National Party leader Christopher Luxon made claims about health outcomes that were clearly false. Why was he left unchallenged?

In the TVNZ leaders’ debate last night, Luxon and Labour’s Chris Hipkins had a testy exchange over Māori healthcare.

Hipkins held firm on the creation of a Māori Health Authority, established last year, arguing strongly that the persistent gaps in health outcomes and care justified it.

• READ MORE: NZ election 2023: Hipkins and Luxon in fast-paced debate but fail to excite pundits
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• Full RNZ data on Māori healthcare

Luxon was equally clear in opposition to it. He framed his critique of the authority around an alleged complete lack of progress on Māori health outcomes. He was very specific.

“Every single health outcome has gone backwards under Chris’s government,” Luxon said.

“Six years, not one has improved for Māori or for non-Māori.”

While sweeping in nature, Luxon’s claim did not get a direct response from Hipkins.

Luxon repeated a similar line later in the debate.

“Gone backwards. Chris, under your government, every single health outcome for Māori or non-Māori [has gone backwards]. You can’t have that.”

Hipkins did push back on this occasion, citing the ongoing reduction in rates of smoking.

Luxon’s claim was far from true — there are a number of areas where health outcomes for Māori and non-Māori have improved while Labour has been in charge.

But it is perhaps understandable that Hipkins was not quick to correct Luxon because the data — even though it’s better in many respects — is still grim. Maybe Hipkins did not wish to dwell on this.

Improved health outcomes
There are a number of health outcomes where, for Māori, statistics have improved.

Perhaps Labour’s biggest boast is their track record on bringing down lung cancer and smoking rates for Māori.

Lung cancer is the second leading cause of death for Māori in Aotearoa. But according to the Ministry of Health, rates of lung disease for Māori have come down.

In 2017, the rate per 100,000 people was 79.9 for Māori. By 2019, it was down to 68.4. This also aligns with smoking rates among Māori dropping.

Pre-colonisation, Māori did not smoke. However, when tobacco was introduced to Aotearoa in the 18th century that quickly changed.

Smoking has been particularly harmful for Māori who have higher smoking rates than non-Māori and experience greater rates of death and tobacco-related illness.

In 2017/18, the smoking rate for Māori adults was 35.3 percent. By 2021/22, it was down to 20.9 percent (approximately 127,000 people).

Rates were falling under National but they have continued to drop under Labour, which has rolled out a number of initiatives in an effort to reduce nation-wide smoking rates.

As part of the Smokefree 2025 Action Plan, historic and world-leading legislation mandated an annually rising smoking age that will mean that anyone born on or after 1 January, 2009, will never be able to purchase tobacco products.

Other cancers
Overall, cancer registrations rates among Māori fell from 416 per 100,000 people in 2017 to 405.7 in 2019.

Breast cancer registration rates for Māori women fell from 140.7 per 100,000 people in 2010 to 122.5 per 100,000 in 2019. Prostate cancer registration rates for Māori fell from 105.5 for Māori in 2017 to 103.5 in 2019.

For non-Māori, overall cancer registration rates increased slightly from 323.2 (2017) to 332.4 (2019).

Life expectancy
The life expectancy gap between Māori and non-Māori may be the most telling indicator of all when it comes to inequities.

According to the latest available data from 2019, life expectancy at birth for Māori men in 2017-2019 was 73.4 years, up 3.1 years from 2005-2007 data.

The life expectancy for non-Māori men is 80.9 years. For Māori women, it was 77.1 years, up 2 years from 2005-2007. Non-Māori women are expected to live to 84.4 years.

While Māori life expectancy has increased over time, the gap to non-Māori persists.

At the current rate of progress it will be more than a century before Māori and non-Māori have equal life expectancy, a study by the Association of Salaried Medical Specialists found in 2021.

Child immunisation
In the debate, after Hipkins raised smoking as an area of improvement, Luxon said child immunisation was a concern. On this, he was correct.

Over the past six years, child immunisation rates have steadily fallen.

In 2017, 86.2 percent of eligible Māori five year olds had completed all of their age-appropriate immunisations. As of last year, the rate had shrunk to only 71.8 percent. That is an alarming 16 point drop in the period Labour has been in power.

In April of this year a report commissioned by Te Whatu Ora’s Immunisation Taskforce found that immunisation failed to achieve “adequate on-time immunisation rates in young tamariki” and to immunise Māori, meaning those who were most susceptible to “vaccine-preventable disease” had the lowest immunisation coverage.

The report highlighted the worst rate in the country — just 34 percent of Māori children in South Auckland were fully vaccinated. It attributed part of the problem to vaccinators being diverted to the country’s covid-19 pandemic response.

“This caused childhood immunisation rates to plummet. These rates are now the lowest they have ever been and ethnic disparities have further expanded,” it said.

The report outlined 54 recommendations covering funding, delivery, technology, communications and governance across the programme.

In the debate, Hipkins suggested the anti-vaccine movement was part of the problem, which he sought to link with National.

National has proposed an immunisation incentive payment scheme. The plan would see GP clinics paid a lump sum for achieving immunisation targets, including full immunisation for two-year-olds, MMR vaccines for ages 1-17, and influenza vaccines for ages 65+.

The clinics would have to either achieve 95 percent coverage for their childhood patients, and 75 percent for the flu shots, or achieve a five percentage point increase for each of those target groups, by 30 June 2024 to receive the payment.

Labour’s Dr Ayesha Verrall said a similar scheme already existed.

Labour has also failed to halt type 2 diabetes, the country’s biggest and fastest growing health condition.

Ministry of Health figures show that in 2021 there were 302,778 people with diabetes, predominantly type 2. Since the Labour government came into power in 2017, the estimated rates of the number of Māori with diabetes per 1000 has risen from 66.4 to 70.1 in 2021.

The rates for non-Māori have also climbed from 27.8 in 2017 to 30.1 in 2021. It is also important to note that the rate of diabetes in Aotearoa has been steadily rising over the past 50 years.

Type 2 diabetes can also lead to devastating health conditions and complications, including heart failure, kidney failure, strokes and limb amputation.

According to Ministry of Health data obtained by RNZ under the Official Information Act, since 2011 there has been a 39 percent increase in diabetic limb amputations across the whole population.

For Māori, the number has more than doubled in the past decade from 130 in 2011 to 211 in 2021. Under Labour, the number of Māori diabetic limb amputations rose by 15 percent.

Māori are still 2.8 times more likely to have renal failure, another complication of diabetes.

Mental health
According to Te Whatu Ora, the rate of suspected suicide per 100,000 Māori population in 2021/22 was 16.1. This is not a statistically significant change from the average of the past 13 years.

This article is republished under a community partnership agreement with RNZ.

New Zealand is scrapping district health boards and creating a new Māori health agency in a radical “fairer and smarter” shake-up of the medical system.

Health Minister Andrew Little announced details to health leaders at Parliament today.

The 20 district health boards which run services for individual areas around the country will be replaced by one new body, Health NZ, which will instead plan services for the whole population.

• READ MORE: ‘Clear’ inequity for Māori in health care – report

Health NZ will have four regional divisions but also district offices.

It will delegate authority to local levels so regional services have a say in what they need and how they work, Little said.

“The system must work in true partnership with Māori… Māori still suffer, on average, worse health than others.”

There will also be a new Māori Health Authority, sitting alongside that, to both set policies for Māori health and to decide and fund those who will deliver services.

Direct commission
The new authority will “have the power to directly commission health services for Māori”.

“There are other equity challenges as well … the system must listen to the voice of Pacific people, disable people, rainbow … and all other people,” Little said.

“We can and must do better.”

The country’s 30 primary health organisations – large regional networks of GPs and primary care – will also be ditched.

And, on the back of covid-19, there will be a new Public Health Agency which will target widespread health problems – like smoking – and try to prepare for pandemics and epidemics.

• WATCH:

RNZ News video of the national health shake-up announcement.

Little said today’s announcement was a plan to create a “truly national health service” that “draws on the best that we have now” but reduces pressure on healthcare workers and hospitals and specialist services.

“By making the changes I am announcing today, we will have the chance to put the focus on primary health care,” he said.

“We can start giving true effect to tino rangatiratanga and our obligations under Te Tiriti O Waitangi.

‘System under stress’
“It’s a system under stress. Our health and care workers strive every day … but demand is growing … and the job is getting harder.”

The changes being announced go further than the Health and Disability System Review, the basis for today’s plan.

That recommended halving the DHBs, and having a Māori health authority but with fewer powers and less autonomy that the one announced today.

The changes have been made to try to stop what is called the “post code lottery of care”, where people get different care – or have different changes of survival – depending on which DHB area they live in.

The report released today says a lot of those problems are caused by the fact that hospitals and specialist care are often managed in isolation from each other, not in a coherent network.

Instead of district health boards, the new Health NZ, will oversee the health needs of four regions.

And there is an increased focused on primary – or GP-level community care.

Primary care funding
The report says at the moment specialist or hospital care draws away a lot of primary care funding and it wants that to stop.

It also wants those community services – including GPs, midwives and pharmacists, to work more together

And the Māori Health Authority is aimed at overcoming the huge health disparities for Māori as a whole, with lower life expectancy and higher rates of disease in many areas.

Associate Health Minister (Māori Health) Peeni Henare said many Māori did not like going to the doctor because their experiences of the health system is negative.

“This authority will drive hauroa Māori and make real change,” he said.

It would represent Māori from all iwi.

“This is where we make a start,” Henare said.

Public health units
“Regional public health units, long underfunded, will stay but under the new Health NZ entity.

Little said he had heard calls for change, quickly.

“The current system no longer serves our needs well. Our goal is a health system that helps all New Zealanders to live longer in good health,” he said.

“We need a system that is not only fairer but also smarter.”

Smarter means making the most of the money and resources available, Little said.

He was not underestimating the challenges faced, he said.

“Our system has become overly complex. It is too complicated for a small nation.

‘Operate as one system’
“We need to operate as one system. Organisations working together should be the norm, not the exception.”

The Ministry of Health would be strengthened, Little said.

But it will no longer directly fund and commission health services.

Health New Zealand – a new Crown entity – will run hospitals and commission primary health care.

It will replace the existing 20 health boards, Little said.

“DHBs have served their communities well.”

But they have their failings, he said.

‘About doing better’
“I want to stress this reform is about doing better with what we have. It is not about cutting services,” Little said.

Little said the fourth element of the announcement was about public health, including “Pacific people, disabled people, rainbow … and all other people”.

“Disability issues span the full range of issues any community faces. That’s why I have more work being done in this area,” he said.

Little said technology would play a part in the new system.

That would include improving access to things like virtual diagnostic tools.

“Health NZ will work with communities … to develop the priorities for their areas, making sure people have a say in the services they get.”

“You should be able to turn up anywhere in the health service and know the health professional has access to information relevant to you.”

New health charter
There will also be a new health charter.

“We will start work on this soon.”

Some aspects of change would take years, not months, Little said.

He acknowledged the challenge of making change during a global pandemic.

He was confident they could safely take place at the same time.

“Covid-19 is not a reason to preserve a system that is not fit for purpose,” he said.

“I am mindful we need to proceed carefully and not disrupt day-to-day services.

“I expect the new system to come into effect in July 2022.”

Establishing interim versions
In coming weeks, work will begin on establishing interim versions of Health NZ and the Māori Health Authority.

New legislation for them will be worked on and Little expects that legislation to be passed by April 2022.

“Together we have an opportunity to make a once in a lifetime change, to put in a new system and improve the health of this, and future, generations.”

DHBs will continue in their roles for now.

“I want to reassure new Zealanders that the care they rely upon will still be available.”

The changes are overdue, and “this time, it must be different”, Little said.

During the process of the reform plan, Little said he had been thinking of those working in the system, and those who needed healthcare.

“We are a small nation, and we can make this change working together, and we can make this change in the spirit of Te Tiriti (O Waitangi).”

This article is republished under a community partnership agreement with RNZ.

Indonesia currently has the highest covid-19 coronavirus mortality rate in Asia – between 8–9 percent – owing to its poor public health management and regional disparities within its health system, reports the Jakarta Globe.

Uncertainty surrounds the effectiveness of Philippine President Rodrigo Duterte’s ban on smoking.

In an executive order titled E026, Duterte ensured an earlier ban on smoking in enclosed public places and on transportation.

Two months after Duterte’s announcement in May, University of Santo Tomas political scientist Edmund Tayao says “we have yet to see if its implementation will be good”.

Despite the positive health benefits of the ban, anti-smoking advocacy group Health Justice Philippines estimates about 240 Filipinos still die a day — or 87,600 a year — due to smoking-related diseases.

The Philippines ban on public smoking has existed since the Tobacco Regulation Act 2003, which bans smoking in public places such as schools, hospitals, nursing homes, laboratories, and public transport.

Elevators and stairwells also fall under the act, while regulations have also been slapped on tobacco advertising, promotion and sponsorship.

Duterte’s executive order enforcing the earlier ban did not come as a surprise, as he has been a long-time enforcer of anti-smoking since his time as a former mayor of Davao City.

Ban ‘good news’
Duterte’s stand against smoking in Davao City – the most economically-progressive urban enclave in Mindanao island – is now being continued by current mayor and presidential daughter Sara Duterte-Carpio.

But while E026 has its critics, Duterte’s reinforcing of the 2003 ban came as good news for 75-year-old widow Juliana Cruz, who lost her husband Rogelio three years ago due to lung complications.

Since he was 15-years-old, Rogelio had consumed two packs of imported, blue-sealed cigarettes daily.

Prior to his death, Rogelio lost his left lung due to a ballooning cyst and had his ribs removed.

The couple were supposed to build a house, but all of their savings went to Rogelio’s hospital bills.

“I was really mad at my sons since they are also smoking. You have seen the fate of your father, but you have not learned from that,” Cruz said.

Duterte’s smoking ban is also good news to smoking victims like cancer survivor Emer Rojas of the anti-tobacco group New Vois Association of the Philippines (NVAP).

Reduce victim numbers
“We may be able to reduce the number of victims, like us,” Rojas said.

The ban’s enforcement is also seen as one of the toughest in the wake of how other countries have implemented their own smoking bans.

An association of thoracic (spine) doctors in Greece appealed to the government recently to crack down on violations, as seven out of 10 Greeks were exposed to second-hand smoke when visiting bars, restaurants and cafes — all prohibited areas.

Soon-to-be Olympic Games host Japan saw some of its world-level athletes banding together with academics and cancer patients to demand the Japanese government to ban smoking in public indoor places.

About 15,000 Japanese die of second-hand smoking annually, a University of Tokyo health policy professor was quoted as saying.

World leaders themselves have also been lax when it comes to observing smoking bans.

In a March state visit to China, Czech Republic President Milos Zeman got Chinese cigars from Chinese President Xi Jinping.

World leaders lax
Government media reported that since Xi quit smoking in August 2016, 300 million Chinese smokers were “inspired” to quit too.

Controversially, Zeman ignored China’s smoking ban by smoking at Xi’s dinner and on the flight to Beijing – the Chinese government has banned smoking in many indoor places, such as hospitals, schools, sports stadiums and public transport.

Despite the apparent ongoing challenges of enforcing a smoking ban in the Philippines, industry lobby group Philippine Tobacco Institute said in a statement it had “always supported regulation of public smoking”.

Their support comes in spite of impacts to the local economy and businesses through a sin tax reform law (Republic Act 10351, passed in 2012) that imposed hefty tax rates on cigarette products.

Before this year, the law provided brackets of taxes for cigarette products depending on their price.

Currently, cigarettes are taxed uniformly at P30 (NZ$80c) a pack.

Jerome P. Villanueva is an MA in Journalism student at the University of Santo Tomas, and produced this story for the graduate class Global Journalism Practice and Studies.

• Read more University of Santo Tomas Journalism stories