Racism, Justice, and Bowel Screening Policy: A Cautionary Tale in Aotearoa New Zealand

Ms Sophia Barham1

1University Of Otago, Dunedin, New Zealand

Creating health equity for disadvantaged groups in our society is a long held goal of both public health and bioethics alike. However, achieving this goal remains a challenge for governments around the world. In Aotearoa New Zealand, there is a clear need to improve health outcomes for Māori, the tāngata whenua (indigenous peoples) of this nation, and the government has clearly outlined this as a priority for the New Zealand health system. A recent decision, however, by the Crown to not lower the bowel screening age for Māori, despite evidence that this will increase bowel cancer inequities, goes against this goal of equity. Using this case study, a question is posed: Are governments ethically obligated to promote equity and justice in health policy and programmes? This presentation looks at the ethical principles and theories that may have justified the government’s decision not to lower the bowel screening age for Māori, and argues that a duty of care and commitment to justice is something that the New Zealand Government has an ethical obligation to do, and that this obligation is inextricably linked to a rights based approach focussed on honouring Te Tiriti o Waitangi (The Treaty of Waitangi). Overall, this case study acts as a cautionary tale for health policy and decision makers, and argues that all health decisions should prioritise equitable health outcomes for disadvantaged groups.


Sophia Barham is a Master of Health Sciences student at the University of Otago. Sophia has a strong interest in health systems and health policy, as well as equity, justice, and indigenous health. Her Master’s thesis is an ethical analysis of ICU bed rationing, looking at how ICU bed rationing can be equitable for Māori and uphold Māori, as well as western, values.

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