Māori have been severely under-represented in New Zealand’s medical workforce for the entirety of the country’s colonial history.[[1–4]] Under-representation of Māori in the health workforce continues today, and while many factors likely drive this under-representation, inequitable and poor outcomes for Māori in the education sector are a major contributing factor.[[5]] It has long been recognised that selection processes into restricted-entry tertiary programmes such as medicine have a critical role to play in ensuring that inequities in health workforce participation are eliminated.[[6–8]]

The benefits to medical education and to the health workforce of diversity and representation are well described,[[9]] yet there has been a failure to support educational pathways that would result in an equitable health workforce. The aim of this paper is to describe a number of sociological and theoretical foundations that underpin selection into tertiary education in New Zealand and that have historically served to limit the participation of Māori students in restricted-entry health professional programmes. The paper further aims to describe practical steps that can be taken to promote pro-equity changes within tertiary institutions.

In order to understand the institutional context and help shape a more inclusive future for the health professions, we explore why and how institutions limit access to higher education for some groups in society while privileging access for others. We challenge some of the fundamental assumptions that underpin the behaviour and policies of tertiary institutions and discuss how tertiary institutions can re-define the concept of merit. We suggest some approaches to helping institutions break free from the written and unwritten rules that limit the extent to which the full benefits of tertiary education are shared by all groups in society.

Policies in tertiary institutions vary, and the analyses in this paper may not apply entirely, or at all, to any particular institution. Nevertheless, we believe it is instructive to understand the dominant ideologies that shape the tertiary environment and enable or obstruct the entry of Māori students into medicine.

The paper has four parts. First, we discuss the sociological concept of meritocracy as a dominant approach to student selection and pedagogy in universities, and we describe the consequences of this approach for Māori students. Second, we discuss the concepts of white supremacy and privilege as two organising sets of values that interplay with each other and shape the tertiary environment. Third, in order to imagine a society that is more explicitly based on egalitarian principles, we discuss possible alternative theoretical and ethical approaches based on Rawls’ theory of justice, mana motuhake (a concept of self-determination) and strengths-based assumptions. In the fourth and final part, we illustrate these alternative approaches, which are fundamentally committed to Te Tiriti o Waitangi, with an example of their successful application.

Meritocracy

This paper is concerned with how the concept of meritocracy has been taken up, used and is now normalised within the sphere of higher education and by the social elites who derive their status and privilege from this usage. In this context, the term focuses on “cultivating the excellent and the talented.”[[10]]

Meritocracy is a multifaceted sociological concept. The concept is old, dating back at least to ancient China, where the idea was introduced in order to address the problem of the nepotistic appointment of incompetent people to senior administrative roles. The concept of meritocracy was introduced to ensure that people were appointed on the basis of their training, skills and aptitudes, rather than family connections.[[11,12]]

The word “meritocracy” is itself a neologism—a combination of Latin and Greek—coined in the late 1950s.[[13]] The term is usually credited to English sociologist Michael Young, in particular his book The Rise of the Meritocracy published in 1958.[[13]] “Mereo” is Latin for “earn,” and “—cracy” is Greek for “power,” as in “plutocracy,” that is, “government by the wealthy.” Meritocracy refers to the idea that power and authority should be vested in individuals on the basis of talent, effort and achievement.

In the context of tertiary education, this achievement ideology defines and frames educational success as a product of individual talent and effort, and academic failure as a lack of talent and hard work; it takes no account of the structures and systems of opportunity and is absent of power analysis. Furthermore, it takes no account of the design and delivery of education that is framed to align with the hidden goals of preferentially meeting the needs of those with relative privilege. Individuals who are perceived to lack skills and intelligence are often relegated to the bottom of the meritocratic heap from a very early age. In this way arbitrary class distinctions are (re-)established, albeit camouflaged by the rhetoric of equal opportunity: “anyone can succeed if they try hard enough.” The concept of merit as used in higher education is frequently essentialised, individualised and inherently eugenicist.[[14]]

Meritocratic approaches in higher education thus define worthiness at the point of entry. In this frame, worthiness at entry is defined largely in terms of the credentials that are the reward for those who make a “choice” to get a “good” education—for those who have come through privileged educational pathways. In many universities, especially those that aspire to be regarded as elite, the idea that higher education should be reasonably accessible for all who have suitable aptitudes has long gone. Higher education, in many universities, is now the preserve of those students who are already established on privileged educational pathways and insufficient account is taken of the known educational and social conditions of students from less privileged backgrounds.[[15,16]] This is accentuated further within tertiary education in programmes, such as medicine, where entry is in part the result of intense competition between students.

The definition of merit is social and, therefore, political and not an inherently personal trait.[[10]] Mijs emphasises the point that there is no neutral definition of merit and documents various definitions of merit that have been used through history—from manliness, aggression, asceticism and bisexuality in Sparta in 400BC, through to white race, male and intelligence in American Ivy League universities between 1900 and 1920 and athleticism, life experience and intelligence in American Ivy League universities between 1950 and onwards.[[11]] Any definition of merit “is a construction that must serve some groups of people, while disadvantaging others.”[[11]] Karabel (quoted in Mijs), talking about the admissions systems at Harvard and Yale, says: “Those who are able to define ‘merit’ will almost invariably possess more of it, and those with greater resources—cultural, economic, and social—will generally be able to ensure that the educational system will deem their children more meritorious.”

Young wrote his book The Rise of the Meritocracy as a dystopian novel set in the year 2034. His novel was an ironic critique of the idea of meritocracy.[[13]] Mijs argues that educational institutions and politicians embrace the notion because it allows them to define an exclusionary elite and provides legitimation of social inequality.[[11]] Young felt compelled to write to The Guardian newspaper and point out to Prime Minister Tony Blair that his novel was about a dystopian future, not an idealised utopia. Littler notes: “For Young, the unironic way ‘meritocracy’ was now deployed, which worked by ‘sieving people according to education’s narrow band of values [using] an amazing battery of certificates and degrees’ meant that social stratifications had hardened, those demoted to the bottom of the social pile were deemed unworthy and demoralised. ‘No underclass’, he wrote, ‘has ever been left as morally naked [as this one].’”[[12]]

Littler quotes French economist Piketty who uses the term “meritocratic extremism” and talks of “the apparent need of modern society, and especially US society, to designate certain individuals as ‘winners’, and to reward them all the more generously if they seem to have been selected on the basis of their intrinsic merits rather than birth or background.”[[12]] Littler argues that “the idea of meritocracy has become a key means through which plutocracy—or government by a wealthy elite—perpetuates, reproduces and extends itself,” and that meritocracy is a device that can only be used individually—it is inherently atomistic and competitive—by promising opportunity while producing social division.[[12]] It ensures that certain people are left behind.

Reay argues that it is the myth of meritocracy that keeps the neoliberal dream alive—that is, the belief that if you work hard, “all can rise to the top.”[[17]] It is a cruel dream with many working-class casualties, with the few relatively high achieving white working class and ethnic-minority students who gain admission to elite universities being at risk of the psychological trauma of marginalisation, as well as more brutal overt and covert forms of racism.[[17]]

Counter-narratives to the concept of meritocracy tend to place emphasis on education as an entitlement of citizenship and acknowledge that contextual factors play a significant role in the likelihood of a student gaining access to higher education and going on to gain access to a place in medical school. With regards to medical education internationally, many medical schools are grappling with how to use a range of approaches to account for contextual factors (eg, access to appropriate science education) and to recognise and mitigate these (eg, the UK Office for Students[[18]]). Carefully considered and strategic tailoring of selection processes to support entry of diverse students, in addition to responsive and effective programmes that support tertiary success among students who have less privileged educational backgrounds, are two of these approaches.

White supremacy and privilege

Brittney Cooper, in Littler, writes: “The merit card is the white equivalent of a race card—it is the highest trump card... [it is] the supposedly race neutral rubric that everyone should naturally agree is the best way to judge candidates, all questions of race aside. The myth of meritocracy is one of the foundational erroneous ideals of white supremacy. Whether we are speaking about increasing racial access to education or jobs, the term merit is thrown around as though it exists in opposition to diversity.”[[12]]

We are not referring solely to the ideology that leads to, for example, openly racist attacks, although that ideology is one important expression of white supremacy. Rather, we are referring to the insidious layering of values that result in the systematic devaluing of Indigenous ways of being and the exclusion and alienation of Indigenous people from social institutions through the insistence that they conform to cultural norms that are not their own, and inaction in the face of need.[[19–22]]

White supremacy is an important foundational values system of settler-colonial societies. It permeates the cultural fabric and institutions, including education,[[22,23]] in deep and often unseen ways. Patel discusses the challenges and conflicts for higher education in making commitments to diversity that are meaningful within the reality that “contemporary initiatives for diversity… reflect a desire for the appearance of diversity without unseating structural inequity.”[[24]] Just as in contemporary society, where white people subject themselves and others to moral contortions in order to ethically justify their unearned privilege,[[25]] so too did colonialists in Australia, New Zealand, Canada and the United States—many of whom were from disadvantaged backgrounds themselves—need a moral justification for land theft, killing and barbarity. White supremacy—the explicit ordering of humans into a hierarchy with white people at the top—along with religious doctrines (eg, the Doctrine of Discovery, which continues to have legal relevance[[26]]), were tailored to this purpose of moral justification. It is alright, according to this narrative, to kill people and rob their land if they are inherently inferior, and if the settlers are pursuing a higher moral purpose.

This ideology aligns with eugenicist arguments. The eugenics movement contributed much to US and wider education policy in the twentieth century, including the racial segregation of US schools, arguing that black pupils were indeed inferior and it was preferable for all students, including black students, to keep schools segregated.[[14]] The legacy of the eugenics movement is reflected, to some extent, in research findings in New Zealand on political attitudes towards the ideology of equality,[[27]] ideological legitimation of the status quo[[28]] and essentialist explanations for mental illness.[[29]] The link with meritocracy is one that suggests academic achievement is about not only deservingness, but also inherent capability.

Central to the functioning of tertiary education systems is the concept of privilege, specifically unearned privilege. Diangelo refers to this unearned privilege as the “tail wind” that assists those with white skin in America through the trials and tribulations of everyday life.[[25]] The converse is the head wind (the hurdles) that African American, Latino and Indigenous people experience in everyday life— including education particularly. Categories of unearned privilege that commonly apply include gender, sexuality, skin colour, ethnicity and social class. They generate the tail wind that eases a person’s passage through life in a neo-liberal, colonial nation such as New Zealand.

Those with unearned privilege are often reluctant to acknowledge it, preferring instead to attribute their relative advantages to hard work and diligence, and are often very reluctant to relinquish it. Diangelo uses the word “fragility” to describe the reactions of white people when confronted with evidence of their unearned privilege.[[25]] Fragility often expresses itself as anger, denial, rejection, and sometimes with tears and emotional diversion.

An alternative theoretical position: egalitarianism, mana motuhake and strength-based assumptions

The point of departure for this section is the concept of egalitarianism, the idea that everyone is enabled to participate in and belong to the wider society while recognising their individual and group differences. For example, students from adverse socioeconomic backgrounds have skills, strengths, knowledge, experiences and attributes that mean we cannot treat them the same as students from privileged educational backgrounds, but they should be able to benefit from and contribute to higher education, as an entitlement of citizenship.

The twentieth century American philosopher John Rawls, in his book A Theory of Justice, expressed the view that social institutions should not confer morally arbitrary lifelong advantages on some persons at the expense of others.[[30]] He argued that society should be judged by the way it treats the least well-off in society.

Rawls conducted a thought experiment, whereby members of society choose the sort of society in which they live. His one stipulation was that no one can know in advance their status in that society—rich, poor, white, black, male, female, gay, lesbian, Indigenous and so on. Given this “veil of ignorance,” people would be unlikely to choose a society that favours one set of arbitrary characteristics, such as skin colour or gender, and are more likely to choose a society that maximises the benefit of everyone, so that wherever they end up in that society they would do as well as possible.

Rawls’ vision is significant because it provides a framework for imagining a society that values egalitarianism and that is not based on values that centre the accumulation of wealth and rule by the wealthy. In practical terms, we can model our tertiary education selection policies and actions on an imagined world the way we wish it to be, noting that some Indigenous scholars have argued that justice is impossible within the context of settler colonialism.[[31]]

The Māori concept mana motuhake aligns with Indigenous self-determination and sovereignty.[[32]] Within tertiary education, it conveys the sense that Māori have a right to be in control of their own pedagogies and the application of those pedagogies, including in ways that engage with and value Māori world views and provide benefits for Māori students. Māori approaches based on mana motuhake reject the gatekeeping (or, more concerningly, gate-locking) notion of merit—including meritocracy’s failure to engage with inequity in opportunity and differences in experiences, attributes and world views—and apply different criteria and measures to the selection of students. It is possible to imagine various ways that mana motuhake could be exercised in tertiary education. For example, mana motuhake could be exercised within the current system, or outside the system as part of an alternative Māori education system. Examples of the former approach can be found in the publicly funded wānanga: Te Wānanga o Raukawa, Te Wānanga o Aotearoa and Te Whare Wānanga o Awanuiārangi. The case study below provides an example of the exercise of greater Māori authority within an existing tertiary education institution, and highlights some of the opportunities for and constraints on exercising mana motuhake within universities.

Strengths-based approaches place emphasis on the enormous richness, experience and expertise people from diverse backgrounds bring into tertiary institutions. Strengths-based approaches do not stigmatise or marginalise students from Indigenous or low socioeconomic backgrounds, but rather value these students for the understandings, approaches and world views they bring.

Implementing pro-equity selection and educational-support policies: a case study

The authors of this paper all work for the University of Otago, which provides the institutional context for this case study. The university, in common with all of New Zealand’s eight universities, is yet to engage fully and meaningfully with mana motuhake and Māori rights in education and in health. This neglect of basic rights and egregious inaction in the face of need is evident in the barriers of access to and pathways through tertiary training of the health workforce. The university has historically resisted the proactive implementation of effective strategies to expand the training of Māori doctors, dentists, physiotherapists, pharmacists and so on. This resistance has tended to reflect typical meritocratic approaches:[[12,22]] “We select ‘the best.’”

One hundred and eighty years after the signing of New Zealand’s foundational constitutional document, Te Tiriti o Waitangi, the participation of Māori students in all tertiary health professional programmes remains persistently well below population parity, with few exceptions.[[15,16]] In association with this, Māori and Pacific people are greatly under-represented across New Zealand’s registered health professional workforce.[[33]]

For the entire history of New Zealand’s health and educational systems, universities and other higher education institutions have been largely inactive in the face of health workforce need. These institutions have not sought to actively address the under-representation of Māori working within the health system. Generally, at most, there have been piecemeal and tokenistic responses to this under-representation.[[2–4]]

We illustrate here the adoption of alternative approaches that focus on pro-equity selection and educational-support policies that, over a ten-year period, have resulted in radical changes in the entry of Māori students into the medical programme at the University of Otago and a growing number of Māori medical graduates. The proportion of Māori students entering the programme increased from 4–5% to over 20%, illustrating that, even when the structures of opportunity are hostile to Māori, it is indeed possible to achieve change in institutional behaviour over a relatively short period of time (Figure 1).

Figure 1: Number of Māori students across all years of the medical programme 2007–2019.

We have identified four overarching factors that facilitated these changes in institutional behaviour. Each of these factors has been necessary, but no factor is sufficient on its own. It is a combination of conditions that has prompted change, and the right combination will most probably vary from context to context, institution to institution. Other critical factors are undoubtedly necessary for successful change to occur in different contexts.

Theory is the first necessary condition. Educational institutions are doomed to carry on swimming around in a soup of conceptual muddle and prevailing meritocratic ideologies as long as they lack knowledge and understanding of Māori histories, concepts of Indigeneity, strong anti-racism theory and analysis, kaupapa Māori theory and sociological understanding and critique of the prevailing ideologies. Specifically, in the pursuit of workforce equity, we re-framed concepts of meritocracy, understood critical race theory[[34–36]] and gave expression to mana motuhake.

Leadership is the second necessary condition. Māori leadership must be fully empowered. In this context, the role of the institution’s senior leadership is to create a safe place for Māori leadership to be fully exercised. Leadership grounded in a Māori world view, drawing heavily on mātauranga Māori (Māori knowledge systems), is inherently strengths-based. The leadership approach taken from the inception of the process had a strong focus on responsiveness, innovation, evaluation, accountability and adaptation.

Effective policy, strategy, planning and implementation is third. At the level of policy and strategy, the University of Otago has a positive and enabling Māori strategy.[[37]] Underneath that strategy, health educators developed and implemented the Mirror on Society policy. This policy aims to select cohorts of students for all the university’s nine health professional programmes that reflect, as much as possible, the ethnic and socioeconomic realities of the communities which graduates would go on to serve.[[15,16]] In addition, Māori leaders developed clear and ambitious plans to radically alter the status quo. They adopted an ongoing process of planning, implementation, evaluation and modification of programmes and further implementation. Programme development has been informed by evidence and culturally centred, with continual quality improvement, evaluation and monitoring.

The final condition is tailored investment. One of the tasks of leadership is to secure the resources necessary for transformative change. In practice, this meant that resources for the support of Māori staff and students were a key area of focus. The programme of support for Māori students was contributed to significantly by Ministry of Health funding, in recognition of the value placed on the outcome of a greatly increased Māori health workforce.

Conclusion

Current health policies prioritise much greater Māori participation in the health workforce. However, the vision for a health workforce where the entry door is open and where Māori participate fully is a very long way from being realised. The key to this door is critically held in the hands of the education sector.

We have used the example of a specific medical programme to illustrate the wider phenomenon of the adherence by tertiary institutions to traditional meritocratic approaches of student selection. In adopting these approaches, tertiary institutions ignore the structures of opportunity in wider society—and the distribution of privilege and disadvantage that determines the level and opportunity for access and participation of prospective students—thereby perpetuating the long-standing and marked under-representation of Māori doctors in the medical workforce.

We have argued that one of the key tasks in tertiary education is to resist and reverse the dual contemporary political and social tendencies towards increasing socioeconomic divisions in society and the increasing entrenchment of privilege. In particular, the application of the principles of meritocracy and the ideology of white supremacy have ensured that barriers to higher education remain in place, albeit well camouflaged behind pseudo-egalitarian language. These barriers have had the effect of ensuring ongoing privileged status for some while denying it to others. We have demonstrated that an alternative approach, based on egalitarianism, Māori approaches and strengths-based assumptions, can be effective in markedly increasing Māori participation in medical education and the medical workforce of the future.

Universities can better serve the needs of society by redefining merit to be a concept that places positive value on Indigeneity and a lived understanding of socioeconomic adversity. By defining these attributes and experiences as meritorious, as opposed to unfortunate liabilities, we welcome into our institutions students who can offer much to our universities and to society, and in turn to whom universities can offer so much.