The University of Otago has had some form of affirmative action in place since the 1950s. Its current policy, Te Kauae Parāoa, covers eight professional health courses and aims to facilitate enrollment among Māori, Pacific Indigenous, rural, refugee or students from lower socioeconomic households.

Analysis of all enrollments between 1994 and 2023 found that Maori and Pacific rates on all health professional courses increased over this period, but were still not in line with other ethnic groups. The exception was in the Bachelor of Medicine and Bachelor of Surgery, where rates had risen to 20.1%.

Otago public health specialist Professor Peter Crampton said these were positive trends but there was still significant work to be done.

Maori representation in the workforce was still relatively low – around 4.7% of all doctors.

Women now make up nearly two-thirds of all enrollments in health professional programs, up slightly from 1994.

“I think the gender balance in tertiary education is worth thinking about,” Crampton said. “Because at what point are we, as a society, concerned about the relative under-representation of young people in tertiary education?”

Over the past 30 years, there has been no change in the proportion of pupils in schools with the lowest deciles (8.5%) or areas with the highest levels of deprivation (1.8%).

“It also gives pause for thought,” Crampton said. “Opportunity structures are highly stratified in our society and that, in my view, is alarming and a cause for concern.”

Crampton said relatively few deliberate efforts were made to attract students from poorer backgrounds. It required interacting with students early in school and supporting them through degree completion, he said.

The NZMJ The study noted recent policy changes had been made in Otago to target more disadvantaged students, but it was too early to measure their impact.

Division of Health Sciences Pro-Vice-Chancellor Associate Professor Megan Gibbons said significant progress had been made in increasing the diversity of the health professional student cohort.

“Success will be when the health care workforce is representative of the population and we are just one part of the education system that is trying to ensure equity in outcomes,” she said.

Gibbons said it was challenging to increase the diversity of socio-economic backgrounds for a number of reasons, including the fact that far fewer students from lower decile schools gained entry to university. She cited other barriers, including the disproportionate impact of the Covid-19 pandemic and economic conditions on school performance among people from lower socio-economic backgrounds.

The university has doubled the number of entrance scholarships for people from these groups, she said, and will increase the number and value of the scholarships again in 2025.

The coalition government is “examining” programs such as Te Kauae Parāoa and Auckland’s Māori and Pacific Admissions Scheme (MAPAS). Act Party leader David Seymour said he I opposed them because they were racial discrimination.

The study’s authors reiterated the benefits of affirmative action programs.

Crampton said the policies were very effective in increasing the participation of rural students, who faced similar structural barriers to Māori and Pacific students.

The study’s authors listed other benefits, including correcting historical injustices; having healthcare professionals from backgrounds similar to the patient has been shown to help their patient-physician relationship; and physicians from disadvantaged communities were more likely to return to serve those communities.

Isaac Davison is an Auckland-based reporter covering health issues. He joined Herald in 2008 and has previously covered environmental, political and social issues.

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