AIM: Our aim was to assess the quality of ethnicity data in the Health New Zealand - Te Whatu Ora human resources (HR) databases. METHODS: This project involved two components. 1) Staff with "not stated" or missing ethni...AIM: Our aim was to assess the quality of ethnicity data in the Health New Zealand - Te Whatu Ora human resources (HR) databases. METHODS: This project involved two components. 1) Staff with "not stated" or missing ethnicity in their HR records were identified from Auckland and Waitematā district HR databases on 30 April 2018 and 2 August 2018. They were asked their ethnicity using the Standard questions via an online survey. 2) Staff data were extracted in June 2017 and linked to the National Health Index (NHI) ethnicity data. The concordance of ethnicity data between the two datasets was assessed in three categories: exact match, partial match or total mismatch. RESULTS: 1) Of the 17,539 staff, the proportions with "not stated" ethnicity were 15.1% at Auckland district and 6.4% at Waitematā district. Among those, 727 Auckland staff and 122 Waitematā staff responded to the survey to update their ethnicity. These respondents most identified as European (64%), followed by Asian (15%) and Pacific and Māori (5% each). 2) Of the 17,539 staff, 86% had matched ethnicity between the HR dataset and the NHI dataset (kappa 0.77, p<0.0001), with the highest agreement level being Asian (93%), followed by European (86%), Pacific (84%) and Māori (83%). CONCLUSIONS: This project assessed the extent of "not stated" staff ethnicity data and misclassification in two large health districts. Staff with "not stated" on their records were willing to provide their ethnicity data when asked the Standard question. This project suggests the need for quality improvement activities in recording HR ethnicity data to support planning and monitoring workforce diversity.
AIM: Ethnic communities in Aotearoa New Zealand are rapidly growing and highly diverse. Migration-related experiences are deeply gendered, shaping health and wellbeing in distinct ways. This multi-methods research study...AIM: Ethnic communities in Aotearoa New Zealand are rapidly growing and highly diverse. Migration-related experiences are deeply gendered, shaping health and wellbeing in distinct ways. This multi-methods research study aimed to understand the mental health needs of ethnic migrant women and girls, and to highlight opportunities for culturally responsive support by co-designing a research agenda with high-priority research questions. METHODS: In-depth interviews were conducted with 12 key stakeholders and analysed using thematic analysis. Insights informed a subsequent stakeholder consultation workshop, facilitated using a collaborative World Café approach to co-design research priorities. RESULTS: Interview findings suggest nuanced contextual factors that affect mental health, lack of safe spaces including family networks, reluctance to engage with mental health services, and limited cultural responsiveness. The co-designed research priorities emphasise the importance of participatory approaches and evidence rooted in lived realities to inform services that are meaningful, culturally safe and responsive to ethnic women's needs. CONCLUSION: Ethnic women's mental health requires a nuanced culturally responsive approach. Through community engagement and co-design, this study identified unmet needs and set clear research priorities to inform meaningful, evidence-based support and care.
New Zealand's health system is under sustained pressure, with worsening access to primary and specialist care, widening inequities and declining public confidence. In this context, there is an emerging but largely unarti...New Zealand's health system is under sustained pressure, with worsening access to primary and specialist care, widening inequities and declining public confidence. In this context, there is an emerging but largely unarticulated shift towards increased reliance on private provision and private financing. This editorial examines whether this represents privatisation by design, default or drift, and considers the likely consequences. Evidence from New Zealand and comparable health systems suggests that increased privatisation is associated with higher costs, reduced equity and no consistent improvement in outcomes. Rising private insurance costs, outsourcing of elective services and public-private partnerships risk undermining the sustainability of the public system while failing to address the fundamental drivers of demand, particularly chronic disease and unmet need in primary care. These trends disproportionately affect Māori, Pacific peoples and low-income populations, raising concerns regarding Te Tiriti o Waitangi obligations. An alternative approach is proposed, centred on sustained investment in primary care and prevention, a clearly defined core package of publicly funded services and a cross-party health accord to ensure policy stability. The future of New Zealand's health system will depend on deliberate choices about equity, access and the role of the public sector.
Achieving equity in health research requires sub-groups to have meaningful, if not equal, explanatory power, ideally through similiar sample sizes. Obtaining equal sample size, though, is often not possible. Small sub-gr...Achieving equity in health research requires sub-groups to have meaningful, if not equal, explanatory power, ideally through similiar sample sizes. Obtaining equal sample size, though, is often not possible. Small sub-group sizes increase the risk of false conclusions being drawn, which may reinforce inequities if results are misinterpreted (e.g., saying there is a difference between study arms when there is not and, conversely, saying there is no difference when there is). Here we provide examples of common pitfalls and potential considerations to guide researchers, reviewers and editors when analysing and interpreting sub-group data. We propose that researchers focus on presenting effect sizes and confidence intervals rather than statistical significance.
Breast density influences both breast cancer risk and the sensitivity of mammographic screening. Several countries routinely notify women of their breast density in community-based screening programmes and provide guidan...Breast density influences both breast cancer risk and the sensitivity of mammographic screening. Several countries routinely notify women of their breast density in community-based screening programmes and provide guidance directly or through general practitioners. In contrast, BreastScreen Aotearoa (BSA) does not currently notify breast density to women, resulting in limited awareness and raising concerns relating to equitable care, patient autonomy in decision making, trust in health professionals and uncertainty regarding clinical pathways. Although the recent Health New Zealand - Te Whatu Ora technical review provides a comprehensive evidence summary and identifies areas for further investigation, policy progression has not occurred as anticipated. An implementation timeline, governance responsibility, communication planning and culturally responsive approach have not yet been specified. Although emerging evidence suggests that artificial intelligence may offer more consistent and reproducible breast density assessment than radiologists, planning for its integration has not been outlined. Research from the comparable settings suggests that misunderstanding, rather than notification itself, drives anxiety. This highlights the importance of communication design, health literacy considerations and primary care readiness. Ethical considerations around transparency and informed decision making remain relevant for screening equity. Addressing the implementation barriers is now crucial, and a coordinated and equity-driven approach is required to inform future policy on breast density notification.
BACKGROUND: Traditional knowledge takes a more holistic view of the interconnectedness between nature and human health compared to modern healthcare systems. This review synthesises literature on the nexus between tradit...BACKGROUND: Traditional knowledge takes a more holistic view of the interconnectedness between nature and human health compared to modern healthcare systems. This review synthesises literature on the nexus between traditional knowledge, the environment and health, with the goal of an environmentally sustainable healthcare system. METHODS: We searched Web of Science, Scopus, Medline and Embase for peer-reviewed publications using keywords related to the natural environment or planetary health, Indigenous/traditional knowledge, and healthcare. Themes were developed by thematic synthesis in an eight-step process. RESULTS: We identified 22 reports across 21 studies; 15 were published in the last 10 years. Six initial themes were identified and subsequently collapsed into two overarching themes: "holistic wellbeing" and "epistemological pluralism". The first theme highlights the need for healthcare to adopt a holistic concept of health centred on nature. The second theme emphasises the importance of embracing diverse epistemologies to achieve optimal health outcomes. Together, these themes suggest that healthcare systems should be guided by a more inclusive, environmentally focussed understanding of health rather than by a predominantly technical paradigm. CONCLUSIONS: Literature on the relationship between traditional knowledge, planetary health and healthcare is both limited and recent. The review suggests that healthcare systems should incorporate respect for nature, diverse cultures and local contexts.
AIM: The inflammatory bowel disease severity index (IBD-DSI) aims to describe inflammatory bowel disease (IBD) severity over the duration of disease. We aimed to correlate the IBD-DSI with a patient-completed disease sev...AIM: The inflammatory bowel disease severity index (IBD-DSI) aims to describe inflammatory bowel disease (IBD) severity over the duration of disease. We aimed to correlate the IBD-DSI with a patient-completed disease severity score (PCDSS). We also aimed to investigate whether individual factors such as psychological measures or clinical characteristics moderate this correlation. METHODS: This multicentre trial involved gastroenterologists completing the IBD-DSI and Harvey-Bradshaw Index or Simple Clinical Colitis Activity Index for each participant while patients completed a self-reported IBD severity score and psychological questionnaires. The excess severity score (ESS) was calculated by subtracting the IBD-DSI from the PCDSS. RESULTS: One hundred and sixty-four patients with IBD participated (98.2% response rate; average age 41.2 years; 105 [62.9%] female; 100 [59.9%] Crohn's disease) and 164 IBD-DSI were completed. The IBD-DSI and PCDSS were positively correlated (r=0.44, r2=0.19, p<0.001) although the mean ESS was 29.0 (23.2). The relationship between the scales is reflected in the equation: PCDSS=39.53+0.59*IBD-DSI. There were larger discrepancies at the lower end of IBD-DSI. After controlling for IBD-DSI, previous colectomy (p=0.03), any IBD or bowel-related surgery (p=0.01) and ulcerative colitis extent of disease (p=0.049) were associated with ESS while 5-aminosalicylic acid use (p=0.01) was negatively associated with ESS. CONCLUSIONS: IBD-DSI and PCDSS are significantly positively associated with each other and with larger discrepancies at the lower end of the IBD-DSI. Possible contributing factors to the discrepancy are floor effects, regression to the mean and patients putting different implicit weights on particular factors than the IBD-DSI does.
AIM: We aimed to describe nurse practitioner (NP) workforce characteristics, clinical practice and enablers and barriers in Aotearoa New Zealand. METHODS: Five cross-sectional, self-reported online surveys were distribut...AIM: We aimed to describe nurse practitioner (NP) workforce characteristics, clinical practice and enablers and barriers in Aotearoa New Zealand. METHODS: Five cross-sectional, self-reported online surveys were distributed biannually in collaboration with Nurse Practitioners New Zealand. Eligible participants were registered Aotearoa New Zealand NPs. Quantitative items covered demographics, practice activities and work environment; qualitative items captured priorities for change. Data were cleaned and reclassified to ensure comparability across survey rounds, and descriptive statistics were used to report findings. Ethics approval: Te Herenga Waka-Victoria University of Wellington, Human Ethics Committee, 2024/HE000107. RESULTS: Of the 1,004 valid responses (52-74% of the workforce per survey), most respondents were practicing clinically (>94%). By 2022, prescribing was near-universal (98%), with most ordering laboratory (92%) and radiology (70%) investigations. Employment was concentrated in district health boards/Health New Zealand - Te Whatu Ora, with increasing representation in primary health organisations, private practice, non-governmental organisations and self-employment. Respondents reported barriers to practicing at full-scope of practice, limited succession planning and challenges to workforce sustainability. CONCLUSION: NPs are an established part of Aotearoa New Zealand's health workforce. However, persistent structural barriers, limited succession planning and variable support for full-scope practice continue to constrain their contribution. Strengthening integration and sustainable policy support are essential to realise the full potential of the NP role.
AIM: We aimed to examine the experiences of Pacific nurses in Aotearoa New Zealand who provide informal language assistance to Pacific patients with limited English proficiency (LEP). METHODS: A cross-sectional online su...AIM: We aimed to examine the experiences of Pacific nurses in Aotearoa New Zealand who provide informal language assistance to Pacific patients with limited English proficiency (LEP). METHODS: A cross-sectional online survey was distributed to 229 alumni of the Aniva Leadership Programme. The survey included quantitative and qualitative questions about interpreting experiences. Descriptive statistics and logistic regression were used for quantitative analysis; framework analysis was applied to free-text responses. RESULTS: The response rate was 69% (n=159). Of respondents, 80% spoke a Pacific language and 85% of these had been asked to interpret in clinical settings, most commonly by patients, families and colleagues. While 75% felt confident interpreting, many reported difficulties with technical terminology. Nurses observed improved patient trust, understanding and engagement when using Pacific languages. However, interpreting often conflicted with core duties, raised ethical concerns and was not formally recognised or supported. CONCLUSION: Pacific nurses routinely provide informal interpreting, significantly enhancing patient care. Yet this work is uncompensated, untrained and exposes nurses to professional risks. Health systems must reduce reliance on informal interpreting by investing in professional services, offering interpreter training for bilingual staff and formally recognising the cultural and linguistic labour of Pacific nurses to support equitable care.
AIM: We aimed to describe demographics and rates of diagnoses of blood-borne viruses and other sexually transmitted infections (STBBI) in sex workers attending an outreach clinic in Auckland. METHODS: Sex workers attendi...AIM: We aimed to describe demographics and rates of diagnoses of blood-borne viruses and other sexually transmitted infections (STBBI) in sex workers attending an outreach clinic in Auckland. METHODS: Sex workers attending an outreach clinic in Auckland from 31 December 2018 to 31 December 2020 were eligible for inclusion. Gonorrhoea and chlamydia rates in sex workers were compared to rates in two comparator groups: attendees to general sexual health clinics and a population-based sample. RESULTS: Three hundred and fifty-six sex workers were eligible for inclusion. The majority were cisgender-gender females (93.5%, n=333). Test positive rates for chlamydia (5.1%) and gonorrhoea (3.9%) in cisgender-female sex workers were lower than for females attending general sexual health clinics. Chlamydia and gonorrhoea rates were higher in transgender-female sex workers than in cisgender-female sex workers, but the numbers were small (n=14). Of the 159 sex worker participants tested for hepatitis C antibody, 25 were antibody positive (15.7%). CONCLUSIONS: Cisgender-female sex workers had lower rates of diagnosis of chlamydia and gonorrhoea than females attending general sexual health clinics. STBBI testing in sex workers should routinely include assessment and testing for hepatitis C. The data indicate that sex workers should continue to be a priority population in the STBBI strategy.
INTRODUCTION: Gynaecological cancers are an increasing concern in Aotearoa New Zealand, with rapid growth in uterine cancer incidence in recent years. Understanding future incidence patterns is essential for planning and...INTRODUCTION: Gynaecological cancers are an increasing concern in Aotearoa New Zealand, with rapid growth in uterine cancer incidence in recent years. Understanding future incidence patterns is essential for planning and service delivery at a sub-national level. METHODS: Cancer registry data (2001-2022) were combined with population projections to estimate incidence of gynaecological cancers to 2045. Projections were generated using age-period-cohort Poisson regression models, with non-parametric bootstrapping to quantify uncertainty. RESULTS: Annual gynaecological cancer cases are projected to increase 82% by 2045, reaching 2,497 (95% uncertainty interval [UI] 2,263-2,774) compared with 1,375 in 2020-2022. The overall age-standardised rate is projected to rise 21% from 36.6 (95% confidence interval [CI] 35.5-37.8) to 44.2 per 100,000 (95% UI 38.9-50.3). Uterine cancer contributes the largest increase, more than doubling from 717 to 1,506 cases annually (110%). Among Māori, cases rise 132% from 214 to 497 per year (95% UI 449-553); for Pacific women, they rise 137% from 165 to 391 (95% UI 340-449). Uterine cancer age-standardised rates are projected to increase from 27.3 to 39.6 per 100,000 for Māori, and from 74.3 to 97.5 for Pacific women. Regional variation is expected: the Northern Region is projected to have the largest absolute increase (+506 cases, 527 to 1,033) and the largest percentage increase (96%). CONCLUSION: Gynaecological cancer incidence in Aotearoa New Zealand is projected to rise substantially over the next 20 years, driven by demographic change and increasing incidence of uterine cancer likely associated with risk factors such as excess body weight and diabetes. Findings highlight the need to prioritise prevention, proactive service planning and equity-focussed early detection.
In the late nineteenth century, the popularity of cycling prompted a series of medicalised warnings, particularly for women. Among these was "bicycle face": a "nervous condition" attributed to a constant state of stress...In the late nineteenth century, the popularity of cycling prompted a series of medicalised warnings, particularly for women. Among these was "bicycle face": a "nervous condition" attributed to a constant state of stress from attempting to balance a bicycle combined with prolonged facial grimacing, which was believed to result in nervous exhaustion and facial disfigurement. In New Zealand, media coverage peaked between 1895 and 1897, framing it as a threat to women's health, beauty and morals. Related conditions included "cyclemania", "bicycle stoop", "bicycle hump", "bicycle walk" and "bicycle heart". These designations reflected gender norms and anxieties over female independence, rather than medical evidence. The episode mirrors a broader historical pattern in which emerging technologies have triggered dubious health fears which parallel contemporary concerns over the safety of mobile phones, 5G towers and wind turbines. The authors explore the cultural and medical construction of "bicycle face" during the late nineteenth and early twentieth centuries, showing how a small number of rogue physicians used the media to amplify unfounded fears, implanting them into the public consciousness. The historical tendency for health practitioners to superimpose prevailing attitudes and beliefs onto health risks linked to new technologies highlights the need for evidence-based evaluations and vigilance against allowing cultural anxieties to masquerade as novel medical conditions.