Pae Ora - The radical change to our health system

The Pae Ora (Healthy Futures) Bill introduces legislation set to replace our current New Zealand public health system.

This legislation will fundamentally change the structure of our health system. The bill's stated purpose is to provide public funding and provision of health services to protect, promote, and improve the health of all New Zealanders, and achieve health equity by reducing health disparities among New Zealand’s population groups. The objective of achieving health equity among New Zealand’s population groups, in particular for Māori, is the key driver of this new health system.

A critical feature of the Act is the change from delivery of publicly funded health services by DHBs to delivery by Health NZ (NZH) and a Māori Health Authority (MHA). It will also establish a Māori advisory committee at a national level and strengthen the existing iwi/Māori partnership boards at a local level.

The MHA, the Māori advisory committee and iwi/Māori partnership boards will focus solely on Māori health - access, experience and outcomes - while HNZ will have the obligation for the delivery of health services for ALL New Zealanders and will also be required to ensure equitable outcomes for Māori.

As HNZ and MHA have the function of jointly developing and implementing a New Zealand Health Plan, which will set the operational direction for the system, our publicly funded health system will be subject to co-governance. (He Puapua in action again?)

The Government makes it clear the Act is about meeting what it sees as Treaty obligations - showing a determination to put the interests of Māori ahead of their obligation to all other New Zealanders. In doing so Pae Ora will effectively institutionalise racial discrimination by creating what is intended to be a permanent structure promoting preference based on race. The legislation contemplates the permanent maintenance of unequal and separate rights for different racial groups. This conflicts with the Crown’s obligation to all New Zealanders to act in good faith, reasonably, fairly and with honour.

In addition to disregarding this obligation to us all, the proposed legislation will contravene the government’s obligations under the International Convention on the Elimination of All Forms of Racial Discrimination. Article 5 of this Convention, which New Zealand signed up to on 22 November 1972, provides that:

In compliance with the fundamental obligations laid down in article 2 of this Convention, States Parties undertake to prohibit and to eliminate racial discrimination in all its forms and to guarantee the right of everyone, without distinction as to race, colour, or national or ethnic origin, to equality before the law, notably in the enjoyment of the following rights:
(e) Economic, social and cultural rights, in particular:
(iv) The right to public health, medical care, social security and social services.

It is of concern that Māori citizens as a group are overrepresented in morbidity and mortality statistics. Our publicly funded health care system should find ways of trying to deal with this anomaly. However, with the aim of achieving equity, this bill does not consider the myriad of other factors that combine to determine the health outcomes of individuals. The 2019 Health and Disability System Review, Interim Report, commissioned by the government to ensure our future system achieves better and more equitable health and wellbeing outcomes for all New Zealanders states that:

“Although many people continue to consider health care in the context of clinical and medical care only, it is widely acknowledged that this accounts for only about 20% of a person’s health and wellbeing status. The other 80% arises from the conditions in which a person is born, grows, lives, works, and ages, including physical, cultural and natural environments, housing, education, the distribution of power and income, and health behaviours. The impacts of these can accumulate over a life time.” (p.25)

Pae Ora’s implications for the rights and interests of the wider community is of great concern. To gain an understanding of whether these concerns are justified, and to inform submissions to the Pae Ora Legislation Committee, we engaged Gary Judd QC to provide analysis and commentary on the proposed Act. After studying the bill, Mr Judd commented that a health service funded by the general taxpayer which gives priority to one section of society not based on their health needs (even though they may have health needs) but on their race is unfair, unjust, and contrary to the principles of a free and democratic society. Please read Mr Judd's overview and conclusions in full here.

Make submission demanding that the Government fairly represents the interests of all of us.

In doing so you are welcome to use Gary Judd’s summary to inform your feedback on the bill, and/or see below an example submission, which can be edited for your own use.

How to make a submission

Submissions are due by 11:59 pm on Thursday 9th December 2021.

To make a submission, and we suggest you do, follow these steps:

1. Create your submission document, this can be based on Gary Judd's summary, our example submission, or your own words.

2. Go to the Select Committee submission site, fill in the form by answering a series of questions: if you are submitting on behalf of an organisation or an individual, if you wish to make an oral submission, and your name and email address.

3. Upload your submission document when prompted, and then click ‘Submit’.

N.B. If you do not want your contact details to be published, only add your name to the submission document itself.

We thank you in advance for taking the time to make a submission on this important bill.

Making a supplementary submission

If you have already made a submission, but would like to add additional comments, you can make a supplementary submission online. This would be given to members alongside your original. Or you can submit a fully updated submission online to replace your original submission, letting the Pae Ora Legislation Committee know which option you would like to take. Their email address is: [email protected]


Pae Ora (Healthy Futures) Bill


Pae Ora Bill doubles down on Treaty partnership ideology

The Pae Ora (Healthy Futures) Bill passed its second reading this week. The hybrid Māori Affairs/Health Select Committee examining the legislation has recommended several amendments, which have been accepted. These changes include provision to further strengthen the Treaty of Waitangi partnership ideology in the legislation. Continue reading

Submissions on the Pae Ora (Healthy Futures) Bill

Oral submission text: Thank you for the opportunity to provide comment on the Pae Ora (Healthy Futures) Bill. I am presenting this submission on behalf of Democracy Action.  Firstly, I want to make it clear we wholeheartedly support the purpose of the Act - that is to protect, promote, and improve the health and future health of all New Zealanders. But, if the intention is to improve the health of ALL New Zealanders, this proposed legislation is absolutely the wrong way to go about it.  Continue reading

The new health system - who will actually be in charge?

On April 21 the government released its plans for a new health system for New Zealand. The key announcements were centred around the disestablishment of our 20 regional DHBs in favour of one new national entity, Health NZ, and the establishment of a new Māori Health Authority to ensure our health system delivers improved outcomes for Māori. Continue reading