Discrediting science as “ideology”: when evidence becomes politically inconvenient

The unprecedented recent move by the minister of health to link his decision not to renew the appointments of the chair and deputy chair of the Medical Council of New Zealand | Te Kaunihera Rata o Aotearoa (MCNZ) to the Council’s consultation on statements covering cultural competence, cultural safety and Māori health¹ represents a threat to the safety of our health system that ought to concern all New Zealanders. This is not only a troubling example of political interference in independent health professional regulation, but the Government’s ideological rejection of evidence for the role health professionals play in reducing avoidable variation in clinical outcomes directly promotes unsafe care and threatens to harm patients.

What is the real ideology here? The Government has publicly expressed views that a patient’s ethnicity is not relevant,² that ethnicity-based targeting is lazy³ and that the health system should be colourblind⁴, in contradiction to volumes of scientific evidence. Research consistently shows that New Zealand’s health outcomes are strongly patterned by ethnicity. Inequities exist for various ethnic groups, but those for Māori are the most confronting, consistent and compelling. Not only do Māori experience higher health need,⁵ but Māori receive less care, later care, poorer-quality care and experience worse health outcomes.^6–11 Experiences of racism, or differential treatment based on ethnicity, are common within our health system, with measurable impacts on health outcomes.^12,13 Cultural mismatch between health professionals and their patients is associated with differences in patient experience, communication quality, treatment engagement and adherence, clinical decision making and clinical outcomes.¹⁴

Reducing avoidable inequities in population health has long been an explicit goal of governments, including New Zealand’s,¹⁵ a commitment reaffirmed by intergovernmental agreements at the World Health Assembly^16,17 and United Nations.¹⁸ The scientific and health community internationally have produced decades of evidence on inequitable outcomes, their causal pathways and interventions to reduce this unfair and avoidable variation in health. Causes of ethnic health inequities are complex, and multiple factors contribute independently and synergistically.¹⁹ However, research demonstrates that the healthcare system, including the role of health professionals, is an important and modifiable determinant. Eliminating Indigenous and ethnic health inequities requires culturally competent and culturally safe health workforces and systems.²⁰ Patient safety and clinical outcomes are compromised when health professionals exercise bias, whether intentional or not. This is why health professional training institutions and regulatory bodies around the world are increasingly including cultural competency and cultural safety in health professional accreditation standards and training programmes.^21–26 Rather than being “ideological”, it is an evidence-based intervention to improve the quality and fairness of our health system.

Other evidence-based and internationally recommended interventions to reduce health inequities have been stopped under the current Government. These include repealing our world-leading Smokefree legislation; reversing plans to lower the bowel cancer screening age for Māori and Pacific peoples despite modelling showing this would help narrow current marked ethnic inequities;²⁷ and, more recently, removing the Special Authority ethnicity eligibility criterion for diabetes medicines for Māori and Pacific people, despite evidence showing this special measure was working to reduce inequities in access and outcomes.²⁸ Public health progress is being threatened by backwards moves on climate change, child poverty and alcohol regulation.

The scientific evidence for what works to reduce ethnic inequities in health outcomes is strong, and well researched in New Zealand. One-size-fits-all approaches are inherently inequitable.²⁹ Evidence clearly tells us that a mixture of universal and targeted measures are required.³⁰ The fundamental problem, therefore, is that the science does not align with the ideological position of the current Government. And because the Government’s position is not evidence based, they need to silence and discredit the scientists and health professionals who speak out.

Is this the real reason the Government is threatened by the leadership on health professional regulatory bodies? The minister’s removal of the MCNZ leadership is not an isolated move. Eight members were recently removed from the Nursing Council of New Zealand, reducing Māori representation from six members to one, and decreasing the proportion of members with nursing experience.³¹ The proposed Health Practitioners Competence Assurance Amendment Bill gives the minister greater powers to direct health professional regulatory bodies to align with “health system priorities” and government targets.³² Doctors employed by Health New Zealand – Te Whatu Ora are increasingly being muzzled, by internal and political pressure, from speaking out publicly on issues of concern.³³ Proposed Pae Ora (Healthy Futures) Act changes will require all Health New Zealand – Te Whatu Ora staff and contractors to uphold political neutrality, and comply with conduct standards relating to public service values and principles.³⁴ Following the abolition of Te Aka Whai Ora – Māori Health Authority, Māori advisory groups across the sector are being weakened or disestablished.

Collectively, this is a dangerous direction that should worry all New Zealanders. New Zealand’s health system has safeguards for good reason—to protect the public from harm. These safeguards, which include ongoing assessment of professional competence, mandatory reporting of concerns, stronger patient rights, independent oversight, quality monitoring and mechanisms for public accountability, are all intended to detect problems earlier, amplify patient voices and reduce the risk of harm being repeated. When the Government explicitly criticises the technical work of an independent health professional regulatory body in determining professional competencies, it threatens to undermine one of the fundamental safeguards of our health system.

This reminds us why it is so important for health professionals to continue to speak up. Health professionals are not merely technicians tasked with implementing government policy; we are independent professionals whose primary ethical responsibility is to patients and populations. When government policies undermine access to effective care, worsen health outcomes, increase inequities or contradict established scientific evidence, health professionals have a duty to raise concerns. Silence in the face of foreseeable harm is not neutrality; it risks becoming complicity. New Zealand incidents such as the Cartwright Inquiry³⁵ reinforce the importance of health professional advocacy when systems fail patients. Public advocacy, conducted honestly and respectfully and grounded in evidence, is not a departure from medical professionalism but one of its highest expressions. Indeed, when governments are unwilling to heed expert advice, public transparency and open debate become essential safeguards for both democracy and public health.

Health is political. Governments do need to make difficult decisions about investment in health and wellbeing. However, this investment must be informed by best practice, where health experts can freely provide robust evidence. Governments of all political persuasions find expert advocacy uncomfortable when it exposes gaps between political priorities and evidence-based interventions. As a result, there can be pressure, whether overt or subtle, to discourage experts from speaking out, through criticism, accusations of partisanship, restrictions on public comment, threats to employment or funding or efforts to undermine professional credibility. A healthy democracy, and a safe healthcare system, depend on protecting the ability of clinicians and scientists to speak honestly about risks to health. The public interest is best served when evidence can be debated openly, professional expertise can be expressed without fear, and policy decisions remain accountable to the people whose lives they affect. Pursuing an ideology that contradicts evidence is undermining clinical excellence, safe care and decades of efforts to reduce avoidable variation in health outcomes.

We as health professionals have an obligation to use our power and our voices to continue to state the evidence, even when this truth is politically inconvenient. Especially when it is politically inconvenient.