Various

Question 1

Equity

Answer 1

In Aotearoa New Zealand, people have differences in health that are not only avoidable but unfair and unjust. Equity recognises different people with different levels of advantage require different approaches and resources to get equitable health outcomes.

Equity is everywhere in the public health sectors - core priority or objective. However, beyond the preamble or section, the content fails to articulate how this commitment is being enacted in a meaningful way.

Failure to acknowledge inequities by ethnicity.

Expressing a commitment to equity = must be alert for, and challenge empty rhetoric on equity.

Question 2

Cultural deficit

Answer 2

Deficits that are inherit to a population (i.e., gene theory) or internal to the culture (i.e., tapu framed as a cause for low cervical screening).

Question 3

Population health

Answer 3

An approach that focuses on interrelated conditions and factors that influence the health of populations over the life course, identifies systematic variations in their patterns of occurrence, and applies the resulting knowledge to develop and implement policies and actions to improve the health and wellbeing of those populations.

Question 4

Racism

Answer 4

1. Institutional racism
2. Personally-mediated racism
   Prejudice and discrimination
   Ties into intersectionality
3. Internalised racism
4. Solution to racism is not cultural awareness. The solution is a critical race consciousness
5. Cultural safety (rather than cultural competence) is an important mechanism to begin the work of critical consciousness where health care professionals and their organisation examine themselves as being part of the problem
6. Examine their own culture rather than the “exotic other”
7. Critique the taken for granted power structures and challenge their own culture and cultural systems rather than prioritise becoming competent in the cultures of others

Prejudice, discrimination, or antagonism by an individual, community, or institution against a person or people on the basis of their membership of a particular racial or ethnic group, typically one that is a minority or marginalized.

Arms length role as an observer or racism to a critical inward reflection on its role in the everyday reproduction of racism.

Question 5

Privilege

Answer 5

A special right, advantage, or immunity granted or available only to a particular person or group

Question 6

Cultural essentialism

Answer 6

1. Belief that racial categories are associated with distinct, fixed and stable cultural patterns
2. Categories of people possess inherent differences or intrinsic characteristics and dispositions
3. Inherent, unchangeable properties
4. Problematic because maori are diverse, fluidity and multiplicity. Plastic maori – tuturu maori

Question 7

Colonisation

Answer 7

The action or process of settling among and establishing control over the indigenous people of an area.

Colonisation imposed abusive, exploitative, racist power relations on society

Through land alienation, economic impoverishment, mass settler immigration, warfare, cultural marginalisation, forced social change and multi-level hegemonic racism, Indigenous cultures, economies, populations and rights have been diminished and degraded over more than seven generations.

Question 8

Worldviews

Answer 8

1. Imperialism
2. Neoliberalism
3. Egalitarianism
4. Critical Indigenous (we need to come from this worldview)
5. Matauranga Maori (we need to come from this worldview)

Question 9

Cultural load

Answer 9

Additional workload in the workplace for Indigenous people who may be the only or small number.

Question 10

White supremacy

Answer 10

White supremacy is the belief that white people are superior to those of other races and thus should dominate them.

Question 11

Cultural safety

Answer 11

a. Acknowledging the barriers to health outcomes arising from the inherent power imbalance between provider and patient
b. Rejects that notion that providers should focus on learning cultural customs of different groups
c. Being aware of difference, decolonising, considering power relationships, implementing reflexive practice and allowing patient to safety
d. Question own biases, attitudes, assumptions, stereotypes and prejudices = critical consciousness, ongoing self-reflection and self-awareness
e. Hold themselves accountable

Question 12

Positionality of mainstream public health

Answer 12

Not ethnically neutral (as suggested by being objective).

Strongly grounded in British colonial understandings and approaches.

Causes difficulties when advocating for efforts to equity as these can be seen as prioritising or favouring groups.

Positionality, bias, un-neutral, racist

Question 13

Cultural bias

Answer 13

Cultural bias refers to the phenomenon where people from one culture make judgements about others based on their own cultural norms, values, and beliefs.

This can lead to misunderstandings or misinterpretations of behaviours, practices, or ideas from different cultures.

Example: Eye Contact

Maintaining eye contact during a conversation is often seen as a sign of attentiveness, honesty, and respect. However, prolonged eye contact can be interpreted as aggressive or disrespectful, especially when speaking to elders or authority figures.

This misunderstanding arises due to the cultural bias of interpreting behavior based on one’s own cultural norms without considering the cultural context of the other person.

Question 14

Partnership

Answer 14

Often inauthentic and unfair, bureaucratic requirements rather than good practice.

Often reduced to consultation or seeking sign off at a late stage once the problem has been defined, priorities identified, research design or policy drafted.

Response time frames controls when in the process Maori are engaged. They hold the power in deciding when, whom and how much engagement which entails inherent racial bias.

Often lone Maori representative in meetings/projects rather than all necessary contributors) which is normalised and unchallenged.

Frequently, engagement with an inappropriate person (using an othering lens that Maori ethnicity along is the only required attribute). For example, using a Māori manager or iwi representative to contribute to a technical public health issue, rather than seeking Māori technical expertise.

True partnership requires humility = mainstream public health has incomplete understandings of the problem and the solutions.

Receptiveness = scrutinised and altered

Question 15

Maori shopping

Answer 15

Inability or unwillingness to embrace multiple Maori perspectives. Played off against each other. Which singular Maori view is palatable or legitimate to unchallenged status quo and endorse

Cultural solution or endorsement which can more easily be incorporated as an adjunct without requiring any significant deviation of the mainstream.

Approaching individual Maori until someone provides the desired sign-off or perspective.

Question 16

Maori rights

Answer 16

Exist independently of health needs / equity

Same level as other marginalised groups

Competing interests of minority groups.

Question 17

Cultural safety / cultural competency

Answer 17

Conflate cultural safety with cultural competency.

Cultural safety = examine themselves and their impact of their own culture, biases, attitudes, assumptions, stereotypes, prejudices, structures, and characteristics that may affect the quality of public health practice.

Public health focuses on cultural competence practices (i.e. karakia sandwich).

Question 18

White fragility

Answer 18

Defensiveness and discomfort of white individuals when presented with evidence or perspectives that challenge their racialised beliefs.

In response to these challenges, they withdraw, defend, cry, argue, minimise, ignore, and in other ways push back to maintain equilibrium.

These individual behaviours serve to paralyse or impede institutional pro-equity.

The centring of white individuals’ feelings in meetings discussing Māori population health need holds back public health institutions from undertaking any rigorous review or improvement of performance for Māori.

Question 19

Tone-policing

Answer 19

Tone policing refers to the practice of focusing on and criticizing someone’s emotional tone or manner of communication rather than engaging with the content or substance of their argument.

It often involves dismissing or devaluing someone’s message based on how they express themselves, which can undermine productive dialogue and perpetuate power imbalances.

Maori are often labelled as aggressive or angry in a way to dismiss the content.

Non-Maori feedback is often regarded more favourably, or even thanked, emphasising white have allies in public health.

White silence, defer to the lone Maori colleague to give critical feedback.

Example: Workplace Diversity Discussion

During a meeting about workplace diversity, an employee passionately expresses frustration about the lack of opportunities for career advancement for people of colour within the company. They speak assertively and with strong emotion, highlighting their personal experiences of discrimination and inequity.

Instead of addressing the concerns raised and discussing potential solutions, a colleague responds by saying, “I understand your frustration, but can you please calm down? Your tone is making me uncomfortable and it’s not helping us have a constructive conversation.”

In this example, the colleague’s response exemplifies tone policing. By focusing on the emotional expression (the passionate tone) of the employee rather than engaging with the substance of their message (issues of systemic racism and inequality), the colleague deflects from addressing important issues and reinforces a power dynamic where the emotions and experiences of marginalised individuals are dismissed or marginalised themselves.

Tone policing can hinder genuine dialogue and perpetuate systemic injustices by prioritising the comfort of the dominant group over addressing the concerns of marginalised voices.

Question 20

Racist use of data

Answer 20

When it comes to ethnic health inequities, data can be collected and analysed in ways that either conceal or diminish inequities — or reveal them.

For example, presenting non-age-standardised Covid-19 data gave the impression that Māori mortality and morbidity were lower than those of non-Māori, yet when appropriate age-standardisation was used (18 months into the pandemic), this pattern reversed to reveal that Māori had twice the Covid-19 mortality and morbidity as non-Māori.

1. Poor quality ethnicity data
2. Selection of inappropriate comparison groups
3. Selection of inappropriate methods of analysis
4. Failure to critically interpret what ethnicity data is actually telling us, and then connect that to policy and programme changes.
5. Normalisation of graphs showing persisting ethnic bias yet a failure to translate this to commensurate action or consequences.
6. Total population analyses will always privilege the dominant ethnicity.

Question 21

Controlling indigenous approaches

Answer 21

Public health institutions share power with Māori reluctantly and only when facing significant risk of failure.

Typically delivers a mainstream approach, then adds a Maori approach to compensate the bias against Maori.

It is about maintaining full control and power.

However, when mainstream approach is in trouble, indigenous-led solutions are supported. Such as we saw when mainstream public health approaches were losing control of Covid-19 spreading among Māori communities.

Distrust and discomfort with indigenous leadership where they try to manage this fear by exercising other means of control.

The requirement for evaluation or monitoring is not evenly applied in public health practice — a much higher degree of scrutiny is applied to Māori-led solutions than to the performance of the mainstream system. Moreover, a mainstream lens is used to evaluate Indigenous models, reinforcing racist bias about whose perspectives are legitimate and deserve priority.

Question 22

Racial bias

Answer 22

Racial bias refers to prejudice or discrimination against individuals or groups based on their race or ethnicity. It involves making judgments, forming opinions, or taking actions that favor or disadvantage people because of their race. Here’s an example to illustrate racial bias:

Example: Hiring Practices

Imagine a company has a hiring manager who unconsciously holds racial biases. When reviewing job applications, the manager may consistently favor candidates who have names typically associated with the manager’s own racial or ethnic group. This bias can manifest even if all other qualifications and experiences are equal among candidates.

In this scenario, the hiring manager’s preference for candidates with familiar names reflects racial bias. This bias could result in qualified candidates from minority racial or ethnic groups being overlooked or receiving fewer opportunities compared to candidates who share the same racial or ethnic background as the hiring manager.

Question 23

Othering

Answer 23

Othering is a social process where certain individuals or groups are marginalized, considered different, and often viewed as inferior or less deserving of rights and respect compared to the dominant group.

It involves creating a distinction between “us” (the dominant group) and “them” (the marginalized group), reinforcing stereotypes, prejudices, and inequalities. Here’s an example to illustrate othering:

Example: Immigrants in Political Discourse

In political discourse, immigrants are sometimes “othered” by framing them as a homogeneous group that threatens the economic stability, cultural identity, or security of the host country. Politicians or media may use language that portrays immigrants as a burden on society, criminals, or people who do not share the same values as the native population.

This othering process can lead to policies that restrict immigration, perpetuate stereotypes about immigrant communities, and justify discriminatory practices. By emphasizing differences and promoting fear or distrust of immigrants, the dominant group (native citizens) may justify their own privilege or perceived superiority, further marginalizing immigrant communities.