Community-led action is essential for building a more effective and equitable health system. Yet Aotearoa New Zealand's history of top-down structural reforms has undermined progress toward "healthy futures for all". We...Community-led action is essential for building a more effective and equitable health system. Yet Aotearoa New Zealand's history of top-down structural reforms has undermined progress toward "healthy futures for all". We draw on complexity science and system-change principles to explain why genuine devolution and community engagement are not just ideological preferences but practical necessities in a complex health system. Community agency and locally tailored innovation can drive emergent, system-wide improvements, but only if central structures enable and sustain these relationships. A key step is reframing our mental model of the health system from a linear machine to a complex adaptive system. We discuss how the turbulence of current policy changes fits into long-running patterns and why a clearer conceptualisation of complexity can guide policymakers toward tangible actions that reorient the system towards patients and communities. Finally, we outline some essential ingredients for how New Zealand can transition from rhetoric and good intentions to the effective implementation of an equitable, community-centred health system.
AIM: While less common than adult blindness, childhood blindness has a significant burden in terms of the total number of "blind years". We aim to determine if there is scope for improved strategies in the prevention of...AIM: While less common than adult blindness, childhood blindness has a significant burden in terms of the total number of "blind years". We aim to determine if there is scope for improved strategies in the prevention of childhood blindness in Aotearoa New Zealand. METHOD: We conducted a review of New Zealand childhood blindness data. RESULTS: In New Zealand, there is a paucity of data on childhood blindness. However, significant scope remains for prevention through optimising maternal health, neonatal care, increasing uptake of immunisations and attendance at vision screening programmes, as well as the earliest possible detection of myopia and keratoconus. CONCLUSION: Ophthalmologists and the Royal Australian and New Zealand College of Ophthalmologists must continue to actively collaborate with obstetricians, paediatricians, general practitioners, optometrists, national screening units, vaccination programmes, epidemiologists and Health New Zealand - Te Whatu Ora to promote primary prevention strategies and improve visual outcomes for our tamariki.
UNLABELLED: Amyotrophic lateral sclerosis (ALS), the most common form of motor neurone disease (MND), is a neurodegenerative condition with typically short life expectancy. Riluzole, the only survival prolonging medicati...UNLABELLED: Amyotrophic lateral sclerosis (ALS), the most common form of motor neurone disease (MND), is a neurodegenerative condition with typically short life expectancy. Riluzole, the only survival prolonging medication funded in Aotearoa New Zealand, has high uptake in other developed countries. AIMS: To quantify riluzole use in New Zealand, identify factors associated with its use and explore reasons for non-use. METHODS: In 2025, people in New Zealand diagnosed with MND were invited to self-complete questionnaires. Data were collected via Qualtrics, exported to Excel and analysed using descriptive and inferential statistics. Respondents with progressive muscular atrophy or primary lateral sclerosis diagnoses were excluded from this analysis. RESULTS: Of 115 respondents, 55 (48%) were currently taking riluzole, 14 (12%) had taken it previously and 42 (36%) had never taken it. Common reasons for non-use included riluzole not being offered and concerns about lack of effectiveness and/or side effects. Uptake was lower with bulbar onset than limb onset (p<0.05). CONCLUSIONS: People with ALS in New Zealand have low uptake of riluzole, despite its survival benefits. Prescribers and people with ALS need up-to-date information about riluzole's benefit-risk profile to increase uptake and confidence in prescription and use. Liquid riluzole is needed in New Zealand to aid uptake.
INTRODUCTION: Dysphagia frequently occurs in movement disorders, leading to malnutrition and aspiration. Percutaneous endoscopic gastrostomy (PEG) provides nutrition directly into the stomach, bypassing the dysfunctional...INTRODUCTION: Dysphagia frequently occurs in movement disorders, leading to malnutrition and aspiration. Percutaneous endoscopic gastrostomy (PEG) provides nutrition directly into the stomach, bypassing the dysfunctional swallow. However, PEG insertion is a complex decision, both clinically and ethically. Although PEG outcomes are reported in other neurological disorders, there is limited research in atypical parkinsonian syndromes such as multiple system atrophy (MSA), progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD). Insertion rates remain variable, reflecting a paucity of research and lack of consistent guidelines. Basic mortality and morbidity data would help inform practice. To our knowledge, this is the first international study of PEG insertion and its impact on survival and aspiration pneumonia in atypical parkinsonian syndromes. METHOD: This was an international retrospective study of 72 patients with MSA, PSP or CBD. Survival was recorded from reported onset of dysphagia to death. Secondary outcomes included hospital admission rate for aspiration pneumonia. RESULTS: Median survival was 17.4 months (95% confidence interval [CI] 14.0-24.9) in non-PEG patients versus 48.8 months (95% CI 44.8 to not reached) in PEG patients, hazard ratio (HR) 0.38 (95% CI 0.18-0.81; p=0.013). PEG was not associated with reduced risk of aspiration pneumonia; 0.76 versus 0.68 admissions per patient-year, incidence rate ratio (IRR) 1.41 (95% CI 0.74-2.68; p=0.297). CONCLUSION: PEG insertion may improve survival in atypical parkinsonian syndromes, though we found no evidence of reduced aspiration risk. Given the rarity of these conditions, international registries may help to determine the safety and efficacy of PEG use.
AIM: Anastomotic leak (AL) is associated with major post-operative morbidity and mortality. The circular stapler, widely utilised in colorectal anastomosis, has seen a technological change from manual firing stapler (MFS...AIM: Anastomotic leak (AL) is associated with major post-operative morbidity and mortality. The circular stapler, widely utilised in colorectal anastomosis, has seen a technological change from manual firing stapler (MFS) to powered automated firing stapler (PAFS). PAFS may reduce user error and technique variation and may be associated with reduced AL rate. The primary aim of the study was to assess differences in AL rate between MFS and PAFS. Secondary aims were to assess differences in length of stay (LOS) and 30-day mortality. METHODS: This was a retrospective, single surgeon review of patients undergoing resection with anastomosis using a circular stapler between 2016 and 2023. A historical MFS group (n=105) and a study PAFS group (n=112) were identified. Demographics, comorbidity, operation type, neoadjuvant therapy, AL, LOS and 30-day mortality were recorded. RESULTS: The populations were comparable, with no significant difference in demographics, BMI, ASA grade, neoadjuvant radiotherapy use or type of operation. The PAFS group contained more non-malignant cases, 35% vs 18% (p=0.01). AL rate was 11.4% in the MFS group and 3.6% in the PAFS group (p=0.04). Fifty-eight percent of the anastomotic leaks in the MFS group needed surgery, compared to zero from the PAFS group (p=0.09). Mean LOS was 10 days in the MFS group and 6 days in the PAFS group (p = 0.01). Thirty-day mortality was 0.9% from the MFS group and zero from the PAFS group (p=0.48). CONCLUSION: While acknowledging confounders may have affected outcomes, in this study PAFS was safe and associated with a significant reduction in AL and LOS.
AIM: This study examines whether ethnicity is an independent marker of health or if ethnic disparities are fully explained by age, sex, rurality, socio-economic position and morbidity. METHOD: Using the Stats NZ Tatauran...AIM: This study examines whether ethnicity is an independent marker of health or if ethnic disparities are fully explained by age, sex, rurality, socio-economic position and morbidity. METHOD: Using the Stats NZ Tatauranga Aotearoa Integrated Data Infrastructure, we identified the resident population of Aotearoa New Zealand each year from 2009 to 2018, establishing 10 cohorts that were followed up with at 12 months for amenable mortality, i.e., deaths from conditions responsive to healthcare in under-75-year-olds. Age, sex, ethnicity, rurality, small area deprivation, personal income and morbidity of cohort members were described. Logistic regression analyses and likelihood ratio tests were used to assess the independent association of these variables with amenable mortality. RESULTS: Ethnicity, socio-economic position and morbidity, along with age, sex and rurality, made significant independent contributions to predicting amenable mortality. Ethnicity predicted amenable mortality after adjusting for other variables. Compared with Europeans, the odds of amenable mortality were 1.46 (95% confidence interval [CI] 1.43-1.50) times greater in Māori and 1.18 (95% CI 1.14-1.23) times greater in Pacific and half as likely in Asian (0.54, 95% CI 0.52-0.57). CONCLUSION: Māori and Pacific ethnicity, and also socio-economic position and morbidity, are independent markers of health need relevant to the distribution of health resources and targeting of health services.
AIM: Diverse ethnic representation in clinical trials is critical to ensuring research priorities align with patient need and uphold commitments to health equity. In Aotearoa New Zealand, this is crucial given the persis...AIM: Diverse ethnic representation in clinical trials is critical to ensuring research priorities align with patient need and uphold commitments to health equity. In Aotearoa New Zealand, this is crucial given the persistent health inequities faced by Māori despite obligations of the government to Te Tiriti o Waitangi/the Treaty of Waitangi. We report the findings of a systematic review of ethnic representation, with a focus on Māori and Pacific peoples, in randomised controlled trials (RCTs) undertaken in New Zealand between 2010 and 2020. METHODS: A search was undertaken for RCTs undertaken in New Zealand between 2010 and 2020, registered in the Australia New Zealand Clinical Trials Registry (ANZCTR) and published in a peer-reviewed journal. Ethnicity data were categorised to Stats NZ Tatauranga Aotearoa (Stats NZ) level one or two codes. The Preferred Reporting Items for Systematic reviews and Meta-Analyses guideline was followed. The primary outcome was the proportion of each Stats NZ level one ethnicity code, for all participants recruited to RCTs conducted in New Zealand which reported ethnicity. RESULTS: One thousand and forty trials were identified, 342 met the inclusion criteria, of which 103 reported no ethnicity data. For 295,254 participants across all 239 included studies, 6.1% of participants were European, 2.9% Māori, 1.4% Pacific peoples, 7.5% Asian, 2.5% Middle Eastern/Latin American/African (MELAA) and 9.0% Other ethnicity, with 70.6% Residual (unable to be categorised). CONCLUSION: Ethnicity reporting in New Zealand-based clinical trials is inadequate and not standardised. Mandatory ethnicity reporting per Stats NZ codes to the New Zealand Health and Disability Ethics Committees, ANZCTR and peer-reviewed journals, should be considered mandatory for RCTs undertaken in New Zealand.
Outpatient referrals for hospital specialist assessment are an increasing workload that carry significant risk if not attended to in a timely manner. This viewpoint discusses how decision support (including artificial in...Outpatient referrals for hospital specialist assessment are an increasing workload that carry significant risk if not attended to in a timely manner. This viewpoint discusses how decision support (including artificial intelligence and machine learning) may address this problem. Of the many possible approaches, we choose a combination of two that illustrate the breadth of available tools and how they combine to complement each other. To understand the issues and inform this discussion, a survey of general practitioners' views was conducted (Appendix 2), an audit of declined referrals was undertaken (Appendix 3) and draft decision trees were constructed (Appendix 4). To have data suitable for automated decision support, the current referral needs to change from free text to a structured format that ensures every patient has a complete minimum dataset. Regarding triaging decisions, at present there is human variability, but the decision support tools will need to be trained on a set of referrals that have an agreed gold-standard decision. In order to maintain patient safety throughout, the process needs to be incremental. We suggest that one way to assure patient safety is to combine simple decision trees with sophisticated contemporary machine learning.
Women with an abdominal aortic aneurysm (AAA) in Aotearoa New Zealand experience inequity at every stage of diagnosis and management. We currently treat women too late in their disease course, where increased age, comorb...Women with an abdominal aortic aneurysm (AAA) in Aotearoa New Zealand experience inequity at every stage of diagnosis and management. We currently treat women too late in their disease course, where increased age, comorbidities, larger AAA diameter, preventable ruptures, loss of eligibility for simple endovascular repair (EVAR) and clinical "turn down for surgery" rates all add to higher AAA mortality. There is scope for great improvements in cardiovascular risk reduction for people living with a small AAA and for considering the inclusion of women in proposals for an AAA screening programme.
Aotearoa New Zealand has one of the highest bowel cancer rates in the world. Bowel cancer incidence is increasing for Māori (the Indigenous people of Aotearoa), while trending downwards for non-Māori. Over half of Māori...Aotearoa New Zealand has one of the highest bowel cancer rates in the world. Bowel cancer incidence is increasing for Māori (the Indigenous people of Aotearoa), while trending downwards for non-Māori. Over half of Māori who get bowel cancer are diagnosed before the age of 60 years and are more likely than non-Māori to die within 2 years. Pacific people also experience bowel cancer inequities. In 2016, a national bowel screening programme for Aotearoa was announced, with an age range of 60-74 years. However, equity modelling showed that the proposed programme would disproportionately benefit non-Māori and that lowering the screening age for Māori and Pacific peoples to 50 years could achieve equal health gains. Over subsequent years, Māori cancer leaders advocated for policy change to lower the bowel screening age by 10 years for Māori. They used academic publications, presentations, letters, position statements, media stories and meetings with government leaders. Despite this advocacy, in 2020, the Government announced it was not going to lower the bowel screening age for Māori and Pacific peoples. The advocates persevered. They were supported in their efforts by new data that further confirmed the increasing bowel cancer incidence for Māori. In 2022, the Government committed to lowering the bowel cancer screening age to 50 for Māori and Pacific peoples. However, what followed was a tardy, phased rollout in only three regions. A year on, a new government embarked on a politically motivated agenda to reject ethnically targeted policies, with further significant equity changes to the programme announced. This paper summarises the lobbying efforts of cancer leaders and the government response, revealing structural and institutional racism, represented by inaction and active rejection of evidence-based advice. We describe the perseverance required to advocate for equity in the face of structural racism and the cost to Māori lives while inaction and racism persist.
AIMS: For over a decade, New Zealand pursued a comprehensive reform of its outdated medicines legislation, culminating in the passage of the Therapeutic Products Act 2023 (TPA) in 2023. In a policy reversal, the Act was...AIMS: For over a decade, New Zealand pursued a comprehensive reform of its outdated medicines legislation, culminating in the passage of the Therapeutic Products Act 2023 (TPA) in 2023. In a policy reversal, the Act was repealed by a new government in 2024. This study provides an analysis of this policy cycle to understand the drivers of the reform, its subsequent repeal and the implications for future health policy. We take a political economy perspective, foregrounding health policy instability and its consequences for patients, clinicians and Māori health interests. METHODS: We conducted a qualitative documentary policy analysis of 25 key government and stakeholder documents, including legislation, regulations, cabinet papers and select committee reports with their submissions. We employed a framework method for a systematic thematic analysis of the corpus to map and interpret the policy narratives. RESULTS: The impetus for the TPA was a consensus that the Medicines Act 1981 and its associated regulations from 1984 and 1985 were "no longer fit for purpose". The repeal was driven by an ideological shift, reframing the TPA as an unacceptable "regulatory burden". This has tangible consequences, including the loss of a pre-market approval framework for medical devices and the erasure of legislative provisions designed to protect and recognise Rongoā Māori (traditional Māori healing). CONCLUSION: The TPA policy cycle is a case study in the fragility of evidence-based health reform. It demonstrates that without a durable, cross-party political consensus, long-term policy projects are highly vulnerable to being dismantled by short-term shifts in political ideology, with downstream harms from regulatory instability. It also illustrates how a targeted "micro‑reform" can generate outsized system‑level consequences.