Ethnicity a vital factor in determining the effectiveness of funded medicines
Associate Professor Dr Ryan Paul, a clinician and technical expert advisor to Te Tiratū, explains why ethnicity should be a criterion for access to funded medications in Aotearoa New Zealand. [This think piece also appeared in The Post and The Press]
He says it is important to look at the evidence objectively. Māori and Pacific peoples are at least 2–3 times more likely to develop type 2 diabetes, acquire complications, and die prematurely from those complications than other New Zealanders.
“Pharmac’s volte-face to then remove the ethnicity criterion suggests that it was either ineffective or unfair, yet no public impact assessment or scientific explanation has been provided,” Dr Ryan Paul says.
Te Tiratū is encouraging whānau, clinicians, providers and community leaders to make a submission opposing the removal of equity access pathways.
Use Our Free Submission Template
We have created a free submission template to make it easy for whānau to have their voices heard.
Simply:
- Download or copy the template HERE
- Add your name and any personal comments
- Email it directly to Pharmac before 11 June 2026
The consultation closes on 11 June 2026.
Te Tiratū Iwi Māori Partnership Board crackdown on vaping
Te Tiratū Iwi Māori Partnership Board is calling for urgent action to curb rising vaping rates among rangatahi Māori across the Waikato rohe, warning that current market practices are fuelling nicotine addiction and harming whānau wellbeing.
Released ahead of World Smokefree Day 2026, Te Tiratū’s new Vaping Position Statement, developed with the University of Otago Faculty of Medicine and Associate Professor Andrew Waa, calls for vaping products to be regulated as therapeutic cessation tools only and available through accredited health services with strict nicotine limits, standardised packaging, reduced flavours, and stronger enforcement against illicit supply chains.
The statement highlights alarming vaping rates among rangatahi Māori, particularly Māori girls, and warns that vaping has become dangerously normalised as a lifestyle product rather than a smoking cessation aid.
Te Tiratū says stronger prevention-focused regulation is essential to protect future generations and uphold the wellbeing of whānau, hapū, and iwi.
Whānau encouraged to send submissions to Pharmac before deadline
Pharmac is proposing to remove Māori and Pacific ethnicity equity criteria from access to important medicines used to treat type 2 diabetes, heart failure and chronic kidney disease. Read our media release for all the details.
These medicines help prevent serious complications including dialysis, amputations, heart attacks and early death. For many whānau, this is not an abstract policy issue it is about survival, quality of life, and equitable access to treatment.
Consultation closes at 5:00pm, Thursday 11 June 2026.
Te Tiratū is encouraging whānau, clinicians, providers and community leaders to make a submission opposing the removal of equity access pathways.
Use Our Free Submission Template
We have created a free submission template to make it easy for whānau to have their voices heard.
Simply:
- Download or copy the template
- Add your name and any personal comments
- Email it directly to Pharmac before 11 June 2026
Every submission matters.
Why This Matters
One of the largest Iwi Māori Partnership Boards in the country, Te Tiratū represents more than 121,300 Māori and is calling on Pharmac to immediately reconsider the proposal.
The ethnicity equity criteria were introduced in 2021 because Māori and Pacific peoples experience significantly higher rates of diabetes, cardiovascular disease and kidney disease, while also facing systemic barriers accessing medicines.
Te Tiratū Co-Chair Glen Tupuhi says:
“These medicines save lives and prevent devastating complications for whānau. Māori are diagnosed younger, become sicker earlier, and die sooner from preventable chronic illnesses. Equity pathways exist because the health system has not delivered equitable outcomes for Māori.”
Research and evidence presented through the Waitangi Tribunal Wai 2575 inquiry has already documented significant “prescription inequity” affecting Māori.
Te Tiratū is calling on Pharmac to:
- Retain ethnicity equity criteria for access to these medicines
- Release equity impact analysis publicly
- Demonstrate how Māori health outcomes will improve if criteria are removed
- Engage directly with Iwi Māori Partnership Boards and Māori health leaders
- Uphold Te Tiriti o Waitangi obligations in medicines policy decisions
Add Your Voice Today
Help protect equitable access to medicines for Māori whānau.
Use the free template, add your name, and email your submission to Pharmac before 5:00pm Thursday 11 June 2026.
Ngā Kōrero a te Poari: Maxine Ketu
Our Board Member Maxine Ketu (Ngāti Maniapoto, Waikato-Tainui), shares whakaaro on improving health outcomes for whānau and communities.
Why this kaupapa?
Firstly, why me?
I was appointed Pouārahi/General Manager of Ngāti Hāua Iwi Trust with a key focus on supporting our Trustees through the completion of our Treaty Settlement journey.
As that role evolved, I was appointed to the Waikato DHB Iwi Māori Council, and over the years I have continued alongside the evolution of Māori health representation to where we are today with Te Tiratū.
The responsibility I carry when representing Ngāti Hāua and our rohe is significant. For me, this mahi is about the difference between life and death for our people.
That understanding comes from lived experience. My own whānau experienced the impacts of rural isolation, poverty, limited access to healthcare, and the inequities Māori continue to face within the health system. Those realities contributed to the untimely loss of a loved one.
That was 11 years ago, but since 2014 I have walked beside many whānau who have experienced the same pain and loss. I have woven waka wairua for whanaunga taken too young, too soon. I have stood at nehu and helped lay our loved ones to rest when I know they should still be here.
My representation, my passion, and my commitment to this kaupapa all come from those lived experiences.
What does real change look like?
Real change starts with whānau feeling empowered to take charge of their own health and wellbeing. That looks like:
- having access to good health education and information
- understanding our own whānau and generational health histories
- feeling confident to ask questions and seek second opinions when needed
- not settling for poor treatment or mediocre care
- putting ourselves and our loved ones first
- making informed and healthy choices through ongoing learning
- knowing we have the right to demand high-quality care for ourselves and our whānau at all times
Real change also means the health system valuing the mātauranga, lived experiences and voices of whānau as part of healthcare assessment, treatment and follow-up.
We need a health workforce that is trained to recognise and address unconscious bias. This learning should not be optional, it should be embedded across all health education, professional training and ongoing development.
For our rural communities, real change means equitable access to healthcare no matter where you live. Communities that are far from hospitals and specialist services need secure, long-term investment that is protected across governments and political cycles. Rural whānau should not receive poorer outcomes simply because of where they live.
We also need stronger systems for accountability and learning. A national complaints and feedback system could help ensure concerns raised by whānau are heard, responded to, and used to improve services over time. The information gathered could help identify gaps in access, improve service delivery, strengthen professional practice, and ultimately lead to better health outcomes for our people.
What needs to stop, shift or grow?
We need to stop accepting inequitable outcomes for Māori and rural communities as normal.
The health system must be shifted toward one that truly listens to whānau, values Māori knowledge, and responds with compassion, accountability and equity.
We need to grow:
- investment in iwi-led health education and prevention
- culturally safe healthcare practices across the system
- unconscious bias training throughout health education and workforce development
- diversity within the health workforce, so our people can see themselves reflected in the system
- better access to healthcare services for rural communities
- stronger systems for listening and responding to whānau feedback and complaints
When whānau feel seen, heard, respected and supported, health outcomes improve. That is the future we should all be working toward.
Pharmac proposes removing priority access of type 2 diabetes meds for Māori, Pasifika
Associate Professor Dr Ryan Paul, a clinician and technical expert advisor to Te Tiratū, has expressed serious concern in an interview with 1News about proposed changes to funding criteria for type 2 diabetes medicines. He warns that removing ethnicity-based access pathways could deepen existing inequities for Māori and Pacific peoples.
The proposed Pharmac changes would expand general access to medicines such as empagliflozin, liraglutide, and dulaglutide, but would remove targeted pathways that currently acknowledge the higher burden of diabetes, cardiovascular disease, and kidney disease experienced by Māori and Pacific populations.
Te Tiratū co-chair Glen Tupuhi notes that equity-focused pathways were introduced because the health system has repeatedly failed to deliver fair outcomes for Māori, who are diagnosed earlier, experience more severe disease, and have higher rates of premature mortality from preventable long-term conditions.
Māori clinicians and health leaders have cautioned that the proposed shift could undo one of the most effective equity interventions introduced in recent years.
The consultation closes on 28 May 2026.
Māori health leaders warn proposed Pharmac changes could deepen inequities and cost lives
Te Tiratū has spoken with Whakaata Māori with serious concerns about proposed changes to access criteria for funded type 2 diabetes medicines, warning the removal of ethnicity-based pathways could worsen long-standing inequities for Māori and Pacific peoples.
The proposed changes by Pharmac would widen general access to medicines including empagliflozin, liraglutide and dulaglutide, but remove the current pathway that recognises the disproportionate burden of diabetes, cardiovascular disease and kidney disease experienced by Māori and Pacific communities.
Te Tiratū co-chair Glen Tupuhi says equity pathways exist because the health system has consistently failed to deliver equitable outcomes for Māori, who are diagnosed younger, experience more severe illness, and die sooner from preventable chronic conditions.
Associate Professor Dr Ryan Paul, clinician and expert technical advisor to Te Tiratū, said he was “really gutted” by the proposal, particularly given the success of the current pathway in improving equitable access to life-saving medicines for Māori and Pacific whānau.
Māori clinicians and health leaders warn the proposal risks reversing one of the most successful equity interventions introduced in recent years.
The consultation closes on 28 May 2026.
Pharmac proposes removing priority access of type 2 diabetes meds
Te Tiratū Iwi Māori Partnership Board co-chair Glen Tupuhi and expert advisor, researcher Dr Leanne Te Karu have spoken to RNZ about growing concerns over Pharmac’s proposal to remove ethnicity-based access criteria for type 2 diabetes medicines, despite new evidence showing significant life-saving benefits for Māori and Pacific communities.
In the interview, Dr Te Karu said the original criteria were introduced because Māori and Pacific peoples were not receiving equitable access to treatment through the health system, despite experiencing higher rates of diabetes, earlier onset disease, and more severe complications.
She said the medicines had been shown to improve equity outcomes and narrow survival gaps, warning that removing the criteria before systemic inequities are addressed risks widening disparities again.
Te Tiratū co-chair Glen Tupuhi said that treating everyone the same within an inequitable system does not create fairness, but instead entrenches inequity. Te Tiratū is filing a submission to Pharmac calling on it to reconsider the proposal and ensure equity remains central to decision-making for whānau experiencing the highest health burden.
Māori mental health inequities in Waikato demand urgent system reform
Te Tiratū represents approximately 121,000 Māori across the Waikato rohe, with around half under the age of 25. In our submission to the Government’s Mental Health and Wellbeing Strategy filed today we said the national mental health policy must be built from the realities of rangatahi Māori and whānau Māori and not retrofitted to them.
In rural Waikato, distress is not abstract. It is shaped by access barriers, workforce shortages, housing and income pressure, and the compounding effects of isolation. Te Tiratū argues that unless these conditions are addressed directly, the mental health system will continue to respond too late, and too often in crisis.
Our core message to Government
Te Tiratū is calling for a strategy that shifts from crisis response to prevention, from generic service design to Māori-led solutions, and from urban-centric planning to rural equity.
Our submission’s most critical recommendations are:
- Increase rural funding and expand telehealth capacity.
- Build and retain a rural mental health workforce.
- Address socioeconomic drivers of distress.
- Resource Māori cultural perspectives and whānau involvement.
- Support youth-led and community-based programmes.
The evidence from Tainui Waka Rohe
Our submission draws on our locality evidence base, which shows persistent and significant inequities in mental health outcomes across our region.
- Between 2017 and 2022, 16.0% of Māori aged 15+ in Waikato District experienced high or very high psychological distress
- Rising to 19.7% for Māori women
- Māori were 1.7 times more likely than non-Māori to experience high or very high distress
The data also shows the depth of unmet need:
- 5% of Māori reported a depression diagnosis
- 1% reported an anxiety disorder
- Māori were 1.9 times more likely than non-Māori to be hospitalised for mental or substance use disorders (2020–2023)
- Including 4.6 times higher hospitalisation rates for schizophrenia
- Around 225 Māori aged 15 to 44 are hospitalised each year for intentional self-harm
What must change in the system
We believe the current system is still too weighted toward crisis care, with insufficient investment in early intervention, rural access, and culturally grounded support.
Our submission says that meaningful improvement will only occur when services are designed closer to communities, delivered earlier, and shaped by a te ao Māori worldview and leadership.
We know workforce retention in rural areas is a critical pressure point because without it, access gaps will persist regardless of funding increases.
Treaty obligations and system accountability
A key concern of our submission is the limited visibility of Te Tiriti o Waitangi within the draft strategy, particularly Article 3 obligations relating to equity.
Without explicit Te Tiriti grounding, the strategy risks failing to address the structural drivers of inequity in mental health outcomes for Māori.
How accountability, investment, and service design are structured determines whether equity is achieved or not.
National context reinforces urgency
National data from Te Hiringa Mahara – Mental Health and Wellbeing Commission confirms the same pattern seen in Waikato, with 22.5% of Māori adults experiencing high or very high psychological distress, and 22.9% of young people aged 15–24 affected.
This aligns strongly with our locality findings and reinforces that rangatahi Māori are carrying a disproportionate burden of distress across the country.
Strategy alignment, but not yet sufficient
Our submission responds to the Ministry of Health New Zealand Draft Mental Health and Wellbeing Strategy 2026–2036, which focuses on prevention, access, workforce, and quality of care.
We support these directions in principle but argues they will not succeed unless they are explicitly grounded in Te Tiriti, rural equity, and Māori-led service design. Without this, the strategy risks maintaining existing inequities under a restructured framework.
Mental health reform will not succeed in Tainui Waka rohe if it continues to treat Māori as an “equity consideration” rather than the foundation of system design. The evidence shows that inequities are persistent, and the solutions are known. What is required now is investment, accountability, and a shift in power toward Māori-led, whānau-centred, community-based approaches.
Important References to inform the strategy:
- Te Tiratū IMPB, Hauora Māori Priorities Summary Report, here, pp.36-41 – Waikato Māori psychological distress, depression, anxiety, suicide, mental health hospitalisations, substance/alcohol-related hospitalisations and intentional self-harm data.
- Te Tiratū IMPB, Monitoring Report to March 2025 here, 15 May 2025, pp.22 and 25-26 – Māori access to primary and specialist mental health and addiction services, ED mental health waits, and commentary that services must remain culturally safe and whānau-friendly.
- Te Tiratū IMPB, Position Statement – Rangatahi Māori Mental Health, here23 September 2025 – Te Tiratū public position on rangatahi Māori mental health in rural Waikato, including rising distress, suicide risk, addictions, takatāpui youth pressures, rural isolation, service gaps, and the call for kaupapa Māori, whānau-led solutions.
- Te Hiringa Mahara – Mental Health and Wellbeing Commission, NZ Health Survey 2024/25 mental health and substance use data summary, 25 February 2026 – national context: 22.5% of Māori adults and 22.9% of young adults aged 15-24 experienced high or very high psychological distress.
- Ministry of Health, Draft Mental Health and Wellbeing Strategy 2026-2036 consultation, 8 April 2026 – consultation context and the four priority areas: prevention and early intervention, improved access, supported workforce, and quality/effectiveness of care.
Equity at risk? Call to retain ethnicity criteria for key diabetes medicines
In a recent opinion piece in Pharmacy Today and NZDoctor by our expert advisor on prescription medicine Dr Leanne Te Karu warns that proposed changes by Pharmac could make health inequities worse for Māori and Pacific whānau.
Pharmac is thinking about removing a rule that helps Māori and Pacific peoples get better access to important diabetes medicines like SGLT2 inhibitors and GLP-1 receptor agonists.
Right now, Māori and Pacific peoples are more likely to get diabetes earlier, get sicker faster, and not always get the same access to the medicines and care they need. The current system was designed to help fix this by making sure people who need it most can get these medicines sooner.
Evidence shows this approach has been working, more Māori and Pacific peoples have been able to access treatment, and it has helped improve health outcomes and survival.
Removing this support before the wider system is fixed could mean going backwards.
Submissions close 28 May. This is a chance to speak up for fair access to life-saving medicines for our whānau.
Pharmac proposal to remove ethnicity criteria criticised
Pharmac is facing strong criticism in NZDoctor and Pharmacy Today over a proposal to remove ethnicity as a criterion for access to several diabetes medicines, with opponents warning the change could lead to more Māori and Pacific deaths and deepen long-standing inequities in the health system.
The proposal would amend Special Authority settings that currently prioritise access for groups disproportionately affected by type 2 diabetes, including Māori and Pacific peoples who experience higher rates of earlier onset and more severe complications.
Te Tiratū Iwi Māori Partnership Board was quoted by both publications because we say removing ethnicity equity criteria raises serious concerns about whether Pharmac is meeting its obligations under Te Tiriti o Waitangi to achieve equitable Māori health outcomes.
We are warning that “treating all universally in the system does not create fairness. It entrenches inequity.”
Our board is calling for Pharmac to retain ethnicity-based access criteria, publish its equity impact analysis before consultation proceeds, clearly demonstrate how Māori health outcomes would improve under the proposed change, and engage directly with iwi Māori partnership boards, Māori clinicians and Māori health providers.
Submissions on the consultation close on 28 May 2026 leaving just 13 days for feedback on a proposal that critics say could reshape access to essential diabetes treatment.