New report examines trends in health determinants
HPE welcomes a new report that examines trends in the determinants of health and how we can best improve health 
and wellbeing outcomes for everyone in Aotearoa New Zealand.
Released by the Public Health Advisory Committee (PHAC), this is the first major report on determinants of health and equity in Aotearoa in over 25 years, and a timely reminder that most of the building blocks of our health and wellbeing come from outside health care itself.
The report - ‘Determining our Future’ - looks at trends since 2000 in the distribution of the determinants of health (such as income, housing, cultural identity and social cohesion) and in health outcomes, and why these are unevenly distributed in our society. Although it found that New Zealanders were living longer, and many health and wellbeing outcomes had improved over the last 25 years, these gains remained unequally shared.
For instance, according to the report health inequities today remain striking, as illustrated by how long we can expect to live.
‘Children growing up in our most urban areas today can expect to live four years longer than those in the most rural areas. A Pākehā (European New Zealander) baby boy born in Waikato today can expect to live eight years longer than his Māori neighbour. Pākehā children can expect to live to 84 years in the northern region, seven years longer than Pacific peoples’ children – a gap that has increased since 2000.’
At the same time, almost two in five people in Aotearoa today find it hard to meet every-day costs. Two-thirds of New Zealanders do not feel ‘well off’, and one in four sometimes do not have enough to eat. There are significant pressures on our health system, and we can expect these to increase as our population grows and ages, and as more of us have long-term health problems, such as diabetes.
The report explores why the determinants of health are unevenly distributed in our society and some of the mechanisms through which they affect our health.
The report later looks forward to 2040 and assesses more recent challenges to health equity and wellbeing, including the impacts of commercial interests and of the ‘megatrends’ - the climate crisis, AI and digital technology.
It identifies that improving health and wellbeing is shaped by the building blocks of wellbeing outside the health sector and requires collaboration between government agencies. But government intentions to do this are often undermined by agencies continuing to pursue objectives in their own silos. This must be addressed by a clear requirement to collaborate around long-term wellbeing goals, agreed at Cabinet level, recommends the report.
Evidence and research from within New Zealand and internationally were assessed to understand what works to improve health and wellbeing outcomes and health equity. The report also drew on the perspectives and experience of young people, community, iwi and public service leaders.
The PHAC recommends actions to the Minister of Health and Government around three key themes.
Firstly, good health and wellbeing are rooted in the strengths, mana and aspirations of whānau and communities. The government and public services must work collectively and more effectively to resource and support communities to achieve their own solutions.
Secondly, we need to get the fundamentals right. The big challenges ahead require courageous leadership, a greater sense of urgency, and shared long-term goals.
Thirdly, PHAC sees many opportunities that are “win-win” solutions to the big challenges ahead, such as the climate crisis. For eg: Build healthy, affordable homes that offer whānau security, help keep children in school and people out of hospital - but also help reduce carbon emissions. Design our infrastructure and cities to support physical activity, public transport and connection with our environment, which is good for the health of people and will help us reach our climate goals.
Kevin Hague, the chair of PHAC said, "we have known for decades that most of the building blocks of our health and wellbeing come from outside health care itself: where we live, learn, what we earn, our housing and our social connections.
“We have learned much from the gains that have been made, but also from the failures to make progress in many key areas. The unnecessary, costly and preventable differences we see today in the determinants of health, and in health and wellbeing outcomes, are not inevitable or fixed. They can be modified through the policies and actions that we choose to implement.”
The PHAC is an independent advisory committee established in July 2022 under the Pae Ora Act. It looks at the long-term health challenges facing New Zealand, providing evidence-based public health advice directly to the Minister of Health and central government health agencies.