Win-win: Public Health Committee Gets it Right

By Sophie Handford

It’s been nearly three decades since Aotearoa’s National Health Committee released its groundbreaking 1998 report on the social determinants of health. This year, the Public Health Advisory Committee reviewed our progress and found that, despite some improvements, significant disparities persist across socioeconomic status, ethnicity, disability, and age. In other words, we still have a long way to go.

I’ll be honest: I wasn’t born in 1998 (but don’t stop reading!). I’ve grown up in the very period this report reflects on. Many of the issues it’s concerned with - such as climate change, deteriorating social cohesion, and growing inequity - are the same challenges I’ve dedicated my working life to tackling. 

I welcome this report and the recommendations it contains. When I first read it, one of my thoughts was, “Have the Committee been secretly listening in on our team calls? Or are the solutions to Aotearoa’s biggest challenges simply so obvious, so grounded in common sense, that many of us are landing on them together?”

Because so much of what the report recommends aligns with the vision we, and many others, have been championing: long-term thinking, prevention over crisis response, and investing in the conditions that help our people and our environment thrive.

The last part (the conditions that we live in) are exactly what is meant by the ‘social determinants’ of health. These are the ‘upstream factors’ that drive our health and wellbeing. Things like access to safe housing, education, food, income, and strong social connections.

This is something we can all intuitively understand. It’s easy to see how poor housing leads to poor health. How “old, cold and full-of-mould” houses drive illness. And, unfortunately, this example has only gotten worse since 1998. As Kevin Hague, the Chair of the Committee pointed out, housing affordability and overcrowdedness have actually increased since 1998, which has worsened New Zealanders’ health outcomes.

But it’s not just housing, we have many other shared challenges. The Committee found that two in five New Zealanders struggle to meet everyday costs. One in four don’t always have enough to eat. Mental health has deteriorated, especially among young people. Trust in government is declining. And the climate crisis looms over it all. 

I see how deeply these realities, and their intersections, weigh on rangatahi. Many feel anxious about the future, and the scale and urgency of the climate crisis, yet they’re also stepping up with vision and determination. I hold hope, because we already have the solutions and the creativity to turn this around, if we choose to act together with courage. 

So now it’s time to focus on those solutions. The concept of ‘failure demand’ offers a useful lens here. It refers to the ongoing costs we incur by responding to harm we failed to prevent in the first place. As Hague puts it: “It’s a drain on the public purse… those massive health dollars that need to go into specialist care to deal with health problems that could have been avoided, with better lives for everyone.” So let’s switch it around. Let’s stop paying for broken systems and start investing in a better future, one that works for current and future generations. 

To that end, the Committee has some excellent recommendations for how to get there. These recommendations feel like a strong step in the right direction, and closely mirror our own calls for change. Let’s take a look at them one-by-one: 

Invest in and empower communities. As the Committee said: “Wellbeing, social cohesion, economic prosperity, and health start within whānau and communities” and they recommend the public service works collectively across government to achieve agreed wellbeing goals with communities. They state this will require ‘making changes in the way public services work together, to enable and empower communities’.

In my time as a Kapiti Coast District Councillor I have seen first-hand the power of community-led initiatives. I think often about the nights I spent with local volunteers delivering food parcels and sewing masks during the pandemic, or the way neighbourhood groups rallied to keep each other warm through winters of rising costs.

Those experiences reminded me that real resilience comes from the ground up, from people who know their community best and who are willing to show up for each other.

In my current role we focus on Community Wealth Building as a practical, place-based approach to economic development. Community Wealth Building is about making sure local people and businesses benefit from the money and resources in their area. It means keeping wealth circulating locally, For example, by using local public money to support local companies, and making sure that assets, like land, housing, and infrastructure, are owned and managed in ways that help communities over the long term. This approach has revitalised local economies in places like Preston (UK) and Cleveland (Ohio, USA). I believe Aotearoa is more than ready for a model like this.

The next main recommendation is to strengthen the fundamental structures of our society so that all New Zealanders have access to the resources they need to thrive. Under this recommendation the Committee proposes ‘initiating a discussion on Te Tiriti o Waitangi as we move towards 2040, about how we want to govern our country.’ Honestly, have the Committee been intercepting our emails because that’s exactly the kind of national kōrero we’re trying to spark: one centred on long-term planning, intergenerational fairness, Te Tiriti justice, and a governance system that genuinely serves future generations. 

Going even further though, the Committee recommended the government ‘articulate an explicit approach to economic growth, societal wellbeing and equity’ as ‘we need an economic system that is more equitable and redistributive by design.’ Ding ding ding! I couldn’t agree more.

Our current “growth-at-all-costs” model isn’t delivering wellbeing. This is not only because the gains aren’t being shared fairly, but also because not all GDP growth is good growth. For example, an oil spill can increase GDP due to the cost of cleanup, but growth like that comes at a real cost to people and planet. It’s time to embrace a wellbeing economy that values people and the environment, unlocking a future that is fairer, healthier, and more sustainable for everyone.

The final area of recommendation is to invest in ‘win-win’ solutions which have compounding benefits for health and other social outcomes. Under this recommendation, the Committee argues that although the solutions to big challenges, like the climate crisis, often come from outside the health system, the solutions can create win-win benefits for health equity and our other big goals. For example, building warm, affordable homes can reduce hospital visits and reduce emissions, support whānau wellbeing, and keep kids in school. Similarly, designing cities that encourage physical activity, public transport, and connection to nature is good for people’s health and for the planet.

This type of long-term thinking is exactly what we’re advocating for. Our current approach is short-sighted. The win-win path is not only more effective and sustainable, it’s also more joyful. Imagine if, instead of constantly defining problems and rushing to the bottom of the cliff with an ambulance, we focused on creating and celebrating the future we do want.