Worse outcomes for Māori after surgery described as possible breach of the Treaty of Waitangi

Māori are more likely to die following surgery than Pākehā, a new study has found, the researchers saying the results could be seen as a breach of indigenous rights.

They looked at data from nearly 4 million procedures carried out between 2005 and 2017 and found "Māori had higher rates of 30- and 90-day post-operative mortality across most broad procedure categories", especially for elective procedures.

For acute procedures, in the month following the mortality rate for Māori was 14 percent higher than for European/Pākehā, and for elective procedures, it was 35 percent worse. 

For some procedures, particularly involving the heart, they were more than twice as likely to die. 

"There's quite compelling evidence," said Jason Gurney, Māori epidemiologist and director of the Cancer and Chronic Conditions Research Group at the University of Otago. 

 "We see it across the board, across a broad range of categories of surgical procedure… Māori patients undergoing an elective amputation for example... are around twice as likely to die compared to European patients within 30 days. Whilst only a small proportion of those patients will die, the disparity between Māori and Europeans is reasonably high."

The study, published in the New Zealand Medical Journal on Friday, said "given the consistent international patterns of worse access to the determinants of good health, impaired access to healthcare and lesser quality of healthcare provided to indigenous compared to non-indigenous populations, it is unsurprising that there are indigenous disparities in post-operative mortality".

"However, these disparities are in breach of the United Nations Declaration on the Rights of Indigenous Peoples, which states that Indigenous peoples have both the right to good health and the 'right to access, without any discrimination, all social and health services'.

"In New Zealand, disparities in outcomes for the Indigenous Māori population can be considered a breach of the Treaty of Waitangi, New Zealand's founding document."

While some of the difference in outcomes could be traced back to comorbidities, even when these were accounted for the disparity remained. Dr Gurney said part of it was down to lower access to top surgeons and pre- and post-op care. 

He said upcoming reform of the health system needed to be comprehensive. 

"Our actions really need to be from system right through to scalpel. We need to realise the system was set up to work well for European patients, not necessarily well for Māori patients. We need to think about the... preoperative environment. things might not be working as well for Māori as they do for European patients. So Māori may not have as good access to things like prehabilitation or primary care." 

Previous research has found consistent disparities in access and outcomes for Māori in the health system

Then-Health Minister David Clark admitted in 2020 it was rife with institutional racism. Earlier this year the Government said it would overhaul the health system completely, including the creation of a separate Māori Health Authority.