NZDep is a small area index of relative socioeconomic deprivation based on census data. Ethnicity graphs for NZDep illustrate how socioeconomic advantage and disadvantage are distributed throughout our society. The first time these graphs were produced followed the production of the first version of NZDep based on the 1991 census (Figure 1). They showed that Māori and Pacific people were severely socioeconomically disadvantaged compared to New Zealand European people (approximated in the figure as the prioritised ethnic group ‘Non-Maori non-Pacific non-Asian’). Almost 30 years later the 2018 version of the same graphs show that while there is a small reduction in Māori people living in the most socioeconomically deprived neighbourhoods, very little has changed in terms of the overall distribution of socioeconomic advantage and disadvantage.

Figure 1: NZDep index of socioeconomic deprivation profile for prioritised* ethnic groups: Māori, Pacific, Asian and Non-Maori non-Pacific non-Asian (New Zealand European), 1991 and 2018.

In interpreting these graphs it is important to keep in mind the use of the prioritised ethnicity classification and the way it handles people with two or more self-identified ethnic affiliations (see footnote to Figure 1), and the changing composition of New Zealand’s population (Table 1). Between 1991 and 2018 there were increases in the numbers, and proportions, of Māori, Pacific and Asian people in the population and, while there has been an increase in the number of New Zealand European people, their proportion of the total population has decreased (as measured using the prioritised classification). The shifts in the underlying population structure over this time amplify the consequences of the lack of change in the distribution of privilege and its inverse. In summary, the question has to be asked: has 30 years of ‘progress’ really amounted to so little change in the underlying structures of opportunity for Māori and Pacific communities? Yes, it would appear so. Hence the title of this editorial.

Table 1: Population numbers and proportions by prioritised ethnic group (usual resident population), 1991 and 2018.

What do we learn from this observation? The boot that is held on the throat of Māori and Pacific people is stubbornly resistant to attempts to shift it. We have not transitioned from a colonial to a postcolonial nation—that transition remains a promise for the future. Our majoritarian political system suffers from something like prostatism and obstruction when it comes to honouring Te Tiriti o Waitangi, leading to dribbling, hesitancy and retention. Successive governments seem unable to lead us out of a state of oppressor/oppressed because of, in part, the dynamics of majoritarian democracy. Yet various components of New Zealand’s unwritten constitution provide us with a map of the way ahead:¹ te Tiriti o Waitangi and the New Zealand Bill of Rights Act are two elements of this constitution that provide clear direction.

Disruptors are necessary to alter the fundamental structures of opportunity for Māori and Pacific communities; disruptors that are effective in embedding real change without doing damage to our society. What would these disruptors look like? Historical literacy is a starting point—if Pākehā are to take responsibility for removing the boot from the throat of Māori and Pacific people then Pākehā need to be educated in New Zealand’s colonial and pre-colonial history. The moves currently underway to ensure that New Zealand history is taught compulsorily in primary and secondary schools are to be lauded and supported.

One example of a disruptor in the health system could be the increased population of our health system with Māori and Pacific health professionals who have the skills and expertise to drive change from within the system, while, at the same time, providing high-quality and compassionate care to all their patients. Some universities are leading the way in this regard; one role of the entire health sector should be to support Māori and Pacific health professionals and to demand an acceleration and ramping up of the production of these health professionals in the workforce.

Another example of a disruptor in the health system could be the recommendation from the majority of the Health and Disability Review panel and the Māori Expert Advisory Group to implement an empowered and properly resourced Māori health commissioning agency,² a recommendation also mooted by the Waitangi Tribunal.³ This agency has the potential to bring the requisite expertise, commitment and drive to the task of commissioning services for Māori communities.

The Black Lives Matter movement tells us that brushing the legacy of white supremacy under the carpet gets us nowhere and simply foments distrust, social unrest and division. We know that any meaningful pathway to health and wellbeing incorporates agency as a key element; agency in relation to language, culture, worldviews, the environment, health, education and so on. Because of this understanding, the health sector has the capacity to provide leadership that could benefit all of society. The past 30 years have produced very little change in the structures of opportunity for Māori and Pacific people in relation to Pākehā people. If we wish to make the next 30 years count for more than the last 30, then Pākehā New Zealanders have an obligation to create and take opportunities to rid our society of racism and to demand equity in the structures, processes and outcomes for Māori and Pacific New Zealanders.