There are strong echoes of the Clark Labour government’s “Closing the Gaps” programme in the system now being used by Auckland surgeons to prioritise patients on ethnicity, geographic location and equity grounds.

“Closing the Gaps” sought to assist socio-economically disadvantaged Māori and Pasifika through specially targeted programmes. Labour had campaigned on this at the 1999 election and started to implement the policy in its first Budget in 2000. Labour’s aim was to combat the systemic racism it saw at the time by confronting socio-economic disparities directly and promoting greater opportunities for Māori and Pasifika.

Although “Closing the Gaps” was popular with Māori, it was dogged from the outset by strident political opposition, culminating in Don Brash’s infamous Orewa Rotary Club speech in early 2004, where he argued for one standard of citizenship for all. The government had stopped referring to “Closing the Gaps” from mid-2000, talking instead about “reducing inequalities”. Nevertheless, it was so stung by the Orewa speech, and the positive response it attracted, that it established an audit of all government programmes to ensure they were being administered on the basis of need, rather than ethnicity. 

Between 1999 and 2004 Labour’s language deliberately changed from an overt, aggressive emphasis on “Closing the Gaps” with Māori and Pasifika to one of meeting needs and reducing inequalities. But the underlying emphasis on improving the socio-economic status of Māori and Pasifika was retained, as they remained the groups where need was the greatest.

Overall, there were material gains by Māori and Pasifika during the entire nine-year term of the Clark government. But Labour stopped acknowledging these after the Orewa speech. Ironically, this gave rise to a sense that Labour was actually neglecting the interests of Māori and Pasifika, reinforced by the foreshore and seabed controversy later in 2004, which was the catalyst for the formation of the original Māori Party.

The same focus on reducing inequality lies behind the ethnicity priority approach Auckland surgeons began following earlier this year to improve Māori and Pasifika access to surgical services. With statistics showing Māori currently have less access to specialist health services because of factors like geographic location, and seven years’ less life expectancy than non-Māori, there is a strong logic supporting the approach being taken in Auckland.

However, the political reaction has been no different from “Closing the Gaps” twenty years ago. The National and ACT Parties have decried the policy as separatist, saying that access to health services should not be determined by need not ethnicity, and that they will overturn it if they form the next government. Prime Minister Hipkins, reminiscent of Helen Clark after the Orewa speech, while defending the policy intent, has sought assurances from his Health Minister that “we are not replacing one form of discrimination with another”. Sounding more doctor than politician, as is her wont, her initial response has been that there are sound clinical reasons for the ethnicity focused approach. But in the meantime, plans to roll-out the initiative across the rest of the country have been put on indefinite hold.     

Already, as with “Closing the Gaps”, the focus of the government’s narrative is shifting from the process, to its intended outcomes. Just as “reducing inequalities” over twenty years ago was promoted by the Clark government as more palatable than “Closing the Gaps”, the early signs are that this government will shift its focus to “reducing disparities”, rather than talking too much about the mechanism by which it intends to achieve this.

But rather than retreat into its shell, and pretend the policy is not happening any more, the way Labour did after 2004, the current government needs to be more activist in explaining why it considers the ethnicity factor to be so important. After all, the evidence that Māori and Pasifika have worse health outcomes than everyone else, is overwhelming. Labour should feel on solid ground in focusing its approach on expanding health access to Māori and Pasifika to improve their life expectancy and overall quality of life, but without implying that this will come at the expense of the needs of others.

But if it decides to ignore the current policy debate, in the hope the controversy surrounding it will evaporate over time, it will run the strong risk, as happened in 2004, of being seen to be doing nothing, handing Te Pati Māori once more a strong weapon to beat it around the head with, but this time only four months before the election.

Given the way things are going right now though, in the words of American baseball great and legendary Malapropist, Yogi Berra, “it looks like déjà vu all over again.”