A leading Māori health expert says proposals to remove ethnicity from access criteria for lifesaving diabetes medicines would have worsened existing health inequities, arguing that prioritised care for Māori and Pacific peoples remains one of the strongest evidence-based tools for reducing preventable illness and death.
Associate Professor Rawiri Keenan, from the University of Waikato’s Primary Care Medicine programme, says maintaining targeted access to diabetes medications for Māori and Pacific patients is the most effective approach to improving health outcomes.
His comments follow recent debate over Pharmac’s proposed changes to the prescribing criteria for new diabetes medicines, which included removing ethnicity as a prioritisation factor before widespread public and clinical feedback prompted a rethink.
Keenan says that, if access is to be broadened, it should be expanded to include all people with diabetes who require better blood sugar control, rather than removing targeted access for groups known to experience significantly poorer health outcomes.
“Short of maintaining the status quo of prioritised access for Māori and Pacific patients with diabetes, widening access to all people with diabetes requiring better control is the most logical step,” he said.
He says the proposal to remove ethnicity as a criterion failed to reflect the realities faced by frontline clinicians.
“The proposed removal of ethnicity clearly fell flat with those at the front line who see the inequities in diabetes care as well as the benefits from these medications.”
Māori continue to experience disproportionately high rates of type 2 diabetes and its complications, including kidney disease, blindness, heart disease and lower limb amputations.
Health experts have long argued that improving access to modern diabetes medicines is critical to reducing those inequities and preventing avoidable hospitalisations.
Keenan says the priority should be removing barriers to treatment rather than creating new ones.
“Keeping these lifesaving medications within easy reach means efforts can remain on eliminating other barriers to accessing care—not creating new ones.”
He also challenged political criticism of ethnicity-based access to healthcare, saying targeted approaches remain firmly supported by clinical evidence.
“Despite the political narrative, access to care and treatment aimed at particular patient groups—including by ethnicity—remains a strongly evidenced way to reduce morbidity and mortality.”
His comments come as debate continues over how New Zealand’s health system should address persistent inequities experienced by Māori and Pacific peoples.
Supporters of targeted healthcare argue that prioritising groups with the greatest burden of disease is necessary to achieve equitable outcomes, while critics contend access should be based solely on clinical need without reference to ethnicity.
For Keenan, the evidence is clear.
He says targeted access is not about giving one group preferential treatment, but about responding to well-documented disparities in disease burden and ensuring those most at risk receive effective treatment before complications develop.
As New Zealand continues to grapple with rising rates of chronic disease, the discussion highlights the broader challenge of balancing universal healthcare with strategies designed to close long-standing health gaps.
For many clinicians working on the frontline, Keenan says the focus should remain where it belongs—on ensuring patients receive the care they need to live longer, healthier lives.
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