Professor Rod Jackson writes about the racism that permeates medicine and his own efforts to combat it, in an essay included in a new book released this week. (Image supplied)

In a new book published this week, Leave Your Big Boots at the Door, 17 Pākehā discuss racism against Māori in Aotearoa, and what they’re doing to prevent it.

Their stories reflect on how to bring about an anti-racist country, and they advocate for a society in which Māori regain tino rangatiratanga over their own lives and aspirations.

This extract is by Rod Jackson, a Pākehā professor who works in epidemiology at the University of Auckland.

I grew up in Dargaville and went to the local school with many Māori kids, but I didn’t really think much about this at the time.

I would say my family were racist but didn’t believe they were.

I am one of five boys (two sets of identical twins and an older brother). I had a very difficult relationship with my father. For some reason, I was singled out. I wasn’t one of his favourites, and I think, unconsciously, I decided to stand for many things that my father didn’t. I became anti-racist even before I knew what those words meant. My father would say things like, “Oh yes, that man is a good worker in spite of being Māori,” and so from an early age, I realised racism was all around me.

I believe many New Zealanders thought that examples of racism overseas were obvious and awful, but they didn’t see their own form of it at home. I was very taken with Taika Waititi’s comments in his anti-racism campaign, particularly, “You don’t have to be a full-on racist, just being a tiny bit racist is enough.”

I was a boarding student at the Auckland Grammar School hostel, and I hated the bullying of younger boys by the older ones. Once you were a senior, it was standard practice, but I couldn’t do it. I hated it. I was very aware of power differentials, so I guess my views on racism and bullying kind of go together because they are both about power. Even when I became head boy at the hostel and I tried to stop the bullying, it was so institutionalised and normalised that I was largely unsuccessful.

In my teens, I became very interested in socialism, particularly the need to redistribute power and capital. Apartheid in South Africa was part of this, and I still remember I was profoundly affected by a book called Time Longer Than Rope by Edward Roux, the story of the civil rights movement in South Africa from 1850–1950. Much of my thinking about power, politics and racism was shaped by my reading. I am a social democrat now, but back in the 1970s and 1980s I read Karl Marx and quite a lot of anarchist writers, and their arguments about power really affected me.

I was overseas at the time of the Springbok protests, but I am sure that if I’d been here, I would have been arrested. I was later in the same vegetable co-op as a lot of people in HART (Halt All Racist Tours), including the pilot who dropped flour from the plane over the rugby ground, and I admired them. I remember having big fights with my family over the pronunciation of “Whangārei”, our nearest town. “It is Wongarei and that’s it,” they’d state. I saw it all as being about power over Māori. I don’t think they realised it, and I don’t think I could have easily explained it at the time, but I knew it was wrong.

I have now been working in medicine for over 50 years. One of the early influences that led me to a career in preventive medicine and public health occurred when I was a student working in Princess Mary Hospital, the children’s hospital in Auckland. The majority of the kids in hospital had brown faces while I knew that Māori and Pasifika people were in the minority in terms of our population. I was always as interested in why particular groups of patients came into hospital as in what their specific diagnoses were.

Later, when I worked in a coronary care unit in Middlemore Hospital, many of my patients were smokers. The conditions that both the children in Princess Mary Hospital and the adult coronary patients presented with were readily preventable, and these conditions were heavily skewed towards those who were socially and economically deprived. This, I believe, is all about power and racism.

The research programme I currently co-lead is called VAREANZ (Vascular Risk Equity in Aotearoa New Zealand). Our work is overseen by a Māori-led data sovereignty group, which consists of six Māori and six non-Māori experts. We try to do our best to walk the talk on racism and equity. We ask if the way we manage cardiovascular disease (CVD) is equitable across different ethnic groups, particularly Māori and Pasifika who have the worst outcomes, but we also consider age and gender.

We collate data on very large cohorts of people (one study has over two million). We do a baseline measurement on them, such as whether they smoke, their blood pressure, prescribed drugs, and so on. We then follow them over time and record any hospital admissions for heart attacks, strokes and other related conditions, and deaths. By linking the baseline information to hospitalisations and deaths, we are able to predict who is going to be at risk. We use this information to develop risk-prediction equations that enable us to predict the whole population’s individual risk of having a heart attack or stroke over a period of time. The equations are now used by doctors and nurses across the country to make decisions about who needs treatment.

Our current plan is to identify every adult who is living in New Zealand by linking lots of data sets, then risk-assess all of them using the equations we have developed, and then we will look at the gap between their predicted risk and the way it is being managed.

All of this is anonymised, so we don’t know the individuals, but we can predict their cardiovascular health and help clinicians anticipate and manage the health of those at higher risk. Our focus is on identifying these gaps, and on equity — the equity of risk management.

In the medical world, there has been an increasing focus on equity. Now if you apply for grants from the Health Research Council, which is the major health funder in New Zealand, they have equity and Māori engagement explicitly in their funding criteria. In our part of health research, we have had Māori co-leaders since 2002, so we have been working with an equity focus for more than 20 years.

I recently assisted colleagues in writing an editorial for the New Zealand Medical Journal (NZMJ). It was stimulated by our experience with the reviewers of a paper based on one of our studies, which included half a million people from primary care. This was the largest study of its kind in the world and also included more Māori and Pasifika people than any study ever done. Our paper described cardiovascular risk factors in different ethnic groups in New Zealand: obesity, smoking, raised blood pressure, and cholesterol levels. We sent the paper to the NZMJ for review. We were told the reviewers included three (anonymous) New Zealand professors of cardiology. However, many of their comments were outright racist. Here are some examples of their comments:

1. In the introduction, our team stated: “Most of the health loss from CVS disease (CVD) is potentially avoidable through prevention and treatment.” A reviewer responded to this by saying: “This may be what the Ministry of Health states but is at variance with international science. Unfortunately, much of CVS disease is driven by unknown genetic and environmental factors for which optimal management is not understood. It would be reasonable to soften this statement.”

Our response was: “There is no evidence that genetic or environmental factors drive ethnic inequities in CVD. Our reference supports our strong statement.”

2. Another wrote: “The penultimate paragraph is poorly served by phrases such as ‘the effects of colonisation’.” The reviewer proposed “the effects of New Zealand development . . . may be more appropriate”.

We responded: “We believe the term ‘New Zealand development’ is subjective and could be considered as a positive move, when evidence suggests that the effects of colonisation have not been a positive development for Indigenous peoples in Aotearoa New Zealand.”

3. A reviewer wrote: ”The authors briefly describe their understanding of Indian immigration to New Zealand. It may be appropriate to also describe the immigration of all the ethnicities, from when there were no people in New Zealand, or none.”

Our response: “We believe that this reviewer’s suggestion is entirely inappropriate. It in effect disregards the rights of Māori as tangata whenua and Treaty of Waitangi partners in Aotearoa New Zealand.”

4. Another reviewer wrote: “With respect to the comment ‘There is an ongoing need to ensure adequate funding to support more high-quality Indigenous-led research into the effectiveness of interventions that achieve CVD equity for Indigenous Māori’, is this an implication that non-Indigenous-led research cannot be helpful? Why the sudden introduction of the concept of Indigenous leadership in research? Idigeneity [sic] is also discussed with respect to Pacific Islanders. What is the relevance of indigeneity in the specific context of this paper? This topic needs either full and dispassionate referenced (i.e. substantiated) discussion in so far as it is pertinent to the data presented — or it should be dropped.”

Our response: “We have changed the statement to say ‘funding to support more high-quality research, particularly Indigenous-led research, into the effectiveness . . .’ We did not imply that non-Indigenous-led research was not helpful, but it is our opinion that it is also important to develop more Indigenous-led research.

“Indigeneity is not discussed with respect to Pacific ‘Islanders’ (an out-of-date term) other than to highlight that Pacific ethnicities are, by definition, not Indigenous to this country. Indigeneity is of relevance to the topic as Māori, the Indigenous Peoples of Aotearoa New Zealand, experience significant inequities in CVD risk, as we have described in the paper.”

I was shocked at how close to the surface this overt racism was. I am sure that they wouldn’t have said those things to our faces or in public. One of our senior Māori authors was exceptionally upset, but it was really concerning to us all. I rang the editor and told him that his reviewers were overtly racist and should not be allowed to review the paper anonymously. We challenged every single comment, made a few minor changes (mostly references), and it went back and forth several times to the same reviewers. The paper was eventually published and the editor invited us to write an accompanying editorial (Selak et al, 2020). However, the effect of that review still remains with us all.

Rod’s essay appears in a new book edited by Lorraine McLeod and published by Potton & Burton this week.

While a lot of our medical colleagues were probably brought up in a similarly racist time and background to me, I believe the majority have tried hard to address racism in their professional and personal lives in recent years. But, sadly, there is clearly a substantial minority who haven’t. After the review experience, it made me wonder how these senior doctors treat their brown patients and what kind of impact they are having on their junior staff who view them as role models.

I do know from our research that if Māori and Pasifika make it into hospital, the care system from then on largely does its very best. In the acute setting, from when you arrive in hospital until you leave, much of the institutional racism has been dealt with and there are not huge ethnic disparities. But there are still barriers that keep many Māori and Pasifika from presenting to hospital when they really need to, and we are not great at supporting their care after they leave hospital.

I try to always deal with racism when I come across it. However, I don’t feel that I am well qualified to speak out about it as an expert. I haven’t felt that I have the rights or the qualifications, as a Pākehā, to be as strong a voice as I would like to be.

I do not speak te reo Māori. I was planning to learn about 30 years ago, but before I enrolled, I spoke to a wise and forthright Māori health leader who said she didn’t feel that Pākehā should take up class spaces as there were very few Māori language teachers and they should be focused on teaching Māori people, not Pākehā.

I guess I still feel a bit uncomfortable about it. I do my best to pronounce Māori words correctly, but I don’t want to be in a room where I might speak te reo more fluently than a Māori person present. I don’t know whether that’s the right way for Pākehā to think about learning te reo. It’s that power thing again.

I try very hard not to be racist, but I am an old white male with a successful career. I have been working in public health since 1981 and I now co-lead a research programme in which two senior and very well-respected Māori academics have chosen to co-lead with me and another Pākehā colleague, so I probably haven’t screwed up too badly. I think they would vote with their feet if I wasn’t genuine. I feel incredibly privileged that we are working together to address inequities in the burden of cardiovascular diseases.

Extract from Leave Your Big Boots at the Door: Pākehā confronting racism against Māori, edited by Lorraine McLeod, $39.99 RRP (Potton & Burton). On sale 23 October.

Dr Rod Jackson is a professor of epidemiology in the School of Population Health at the University of Auckland. His teaching and research over the past 40 years has focused on the epidemiology of chronic diseases, particularly of cardiovascular diseases.

Rod co-leads a research team with Associate Professor Sue Wells (Pākehā co-leader), and with Associate Professor Matire Harwood and Professor Sue Crengle (Māori co-leaders). The research predicts the risk of cardiovascular diseases to help target the right treatments to the right people to combat heart attacks, stroke, diabetes, gout and other related conditions.