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LETTER |
Frank Houghton is with the Department of Public Health, Mid-Western Health Board, Limerick, Republic of Ireland, and the Department of Geography, National University of Ireland—Maynooth.
Correspondence: Requests for reprints should be sent to Frank Houghton, MA, MSc, Department of Public Health, Mid-Western Health Board, 31-33 Catherine St, Limerick, Republic of Ireland (e-mail: fhoughton{at}mwhb.ie).
The recent article by Stehr-Green et al.1 that details the effect of racial/ethnic misclassification (underclassification) of American Indians and Alaskan Natives on death certificates in Washington State highlights a global difficulty for indigenous and minority peoples. In New Zealand, reports on the health status of the Maori population make grim reading in comparison with reports on the health status of the "Pakeha" (European) population.2 Life expectancy, for example, is currently 7 years shorter for Maori than for non-Maori people.3 It is, however, widely acknowledged that the full extent of the health divide is significantly greater than this.
Numerous studies have highlighted the underrepresentation of the Maori ethnic group in mortality and hospital discharge data sets.4–6 It has been suggested that the undercounting of Maori may have served to lower official reports of Maori mortality by up to a third.7 This has been described locally as the "final colonization."8 As Papaarangi Reid reminds us, "not counting in death is the ultimate hallmark of social exclusion."8
It is abhorrent that the full extent of the racial/ethnic morbidity and mortality divide is effectively hidden and misrepresented by the delicate sensitivities of hospital staff, most of whom are members of the majority culture and enjoy a superior health status. Issues of race and ethnicity need to be addressed openly and directly if significant changes in the existing structures of health inequality are to be overcome.
It is not acceptable for hospital staff to simply guess a person’s ethnicity. Appearance is no guarantee of ethnic status. As Stewart-Harawira notes from New Zealand, "a number of Maori today, particularly in the South, have fair skin, blue or green eyes, and blond or red hair." The first stage in the process of rectifying the misclassification issue may be the introduction of decolonization and cultural awareness programs for staff.
References
1. Stehr-Green P, Bettles J, Robertson LD. Effect of racial/ethnic misclassification of American Indians and Alaskan Natives on Washington State death certificates, 1989–1997. Am J Public Health. 2002;92:443–444.
2. Howden-Chapman P, Tobias M, eds. Social Inequalities in Health: New Zealand 1999. Wellington, New Zealand: Ministry of Health; 2000.
3. Statistics New Zealand. Health. Available at: http://www.stats.govt.nz/domino/external/web/Prod_Serv.nsf/htmldocs/Health. Accessed April 4, 2002.
4. Pomare E. Maori Standards of Health: A Study of the 20-Year Period 1955–1975. Auckland, New Zealand: Medical Research Council; 1981.
5. Cohen P. Accuracy of death certificates. N Z Med J. 1999;112:259–260.
6. Priest PC, Jackson RT. The validity of Maori hospital discharge statistics for ischaemic heart disease in New Zealand. N Z Med J. 1994;107:3–4.[Medline]
7. Graham P, Jackson R, Beaglehole R, de Boer G. The validity of Maori mortality statistics. N Z Med J. 1989;102:124–126.[Medline]
8. Reid P. Nga mahi whakahaehae a te tangata tiriti. In: Davis P, Dew K, eds. Health and Society in Aotearoa New Zealand. Auckland, New Zealand: Oxford University Press; 1999:83–93.
9. Stewart-Harawira M. Maori, who owns the definition? The politics of cultural identity. Te Pua. 1993;2(1-2):27–34.
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