Damien Grant is an Auckland business owner and regular opinion contributor for Stuff, writing from a libertarian perspective.
OPINION: One of the questionable consequences of our obsession with race is the collection of data on causes of death among Maori and non-Maori.
Heart disease is a favorite tool used by the Grim Reaper across all ethnic groups; a timely reminder for all of us to shed a few pounds.
Lung cancer and diabetes are the preferred means by which Maori leave for the afterlife, while breast and bowel cancer are popular in the Pākehā community.
Motor vehicle deaths are well noted in people cursed with an XY chromosome, while double Xs show a tendency towards strokes.
* Funding Keytruda for melanoma but not lung cancer is racist, say health advocates
* Cancer in New Zealand: Survival rates on the rise, but inequalities persist
* Bowel cancer: 65,000 more Aucklanders can now access free screening
* Refusal to lower bowel screening age for Maori is branded ‘institutional racism’
* Screening scheme to be extended to Maori in their 50s – Bowel Cancer NZ
Why, dear reader, am I sharing this appalling dataset while you’re lying in bed on this lazy Sunday? I’m glad you asked.
The Pharmaceutical Management Agency, better known as Pharmac, has $1.045 billion to spend on drugs each year.
It is widely considered a success. By deploying a single buyer model, Pharmac can negotiate terms that we would struggle to obtain if we acted individually.
I haven’t checked this, but it seems believable. Lives have been saved and years of high quality have been added to countless Kiwis through this success.
This rare example of effective state agency is about to be sacrificed on the altar of fairness.
The government commissioned a report. Of course he did.
The interim report, published last year, states: “Pharmacy is starting with a utilitarian approach, in that it seeks to obtain the best use for society of available funding. Utility means getting the best possible result for the greatest number of people.
In the healthcare system, this is measured using a quality-adjusted life year, or QALY. A QALY is a year of perfect health, a zero QALY means you are dead, or worse, a resident of Feilding.
Pharmac reviews its budget and decides how to spend its limited money to achieve the best possible outcome for all residents of these shores. It does not look at the religion, race, gender, or physical attractiveness of human beings whose lives are enhanced.
This approach is currently being updated. In the future, if you have the right whakapapa, your medical well-being will matter more than that of the nurse who arrived from Manila last month and who will administer the medicine to you.
This interim report insists on this point: “Screening [for bowel cancer] is highly cost effective compared to other health care interventions. But because the disease had a relatively lower incidence among Maori, it could increase inequality by focusing on less common disease among those with the greatest health needs.
The final report landed in June and recommends, “Pharmacy should integrate equity considerations into all stages of its assessment processes.
Andrew Little is enthusiastic. “Pharmac will focus much more on improving the health of Maori, Pacific peoples, people with disabilities and other groups who do not yet share equitably in the benefits that Pharmac provides.”
Dr Bryce Wilkinson, in a report written for Wellington think tank, the NZ Initiative, does an outstanding job of deciphering exactly what is on offer.
Pharmac has a capped budget and buys drugs that do the most good for the most people. Forcing Pharmac to focus on increasing the QALY of one area of society means it has to cancel a drug elsewhere.
Wilkinson writes: “Forcing Pharmac to fund drugs on the basis of race or ethnicity is to propose that a unit of a quality-adjusted life year for Maori is worth more than a unit for non-Maori, regardless of any other consideration”.
The argument is a bit technical but easy to grasp with a simplified example.
Bowel cancer screening costs, say, $10 million and saves 100 lives. Five are Maori.
Diabetes drug costs $10 million and saves 50 lives. Ten are Maori.
Under current rules, Pharmac invests in bowel cancer screening. According to the proposed guidelines, he chooses the diabetes medicine.
Wilkinson goes further.
Part of the justification for these changes lies in allegations of systemic racism, made by, among others, the yet to be knighted Dr Ashley Bloomfield, who told the Waitangi court: “The impact of racism personal and institutional is significant both on the determinants of health and on access to health care itself and on its results.
Wilkinson issued several Official Information Act demands for evidence of this “institutional racism.” He received a weak response and concluded that what the research shows is a link between self-reported experiences of racism and poor health, and notes that this shows a correlation, but not that racism causes or is responsible for health outcomes. Maori and Pasifika.
He’s more restrained than I want to be. The cabinet is bare and the data visible.
Lung cancer and heart disease are, overall, diseases of choice. To assume that those who smoke or enjoy the delights of a light vegetable diet are unaware of the consequences of their decisions is to deny the action of these individuals.
I know wearing a spare tire around my middle riff has the cost of unlived years. I am aware that earning a living in the stressful existence of commerce comes with an increased risk of stroke and heart disease.
More men than women make these choices, and this is part of the reason why men spend less time between birth and burial than women. That and a penchant for motorcycling, boxing, and other reckless acts we do to impress women.
This lack of male years lived is not the result of sexism, nor is it a justification for discarding breast cancer screening in favor of mandatory prostate exams.
What is proposed by Andrew Little and his minions is morally abhorrent. It is the burden of a paternalistic white man reinvented for a modern age.
As the title of the Initiative’s report suggests, every life is of equal value.
It’s incredible that this has to be said, and it’s a credit to Bryce Wilkinson and the Initiative that they did.
* Damien Grant is a member of the NZ Initiative through his company, Waterstone Insolvency.