The performance of New Zealand's health system - from hospital staffing and resourcing to access to primary care and general practitioners - is a key election battleground once more.
Authors
- Ben Gray
Associate Professor of Primary Health Care and General Practice, University of Otago
- Hoani Smith
Lecturer in Sport Management and Sport Science, Lincoln University, New Zealand; University of Southern Queensland
- Phil Borell
Senior Lecturer (Above the Bar), Aotahi School of Maori and Indigenous Studies, University of Canterbury
Around 200,000 people, half of them Māori , have no GP. In the 2024-25 New Zealand Health Survey , one in seven adults (14.9%) reported not visiting a GP due to cost (25.1% for Pacific adults, 18.7% for Māori).
But beneath these system pressures sits a more persistent reality: Māori and Pasifika communities continue to carry the country's heaviest burden of preventable disease .
Health inequities mean Māori and Pacific peoples are far more likely to develop chronic diseases earlier in life, live with multiple preventable conditions at the same time, and die years sooner than other New Zealanders.
This isn't because of genetics or individual choices, but because of long-standing structural inequalities shaping income, housing, education, food access and health care.
Multiple preventable risks
The latest research puts hard numbers on what the gap means. Māori males can expect to live 73.7 years, and Māori females 78.0 years, compared with 81.1 and 84.3 years for "European and other" ethnicities. Pacific peoples sit in between, but still face a five-to-six-year longevity deficit.
No single condition is driving this disparity. It's the clustering of multiple preventable risks.
Start with tobacco: the New Zealand Health Survey put overall adult daily smoking at 6.8% of the population, but the ethnic gradient remains sharp: 15.0% for Māori, 10.3% for Pacific peoples, and 5.7% for European/other.
Obesity shows an even stronger gradient . In 2024-25, 69.5% of Pacific adults and 46.9% of Māori adults were classified as obese, compared with 33.5% of European/other adults, and 17.8% of Asian adults.
Screening for disease shows uneven progress. Data from April 2024 showed breast screening coverage was 63.8% for Pacific peoples and 60.3% for Māori, compared with 68.2% for non-Māori and non-Pacific populations. Cervical screening shows an even wider gap: 56.0% for Pacific women and 56.2% for Māori women versus 72.1% for others.
These differences are unlikely to be explained by individual choice alone. They also reflect wider environments shaped by food affordability, marketing exposure, housing conditions, chronic stress and neighbourhood deprivation.
Diabetes illustrates how these risks accumulate. Prevalence is at 12.5% for Pacific peoples and 7.0% for Māori, compared with 5.4% for European/other populations. When diabetes appears earlier in life, the cumulative burden on hearts, kidneys and eyes - and therefore health services - rises sharply.
'Unjust and avoidable'
New research published in the New Zealand Medical Journal finds ethnicity itself remains an independent predictor of preventable death even after adjusting for age, sex, deprivation, income and morbidity.
Māori have 1.46 times higher odds of preventable death than European New Zealanders, and Pacific peoples 1.18 times higher odds.
The implication is uncomfortable but clear: health need is not fully captured by socioeconomic measures alone. Yet current policy is moving in the opposite direction.
The revised primary care funding formula which came into force in July this year removed ethnicity as one of the key indicators, despite evidence it is an important independent predictor of health need.
The National-led coalition government also amended the law to reverse several measures introduced as part of New Zealand's Smokefree Aotearoa 2025 strategy. Smoking rates had steadily declined between 2011 and 2023, but have since remained unchanged , disproportionately affecting Māori.
The disestablishment of Te Aka Whai Ora (the Māori Health Authority) without an alternative plan raises questions about the health system's capacity to address avoidable Māori health inequities.
Te Aka Whai Ora's statement of intent noted that health disparities were "unfair and unjust - and avoidable", pointing to major disparities in cardiovascular disease, childhood mortality, cancer and life expectancy.
For those reasons, the Waitangi Tribunal recommended "the Crown commit to revisiting the option of a standalone Māori health authority".
Shifting the dial
When prevention and early detection lag behind for the populations with the highest disease burden, downstream consequences are predictable: later diagnoses, more complex treatment and widening gaps in life expectancy.
If current inequities persist, the consequences will be felt in health outcomes, demand for care, and a continuing gap between population groups.
Pressure on an already stretched health workforce will grow. More importantly, the life expectancy gap is likely to remain, despite improvements in New Zealand's overall health.
Expanding primary care access and reducing the burden of chronic disease will depend on workforce capacity, sustained funding and cross-sector policy alignment. As parties roll out health policy, voters concerned about equity should look beyond headline pledges.
Policies most likely to shift the dial include:
sustained investment in the primary care workforce
measures that reduce cost barriers to GP access
stronger tobacco, obesity and chronic disease strategies
funding and resourcing that account for ethnicity as well as deprivation, morbidity and other markers of health need
culturally grounded, whānau-centred prevention approaches.
When obesity affects nearly half of Māori adults and around 70% of Pacific adults, when around one in eight Pacific adults is living with diabetes, and when life expectancy gaps stretch well beyond half a decade, individual behaviour alone cannot explain the pattern.
New Zealand's overall health indicators may continue to improve. But if Māori and Pacific peoples continue to shoulder the heaviest burden of preventable disease, national averages will continue to mask substantial differences between population groups.
The authors acknowledge the contribution of Christchurch GP Dr Ben Green in the preparation of this article.
From the cost of living and a health system under extreme pressure to how best to tackle climate change, the coming election involves some big choices.
This article is part of The Conversation's Election 2026 series : expert analysis of the major policy debates and the big challenges New Zealand's next government will face.
The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.
