By Jaime King.

On 29 November 2023, the National Coalition Government (NCG) released its 100 Day Plan which charted a course of 49 actions for the government to achieve. This overview post examines NCG’s health-related policy decisions in the first 100 days and their broader implications for health. The Collective will also feature several more specialised posts on various features of the 100 days plan, so keep an eye out!

The 100 Days Promises

First things first, NCG’s 100 Day Plan sets out to achieve the following health-related goals:

The NCG has begun rapidly executing these plans. On 29 November 2023, the same day as  the release of the 100 Days Plan, New Zealand reserved its position on the 2022 technical amendments to the World Health Organisation’s (WHO) International Health Regulations pending an evaluation of whether the amendments serve the national interest of New Zealand. The IHRs are the principal legal framework for preventing and controlling the spread of diseases and other public health risks from country to country, and the amendments were designed to improve this process following COVID-19.  Unanimously passed by WHO member states, the amendments were technical in nature, including the factors used to determine a public health emergency, features of an alert system, and the international movement of persons, baggage, and cargo. To reserve its position, the government had to reject the amendments outright, with the option of adopting them in the future pending further debate and public comment. New Zealand was the first to reverse its position on the amendments, but its actions were followed by several other countries including Estonia, Iran, the Netherlands, and Slovakia. Ashley Bloomfield is co-chairing the IHR negotiations with different nations to see if countries can be brought back to the table.

On 13^th February, NCG signed a Memorandum of Understanding with University of Waikato to explore the possibility of creating a third medical school focused on training primary and community care providers in a four-year post-graduate programme. The programme aims to promote the long term sustainability of the medical workforce and train providers for work in rural and provincial areas. The MOU was clear, however, that no commitments would be made without review of a full cost-benefit evaluation.

On Tuesday 26^th February, the Minister of Health, Shane Reti, introduced the Pae Ora (Disestablishment of Māori Health Authority) Amendment Act 2024 under urgency in advance of a Waitangi Tribunal hearing to examine whether disestablishment of Te Aka Whai Ora violated Te Tiriti o Waitangi scheduled to commence on Thursday 29^th February. Despite significant protestations by opposition MPs that the use of urgency to disestablish the Māori Health Authority flew in the face of the spirit and intention of Pae Ora and the significant consultation that went into its creation, the amendment was not sent to a select committee for comment and proceeded through its three readings in under 24 hours.

Likewise, the government’s passage of the Smokefree Environments and Regulated Products Amendment Act 2024 under urgency has received little to no fanfare and appears to disregard both health and economic data. Reversing this “world leading” legislation to end smoking in New Zealand will not only cost thousands of lives and billions of dollars, but it also raises significant questions about the NCG government’s motives and whose interests they are serving. Researchers at the University of Melbourne, Australian National University and the University of Otago estimated that the Smokefree legislation would decrease future smoking prevalence for Māori from 31.8% in 2022 to 7.3% in 2025 and from 11.8% in 2022 to 2.7% in 2025 for non-Māori. They estimated the legislation would avoid 8150 deaths by 2040 and save nearly 600,000 years of healthy living for New Zealanders. In addition to saving lives, the legislation was also predicted to generate gain of over $50 billion NZD ($31B USD) in income for the New Zealand population by 2050. Interestingly, the same study also showed that due to increased superannuation payments and fewer tobacco excise tax revenues, the government was at risk of losing revenue under the act in the same time frame. The fact that any losses predicted losses could be planned and accounted for over the next 25 years, the rush to repeal begs the question – who is the NCG serving? The public? Itself? Big business? Since it was not featured in the election, repealing the tobacco end game legislation deserves to be weighed heavily by the public with all the evidence displayed so that we can evaluate it, as well as our politicians.

Lastly, on 8th March, PM Christopher Luxon and Minister of Health Shane Reti announced five new health targets related to cancer treatment, child immunisation rates, ED stay times, specialist assessment wait times, and elective treatment wait times to round out the goals of the 100 day plan. These targets are:

• 90 percent of patients to receive cancer management within 31 days of the decision to treat;
• 95 percent of children to be fully immunised at 24 months of age;
• 95 percent of patients to be admitted, discharged or transferred from an ED within six hours;
• 95 percent of patients to wait less than four months for a first specialist assessment; and
• 95 percent of patients to wait less than four months for elective treatment.

Health targets are not a new strategy, but have had mixed results in the past. Whether the government can improve upon the old model and address the work force issues that may hinder such targets remains to be seen.

The remainder of the 100 Days goals have received less significant attention. The coalition government has made an initial start on extending breast cancer screening to women aged 74, repealing the Therapeutic Products Act 2023, and introducing legislation to permit the sale of pseudoephedrine in pharmacies. While the NCG has deemed its 100 Days Plan a success, the long term health implications of the changes may reveal a very different picture.