Maori Medical Student and Physician Exposure to Racism, Discrimination, Harassment, and Bullying.

Importance: Discrimination, bullying, and harassment in medicine have been reported internationally, but exposures for Indigenous medical students and physicians, and for racism specifically, remain less examined. Objective: To examine the prevalence of racism, discrimination, bullying, and harassment for Maori medical students and physicians in New Zealand and associations with demographic and clinical characteristics. Design, Setting, and Participants: This cross-sectional study used data from an anonymous national survey of Maori medical students and physicians in New Zealand in late 2021 and early 2022. Data were analyzed from March 2022 to April 2024. Exposures: Age, gender, marginalized status (ie, in addition to being Maori, belonging to other groups traditionally marginalized or underrepresented in medicine), year of medical school, year of graduation, and main work role. Main Outcomes and Measures: Direct and witnessed racism, discrimination, bullying, and harassment were measured as any experience in the last year and ever. Any exposure to negative comments about social groups and witnessing discriminatory treatment toward Maori patients or whanau (extended family). Considering leaving medicine, including because of mistreatment, was measured. Results: Overall, 205 Maori medical students (median [IQR] age, 23.1 [21.6-24.3] years; 137 [67.2%] women) and 200 physicians (median [IQR] age, 36.6 [30.1-45.3] years; 123 [62.8%] women) responded. Direct and witnessed exposure to racism (184 students [91.5%]; 176 physicians [90.7%]) and discrimination (176 students [85.9%]; 179 physicians [89.5%]) ever in medical education, training, or work environments was common. Ever exposure to witnessed and direct bullying (123 students [66.5%]; 150 physicians [89.3%]) and harassment (73 students [39.5%]; 112 physicians [66.7%]) was also common. Most respondents reported witnessing Maori patients or their whanau being treated badly in clinical settings, in direct interactions (67 students [57.8%]; 112 physicians [58.9%]) or behind their backs (87 students [75.0%]; 138 physicians [72.6%]). One-quarter of Maori medical students (45 students), and 37.0% of physicians (61 physicians) had considered leaving or taken a break from medicine because of these experiences. Additional marginalized statuses were significantly associated with any direct experience of mistreatment in the last year for students and physicians. Exposure to some forms of mistreatment were also significantly associated with higher likelihood of thinking about leaving or taking a break from medicine for physicians. Conclusions and Relevance: In this study, Maori medical students and physicians reported high exposure to multiple forms of racism, discrimination, bullying, and harassment in medical education, training, and work environments, requiring an urgent response from medical institutions.

The impact of racism on subsequent healthcare use and experiences for adult New Zealanders: a prospective cohort study.

BACKGROUND: Racism is an important determinant of health and driver of racial/ethnic health inequities. Experience of racism has been linked to negative healthcare use and experiences although most studies have been cross-sectional. This study examines the relationship between reported experience of racism and subsequent use and experience of health services. METHODS: This is a prospective cohort study design. The 2016/2017 adult New Zealand Health Survey (NZHS) provided the sampling frame and baseline data on exposures, health status and confounders. This stand-alone study invited all exposed individuals to participate when sampled based on their reported experience of racism (ever), stratified by broad ethnic groupings (Maori, Pacific, Asian, European/Other). Equal numbers of unexposed participants were selected for invitation using propensity score matching (propensity to experience racism, based on key available predictive factors). Follow-up was one to two years after NZHS interview. Outcome variables (last 12 months) were: unmet healthcare need (overall, for mental health, for a general practitioner); satisfaction with usual medical centre; and experiences with general practitioners (explaining care, involvement in decision-making, treated with respect/dignity, confidence and trust). Logistic regression models examining the association between experience of racism (at baseline) and health service use and experience (at follow-up) used doubly-robust estimation to weight for propensity scores used in the sampling with additional adjustment for confounders. RESULTS: The study had 2010 participants. Experience of racism (ever) at baseline was associated with higher overall unmet need at follow-up (adjusted OR (aOR) = 1.71, 95% CI 1.31, 2.23), with similar patterns for other unmet need measures. Experience of racism was associated with higher dissatisfaction with a usual medical centre (aOR = 1.41, 95% CI 1.10, 1.81) and with higher reporting of negative patient experiences. CONCLUSION: In line with how racism structures oppression, exposure to racism is largely felt by non-European groups in Aotearoa New Zealand. Experiences of racism potentially lead to poorer healthcare and healthcare inequities through higher unmet need, lower satisfaction and more negative experiences of healthcare. The health system has a critical role to play in addressing racism within healthcare and supporting societal efforts to eliminate racism and ethnic inequities.

'It absolutely needs to move out of that structure': Maori with bipolar disorder identify structural barriers and propose solutions to reform the New Zealand mental health system.

OBJECTIVES: This paper synthesises critique from Maori patients with Bipolar Disorder (BD) and their whanau to identify barriers and propose changes to improve the structure and function of the New Zealand mental health system. DESIGN: A qualitative Kaupapa Maori Research methodology was used. Twenty-four semi-structured interviews were completed with Maori patients with BD and members of their whanau. Structural, descriptive and pattern coding was completed using an adapted cultural competence framework to organise and analyse the data. RESULTS: Three key themes identified the impact of structural features of the New Zealand mental health system on health equity for Maori with BD. Themes involved the accessibility, delivery and scope of the current health system, and described how structural features influenced the quality, utility and availability of BD services for Maori patients and whanau. Structural barriers in the existing design, and potential changes to improve the accessibility, delivery and scope of BD services for Maori, were proposed including a redesign of operational, environmental, staffing, and navigation points (information, transition, fatigue) to better meet the needs of Maori with BD. CONCLUSION: A commitment to equity when implementing structural change is needed, including ongoing evaluation and refinement. This paper provides specific recommendations that should be considered in health service redesign to ensure the New Zealand mental health system meets the needs of Maori patients with BD and their whanau.

Understanding the context of hospital transfers and away-from-home hospitalisations for Maori.

In Aotearoa New Zealand, people regularly travel away from their home to receive hospital care. While the role of whanau support for patients in hospital is critical for Maori, there is little information about away-from-home hospitalisations. This paper describes the frequency and patterning of away-from-home hospitalisations and inter-hospital transfers for Maori. Data from the National Minimum Dataset (NMDS), for the 6-year period of 1 January 2009-31 December 2014, were analysed. Basic frequencies, means and descriptive statistics were produced using SAS software. We found that more than 10% of all routine hospitalisations constituted an away-from-home hospitalisation for Maori; that is, a hospitalisation that was in a district health board (DHB) other than the DHB of usual residence for the patient. One quarter (25.19%) of transfer hospitalisations were to a DHB other than the patient's DHB of domicile. Away-from-home hospital admissions increase for Maori as deprivation increases for both routine and transfer admissions, with over half of Maori hospital admissions among people who live in areas of high deprivation. This analysis aids in understanding away-from-home hospitalisations for Maori whanau, the characteristics associated with these types of hospitalisations and supports the development and implementation of policies which better meet whanau Maori needs. The cumulative impact of the need to travel to hospital for care, levels of poverty and a primarily reimbursement-based travel assistance system all perpetuate an unequal cost burden placed upon Maori whanau.

"If we can just dream " Maori talk about healthcare for bipolar disorder in New Zealand: A qualitative study privileging Indigenous voices on organisational transformation for health equity.

OBJECTIVES: This paper identifies barriers to equity and proposes changes to improve the organisation of healthcare in New Zealand for Maori with bipolar disorder (BD) and their families. DESIGN: A qualitative Kaupapa Maori methodology was used. Twenty-four semi-structured interviews were completed with Maori with BD and members of their family. Structural and descriptive coding was used to organise and analyse the data, including an analytic frame that explored participants' critique of attributes of the organisation of healthcare and alignment with Maori health policy. RESULTS: Transformation to the organisation of healthcare is needed to achieve health equity. Executive management must lead changes to organisational culture, deliver an equity partnership model with Maori, embed cultural safety and redesign the organisation of healthcare to improve wellbeing. Healthcare incentive structures must diversify, develop and retain a culturally competent health workforce. Information management and technology systems must guide continued whole system improvements. CONCLUSION: This paper provides recommendations that should be considered in planned reforms to the organisation of healthcare in New Zealand. The challenge remains whether resourcing for an equitable healthcare organisation will be implemented in partial fulfilment of promises of equity in policy.

Co-design for indigenous and other children and young people from priority social groups: A systematic review.

Background: Co-design has increasingly been posited as a useful approach for Indigenous peoples and other social groups that experience inequities. However, the relatively rapid rise in co-design rhetoric has not necessarily been accompanied by increased understanding of whether co-design works for these social groups, and how equity is addressed. Methods: We conducted a systematic review to identify the current state of co-design as theory and praxis within the context of health and/or disability related interventions or services, with a specific focus on equity considerations for Indigenous and other children and young people from priority social groups. Six electronic databases were searched systematically to identify peer-reviewed papers and grey literature (dissertation and theses) published between January 1, 2000 to December 31, 2020, and a hand-search of reference lists for selected full texts was undertaken. Results: Fifteen studies met the inclusion criteria. Although all studies used the term 'co-design', only three provided a definition of what they meant by use of the term. Nine studies described one or more theory-based frameworks and a total of 26 methods, techniques and tools were reported, with only one study describing a formal evaluation. The key mechanism by which equity was addressed appeared to be the inclusion of participants from a social group experiencing inequities within an area of interest. Conclusion: A dearth of information limits the extent to which the literature can be definitive as to whether co-design works for Indigenous and other children and young people from priority social groups, or whether co-design reduces health inequities. It is critical for quality reporting to occur regarding co-design definitions, theory, and praxis. There is an urgent requirement for evaluation research that focuses on co-design impacts and assesses the contribution of co-design to achieving equity. We also recommend culturally safe ethical processes be implemented whenever undertaking co-design.

Culturally competent, safe and equitable clinical care for Ma¯ori with bipolar disorder in New Zealand: The expert critique of Ma¯ori patients and Wha¯nau.

OBJECTIVE: Research designed to increase knowledge about Maori with bipolar disorder is required to understand how health services support wellbeing and respond to identified levels of community need. This paper synthesises the expert critique of Maori patients with bipolar disorder and their whanau regarding the nuances of cultural competence and safety in clinical encounters with the health system. METHODS: A qualitative Kaupapa Maori Research methodology was used. A total of 24 semi-structured interviews were completed with Maori patients with bipolar disorder and members of their whanau. Structural, descriptive and pattern coding was completed using an adapted cultural competence framework to organise and analyse the data. RESULTS: Three themes were evident from participants' critique of clinical components of the health system. Theme 1 established that the efficacy of clinical care for bipolar disorder was dependent on Maori patients and whanau having clear pathways through care, and being able to access timely, consistent care from clinically and culturally competent staff. Theme 2 identified the influence of clinical culture in bipolar disorder services, embedded into care settings, expressed by staff, affecting the safety of clinical care for Maori. Theme 3 focused on the need for bipolar disorder services to prioritise clinical work with whanau, equip staff with skills to facilitate engagement and tailor care with resources to enhance whanau as well as patient wellbeing. CONCLUSION: The standard of clinical care for Maori with bipolar disorder in New Zealand does not align with practice guidelines, Maori models of health or clinical frameworks designed to inform treatment and address systemic barriers to equity. Research also needs to explore the role of structural and organisational features of the health system on Maori patient and whanau experiences of care.

Bowel cancer screening age range for Maori: what is all the fuss about?

The current New Zealand Bowel Screening Programme (BSP) is inequitable. At present, just over half of bowel cancers in Maori present before the age of 60 years (58% in females and 52% in males), whereas just under a third of bowel cancers in non-Maori are diagnosed before the same age (27% in females and 29% in males). The argument for extending the bowel screening age range down to 50 years for Maori is extremely simple-in comparison to non-Maori, a greater percentage of bowel cancers in Maori occur before the age of 60 years (when screening starts). Commencing the BSP at 50 years of age for Maori with high coverage will help fix this inequity. In this paper we review the current epidemiology of colorectal cancer with respect to the age range extension for Maori.

Indigenous Peoples' Data During COVID-19: From External to Internal.

Global disease trackers quantifying the size, spread, and distribution of COVID-19 illustrate the power of data during the pandemic. Data are required for decision-making, planning, mitigation, surveillance, and monitoring the equity of responses. There are dual concerns about the availability and suppression of COVID-19 data; due to historic and ongoing racism and exclusion, publicly available data can be both beneficial and harmful. Systemic policies related to genocide and racism, and historic and ongoing marginalization, have led to limitations in quality, quantity, access, and use of Indigenous Peoples' COVID-19 data. Governments, non-profits, researchers, and other institutions must collaborate with Indigenous Peoples on their own terms to improve access to and use of data for effective public health responses to COVID-19.

A Collaborative Indigenous-non-Indigenous Partnership Approach to Understanding Participant Experiences of a Community-Based Healthy Lifestyles Program.

We describe the approach of an Indigenous-non-Indigenous research partnership in the context of a qualitative study which aimed to understand barriers and facilitators to engagement in a community-based healthy lifestyles program in Aotearoa/New Zealand. Informed by Kaupapa Maori research principles and by "Community-Up" research values, this collaborative approach between the mixed Maori-non-Maori research team effectively engaged with Maori and non-Maori families for in-depth interviews on participant experience, including with non-service users. "Community-Up" research principles allowed for a respectful process which upheld the mana (status, dignity) of the interview participants and the research team. Challenges included maintaining flexibility in our conceptions of ethnicity to reflect the complexity of modern family life in Aotearoa/New Zealand. We were committed to ongoing communication, awareness, and attention to the relationships that formed the basis of our research partnership, which allowed effective navigation of challenges and was critical to the study's success.

Observations by and Conversations with Health Workers and Hospital Personnel Involved in Transferring Maori Patients and Whanau to Waikato Hospital in Aotearoa New Zealand.

The predominant focus of Aotearoa New Zealand's public health system on biomedical models of health has left little room for meaningful engagement with holistic indigenous approaches. Culturally appropriate provision and support are recognized for their relevance and importance during hospital transferals. Hospital staff involved in transfers to one of New Zealand's trauma centers share their observations of whanau Maori engagement during an admission away from their home base. Sixteen key informants share their experiences, which are presented as strategies and challenges to whanau engagement. Three main themes highlight challenges within the health system that make it difficult for hospital staff to engage whanau in the desired ways and as often as both parties would like. Key informants described services and practices that are not designed with patients and their whanau in mind; instead they are designed by clinicians around the needs of administrative systems. As employees within the public health system, key informants felt powerless to challenge dominant settings. Nevertheless, employees managed to circumnavigate processes. Our findings highlight the need for continued decolonization and anti-racism work within public health settings.

Racism and health in Aotearoa New Zealand: a systematic review of quantitative studies.

BACKGROUND: Racism is an underlying cause of ethnic health inequities both in Aotearoa New Zealand and internationally. It is timely to synthesise racism and health research within New Zealand particularly given the current policy environment and shift towards addressing the health effects of racism. AIM: To review quantitative research examining self-reported experiences of racial discrimination and associations with measures of health (health conditions, health risk, health status and healthcare) in New Zealand. METHODS: MEDLINE, PsycINFO, Web of Science and CINAHL databases were searched for studies reporting on associations between experiences of racism and health. RESULTS: The systematic review identified 24 quantitative studies reporting associations between self-reported racial discrimination across a wide range of health measures including mental health, physical health, self-rated health, wellbeing, individual level health risks, and healthcare indicators. CONCLUSIONS: Quantitative racism and health research in New Zealand consistently finds that self-reported racial discrimination is associated with a range of poorer health outcomes and reduced access to and quality of healthcare. This review confirms that experience of racial discrimination is an important determinant of health in New Zealand, as it is internationally. There is a pressing need for effectively designed interventions to address the impacts of racism on health.

Survey of Barriers and Facilitators to Engagement in a Multidisciplinary Healthy Lifestyles Program for Children.

OBJECTIVE: To understand facilitators and barriers to engagement in a multidisciplinary assessment and intervention program for children and adolescents with obesity, particularly for Maori, the Indigenous people of New Zealand. METHODS: Whanau Pakari participants and caregivers (n = 71, 21% response rate) referred to the family-based healthy lifestyles program in Taranaki, New Zealand, were asked to participate in a confidential survey, which collected self-reported attendance levels and agreement with statements around service accessibility and appropriateness and open-text comments identifying barriers and facilitators to attendance. RESULTS: Self-reported attendance levels were higher when respondents reported sessions to be conveniently located (P = .03) and lower when respondents considered other priorities as more important for their family (P = .02). Maori more frequently reported that past experiences of health care influenced their decision to attend (P = .03). Facilitators included perceived convenience of the program, parental motivation to improve child health, and ongoing support from the program. CONCLUSIONS AND IMPLICATIONS: Program convenience and parental and/or self-motivation to improve health were facilitators of attendance. Further research is required to understand the relationship between past experiences with health care and subsequent engagement with services.

' but I just prefer to treat everyone the same ': general practice receptionists talking about health inequities.

General practice receptionists are positioned at the beginning of a patient's journey within the healthcare system, yet their influence on a patient's experience is unknown. The limited data on, and research involving, general practice receptionists both in New Zealand and internationally is evidence of this. This research undertook an exploration of the discourses used by a group of general practice receptionists in Wellington, New Zealand to discover how they talk about, and represent, health inequities. Eight in-depth semi-structured interviews were conducted, guided by Social Constructionism and Decolonising Theory. Three reoccurring patterns of discourse were identified: discourses about the social determinants of health; discourses about Maori culture and behaviour; and discourses about egalitarianism. Further, narratives that could be seen as deficit-focussed or victim-blaming were identified. Racism was not directly discussed by participants as a health determinant. The findings support the need for training guided by cultural safety and anti-racism principles to be available for all general practice receptionists.

The impact of racism on the future health of adults: protocol for a prospective cohort study.

BACKGROUND: Racial discrimination is recognised as a key social determinant of health and driver of racial/ethnic health inequities. Studies have shown that people exposed to racism have poorer health outcomes (particularly for mental health), alongside both reduced access to health care and poorer patient experiences. Most of these studies have used cross-sectional designs: this prospective cohort study (drawing on critical approaches to health research) should provide substantially stronger causal evidence regarding the impact of racism on subsequent health and health care outcomes. METHODS: Participants are adults aged 15+ sampled from 2016/17 New Zealand Health Survey (NZHS) participants, sampled based on exposure to racism (ever exposed or never exposed, using five NZHS questions) and stratified by ethnic group (Maori, Pacific, Asian, European and Other). Target sample size is 1680 participants (half exposed, half unexposed) with follow-up survey timed for 12-24 months after baseline NZHS interview. All exposed participants are invited to participate, with unexposed participants selected using propensity score matching (propensity scores for exposure to racism, based on several major confounders). Respondents receive an initial invitation letter with choice of paper or web-based questionnaire. Those invitees not responding following reminders are contacted for computer-assisted telephone interview (CATI). A brief questionnaire was developed covering current health status (mental and physical health measures) and recent health-service utilisation (unmet need and experiences with healthcare measures). Analysis will compare outcomes between those exposed and unexposed to racism, using regression models and inverse probability of treatment weights (IPTW) to account for the propensity score sampling process. DISCUSSION: This study will add robust evidence on the causal links between experience of racism and subsequent health. The use of the NZHS as a baseline for a prospective study allows for the use of propensity score methods during the sampling phase as a novel approach to recruiting participants from the NZHS. This method allows for management of confounding at the sampling stage, while also reducing the need and cost of following up with all NZHS participants.

Self-reported sleep complaints are associated with adverse health outcomes: cross-sectional analysis of the 2002/03 New Zealand Health Survey.

OBJECTIVE: The aim was to investigate the prevalence of self-reported sleep complaints in New Zealand adults and determine the independent association of sleep complaints with adverse health outcomes. DESIGN: We used 2002/03 New Zealand Health Survey data (n = 12,500 adults, ≥15 years). The prevalence of self-reported sleep complaints was estimated by ethnicity. The relationship between sleep complaints and mental health, physical health and health risk behaviors were investigated using multivariable logistic regression models. RESULTS: The prevalence of each sleep complaint measure was highest for the indigenous Maori population (23.6% reported 'any' sleep complaint; 10.3% reported multiple sleep complaints). Reporting 'any' sleep complaint was associated with higher odds of poorer mental health, diagnosed high blood pressure, diagnosed diabetes, diagnosed heart disease, poor/fair self-rated health, obesity, current smoking, and hazardous drinking. CONCLUSION: The higher prevalence of sleep complaints among Maori and the consistent association with poor health suggests a potential role for suboptimal sleep in ethnic health inequities.

Experience of racism and associations with unmet need and healthcare satisfaction: the 2011/12 adult New Zealand Health Survey.

OBJECTIVE: Racism may affect health through differential access to, and quality of, healthcare. This study examined associations between experience of racism and unmet need and satisfaction with healthcare. METHODS: Cross-sectional analysis of the 2011/12 adult New Zealand Health Survey (n=12,596) was undertaken. Logistic regression was used to examine associations between experience of racism (by a health professional and other experiences of racism [ever]) and unmet need for a general practitioner and satisfaction with a usual medical centre in the past year. RESULTS: Experience of racism by a health professional and other forms of racism were higher among Maori, Pacific and Asian groups compared to European/Other. Both racism measures were associated with higher unmet need (health professional racism adjusted OR 3.52, 95%CI 2.42-5.11; other racism OR 2.21, 95%CI 1.78-2.75) and lower satisfaction with a usual medical centre (health professional racism adjusted OR 0.25, 95%CI 0.15-0.34; other racism OR 0.60, 95%CI 0.45-0.79). CONCLUSIONS: Racism may act as a barrier to, and influence the quality of, healthcare. Implications for public health: Addressing racism as a public health issue and major driver of inequities in healthcare and health outcomes is required within the health sector and wider society.

The experience of gestational diabetes for indigenous Maori women living in rural New Zealand: qualitative research informing the development of decolonising interventions.

BACKGROUND: Although early detection and management of excess rates of gestational diabetes mellitus (GDM) among Indigenous women can substantially reduce maternal and offspring complications, current interventions seem ineffective for Indigenous women. While undertaking a qualitative study in a rural community in Northland, New Zealand about the complexities of living with diabetes, we observed a common emotional discourse about the burden of diabetic pregnancies. Given the significance of GDM and our commitment to give voice to Indigenous Maori women in ways that could potentially inform solutions, we aimed to explore the phenomenon of GDM among Maori women in a rural context marked by high area-deprivation. METHOD: A qualitative and Kaupapa Maori methodology was utilised. A sub-sample of women (n = 10) from a broader study designed to improve type 2 diabetes mellitus (T2DM) who had experienced GDM or pre-existing diabetes during pregnancy and/or had been exposed to diabetes in utero were interviewed. Participants in the broader study were recruited via the local primary care clinic. Experiences of GDM, in relation to their current T2DM, was sought. Narrative data was analysed for themes. RESULTS: Intergenerational experiences informed perceptions that GDM was an inevitable heritable illness that "just runs in the family." The cumulative effects of deprivation and living with GDM compounded the complexities of participant' lives including perceptions of powerlessness and mental health deterioration. Missed opportunities for health services to detect and manage diabetes had ongoing health consequences for the women and their offspring. Positive relationships with healthcare providers facilitated management of GDM and helped women engage with self-management. CONCLUSION: Maori women living with T2DM were clear that health providers had failed to intervene in ways that would have potentially slowed or prevented progression of GDM to T2DM. Participants revealed missed opportunities for appropriate diagnostic testing, treatment and health promotion programmes for GDM. Poor collaboration between health services and social services meant psychosocial issues were rarely addressed and the cycle of intergenerational poverty and disadvantage prevailed. These data highlight opportunities for extended case management to include whanau (family) engagement, input from social services, and evidence-based medicine and/or long-term management and prevention of T2DM.

Audit of ethnicity data in the Waikato Hospital Patient Management System and Trauma Registry: pilot of the Hospital Ethnicity Data Audit Toolkit.

BACKGROUND: Maori are disproportionately impacted by injury in New Zealand, therefore reliable ethnicity data are essential for measuring and addressing inequities in trauma incidence, care and outcomes. AIM: To audit the quality of ethnicity data captured by the Waikato Hospital Trauma Registry and Waikato Hospital patient management system against self-identified ethnicity. METHOD: Self-identified ethnicity using the New Zealand Census ethnicity question was gathered from 100 consecutive trauma patients and compared with ethnicity recorded in their Trauma Registry record and in the hospital's patient management database. RESULTS: Twenty-nine (29%) participants self-identified as Maori, of whom six were classified as New Zealand European (NZE) only in the Trauma Registry and five as NZE on the hospital patient management database. Over half of Maori (n=18/29) reported more than one ethnicity compared with 4% (n=3/71) of non-Maori. Self-identified ethnicity matched Trauma Registry ethnicity for one quarter (n=7/29) of Maori versus 9% of non-Maori. CONCLUSIONS: The degree of misclassification of Maori ethnicity data among patients in the Waikato Trauma Registry and the Waikato Hospital patient management system highlights a need for improvements to how ethnicity data is captured within these databases and potentially many other similar entities collecting ethnicity data in New Zealand. The release of revised standardised protocols for the collection of ethnicity data is timely given the recent establishment of a national trauma registry. Without quality data, the opportunity to investigate and address ethnic inequities in trauma incidence and management is greatly compromised.