Response to Health and Disability System Review

Healthier Lives National Science Challenge welcomes the opportunity the Health and Disablity System Review presents for the New Zealand health system to “…evolve into a system which delivers health outcomes for all New Zealanders both equitably and efficiently.”

We commend the Review’s focus on reversing deeply entrenched health inequities and structural racism within the health system, and on re-balancing the system to focus on the prevention of illness at a population level as well as better treatment of individuals who become sick.

These aspirations chime with our own.

Healthier Lives’ research is firmly focussed on contributing to the systems-level change the Review envisions.  For example:

• In partnerships with others, we have co-designed and evaluated kaupapa Māori and whānau ora service delivery models as well as a kaupapa Māori framework for developing health interventions. We are also investigating culturally appropriate models that work for Pacific communities.

• Our cancer research holds promise that cancer monitoring will eventually be delivered in the communities where people live, removing a major access barrier for people in rural areas.
• We have investigated the potential forseveral digital services and technologies to improve the delivery of healthcare.

• A new area of our research is focussed on evaluating population level health outcomes through improving food and physical activity environments.

• We have jointly funded research with the Heart Foundation looking at ways to systematically reduce the barriers faced by Māori and Pacific people in accessing treatment for heart disease along the healthcare continuum. And we are currently in the early stages of planning research about how to successfully implement the sort of system changes – across macro, meso and micro levels – which the Review says are necessary.

However, while we aim to play our part in helping to effect systems change we have concerns about some of the Review’s recommendations and how they may be implemented.

If the proposed Māori Health Authority does not control funding and commissioning of services for Māori it will not be able to deliver the transformational changes needed to achieve health equity.  We agree with the Alternative view of the majority of Panel members and the Māori Expert Advisory Group on this. This advisory approach has been implemented in various forms since the 1980s and has demonstrably failed to deliver significant gains towards health equity. Opportunities for major structural change to the health sector are rare and we see no point wasting this one by repeating a failed model.

The Review has correctly identified that strengthening population health measures is essential but has proposed that these responsibilities be spread across all parts of the system.  Without organisational focus for population health and a ring-fenced budget there is a risk this will become everyone’s and no-one’s responsibility, and will be crowded out by overwhelming clinical pressures.  There is also a risk that public health approaches to non-communicable diseases, which account for the majority of health loss in New Zealand, will be overshadowed by the need to prepare for and respond to emergencies such as the Covid-19 pandemic.  The public health community  has long been arguing for a single independent body to oversee population health measures in New Zealand.   However, re-establishing a Public Health Advisory Committee, which the Review proposes, is going back to the past.  New Zealand needs a body with sufficient authority to produce the health outcomes needed.

The Review proposes investment and a range of recommendations to improve New Zealand’s capacity to use health data.  This is essential if we are to combat all forms of inequity across the health system.  The Ministry of Health’s data and analytics capacity has been severely diminished over recent years due to under-investment.  There are major gaps in current data collection, and data is not made available in a timely way. Future investment will need to be substantial, strategic and specifically focussed on equity so that it can inform change in a timely manner.

Critically, the Review has called for a healthcare system that is better informed by local evidence and research, more community or whānau-centred, and one which uses new technologies to provide healthcare which is more targeted.  Moreover, the Review highlights the importance of personalised medicine and genomics, stronger focus on prevention of illness, and better use of new digital tools for self-management.  Healthier Lives is already active and committed to each of these areas; it is pleasing to see that our own strategy and philosophy aligns so well with this once in a generation opportunity for enhancing our health and disability system.

However, if the commendable aspirations of the Review panel are to be achieved, the government will need to reconsider the funding and operational models for the proposed Maori Health Authority as well as commit to a more structured oversight of population health imperatives than is currently proposed.

Read more about the New Zealand Health and Disability Services Review (systemreview.health.govt.nz).