Te Rp Rangahau Hauora a Eru Pmare

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Te Röpü Rangahau Hauora a Eru Pömare
Scenarios and Slogans
Health Inequalities Symposium Te Papa August 2004
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Scenarios and slogans
a scenario - (data)
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Scenarios and slogans
a scenario - (data) viewed from different
mountain tops - (analysis)
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Scenarios and slogans
a scenario - (data) viewed from different
mountain tops - (analysis) within the
culture, values and norms of that place
(ideology)
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Scenarios and slogans
a scenario - (data) viewed from different
mountain tops - (analysis) within the
culture, values and norms of that place
(ideology) becomes a truism (evidence)
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Scenarios and slogans
a scenario - (data) viewed from different
mountain tops - (analysis) within the
culture, values and norms of that place
(ideology) become truisms (evidence) and
(un)common sense (discourses)
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(No Transcript)
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Discourses about Inequalities

• 3 main political discourses about inequalities
• RED redistributive discourse
• SID social inclusion discourse
• MUD moral underclass discourse
• Carlisle 1996

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Discourses about Inequalities

• RED redistributive discourse
• seen as left wing
• focus on wealth as well as poverty
• strengthen welfare state
• redistribute through taxation
• evidence to show it decreases inequalities

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Discourses about Inequalities

• SID social inclusion discourse
• dominates new Labour approach
• assoc with social capital social cohesion
• seeks to improve community support for those in
  poverty, at risk etc
• doesnt seek to change conditions directly
• no evidence to show reduces inequalities

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Discourses about Inequalities

• MUD moral underclass discourse
• assoc with new Right politics
• individual (ir)responsibility
• promotes individual adaptation
• community development to contain problems at the
  local community level
• fails to acknowledge structural factors
• no evidence that it reduces inequalities

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Scenarios and slogans

• Discourses reflect ideologies and often frame
  those at fault and fail to name those who are
  privileged -
• 1000 teenage girls got pregnant last year
• Discussions on inequalities need also to
  consider these issues of gaze and privilege.

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Theories of Ethnic Inequalities

• Two main (opposing) theoretical positions
• That ethnic inequalities are due to
• the racialised expression of biology
• (bad genes), OR
• the biological expression of racism?
• (discriminatory and stressful society)
  N Kreiger 2001

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Root and Surface Causes
Williams 1997 AEP 7322-333
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Levels of Racism

• Institutionalised racism
• Differential access to the goods, services, and
  opportunities of society by race. Acts of
  omission as well as commission.
• Inaction in the face of need.

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Levels of Racism

• Personally-mediated racism
• Prejudice and discrimination, where prejudice
  means differential assumptions about the
  abilities, motives, and intents of others by
  race, and discrimination means differential
  actions toward others by race based on those
  assumptions.

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Levels of Racism

• Internalised racism
• Acceptance by members of the stigmatized races
  of negative messages about their own abilities
  and intrinsic worth.

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Jones et al, 2001
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Racism and ethnic inequalities

• How?
• Ideas - define conventional wisdom
• Organisational structures - frame what is
  possible
• Processes and rules - dictate how we work

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Ethnic disparities - 3 levels

• Differential access to health determinants or
  exposures ? differences in disease incidence
• Differential access to health care
• Differences in quality of care received
• Jones, 2001

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Distribution Gap
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Ethnic disparities - 3 levels

• Differential access to health determinants or
  exposures - differences in disease incidence
• Differential access to health care
• Differences in quality of care received
• Jones, 2001

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Ischaemic Heart DiseaseMortality 1996-99 and
Interventions 1990-99 Male standardised rates
per 100,000
Ajwani et al 2003 Tukuitonga
Bindman 2002
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Ethnic disparities - 3 levels

• Differential access to health determinants or
  exposures - differences in disease incidence
• Differential access to health care
• Differences in quality of care received
• Jones, 2001

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Differential quality of care

• lower satisfaction with care
• preventive asthma medication less likely
• antidepressants less likely
• fewer caesarean sections even when main
  confounders controlled for
• fewer cardiovascular interventions
• diabetes - equity in quality can be improved
  through monitoring, feedback and protocols but
  still need to address inadequate coverage/access

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Scenarios and slogans

• Before we intervene what should we know?
• where and how to intervene

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Racisms

• Intrinsic ideological (not rational)
• Extrinsic may respond to evidence (Appiah,
  1990)
• Aversive prowhiteness rather than anti-Mäori
  (ingroup favouritism)
• Responds to pressure, monitoring
• Diffusion of responsibility
• Current antidiscrimination laws ineffective
• Requires affirmative action
• (Gaertner, Dovidio et al in Off White 1997,
  Dovidio 1997)

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Scenarios and slogans

• Before we intervene what should we know?
• where and how to intervene
• who and what is the problem here

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Whiteness

• What if we took the position that racial
  inequities were not primarily attributable to
  individual acts of discrimination targeted
  against persons of color, but increasingly to
  acts of cumulative privileging quietly loaded up
  on whites?
• Michelle Fine 1997. Off White. p57.

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Whiteness

• Not a set of cultural characteristics but a
  discourse which effectively secures privileges
  and forms of exclusion
• Tactics include
• Ex-nomination capacity not to be named
• Naturalisation by othering
• Universalisation e.g. cultural perspectives
• Bhattacharyya 2002

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Scenarios and slogans

• Before we intervene what should we know?
• where and how to intervene
• who and what is the problem here
• is it really about need or greed

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Scenarios and slogans

• Inaction/denial of inequalities need to prove
• Victim-blame analyses bad Maori
• Highlights colonial/racist ideology
• Focus on needs not rights assumes right to define
  and decide needs pakeha control
• Indigenous rights (UN Draft Declaration) breached
  identity, freedom from discrimination
  propaganda, development

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Scenarios and slogans
When enough is enough (10 years less
life expectancy)
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Scenarios and slogans
Its the putting right that counts