New GPS off track when it comes to tackling inequity

In early July, health minister Shane Reti released his Government Policy Statement on Health 2024–27, as required under the Pae Ora (Healthy Futures) Act 2022. It is immediately apparent that the 2024 GPS represents a different approach to the earlier interim GPS (released in 2022) – from its front cover (graphic design rather than pictures of tamariki) to its lack of Te Tiriti o Waitangi references.

But what does this mean for health organisations and health professionals? Does it mean anything at all to daily practice?

To answer this question, it might be helpful to look at what the GPS actually is.

Under the act, the health minister is required to issue a GPS at intervals of no more than three years apart. The GPS sets a focus for the health system and funding priorities and what is expected of health sector entities between now and 2027. Much of what this will mean for service priorities and objectives will be spelled out in more detail in the New Zealand Health Plan (also required under the act). The overarching vision beyond the three-year horizon of the GPS is the domain of health strategies (like the Māori health, health of disabled people, rural health, Pacific health and women’s health strategies, also required under the act).

The words equity, te Tiriti and racism are not mentioned in the 2024 GPS or its accompanying Cabinet paper

The 2024 health GPS wears its heart on its sleeve, if by heart you mean love of targets, metrics and “evidence-based” decision-making. In addition to the five health targets and five mental health and addiction targets already announced by ministers, the GPS priorities for action are listed as:

• timely access to quality healthcare (which is much as the name suggests but also includes workforce, infrastructure, and targets and does not talk about equity explicitly)
• prevention (which includes taking a population-needs-based approach for groups with the highest health needs, prioritising investment in children and shifting resources closer to communities)
• partnering to respond to the broader determinants of health – this appears to largely be about partnering with other parts of the Government – such as regional public service commissioners – and with iwi Māori partnership boards. (Although these are the priorities in the document itself, the Cabinet paper seeking approval of the 2024 GPS lists only access, timeliness, quality, workforce and infrastructure as priorities – with no mention of prevention as an explicit focus.)

The GPS also states that its vision includes the priority populations identified in the act (that is, Māori, Pacific peoples, disabled people, women, and people living in rural communities and others) – all while being financially sustainable and making evidence-based decisions.

The differences between this GPS and the 2022 interim GPS¹ are stark. The interim GPS was explicit about achieving equity and meeting obligations under Te Tiriti o Waitangi (these were the first and second priorities under the interim GPS, respectively), and there were specific references to eliminating racism. In contrast, the words equity, te Tiriti and racism are not mentioned in the 2024 GPS or its accompanying Cabinet paper.² Nor are there proposed actions that could achieve the same ends. Instead, as retro as it sounds, the GPS looks to be focused on better, sooner and more convenient services.

For the health system, the GPS signals the move towards a more narrowly defined role – less about understanding and tackling the causes of poor and inequitable health outcomes (like racism) and more about ensuring services are accessible, timely and monitored. It also signals a decreased interest in the health system’s role in protecting and meeting te Tiriti or human rights obligations or reflecting a Māori worldview. The focus is instead on “evidence”, which probably points to an increased interest in social investment.³ Social investment has been attempted in health on a small scale (for example, programmes looking at health services for job seekers), but this is likely to expand with it being positioned as this Government’s solution to almost any policy problem. Whether social investment is good or bad is too big a question for this column, but needless to say – it is something to keep our eyes on.

For health organisations and health professionals, however, I’m not sure that this GPS should signal big changes to day-to-day practice, especially when it comes to meeting the needs and aspirations of Māori.

This is for two reasons. First, lessons from other sectors are that GPS signals don’t necessarily lead to rapid change. For example, there have been requirements for a land transport GPS for about 15 years, and a recent evaluation⁴ of the 2018 land transport GPS’ shift towards walking, cycling and public transport highlighted that there was slow progress and “little margin for change” because there were already so many other projects under way. In other words, it is always hard to change the status quo. Usually, this is used to argue for why it is hard to get traction for Māori health. But with six or so years of providers and professionals saying they’re prioritising Māori health, maybe the status quo is a good thing.

Second, the GPS hasn’t changed the existing obligations of health practitioners or health organisations. Specifically, I think of practitioner obligations to practice in culturally safe ways. Nurses have always led the way in this regard. More recently, the Medical Council’s Statement on Cultural Safety emphasises the need for doctors to “acknowledge and address their own biases, attitudes, assumptions, stereotypes, prejudices, structures and characteristics that may affect the quality of care provided” and the Council of Medical Colleges has set out a cultural safety training plan for vocational medicine⁵ in Aotearoa, which outlines how to embed such an approach.

The current health and disability standards (Ngā Paerewa),⁶ which set out a framework for certification for health organisations, also have a strong focus on cultural safety. Furthermore, Ngā Paerewa expects service providers to “work collaboratively to embrace, support and encourage a Māori worldview of health and provide high-quality, equitable and effective services for Māori framed by Te Tiriti o Waitangi”.

All of this is to say that the 2024 GPS is a departure from a focus on Māori health and wellbeing and away from achieving equitable outcomes for priority populations, including tāngata whaikaha Māori. But that departure doesn’t mean that those of us working in health can down tools and instead only focus on the targets prescribed by the minister. Obligations to work in culturally safe ways, that are high quality, equitable and effective mean that everyone working in the health system must also continue to be thoughtful about how they work and seek to expressly improve outcomes for those most underserved by the health system. No GPS can change that.

Gabrielle Baker (Ngāpuhi, Ngāti Kuri) is an independent health policy consultant