Ora. Jury well out on that. National’s ‘plan’ is to shut down Te Aka Whai Ora and…we don’t know it’s full health policy yet. But no indication at this stage of properly funding health for both opex and capex. National haven’t detailed their formal fiscal policy yet, which everything else derives from. That policy will have to include how fast National wants to get the debt track down and what its ceiling will be. I’ll also try to find out what National’s funding committment to health might be, including around per-capita and real growth, remembering that a lot of health costs (devices and drugs in particular) rise faster than inflation (even with Pharmac’s own contribution to the sinking lid). I welcome other suggestions for questions on health policy.
It would be lovely if you could pick some calmer colours like forest-green or baby-blue for your climate related chart themes Bernard... All the alert-red all the time now is giving me real "monsters on the world" vibes...
I'm sure Mitre 10 will have a double-sided lock for your cat door Tim. Relax.
Ha!
Ha! Know the feeling. I’ve been reading a lot more lately about these very fast rises in termperatures in the last couple of months. It’s not making me sleep well. Partly because I’m now in Paris in a 25 square metre apartment. Near 30 degrees.
Morning thanks for doing this Bernard. The words racism and disgusting comes to mind with the proposals. Everyone is familiar with the concept of triaging when in a mass casualty event like an earthquake doctors have to decide who to save and let die like lifeboats in the Titanic. Such are the ugly realities of life and people may have different opinions on who gets triaged (say should a mother with young children get prioritized over a childless women) but I think very few would say in a big earthquake in Wellington and David Seymour and Ibrahim Omer (a Labour MP who came to NZ from Eritrea as a refugee and is currently their Wellington Central candidate) were both equally injured David Seymour should get priority because he is Maori and Ibrahim Omer not. Likewise I find it hard to reason why David Seymour should get priority for any other surgery and think candidates on the campaign trail should be asked their view on a triage between David Seymour and Ibrahim Omer and justify their choices. To me this should be a major election issue and I really hope it becomes one
The requirement are "to prioritise patients according to clinical priority, time spent on the waitlist, geographic location, ethnicity, and deprivation level." Not just ethnicity. So I think in your example, Seymour will be lower on the list as though he is of Māori decent he is swimming in privilege.
Writing in support of your comments, Merav. If someone reads the Herald article carefully they'll see it's written using a form of the journalism triangle, with the sensationalist pieces that are designed to generate most outrage up the top, knowing that most don't read beyond that. The other side of the explanation, or the more balanced part of it, depending on one's point of view, comes from Dr Mike Smith's comments near the end:
“It’s important to note that ethnicity is not the only element considered in the scoring system,” Shepherd said.
He said the equity adjuster waitlist score helps reduce barriers and inequities in the healthcare system, to ensure that people have equitable outcomes, regardless of their ethnicity, socio-economic circumstances or where they live.
“These adjustments are based on evidence which shows these groups often have inequitable health outcomes, which often begin at the start of their healthcare journey. Early analysis shows the tool is effective at helping to eliminate the existing inequities.”
Totally agree Maisie. And that type of journalism is BAU for the Herald and ZB, unfortunately.
Thankyou Maisie
And what do you know, here's Stuff's take on the same info:
https://www.stuff.co.nz/national/health/300908591/new-ranking-system-prioritising-patients-on-ethnicity-to-improve-equity-experts-say
You seem knowledgeable, Merav, do you know if there is any ‘valid’ or positive clinical reason why ethnicity would be included on the list.? I would like to know more before going straight to the seemingly racist conclusion.
I don't have much problem with those other factors. I don't know too much about Seymours background but he is swimming in privilege today. But Omer while having a lot of disadvantage early in life is well of now. Suppose Omer got into cabinet (a real possibility) and became as well off as Seymour and both got the same cancer at the same time and the cancer had progressed equally. I strongly oppose prioritizing Seymour over Omer for ethnic or racial factors. And while this may seem an extreme case there will no doubt be plenty of pakeha in Auckland who do face real disadvantage in life (unlike Omer and Seymour today) being disadvantaged over their Maori and Pacific neighbours due to anti non-Maori or Pasifika racism.
That’s fair Merav. I would really like to know how the algorithm referred to in the article works, and who built it.
Triage. Tri = 3. So you scan the mayhem. Group 1 is going to die anyway. Leave them. Group 2 is noisy, complaining, so will live for a short while. Leave them for now. Group 3 is quiet but signs of life, attend to them first as they are the most salvageable, i.e. they will die without immediate assistance such as rolling into the recovery position or removing bodily from danger. These snap decisions are based on long experience at assessment and also (very importantly) on ethics. The most good to the most people. Ethics takes no consideration of "ethnics" so no prejudice (political nor personal) should EVER enter an ethical decision.
Medical professionals prioritising a surgery list can apply the triage rule to their immediate problem which (as correctly pointed out by one commentator) is actually a result of inequities at source. But dealing with inequities of access to primary care, safe housing, etc is not their present problem. They need to apply ethical prioritisation to a list of people who have got to the "needing surgery" part of their health journey. Politicians should stick to providing help much further back in the health tsunami, and leave tertiary health professionals to do their job unhindered by dopey band-aid, blame-shifting "solutions".
I was one of those providers and I agree with you totally but bias kicks in while making those triage decisions. Research done at Auckland University clearly shows that morbidity and mortality are higher for Maori and Pacific Island populations, controlling for all other variables. I’ll try to dig out the relevant papers.
https://journal.nzma.org.nz/journal-articles/disparities-in-post-operative-mortality-between-maori-and-non-indigenous-ethnic-groups-in-new-zealand-open-access
Thank you Mathew. It's a shame that bias exists at all, but we are all human. Regarding the NZ Medical Journal article above: The figures are clear that Māori and Pacifica are, per head of population, greater at risk of post operative mortality. The interesting statistic in the Table is in the Elective/Waiting List category, where the strongest ethnic disparities* occur, compared to the Acute setting. In this Elective/Waiting List category, under Valve Repair/Replacement, the death rates of Māori and European are the same: 3.2 n/100.
Rheumatic Fever public health programmes in Māori communities (e.g. Mōerewa), have been running for years, and I think this figure shows that preventative health in a targeted population does work. (Cardiac valve repair being a common later-life necessity in cases of childhood Rheumatic Fever, my own brother, included).
(*In both Māori and Pacifica communities, there is a generalised reluctance to present to a GP. Cost, lack of trust, lack of access, chaotic lives due to poverty - many reasons. This is where The State must intervene to work with both communities to improve uptake of early intervention in emerging health problems. This is the end of the health journey [the beginning!] where decisions based on ethnicity is most relevant.)
Yep. Thanks Nicholas. It is a really gnarly one. You could argue there always have to be funding limits, which means there will always have to be choices made. I’d much prefer the funding limits were less about meeting a notional and pointless debt target and more about actual limits. But even then, priorities have to set and choices made. I don’t know health economists sleep well at night. There is a fundamental unfairness in how our health system is set up for the majority, and how the combined effects of repeated unfairness and discrimination in health, education, housing, etc have meant there is a case to redress the balance for Maori and Pasifika. But why just health. Why not other areas?
You're upset at a system which provides unequal treatment based on race.
That is what the current system does despite being de jure race blind until now.
You're right that a racist healthcare system should be an election issue. The fact is that the health care system provides poorer treatment and poorer outcomes for maori and pasifika.
What is your proposal to fix a system which produces racist outcomes despite not factoring in race. How do you adjust a system acting in this way without considering race?
I'll take a wild bet (no, not wild at all) that this new requirement to also consider ethnicity will be blown out of proportion as is the usual modus operandi of National & ACT whenever white NZ needs to acknowledge the systemic racism and deprivation of Māori and Pacifica population. This will yet again divert the conversation away from having to discuss decades of underfunding, our built in reluctance to pay more tax and out tendency to magical thinking we can have Scandinavian level of public services while having yet another tax cut because of the beloved corporations buzz words.
100% agree, Merav! You've taken the words out of my mouth and arranged them far more succinctly than I could have.
Like Glenys I agree with you 100% too, and am glad you could put words to all the thoughts racing round in my head..
Politics seems now like flying around on roller skates leaping from one hopeful headline to the next. Are many of them genuinely ignorant of all the well-researched knowledge that is so readily available?
I remember as early as standard 4 in 1991 learning about how antarctic ice sheets could melt in our lifetimes. Pretty mad that is appears to be happening now.
I wonder how MPs would treat health spending if they, and their immediate family, were forbidden to have private health insurance. Yeah, they could still pay cash for private health care, but make it a disclosable requirement.
People could just as easily jump on the irony of "geographic location" being used to prioritise access to health care when "post code lottery" was such a prominent part of the political messaging for why we needed reform.
> forcing doctors to make the ugliest choices
This is bang on. Health care is a scarce resource so there's always going to be some level of prioritisation. But the scarcity is now so extreme that we have to resort to this level of prioritisation!
Public healthcare has degraded as private healthcare has expanded. The poor suffer with deteriorating health and prolonged suffering while the wealthy maintain and extend their privilege using the private system to bypass the poor masses. We have "Americanized" our healthcare system with all the associated inequities and this will continue while the well off have no need to use the public (system of the poor). Ethnicity arguments will simply distract from examining the now entrenched system disparities.
I have friends recently who have had hip or knee surgery at both public and private hospitals. The public system has provided far better all over service - assessing from physio, home support , and OT.
The social media discourse I’ve read this morning on this has been nothing short of disgraceful. Irresponsible rage bait framing by media outlets driving superficial and frankly lazy narratives.
Hurray for the clicks and engagement metrics. Everyone loses.
Morgan Godfery put it nicely on Twitter:
"There’s decades worth of clinical evidence documenting inequitable outcomes for Māori and Pacific people at diagnosis, referral, and treatment which literally results in premature death. But as soon as you do something, anything, to help close those inequities it’s racist."
An acquaintance of mine just did an amazing thing to celebrate his 60th birthday. He walked the length of Aotearoa. It was important to him because in his whanau they mostly die before they turn 60. Do Māori have some defect that causes them to die younger at greater numbers than other ethnicities? Or maybe it is the systemic problems we have in this country that are having an effect?
Let's say a certain ethnicity has a genetic predisposition to certain illnesses. Should ethnicity be included in determining who should get priority screening/treatment? If not, why not?
They die because they are too lazy to look after themselves. They drink, they eat too much fat, they don’t do any exercise, they smoke too much or it must be in their genes. All of the above are true but the fact remains that controlling for all of the above the evidence shows that they die mainly because the standard of care they get is worse than their European brothers and sisters.
Good example of a no-think lazy narrative.
It takes a brave man to say this Mathew. I concur with both of your statements, based on my career. During which I saw lives that were part joy, part immense sadness, and I nursed both sides of those people. I had to do things that were cultural, that I didn't think were beneficial, but that were asked of me by relatives, and who am I to argue? From my modest position, I think that one political decision does need to have a highly ethnic basis: Universal Superannuation for Māori and Pacifica should be granted at least 10 years earlier than the rest of us. Individuals can opt out, but many won't and I for one am happy about that.
https://e-tangata.co.nz/media/the-real-racist-tools-were-in-media-not-health/