Kyle Tan Tēnā koutou katoa. Nō Malaysia ahau, ko Kyle Tan 陳嘉豪 tōku ingoa. I was trained in community psychology and population health. My research interest lies in the facilitators and barriers to achieving health equity for Asian and migrant communities. My recent participation in writing a submission alongside Dr Waikaremoana Waitoki for the Pae Ora (Healthy Futures) 2021 Bill prompted me to write this blogpost. Below, I outline evidence from existing research on Asian health to support the development of an Asian health strategy and the naming of racism as a health determinant in the Bill.
Asians in Aotearoa New Zealand
The 2018 Census identified Asians as the third largest ethnic group in Aotearoa (15.1%). Despite often being lumped into a single category, Asians in Aotearoa are incredibly diverse in terms of nationality, length of residence, religion, culture, and language. Te Tiriti o Waitangi establishes Tiriti relationships between Asians as tauiwi and Indigenous Māori. In this regard, Māori recognise Asians as Tangata Tiriti (people of the Tiriti) who sit within the Crown side of Te Tiriti. In Article 3 of Te Tiriti (oritetanga or equality), Asians have equal rights and privileges as Pākehā and Māori; we are able to practise our culture freely and maintain the ways of living of our ancestors.
Asians in the Pae Ora Bill
The Pae Ora Bill replaces the existing 20 District Health Boards with one entity, ‘Health New Zealand’ (as a Crown entity), which will work in partnership with an independent Māori Health Authority. This centralisation aims to establish common principles to guide health providers and organisations to work together in improving the health of all New Zealanders. While the Bill aspires to reduce health disparities for Māori and minoritised ethnic communities by honouring Te Tiriti o Waitangi, the bill in its current form fails to recognise racism as a determinant of health and to acknowledge the role of the Government as kāwanatanga in enhancing cultural responsiveness to Asians in health structures and systems. A focus on oritetanga indicates a need to employ an equity lens to achieve pae ora for all people in Aotearoa. However, I was dumbfounded to find that “Asian appeared 0 times in 0 clauses” when searched in the Bill. I got in touch with representatives from Asian organisations and community groups to find out their impression of the Bill. The Asian Caucus of the Public Health Association highlighted that the deliberate exclusion of Asians in the bill would lead to missed opportunities to include Asians in national directions of health structure reform and regional and locality planning of healthcare delivery. Indeed, the invisibility of Asians in the Bill perpetuates the settler colonial narrative of Asians as “inherently foreign” despite the long history of Asian migration in Aotearoa since the 1860s.
Racism towards Asians: What do we know?
The Asian Network Inc (TANI) released the Asian Public Health Report in 2021 , which noted Asians in Aotearoa face the highest rates of discrimination, often greater than or equal to the rates experienced by Māori. Critical race theory contends that contemporary racism is integral and normal rather than aberrational. Racism can appear relatively ordinary in many instances and as a result it can be difficult to address explicitly. While some Asians do experience overt racism (e.g., discrimination and violence), which has spiked during the pandemic due to the politicising efforts of political leaders and the rise of conspiracy theories, the experience of institutional racism among Asians is ubiquitous. Institutional racism in Aotearoa refers to an entrenched pattern of differential access to societal goods, services, and opportunities that stems from White supremacy that (consciously and unconsciously) considers Whiteness as neutral and normative while racialising other ethnic groups. Earlier this year, I listened to the podcast series “The Elephant in the Bedroom”, which discussed the existence of racial hierarchy and social class systems when Asians interact and form social relationships with other ethnic groups. The hosts spoke from their experiences as Asians and interviews with friends, and they found evidence of unfair power dynamics manifesting as internalised racism within ourselves, and stereotypes that prevent meaningful intercultural and interracial bonding. Research shows Asians experience unique stratification along the racial hierarchy as we are racialised through a triangulation framework vis-à-vis the racial position of Pākehā and Indigenous Māori, migration and refugee policies, and narratives of ‘model minority’ and ‘grateful migrants’ that impose the burden of assimilation according to White norms. As we heard from Dr Bev Hong and other Asian community champions in the Te Tiriti-based Future webinar, Asians have long been subjugated to institutional racism through forced acculturation processes that compel us to value individualism over our own cultural systems, adopt an English name, converse in a Kiwi accent, and forgo cultural identity in pursuit of a unitary “Kiwi” identity. Racism at interpersonal and institutional levels has detrimental impacts on Asians’ access to employment, education, health care and support services, which will subsequently contribute to poorer health outcomes. To mitigate the effects of institutional racism, scholars in Aotearoa have urged for the centering of a Te Tiriti framework as an anti-racism praxis across institutions to prioritise Māori, Pasifika, Asian, and other minoritised ethnicities’ responses to racism.
Recommendation 1: Naming Asians in the Pae Ora Bill and the New Zealand Health Bill
In a review conducted by one of our WERO colleagues, Dr Rachel Simon-Kumar, she and her team found very few studies on Asians’ health conditions and their determinants in Aotearoa. The relative invisibility of conversation around Asian health is related to the lack of recognition of Asians as a priority group. Also evident in the Pae Ora Bill, which falls short of having Asian representation and acknowledging Asian health determinants, is that the cycle of “not a priority – no funding – no evidence generated – no problem found” is likely to harm Asian health for years to come. While Asians do not always have the worst health statistics, the Asian Public Health Report 2021 found Asians to have the lowest rate of accessing health care and social support services compared to other ethnicities in Aotearoa. Barriers to accessing healthcare include the limited availability of culturally appropriate services, including those operating on a family-centred care approach; fear of discrimination; and institutional racism that delegitimises Asians’ expertise and experiences of health. International students and new migrants have an even lower rate of healthcare usage as they face language barriers or are unaware of available services. In this regard, tailored culturally responsive strategies, including an Asian health strategy, are required to cater to the specific health needs of Asians and to enhance and resource health research and community organisations to better respond to racism as a social determinant of health.
Recommendation 2: Naming Racism in the Pae Ora Bill and the New Zealand Health Plan
A Critical Tiriti Analysis on the Pae Ora Bill displayed its fair engagement with most Te Tiriti principles to address equity issues for Māori, although the wairuatanga (spirituality) aspect was absent. The WERO research team noted that a Te Tiriti-informed bill is a step towards demonstrating Crown responsibilities within a relational sphere (i.e., balancing the rangatiratanga and kāwanatanga spheres) in which Māori and the Crown share governance over the national health structures. However, the current bill does not go far enough in identifying racism as a major determinant of health and the underlying cause of ethnic health inequities in Aotearoa. Likewise, the search result for the term “racism” in the Bill was “Racism appeared 0 times in 0 clauses”. A bill that focuses on healthcare delivery but not on the health determinants exemplifies an “ambulance at the bottom of the cliff” approach, which will have minimal impact in preventing health issues. In order to fully uphold the aspirations of Pae Ora, the newly formed Health New Zealand and Mental Health Authority play crucial roles in examining structures that perpetuate racism and developing anti-racist interventions and policies to reduce ethnic health inequities. It is time to recognise the effect of settler colonialism that has normalised Whiteness across institutions designed to benefit Pākehā in this country, and to address the resultant inequitable health outcomes that Māori, Pasifika, Asian and other minoritised ethnic groups face. For more details, readers are welcome to refer to the full submission made by WERO. Kyle Tan has a PhD in Psychology from the University of Waikato. He is a Research Fellow in the WERO research programme.