Concerns are mounting over Pharmac’s proposal to remove priority access pathways for type 2 diabetes medicines currently available to Māori and Pacific peoples, with health leaders warning the move could deepen already severe inequities in chronic disease outcomes.
Dr Rawiri McKree Jansen, a leading Māori GP and long-time advocate for Māori health equity, says the proposal risks undermining years of work aimed at addressing disproportionate diabetes rates among Māori and Pacific communities.
Type 2 diabetes remains one of the most significant long-term health challenges facing Māori, with Māori and Pacific peoples experiencing higher rates of diagnosis, earlier onset of disease, and greater risks of complications including kidney failure, amputations, blindness, stroke and heart disease.
Targeted access settings were originally designed to respond to those inequities by helping Māori and Pacific patients gain earlier access to newer diabetes medications shown to improve long-term health outcomes and reduce complications.
Dr McKree Jansen says from a clinical perspective, equitable healthcare does not always mean treating everyone identically, particularly when some populations carry a far heavier burden of illness due to longstanding structural inequities.
He says targeted access recognises the reality that Māori and Pacific communities often face multiple barriers to healthcare, including affordability, delayed diagnosis, transport access, workforce shortages and systemic bias within the health system.
Health advocates fear removing priority pathways could lead to delays in treatment escalation, poorer diabetes management and worsening long-term outcomes for patients already overrepresented in avoidable hospital admissions and chronic disease statistics.
The proposal has also triggered wider concern about the direction of Pharmac’s equity approach following recent debates over Māori-specific health policies and the future role of equity measures inside the public health system.
Dr McKree Jansen says changes that appear to weaken targeted equity responses risk damaging trust among Māori communities who have repeatedly experienced poorer health outcomes despite decades of official commitments to equity.
He says trust in the health system depends not only on access to services, but on whether communities believe decision-makers genuinely understand and respond to the realities Māori patients face.
Health experts argue diabetes management is not simply about medication, but about broader prevention, whānau support, nutrition, housing, access to primary care and culturally safe healthcare delivery.
If the proposal proceeds, Dr McKree Jansen says safeguards would need to include stronger monitoring of Māori and Pacific health outcomes, improved primary care support, culturally responsive diabetes services and mechanisms ensuring patients are not pushed further behind.
He also says Māori voices must remain central in decision-making around medicine access and public health policy, particularly when changes could disproportionately affect communities already carrying the greatest burden of disease.
The debate comes amid ongoing pressure on the health system to balance cost management with equity commitments, while Māori health leaders continue calling for stronger investment into prevention, early intervention and community-led healthcare solutions.
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