NZREX Cultural Safety & Māori Health 2 — Questions and Answers
Question 1: Which of the following best describes 'institutional racism' in the NZ health system?
- Policies and practices within health organisations that produce inequitable outcomes for Māori without necessarily involving individual racist intent (Correct answer)
- Individual prejudiced attitudes of specific health workers
- Māori patients choosing not to engage with the health system
- Funding shortfalls unrelated to ethnicity
Correct answer: Policies and practices within health organisations that produce inequitable outcomes for Māori without necessarily involving individual racist intent
Institutional racism refers to systemic policies, practices, and norms within organisations that result in worse outcomes for racialised groups — often without individual prejudice. In NZ health, this manifests as inequitable access, quality, and outcomes for Māori.
Question 2: The principle of 'equity' in Te Tiriti o Waitangi is associated with which article?
- Article 3 — equal rights and citizenship for all New Zealanders (Correct answer)
- Article 1 — Crown governance
- Article 2 — Māori rangatiratanga
- Article 4 — freedom of religion
Correct answer: Article 3 — equal rights and citizenship for all New Zealanders
Article 3 of Te Tiriti guarantees Māori the same rights and privileges as all New Zealand citizens (ōritetanga/equity). In health, this underpins the obligation to ensure Māori achieve health outcomes equivalent to non-Māori.
Question 3: A Māori patient presents with chronic pain. Which approach is most consistent with culturally safe practice?
- Explore the patient's own understanding of the pain including any spiritual or cultural dimensions, and involve whānau if appropriate (Correct answer)
- Treat the physical pain only and avoid raising cultural topics
- Assume the patient prefers traditional Māori healing over Western medicine
- Refer immediately to a Māori health provider without assessment
Correct answer: Explore the patient's own understanding of the pain including any spiritual or cultural dimensions, and involve whānau if appropriate
Culturally safe practice involves exploring the patient's own health beliefs, including spiritual dimensions, and integrating this with biomedical care. Whānau involvement and the patient's preferences should guide the approach.
Question 4: Which of the following is an example of a social determinant of Māori health inequity?
- Disproportionate Māori representation in lower socioeconomic groups, leading to reduced access to healthcare (Correct answer)
- Māori genetic susceptibility to specific diseases
- Māori cultural practices that prevent healthcare engagement
- Lack of Māori interest in preventive care
Correct answer: Disproportionate Māori representation in lower socioeconomic groups, leading to reduced access to healthcare
Social determinants including poverty, housing insecurity, unemployment, and reduced educational opportunity — all of which disproportionately affect Māori — are major drivers of Māori health inequity. These are the result of historical colonisation and ongoing systemic disadvantage.
Question 5: In the context of Māori health, what does 'taha wairua' refer to and why is it clinically relevant?
- Spiritual health — relevant because spiritual wellbeing affects overall health and may influence treatment decisions and recovery (Correct answer)
- Physical health — relevant to medication management
- Mental health — relevant to psychiatric assessment only
- Family health — relevant to social history only
Correct answer: Spiritual health — relevant because spiritual wellbeing affects overall health and may influence treatment decisions and recovery
Taha wairua (spiritual health) is one of the four walls of Te Whare Tapa Whā. For many Māori patients, spiritual wellbeing is integral to overall health. Ignoring this dimension results in incomplete, culturally unsafe care.
Question 6: A non-Māori doctor works in a clinic serving a predominantly Māori community. Which ongoing professional activity is most important for providing culturally safe care?
- Reflective practice examining own biases, cultural assumptions, and power dynamics (Correct answer)
- Completing a one-off cultural awareness course
- Learning conversational te reo Māori exclusively
- Employing Māori reception staff only
Correct answer: Reflective practice examining own biases, cultural assumptions, and power dynamics
Cultural safety is grounded in ongoing self-reflection about one's own cultural identity, biases, and the power dynamics inherent in clinical relationships. It is a continuous professional obligation, not a single training event.
NZREX Cultural Safety & Māori Health 2
Which of the following best describes 'institutional racism' in the NZ health system?