Health of Maori

prompted CPSO registrar Dr Michael duct is now mandatory, a provision critiing the CPSO absolute regulatory and disDixon, who claims that court interference cised by many Ontario doctors for disre- 1 ciplinary control over Ontario doctors, with college powers has become systemgarding patient rights, identification being including licensing and control of the atic, to criticise Canada’s top court for a inevitable. A full range of sanctions rang- 1 physical buildings where physicians are decision that "undermines the college’s ing from reprimand to lifetime loss of allowed to practise, a move seen by some licence are available to disciplinary com- 1 as a means of regulating the number and authority to govern the practice of medicine". j mittees for any level of sexual offence1 location of doctors in the province. Also The registrar also chastised the Ontario except intercourse, which carries a objectionable to the OMA are Bill 100 judiciary for rulings "inconsistent with the mandatory minimum punishment of provisions for the creation of a "quality standards society expects of physicians licence revocation for five years. In1 assurance program" (QMP), which gives and others in positions of power and trust,essence, the five-year suspension is a prothe CPSO power to refer any doctor withand inconsistent with pending legislation". fessional death sentence if the College’s1 in its jurisdiction who is suspected of any Specifically, he was referring to Bill 100, disciplinary findings are upheld on appeal1 form of incompetence or improper conto a divisional court, since obstacles to duct to a OMA investigative committee passed as an amendment to the 1991 Regulated Health Professions Act (see Lancet : reinstatement are formidable. Offenders 1 for examination. Although the QMP com1992; 340: 1400-01), which will not must convince the College and "society at mittee will not be involved in sexual misbecome law until it and the original legislarge" of their successful rehabilitation by1 conduct cases except for "minor lation are simultaneously "proclaimed" on psychiatric counselling, pay a Can$ offences (improper gestures or verbal conJan 1, 1994. In large part, the delay in 35 000 conviction fine, plus a$10000 duct), it can in all other competency and Royal assent has been orchestrated by the victim’s compensation fine, and reimburse v misconduct cases impose terms, condithe College for investigating and disciplinCPSO, which has worked through the rections, and limitations, including suspenommendations of its own Task Force on ing their case-an amount that in one sion of a doctor’s licence for up to six Sexual Abuse for two years, writing Bill Manitoba misconduct hearing (not involvmonths without appeal or recourse to pro100 in collaboration with government and ing sex) exceeded$230 000. j cedural safeguards. in in with the the OMA consultation OMA. Although agrees ostensibly principle What remains unclear, however, is how Intended to send a clear message to the with the need for stiff sexual misconduct much power the Ontario government will courts, Bill 100 curtails the judiciary’s penalties, it believes the CPSO used Bill allow the CPSO to wield, and how far it ability to reduce penalties imposed by the 100 to grab sweeping new powers.1 will push when the regulation becomes College for serious sexual misconduct. As According to Dr John Gray, an OMA law. The OMA and the Canadian Medical it now stands, sexual misconduct under executive included in the drafting process, Protective Association, which represents the Act is broken into three categories, the the College wrote amendments in secret1 physicians in disciplinary hearings, are least serious being improper words and with the Ontario government that were1 already anticipating appeals to the gestures, followed by inappropriate sexual "slipped into Bill 100 at the llth hour"Supreme Court under charter of rights touching and sexual intercourse with a for passage into law. The amendmentsguarantees. patient. Further, peer reporting of doctors have little to do with sexual misconduct,1 suspected of any level of sexual miscon-says Gray, but everything to do with giv- Gordon Bagley "

the unskilled and under-educated. Low socioeconomic status contributes to the grim catalogue of health statistics Like other former far-flung corners of the detailed by the Public Health Commission Empire, New Zealand continues to bear report. Maori have more than double the the legacy of colonisation. Although, as a European rate for hepatitis B, and nation, New Zealand enjoys a relatively fifteen times the European rate for rheumatic fever. Maori have disproporhigh standard of health by world stanthe health status of the dards, indigenous tionately high hospital admission rates for all cancers, asthma, pneumonia, and diainhabitants-the Maori-is poor, resembetes mellitus. The current death rates for bling in some aspects a third world subcoronary heart disease among Maori are population within the larger society. This discrepancy was highlighted in the Public the highest in the OECD group of countries. Maori, especially women, are heavy Health Commission’s report, Our Health, Our Future: The State of Public Health in smokers, a tradition adopted during the earliest years of European settlement of New Zealand, 1993. This report is the first New Zealand. The incidences of cancer of in what is intended to be an annual assessthe lung among Maori men and women ment of the nation’s health. are the highest reported from 166 cancer 13% of New Zealanders are Maori. It is Maori a young population; only 4-3% of registries throughout the world, and the death rate of Maori women from lung are over 60, compared with 17-1% of noncancer is the highest in the OECD counMaori. This difference reflects both a tries. and the birth rate Maori higher among Total infant mortality in New Zealand lower life-expectancy of the Maori populais one of the worst in the OECD countion compared with New Zealanders of tries, with rates highest for Maori. Sudden European descent. Although fiercely infant death caused 47% of deaths of proud of their culture and language, Maori infants, compared with 28% of Maori lost much of their economic base non-Maori. Maternal smoking and bedthrough land sales and confiscations after the New Zealand wars of the nineteenth sharing are thought to be factors here. women are also more at risk of lowMaori in New ZeaThe downturn century. land’s economy from the mid-1980s has birth-weight babies. had a particularly strong impact on Although such discrepancies between Maori, who are over-represented among Maori and European in New Zealand lead

Health of Maori

46

periodic outbreaks of hand-wringing among health authorities, Maori groups have noted that they rarely lead to action

to

or a reallocation of resources. They say that while researchers’ careers benefit from research on Maori, the constant repetition of bad news about the Maori race results in a form of victimisation. Increasingly there are calls for Maori control of research and data on Maori. The National Cervical Screening Programme has a Kai Tiaki or guardian group that controls the release of aggregated Maori data, and there are demands that a separate Maori committee should be established alongside the proposed national ethical committee to monitor all research involving Maori. In 1992 the government established two small Maori-run research centres-Te Manawa Hauora-at the Wellington School of Medicine and Massey University. The Wellington centre is run by Prof Eru Pomare, a descendant of Sir Maui Pomare, the first Maori doctor employed by the Department of Public Health. The centres work with Maori tribal groups to carry out their own research, Pomare arguing that academics do not have a monopoly on carrying out valid research.

Current projects are focusing on smoking and appropriate health promotion and screening programmes for Maori. Sandra

Coney