Louisa Wall (in purple) is part of the Iwi Māori Partnership Board and represents Kaitiaki Hauora, a nationwide coalition that aims to protect and strengthen the public health system.
Pharmac plans to change who can receive funded treatment for some diabetes medicines. While across-the-board access will be widened, the changes include removing the eligibility criterion that improves access to those medicines for Māori and Pacific patients.
That’s a self-defeating move if the country is serious about improving overall health outcomes, writes Louisa Wall.
Pharmac’s proposal to broaden access to important Type 2 diabetes medicines should be welcomed. Lowering the cardiovascular risk threshold for medicines such as empagliflozin and dulaglutide from 15 percent to 10 percent could improve health outcomes for many New Zealanders living with diabetes.
But alongside this positive change is a proposal that takes us backwards on Māori and Pacific health equity. Pharmac is also proposing to remove the ethnicity pathway that allows Māori and Pacific peoples to access these medicines without first demonstrating specified cardiovascular or renal risk factors.
The rationale appears to be that lowering the threshold for everyone creates fairness through universal settings.
But treating unequal circumstances equally doesn’t achieve equity.
Over the past two years, the work we’ve been doing across the Tūwharetoa rohe has consistently shown that people don’t enter the health system from the same starting point.
Whānau describe long travel distances to appointments, transport costs they can’t afford, delayed referrals, doctor shortages, fragmented communication, and systems that are difficult to navigate. Many also describe feeling unheard or being misunderstood by services that don’t reflect their cultural or community realities.
For some whānau, diabetes and related conditions are already well advanced by the time consistent care is established. For others, managing long-term illness becomes a shared whānau burden shaped as much by income, housing, and access to services as by clinical need.
These realities matter because “neutral” clinical eligibility settings assume equal ability to access care in the first place. Far from being neutral or “equal”, such settings simply favour the status quo — meaning those with the right resources will continue to get what they need while others miss out.
Māori experience disproportionately high rates of Type 2 diabetes, cardiovascular disease, and renal disease, often with earlier onset and more severe progression. This has nothing to do with biology. It has to do with the structural factors that influence prevention, diagnosis, treatment, and continuity of care.
Lowering a cardiovascular risk threshold may improve overall eligibility. But it doesn’t do anything to remove barriers to access, diagnosis, affordability, or trust in the system. That’s why targeted equity mechanisms exist in the first place.
The current Māori and Pacific access pathway was introduced because universal systems have failed to deliver equitable outcomes. Removing it before those inequities are meaningfully reduced conflates equality with equity.
In our work, we hear a consistent theme from whānau. For them, access to healthcare isn’t determined by policy criteria, but by whether services are understandable, affordable, culturally safe, and locally accessible.
Whānau repeatedly emphasise the importance of early intervention and prevention. They want support and treatment before their conditions become severe, not after complications have developed.
They also consistently identify kaupapa Māori providers, marae-based clinics, and Māori health workers as their most trusted spaces to get what they need, which includes clear communication and holistic care.
Diabetes, in particular, is not experienced in isolation. Whānau with diabetes often have multiple health conditions, which affect finances, caregiving responsibilities, employment, food security, transport, and emotional wellbeing.
It makes no sense to reduce such complexity down to eligibility thresholds alone.
Yes, broadening access appears positive. But if it comes at the cost of removing mechanisms that recognise unequal starting points, then it undermines the whole objective of improving outcomes fairly for everyone.
If anything, the work we do in communities reinforces the need for both approaches to coexist. There should be universal improvement in access settings alongside targeted provisions that address persistent inequities.
Those in power love to “acknowledge” and “recognise” the inequities in Māori health outcomes, while still ploughing ahead to dismantle the tools that we’ve designed to address them.
Equity requires deliberate design choices that account for differences in experience, access, and outcome.
Medicines are an important part of diabetes care. But they sit within a wider system. Our work with whānau consistently points to the need for stronger access to primary care, culturally safe services, Māori workforce development, rural service availability, and navigation support to help whānau move through complex systems.
Whānau need a system that understands their realities and responds accordingly.
If we’re serious about cutting our diabetes rate for the whole country, then targeted equity mechanisms must remain part of the solution, not be the first thing removed.
It doesn’t matter if “more” people can access medicines, unless those medicines reach the people who need them most, in time, and in ways the system can actually deliver.
That’s the standard we should be aiming for.
Consultation on the Pharmac proposal is open until June 11, extended from May 28.
Louisa Wall **(**Ngāti Tūwharetoa, Waikato, and Ngāti Hineuru) is chair of the Tūwharetoa Iwi Māori Partnership Board and spokesperson for Kaitiaki Hauora.
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