Ethnicity, equity, and quality: lessons from New Zealand.

ife expectancy for indigenous people in colonised countries is shorter than it should be. In New Zealand, Ma ¯ori die on average 10 years younger than people of Anglo-European descent. 1 The usual suspects of poverty and poor socioeconomic opportunities contribute to inequity, but failures in service organisation and delivery are part of the picture. New Zealand is not the only colonised nation where higher rates of illness and premature mortality exist, but it is a country making concerted efforts to address the disparity. The starting point in identifying inequality in health outcomes is ensuring accuracy of data. New Zealand is a diverse country; the 2001 census indicates that 14.1% of the population are Ma ¯ori, 6.2% are Pacific people, and 6.4% are Asian. 2 Each of these groups is actually growing at a faster rate than pakeha (the white descendants of colonial settlers). However, until recently, documentation of ethnic origin in relation to health was not routinely collected. Even when ethnicity was recorded, it tended to be based on health workers' assessment of the appearance of the service user. Addressing health needs and planning appropriate levels of service clearly requires a more accurate and sensible approach. Self-identification of ethnicity is now established as " best practice " in New Zealand 1 and, as a result, knowledge about health and the incidence and prevalence of certain conditions is improving. A second step in enhancing responsiveness to cultural needs of patients is " cultural safety " introduced by Irihapeti Ramsden. 3 Cultural safety goes further than learning factual information regarding dietary or religious needs of different ethnic groups. Rather, it means engaging with the sociopolitical context of beliefs about whanau (family) and of what is tapu (forbidden) in a range of healthcare practice, from washing someone through to physical examination or handling of biological specimens. It is increasingly understood that failure to take such things into consideration may well lead to interventions that fail in the short term and that build suspicion in the longer term as people lose their trust in healthcare providers. While cultural safety began as a movement within nursing, it is now being introduced within the other undergraduate cur-ricula and professional development programmes. Difficulties in accessing services have been identified for Ma ¯ori and other ethnic groups in New Zealand. 1 Resultant delays in initiating treatment may well contribute to the significantly worse outcomes found in patients …