Aotearoa needs to stop treating every new health crisis as an isolated emergency and start confronting the decades of compromises and short-term decisions that created the system we have today, according to poet, author and GP Dr Glenn Colquhoun.
His challenge comes as healthcare again emerges as a major election issue, with political parties promising different solutions to workforce shortages, GP costs, hospital waiting times and growing demand.
But Colquhoun’s argument raises a bigger question.
Rather than continually asking how the country gets through the next health crisis, should Aotearoa finally decide what kind of health system it wants for the next generation?
A system built piece by piece
New Zealand’s health system was not designed in one moment.
It has evolved through decades of political decisions, reforms, restructures, funding arrangements and compromises between governments, health professionals and communities.
That history matters.
Successive governments have attempted to improve access, contain costs, restructure administration and respond to changing health needs.
But short political cycles can encourage governments to focus on problems requiring immediate attention while deeper structural issues remain unresolved.
The result is a system frequently responding to pressure rather than preventing it.
Emergency departments become overloaded.
Surgery waiting lists grow.
People struggle to find a GP.
Health professionals face increasing workloads.
Governments then inject additional resources or announce another policy intervention.
The immediate pressure may ease, but the underlying drivers remain.
The GP clinic is where pressure becomes personal
As a GP, Colquhoun brings a perspective from the part of the health system where many New Zealanders first experience those pressures.
Primary healthcare is supposed to prevent illness, identify conditions early and keep people well enough to avoid hospital.
But when patients cannot afford an appointment, cannot enrol with a GP or have to wait too long to be seen, relatively manageable health problems can become considerably more serious.
That shifts pressure further down the system.
A condition that could have been treated in primary care can eventually require emergency or hospital treatment, often at substantially greater human and financial cost.
It makes access to general practice much more than a question about the price of visiting a doctor.
It is fundamental to whether the entire health system works.
For Māori, reform cannot simply mean another restructure
The debate is particularly important for Māori.
Persistent inequities in life expectancy, cardiovascular disease, cancer, diabetes and access to healthcare demonstrate that simply maintaining the existing system is not enough to guarantee equitable outcomes.
For whānau Māori, barriers can begin well before somebody reaches a hospital.
The cost of seeing a doctor, transport, housing, income, employment conditions and access to culturally appropriate services can all influence whether people seek treatment and how early they receive it.
That means meaningful health reform cannot be measured solely by hospital beds, operating theatres or administrative structures.
It must also consider whether whānau can access care early enough to stay well.
And for Māori, any long-term conversation must include Māori leadership and approaches to hauora rather than treating equity as something added to the system after its fundamental design has already been decided.
Prevention versus treatment
One of the biggest long-term questions is where New Zealand invests its health dollars.
An ageing population and increasing rates of chronic illness will continue putting pressure on healthcare spending.
Treating disease will always be essential.
But preventing illness from developing — or identifying it earlier — can reduce pressure across the entire system.
That means public health, screening, immunisation, healthy housing, nutrition, mental health, addiction services and accessible primary care all become part of the same conversation.
It also requires governments to look beyond the health portfolio.
A child growing up in a cold, overcrowded home is experiencing a housing problem, but the consequences can eventually arrive at the doors of the health system.
Poverty can become a health issue.
Unemployment can become a health issue.
Poor housing can become a health issue.
The health of the population is therefore shaped by decisions made far beyond hospitals.
Workforce cannot be an afterthought
Long-term reform must also confront the health workforce.
Doctors, nurses, midwives, allied health professionals and community health workers cannot simply be produced when shortages suddenly become politically urgent.
Training takes years.
That means decisions made today about education, workforce planning, immigration, retention and working conditions will determine what healthcare capacity looks like well into the next decade.
The same applies to developing and retaining a strong Māori health workforce.
If Aotearoa wants a system capable of delivering equitable care, Māori need to be represented not only among patients but among clinicians, researchers, managers and those making decisions about the future of healthcare.
Election promises meet a generational problem
Healthcare will inevitably feature heavily in Election 2026.
Voters will hear promises about GP visits, hospitals, medicines, workforce numbers and waiting lists.
Those commitments matter.
But Colquhoun’s argument challenges politicians to look beyond the next Budget and even beyond the next term of government.
Health infrastructure can take years to build.
Doctors can take more than a decade to fully train.
Population ageing unfolds over generations.
Reducing entrenched health inequities requires sustained investment rather than policies that repeatedly change with governments.
That raises the possibility that some of the most important health reforms require a level of political consensus capable of surviving election cycles.
From repairing the system to redesigning it
Perhaps the biggest question is whether New Zealand continues repairing individual parts of its health system or finally confronts the design of the system itself.
What should primary healthcare look like in 10 or 20 years?
How much should patients be expected to pay?
What role should prevention play?
How should Māori exercise leadership over Māori health?
How many doctors and nurses will the country need?
And how much of the nation’s future health spending should be directed towards keeping people well rather than treating them once they become seriously ill?
Those are much harder questions than responding to the latest crisis.
But that is precisely the challenge Colquhoun’s argument places before Aotearoa.
The next health crisis will demand another immediate response. Long-term reform asks something harder — whether we are prepared to build a system that prevents as many of those crises as possible in the first place.
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