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Figure 9.2: Refugees as ‘Others’

Excluded populations Prioritising populations ‘Auckland’s issues’ Refugees as ‘Others’ Introduction

Chapter nine is the first of five data analysis chapters which will explore, in the context of the New Zealand health system, how refugee groups are overlooked as social, cultural and linguistic citizens and the opportunities that exist for inclusion. Although it is recognised that there are a number of difficulties with the concept of social exclusion, it is argued that Samer’s (1998) concept-process (see chapter one) has utility in terms of unpacking what exactly refugees are excluded from in New Zealand health systems.Samers (1998, p.126) raises the question of the representation of minority groups as a matter of social visibility, or of ‘invisibility’ in government reports and surveys. Chapter nine shows that the matter of whether minority groups are discursively excluded or included has real effects on the affected populations, as well as upon the regions and organisations that serve them.

Participant Data - Refugees as ‘Others’

In the conceptual category ‘Refugees as ‘Others’’, shown in Figure 9.2, the ethnic data collection systems used in health care report refugee groups only as ‘Other'. As a result refugee groups are not a priority population in national reducing inequalities strategies (Ministry of Health, 2002d). In the study, the health service providers who were interviewed found it difficult to plan for and to provide services for refugee groups within existing service specifications. In essence, what participants were reporting was the growing presence of refugees in health services in the Auckland region, but that they were omitted from any specifically targeted population health programmes. This phenomenon is categorised as ‘excluded populations’ in Figure 9.2.

Excluded Populations

In chapter seven it was explained that the term ‘Others’ is the category given by the Ministry of Health to populations who are not Maori, Pacific peoples, or New Zealand Europeans. This section explores the impact on service provision of being designated as the ethnic category ‘Other’. There are two main issues in this section: the first issue is the discursive exclusion of refugee groups in New Zealand studies of ethnic group disparities and inequalities; and the second is discriminatory practices towards refugees from health care workers. In the study, health professionals expressed the view that designating refugee groups as ‘Other’ meant that they missed out on targeted funding and interventions, when they had significant health inequalities. Service managers stated that often their efforts to highlight refugee health issues in national policies were perceived as merely ‘Auckland’s issues’. Health service requests to central funding agencies for additional funding or resources to address the unmet needs in refugee groups had therefore elicited no, or a negative response.

Discursive Exclusion

The first point—discursive exclusion—demonstrates how the absence of strategic direction from the Ministry of Health impacts on health care delivery to refugee groups. Mostly, health policies and contracting processes do not specify refugees as a target population. Therefore at an operational level there were no service plans or funding for refugee groups. The provision of appropriate services for refugees and the funding of these were left to individual health services to manage. For instance, in the primary health care sector, in a Union Health service, refugees and new migrants made up 47 per cent of the client caseload. A significant proportion of the clients did not speak English and there were no interpreters available to the service. The practice was funded on a fixed capitation rate based on standard consultation times of fifteen minutes. The manager of the service stated that the funding available did not meet the costs of providing care for refugees and asylum seekers. The service’s budget deficit had been only partially relieved by a one-off reducing inequalities contingency fund which provided free access to primary health care for under 18 year olds (Ministry of Health, 2002d). The service had met the criteria for funding from an American charitable trust, the Baxter Foundation, because the service could demonstrate, that their refugee health project did not have:

... a level of government support (Kate, 1: 133).

Another example of discursive exclusion is provided by the Royal New Zealand Plunket Society (Plunket), a national provider of child and family health services. The Plunket Society clinical and support programmes include: home visits and child health clinics; parent education; car seat rental schemes; child safety programmes; ante-natal education classes; and community support initiatives, based on local needs (The Royal New Zealand Plunket Society, 2005). The service is a not for profit organisation and relies on an extensive volunteer support network. In a further example of the ‘one-off’ funding rounds introduced to reduce inequalities, Plunket were given additional funding to improve child health in high needs areas of the Auckland region. However, in analyses of areas of deprivation in the Auckland region there:

… was nothing specifically said about new immigrants… just…how many people living in deprivation areas…The idea behind it was…home visiting for high need families and high needs families translated at the beginning as having been Pacific Island, Maori, but then of course gradually there has been an increase of new immigrants into Mt Roskill…(Jo, 1: 18).

Many of these immigrant families were refugees from Somalia, Ethiopia, Eritrea, Iraq, Iran and Afghanistan (Lawrence & Kearns, 2005).

Refugee groups have not been included in any New Zealand deprivation studies and have been ‘invisible’ in Samer’s (1998) discursive sense in government reports such as the Ministry of Social Development Social Report. The annual report gives an indication of social well-being in New Zealand population groups in areas that include health, education, employment and income (MSD, 2006). The Social Report could potentially be used to monitor the disparities between refugee and other New Zealand populations and provide a basis for improving their social conditions.