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Health and social inequities predicted to increase in Aotearoa/New Zealand under new government

Introduction by Croakey: For the first time in Dutch history, a party of the extreme right – Geert Wilders’ Party for Freedom – is the largest in the national parliament, following the 22 November election, which has sent shockwaves across Europe.

Wilders is known for inflammatory anti-immigration rhetoric, advocates for the Netherlands leaving the European Union, and is anti-Islam.

While the make-up of the coalition that will form government is still under negotiation, the strong support for Wilders – which follows other far-right victories in Europe – is likely to lead to many harmful outcomes for public and global health.

Meanwhile, a public health alarm is also being sounded about the new conservative coalition government in Aotearoa/New Zealand. As Croakey reported this week, the global public health community has been urged to mobilise in denouncing its attack on world-leading tobacco control measures.

The Royal New Zealand College of General Practitioners has issued a statement expressing disbelief and concern about the “the announced changes that will have dire consequences for the health outcomes of thousands of New Zealanders”.

“The appalling changes announced as part of the coalition agreements with ACT and New Zealand First will undo many years of good work that has seen over one million New Zealanders give up smoking,” said College President Dr Samantha Murton.

Meanwhile, Dr Dermot Coffey, co-convenor of OraTaiao: The New Zealand Climate and Health Council, writes below that an increasing and widening inequity in health and social outcomes is predictable under the new Government.

Among the casualities will be the Te Aka Whai Ora, the Māori Health Authority, which was created only 17 months ago and which will be closed “without have ever been given a chance to fulfil its mandate”.


Dermot Coffey writes:

Given the length of time that has elapsed and the international events that have happened in the meantime, the 2023 New Zealand General Election might seem like a story from earlier, simpler times.

The country went to the polls on October 14 and finally, after a biblical-sounding 40 days and 40 nights of uncertainty, we have a right-wing coalition agreement between the National Party and minor parties ACT and New Zealand First.

The nature of this agreement and the proposed policy work will have major implications for both our healthcare system and our climate change response. It also contains a number of eye-openingly regressive race-based policies that threaten to undo decades of work and give a sheen of vindictiveness and nastiness to the new Government even before it has been sworn in.

Much of the delay in negotiations can be put down to the quirks of the New Zealand electoral system. Although preliminary results on election night gave a clear overall picture of the trends – namely that the incumbent Labour Party had suffered a heavy and humiliating defeat – it was not clear whether National would be able to form a coalition government with ACT alone, or whether it would require New Zealand First support as well.

And so it proved three weeks later when the special votes (votes cast outside a voter’s registered constituency, or ones where a voter registered late, plus overseas votes) were counted, and revealed the National Party had lost two seats to the Green Party and Te Pāti Māori, and would now require the support of both ACT and NZ First.

ACT, a right-wing libertarian party, and New Zealand First, promoting an unusual mix of populist, anti-immigration and social conservative policies and led by the ageless Winston Peters, have spent much of the last three years at each other’s throats. There were doubts for a while that they would be able to put these differences aside and avoid another election.

The canniness of the experienced Peters and his counterpart in ACT, David Seymour, won through, however, and they have been able to extract a significant number of concessions from the inexperienced National Party leader and Prime Minister, Christopher Luxon.

One of the major promises of the National Party has been ditched as a result of these negotiations. Currently, foreign buyers are not allowed purchase residential property in New Zealand and the National Party had planned to fund a large part of their tax-cut (loaded for wealthier New Zealanders) by allowing purchasing of properties worth more than $2 million by foreign buyers and levying a 15 percent tax on the purchase. This has been dropped due to New Zealand First opposition, leaving a large fiscal hole if they are to proceed with their pre-election promises, and raises the likelihood of a GST increase.

There was some positive, or at least less negative, news. There will not be an early referendum on “the principles of The Treaty of Waitangi”, a key election promise by ACT. This policy stood to create massive division in the country and there were concerns the National Party would cave to ACT’s demands regardless of the consequences, in the way David Cameron did to the extreme eurosceptic wing of the Conservative Party in the UK in 2015 leading to the Brexit crisis.

During the election campaign it was poorly communicated, possibly on purpose, and was often erroneously described by the public as a referendum on the Treaty itself. The overall impression was of a party, in order to improve their vote share, leaning into the relatively widespread racist opinion that Māori have too much say and that Māori culture and influence is too prevalent.

This question will now go through a government select committee process with no guarantee of ongoing National Party support. While this doesn’t permanently remove the risk of a referendum on Indigenous rights, it will take some of the heat out of the debate.

In other positive news, New Zealand’s 2050 net zero climate goals remain intact and the Climate Change Commission, established to oversee and advise on how we as a country best achieve these, will also continue.

Poor prognosis

The prognosis for the health system in Aotearoa is not good. Apart from a few woolly sounding commitments to “train more doctors, nurses and midwives” and outcome target setting, there is little of substance for improvements in the health sector in the coalition agreement.

Indeed, one of the National Party’s primary routes for achieving this increased training – establishing a third medical school – met with strong opposition from ACT and has been watered down accordingly.

Te Aka Whai Ora, the Māori Health Authority, will be disestablished despite widespread pushback to this decision within the health sector. It was created only 17 months ago during health sector reforms, with the aim to return decision making about Māori healthcare to Māori and close the persistent gap in health outcomes between Māori and non-Māori. It will now be closed without ever having been given a chance to fulfil its mandate.

Clinicians, health advocates and our professional colleges should meet this decision with the opposition it deserves.

As well, wider determinants of health, such as housing security, rental rights, job security, suburban sprawl and road safety measures, will all worsen directly under the new Government’s policies.

And in an utterly bizarre decision, the Government will repeal world-leading smoke-free laws. The incoming Minister for Finance, National’s Nicola Willis, has confirmed that they expect to use the taxes from increased tobacco use to fund tax cuts.

As New Zealand’s smoking rates are higher in Māori and Pacific people and those who are poorer and more marginalised, this represents direct harm to the health and lives of these groups in order to afford tax cuts for those who are least likely to need them.

Climate policy will also suffer. Despite our 2050 net zero emission target (which received bipartisan support in the 2019 Zero Carbon Act) remaining in place, the Government will remove much of the policy designed to get us there.

While the Government promises to be “principled, results-driven, evidence-based and fiscally responsible” with any new policy, it clearly hasn’t applied these lofty goals to its climate work. A grant for electric vehicles will be stopped and a tax on high-emitting utes will be removed.

Transport infrastructure will shift massively towards further road development and there are explicit plans to stop government support for urban light rail and active transport development in Auckland and Wellington.

Plans are being developed to restart offshore gas and oil exploration, banned under the previous administration and despite recent IEA reports highlighting the rapid and accelerating international shift to renewables, and that there is explicitly no need for any further gas or oilfield development.

Plans to address agricultural emissions (which were not successfully advanced under Labour) will now be moved further down the road to 2030. And finally, the newly established Climate Emergency Response Fund is likely to be raided to fund tax cuts for the likes of landlords and high-income earners.

Attacks on Māori rights

The Government policies are even worse for Māori rights, and it’s hard to escape a feeling of vindictiveness and spite behind many of them.

There are explicit threats to Māori and Pacific entrance schemes to medical schools, use of Te Reo Māori, co-governance in the delivery of public services, Māori representation in local councils and bodies as well as the disestablishment of Te Aka Whai Ora Māori Health Authority and threats to refine the scope of the Waitangi Tribunal, which investigates Treaty breaches.

Plans are in place to look at any references to Treaty Principles in legislation and either remove and rewrite these. As mentioned by Annabelle Lee-Mather on RNZ, these have been inserted precisely to avoid conflict between legislation and Te Tiriti with the goal of avoiding the need to seek decisions via the Waitangi Tribunal in future.

Many of these policies are from ACT and NZ First and the only conclusions that we can draw are that either National supported them all along, or the naivety of their negotiation team and desire to get any deal regardless of the consequences meant they acquiesced meekly.

The coalition agreement doesn’t say that all these have to be achieved, and some are so nebulous (“restore balance to the Aotearoa New Zealand’s Histories curriculum”) as to be virtually meaningless.

What it does do is give us a sense of how things will feel under this Government. It is one that will simultaneously worsen numerous social determinants of health immediately, yet offer us no plan beyond platitudes for improving the existing stresses in the health system.

It is one that supposedly supports necessary net zero goals while simultaneously making it more difficult to meet them.

It is one that takes the single most unique and enriching thing about the country, Māori culture, and seeks to relegate it behind a drab “little England” of increasingly wealthy landlords, traffic-clogged cities, farming-eutrophied rivers green with toxic algae and conservation land destroyed by mining.

It’s one where we can expect an increasing and widening inequity in health and social outcomes. It’s a government that isn’t so much as pulling the ladder up from poorer, browner and younger people, as pulling it up, ripping it apart and burning it.

In short, it’s a government that’s looking backwards, not just 5 or 10 years, but to the 1950s and 1960s and a mythical time of plenty, social cohesion and racial harmony.

It didn’t exist then, and unavoidable external realities – like the impacts of climate change, trading partners that actually take climate change mitigation seriously and international health workforce shortages – mean there is absolutely no chance they will achieve it now.


Further reading


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