Chapter 7. Health Targets Decoupled From Policies. No Power to Stop Rising Disease Rates.

We welcome your use of this resource but please cite:

PSGRNZ (2026) Reclaiming Health: Reversal, Remission & Rewiring. Understanding & Addressing the Primary Drivers of New Zealand’s Metabolic & Mental Health Crisis. Bruning, J.R., Physicians & Scientists for Global Responsibility New Zealand. ISBN 978-1-0670678-2-3

RETURN TO CONTENTS PAGE.

Figure 10. Five Targets for the Health System. https://www.health.govt.nz/statistics-research/system-monitoring/health-targets#Thetargets

The key indicators of New Zealanders’ health and wellbeing include self-rated health, life expectancy, mortality rates across the population and maternity measures.[1] In contrast, the health targets that are published in the Government Policy Statement on Health 2024-2027 concern Ministry priorities and expectations for service care and delivery in the medical system.[2] No health targets exist for lowering the prevalence and incidence of diabetes, heart disease, the spectrum of problems driven by obesity (including pain and inflammation) and mental illness, in the public health directorate policies.

The targets are decoupled from the indicators, with no chain-of-logic that would support the integrative, health-protective approach that is necessary to sustain health and wellbeing. This policy–indicator misalignment means that targets do little to arrest upstream drivers of symptom clusters that precede diagnosis. Ministry targets instead centre on disease metrics and medical treatment.

This misalignment helps explain why metabolic and mental health burdens continue to rise despite expanded service access. The health targets do nothing to mitigate or stop the upstream drivers of the clusters of symptoms that drive complex illness and that precede a medical diagnosis, and produce declining health, wellbeing and life expectancy. The health targets are unable to address the drivers of chronic illness and multimorbidity and years lost due to illness.[3] [4]

Primordial prevention revolves around building and sustaining a healthy metabolism from the outset to prevent decline. Primordial prevention is absent from the current strategy. Instead, the health targets prioritise medically-focussed secondary and tertiary interventions. This structural misalignment helps explain why metabolic and mental health burdens continue to rise despite expanded service access.

Health targets include shorter stays in emergency departments, and shorter wait times for specialist assessments. Such policies can be presented in parallel with primordial and primary prevention strategies. The health targets focus on faster cancer treatment, yet there are no policies that prevent cancer arising in the first place.

The Ministry of Health maintains a page on multimorbidity, which is drawn from staff presentations at General Practice consultations.[5] The page includes a section on prevention, which includes:

lifestyle modification (increase physical activity, improve nutrition, smoking cessation, alcohol moderation)
motivational interviewing
referrals to community providers for support eg Green Prescriptions.
smoking cessation, treating hypertension and hypercholesterolemia.

It is not evident that primordial and primary prevention strategies have been clearly distinguished or prioritised by health officials. Current dietary guidelines appear to be treated as the extent of prevention in this domain. The current priority of screening and immunisation may also have, in practice, displaced earlier and more fundamental prevention strategies.

PUBLIC HEALTH FRAMEWORK

Primordial prevention:

Preventing the upstream social, environmental, cultural and dietary risk factors that disrupt the metabolic function of the individual. Risk factors can include factors that drive low-grade inflammation; dysregulate the endocrine and immune system; overload hepatic–renal clearance; and impair digestive, mitochondrial, cardiovascular, and neurodevelopmental function.

Primary prevention:

Reduce the risk of future disease by identifying and targeting modifiable risk factors in healthy people who are at risk of chronic disease through relevant support programmes. Nutritional and biomarker screening to identify e.g. methylation problems can identify personal vulnerabilities. Programmes may include doctor-patient and clinic-patient support, community support and local government and regional support. Programmes can increase knowledge, skills, and access to healthy food; reduce barriers to exercise and the natural environment; and promote connected communities.

Secondary prevention:

The identification of people with early/asymptomatic disease via the use of screening programmes in order to treat patients early, and ensure health status does not decline further. Programmes currently emphasise medical screening, and nutritional and biomarker screening can be more fully integrated to ensure an integrative approach to support optimum biological health.

Tertiary prevention:

Diagnosis of and treatment of people with the fully developed disease, so as to prevent recurrence and complications. Nutritional frameworks are yet to be adapted into tertiary prevention modalities.

Health Policy: A Prevention Framework That Sidelines Nutrition.

New Zealand health policy documents consistently emphasise central values of wellbeing, equity, and health. ‘Prevention’ in New Zealand health policy refers predominantly to health system interventions such as screening and early treatment. At times prevention refers to the need for a healthy diet. A healthy diet explicitly applies to Ministry of Health dietary guideline information.

‘Health promotion’ in New Zealand draws from the Ottawa Charter, the Bangkok Charter for Health Promotion and Māori models of health.[6] [7] These Charters recognise that a wide range of factors support health: peace, shelter, education, food, income, a stable eco-system, sustainable resources, social justice, and equity.

The Charters and corresponding Ministry of Health policy and health promotion literature under-emphasise the outsize role of diet in protecting the gut microbiome and digestive tract, supporting metabolic health to protect people from chronic metabolic diseases and syndromes, including mental illness. Papers outlining central role of nutrition in increasing resilience to the physical and emotional stresses of life, which includes supporting sleep, could not be identified. [8]

The Charters infer that current health information is correct. For example, the Bangkok Charter states:

‘Health promotion has an established repertoire of proven effective strategies which need to be fully utilised’.

In a response to an Official Information Act request regarding the Ministry’s Eating and Activity Guidelines (EAHs) Dr Nicholas Jones, Director of Public Health at the Public Health Agency confirmed that the primary documents for current guidelines consist of two background papers[9] [10] and the Australian Guide to Healthy Eating.[11] Dr Jones confirmed that the updated advice was ‘based on recent large international evidence reviews that: [12]

The updated advice in the EAGs is based on recent large international evidence reviews that were used to develop dietary guidelines for Australia, the United States and the Nordic countries. This multi-sourced evidence consistently describes a healthy eating pattern that is high in vegetables and fruit; includes whole grain cereals; low-fat milk products; legumes and nuts; fish and other seafood; and unsaturated oils. This eating pattern is low in processed meats, saturated fat, sodium (salt) and sugar-sweetened foods and drinks. The evidence shows that this way of eating is associated with a lower risk of heart disease, stroke and other health conditions.

The EAGs advice is also closely linked to evidence-based recommendations from the World Health Organization and the World Cancer Research Fund. The link between saturated fat consumption, blood cholesterol levels and heart disease are well established, with evidence building over the past 60 years.

In 2020 Health New Zealand updated its serving size advice, the first adjustment since 1991, to reflect Australian changes.[13] The Australian National Health and Medical Research Council (NHMRC) updated the Australian Guide to Healthy Eating[14], and this was adjusted to reflect data published in the 2006 Nutrient Reference Values for Australia and New Zealand.[15] These reference values as this paper discusses elsewhere, are based on the blood levels of healthy people from the 1980s- to the early 2000s.

The Health Promotion Directorate oversees public health campaigns; health promotion programmes and develops educational resources and publications. Nutrition and dietary information are based on Ministry of Health dietary guidelines which are then translated into promotional flyers and published on the HealthEd Resource database.[16]

Where food is mentioned in policy and health promotion literature, people are encouraged to consume more fruit and vegetables and consume less sugar. The scientific basis that high carbohydrate diets play a substantial role in increasing blood glucose levels and promote insulin resistance and inflammation is well established. However, New Zealand dietary guidelines do not communicate that cumulative dietary carbohydrate intakes elevate blood glucose and triglyceride levels and increase risk for insulin resistance. The government does not recommend paleo, detox or very low (e.g. ketogenic) diets, but does not show evidence of recently having undertaken reviews of the scientific literature to support this position.[17]

As we discussed in chapter 2, official recommendations that revolve around the reduction of saturated fat increasingly appear to be misdirected. The promotional PDFs discuss the benefits of all dietary categories with the exception of fat, and the guidelines recommend low-fat dairy products, and that fat is cut off meat. Although fat is an essential macronutrient, fat is regarded as a high-risk food. Children are advised to only consume foods high in fat, sugar or salt less than once a week.

Increasing evidence suggests that good quality dietary fats support metabolic including cardiac health.[18] Healthy minimally processed dietary fats play an important role in satiety, particularly for people reducing their fat to carbohydrate ratio, aiming to reverse a prediabetic or T2DM diagnosis.[19] [20] [21]

Important nuances in dietary intake are not addressed. This paper focusses on the challenge of refined, ultraprocessed food, yet, for example, official documents do not discern between the health potential of wholefood diets high in saturated foods but low in refined ingredients, versus diets that contain a high proportion of processed and refined products that might also include saturated fats.[22] [23]

There is no advice concerning the role of vitamins and minerals in preventing chronic and infectious disease (including respiratory illnesses). Despite the role of dietary nutrition in epigenetic, hormonal, neurotransmitter and immune regulation, and in moderating inflammation and oxidative stress, dietary nutrition is not prioritised in key health policies. Relatedly, guidance in the promotional flyers for stress, depression and anxiety does not educate or discuss the role of food and nutrition in contributing to improved or impaired mental health.[24]

Nutrition: The Missing Pillar in New Zealand’s Health Policy and Prevention Strategy.

The Government Policy Statement on Health (July 2024)[25] and the New Zealand Health Plan (August 2025)[26] [27] do not carry substantive policy content that provides pathways for health agencies to assess and address dietary inadequacies and nutritional deficiencies. The Statement notes:

The Government is particularly focused on accelerating action to address five non communicable diseases: cancer, cardiovascular disease, respiratory disease, diabetes and poor mental health. Together, these conditions account for around 80% of deaths from non-communicable diseases in New Zealand and considerable health loss experienced by New Zealanders.

Improved prevention of these non-communicable diseases will be achieved through addressing five modifiable risk factors: alcohol, tobacco, poor nutrition, physical inactivity, and adverse social and environmental factors. [28]

The action, or target, of ‘poor nutrition’, which directly relates to nutrition and diet, is the Policy Statement aim to increase the:

Percentage of people eating the recommended daily intake of vegetables and fruit (five or more servings of vegetables, and two or more servings of fruit).[29]

This insubstantial lever cannot address the increasing non-communicable disease burden. This aim drafts out and downplays the role of non-carbohydrate macronutrient groups in supporting health, micronutrients in supporting health and the problem of refined food intakes.

When the policy language consistently fails to prioritise dietary and nutritional drivers, officials are unlikely to launch into related policy development. More opaque outcomes might improve health outcomes in the long term, but direct policy focusing on diet and nutrition might improve health outcomes more swiftly.

Social determinants and environmental factors such as education, employment, income, housing, transport and climate account for the majority of health loss, but when strengthened, these same factors also provide a significant opportunity to improve health outcomes. [30]

The Policy Statement lists seven key health strategies over the next 5-10 years in providing the direction to guide health entities in protecting, promoting, and improving specific health outcomes. As with the overarching document, these key policy papers neglect or downplay the role of diet and nutrition, effectively amplifying the silence around the dietary drivers of New Zealand’s burden of disease.:

Pae Tū: Hauora Māori Strategy (2023): No mention of diet, nutrition or diabetes. Wellbeing mentioned 81 times, equity mentioned 40 times, health mentioned 628 times.
Whakamaua: Māori Health Action Plan 2020–2025 (2020): No mention of diet or nutrition. Diabetes mentioned 5 times, regarding an action plan to prevent and manage gout and diabetes. Wellbeing mentioned 61 times, equity mentioned 54 times, health mentioned 760 times.
New Zealand Health Strategy (2023): Dietary risk factors (mentioned once), and notes (once) need for better access to healthy food and nutrition. Refers to the work of Healthy Families NZ. Wellbeing mentioned 104 times and equity mentioned 32 times.
Te Mana Ola: The Pacific Health Strategy (2023): Notes Pasifika people are three times more likely to have diabetes than European. Mentions dietary risk factors. This policy recommends an expansion of healthy school lunches and a food reformulation target work programme to reduce sodium and sugar in processed food.
Health of Disabled People Strategy (2023): Report mentions higher rates of heart disease, diabetes, respiratory disease and mental health experienced by disabled people. No mention of diet or nutrition. Wellbeing mentioned 129 times, equity mentioned 12 times, health mentioned 780 times.
Women’s Health Strategy (2023): Mentions poor nutrition and that women spend more of their life in poorer health. Priorities 1-3 focus on health system support and pregnancy care. Priority 4 ‘living well and ageing well’ concerns prevention and early intervention but does not mention diet or nutrition.
Rural Health Strategy (2023): No mention of diet or nutrition. One case study discusses a poor diet and diabetes. Wellbeing is mentioned 51 times, equity 28 times, and health 770 times.

The policies repeatedly stress prevention, however, consistent with the Policy Statement on Health, these papers predominantly view health promotion as timely access to health services including screening and immunisation services.

The seven health strategies frequently refer to chronic illness being driven by the broader social determinants of disease, and acknowledge that fast-food businesses will cluster geographically near low-income communities.

New Zealand’s relatively recent mental wellbeing plan does not address the role of nutrition in supporting brain health, despite the He Ara Oranga Report of the Government Inquiry into Mental Health and Addiction (2018) consistently acknowledging associations between poor nutritional status and poor mental health outcomes. The Inquiry was informed by more than 5,200 public submissions and over 400 engagement meetings with communities, clinicians, and sector stakeholders. [31]

‘He Ara Oranga translates as Pathways to Wellness’

The Inquiry was therefore explicitly tasked with examining systemic pathways that support mental wellbeing across the life course. However, despite repeated recognition of nutrition as a contributing factor, the Inquiry did not recommend the allocation of public resources to systematically evaluate the role of diet and nutrition in brain health by age, sex, developmental stage, or multimorbidity status.

As a consequence, no policy mandate exists that might address nutrition and embed nutrition and dietary health as a core consideration in subsequent policy development. Neither the ten-year strategy Kia Manawanui Aotearoa: the Long-term pathway to mental wellbeing’,[32] nor a recent update[33], includes a coherent policy framework for integrating nutrition into mental health service design, prevention strategies, or therapeutic pathways.

Policies that highlight the problem of insufficiency, suggest ways to identify insufficiency, and which tangibly increase access to nourishing food do not exist in the strategies. Some policies have wish-lists and most policies hope for people to eat healthier diets, however healthy diets are aligned with Ministry of Health guideline recommendations which do not address optimum nutritional status.

PSGRNZ could locate only one only consistently funded programme by the Ministry of Health and Health New Zealand that is directly related to improving dietary nutrition and health in New Zealand communities. Healthy Families NZ commenced in 2014. It has received $10 million annually to provide resources to encourage ‘community-up’ leadership and collaboration to leverage activities which support health and equity. The programme has worked across ten locations, primarily Māori communities, with the aim of preventing the rise of chronic disease.[34]

Healthy Families NZ adopted a ‘six conditions of systems change’ approach (aimed at shifting conditions which hold a problem in place[35]) coupled with Kaupapa Māori and mātauranga Māori to drive purpose and impact in local communities. Projects supported by Health Families NZ include the Papatoetoe Food Hub initiative and a Tupu Tahi Whangaroa Growing Together Initiative.[36]

The programme is funded by the Ministry of Health. However, this initiative is not mentioned in Ministry Annual Reports, nor is the allocated funding referred to in the past two Vote Health appropriations. It is not known if funding will extend after 2026.

It is unlikely that other similar projects are funded from the Ministry of Health’s $31 billion budget, other than this $10 million per annum project, that increase access in local communities to high quality wholefoods and which support nutrition and dietary education (including cooking education).

Chapter 8. Health, Research & Academic Sector: No Pathways for Knowledge.

RETURN TO CONTENTS PAGE.

REFERENCES

NB: Number order differs from the original Reclaiming Health publication (PDF).

[1] Ministry of Health. 2024. Health and Independence Report 2023 - Te Pūrongo mō te Hauora me te Tū Motuhake 2023. Wellington: Ministry of Health.

[2] Delivery Plan A summary of the plan to improve healthcare and achieve the Government’s priorities. March 2025 – June 2026

[3] Ministry of Health (September 2024). Achieving the Health Targets. High Level Implementation Plans. July 2024 – June 2027. ISBN 978-1-99-106778-4

[4] Minister of Health (July 2024). Government Policy Statement on Health 2024 – 2027. HP9076. ISBN 978-1-991075-77-2 Wellington: Ministry of Health.

[5] Health New Zealand (January 2024). Multimorbidity. https://www.tewhatuora.govt.nz/for-health-professionals/clinical-guidance/diseases-and-conditions/long-term-conditions/management-of-multimorbidity

[6] Health New Zealand. Models of Health. https://www.tewhatuora.govt.nz/health-services-and-programmes/public-health/models-of-health

[7] WHO. The 1st International Conference on Health Promotion, Ottawa, 1986. https://www.who.int/teams/health-promotion/enhanced-wellbeing/first-global-conference

[8] Sierra P. Feeney et al. (2025) Sleep loss is a metabolic disorder. Sci.Signal. 18,eadp9358. DOI:10.1126/scisignal.adp9358

[9] Ministry of Health. 2012. Food and Nutrition Guidelines for Healthy Children and Young People (Aged 2–18 years): A background paper. Partial revision February 2015. Wellington: Ministry of Health. HP 5480. https://www.health.govt.nz/system/files/2012-08/food-nutrition-guidelines-healthy-children-young-people-background-paper-feb15-v2.pdf

[10] Ministry of Health. 2013. Food and Nutrition Guidelines for Healthy Older People: A background paper. Wellington: Ministry of Health. HP 5574. https://www.health.govt.nz/system/files/2011-11/food-nutrition-guidelines-healthy-older-people-background-paper-v2.pdf

[11] Ministry of Health Official Information Act Request response. September 4, 2024. H2024048401 https://fyi.org.nz/request/27933/response/107134/attach/9/H2024048401%20Response%20Letter.pdf

[12] Ministry of Health Official Information Act Request response. September 4, 2024. H2024048401

[13] Health New Zealand (December 2020). New Serving Size Advice. https://www.tewhatuora.govt.nz/assets/Health-services-and-programmes/Nutrition/new-serving-size-advice-dec20-v3.pdf

[14] NHMRC. 2013. Australian Dietary Guidelines. Canberra: National Health and Medical Research Council. URL: www.eatforhealth.gov.au/sites/default/files/files/the_

guidelines/n55_australian_dietary_guidelines.pdf

[15] NHMRC. 2006. Nutrient Reference Values for Australia and New Zealand including Recommended Dietary Intakes. Canberra: National Health and Medical Research Council; Wellington: Ministry of Health.

[16] Healthed. Healthy Eating. https://healthed.govt.nz/collections/topic-healthy-eating

[17] Health New Zealand (July 2025). Popular diets review. https://info.health.nz/keeping-healthy/eating-well/popular-diets-review

[18] Wu JH, Micha R & Mozaffarian D. Dietary fats and cardiometabolic disease: mechanisms and effects on risk factors and outcomes. Nat Rev Cardiol 16:581–601 (2019). DOI: 10.1038/s41569-019-0206-1

[19] Masood W, Annamaraju P, Khan Suheb MZ, et al. (June 2023). Ketogenic Diet. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499830/

[20] Dashti HM, Mathew TC, Hussein T, et al (2004) Long-term effects of a ketogenic diet in obese patients. Exp Clin Cardiol. 2004 Fall;9(3):200-5. PMID: 19641727; PMCID: PMC2716748.

[21] Kelly, T, Unwin, D, Finucane, F. (2020). Low-Carbohydrate Diets in the Management of Obesity and Type 2 Diabetes: A Review from Clinicians Using the Approach in Practice. Int. J. Environ. Res. Public Health 2020, 17, 2557. DOI: 10.3390/ijerph17072557

[22] Hendriksen RB, van der Gaag EJ (2022). Effect of a dietary intervention including minimal and unprocessed foods, high in natural saturated fats, on the lipid profile of children, pooled evidence from randomized controlled trials and a cohort study. PLOS ONE 17(1): e0261446. https://doi.org/10.1371/journal.pone.0261446

[23] Astrup, A, Magkos, F, Bier, D. et al. (2020) Saturated Fats and Health: A Reassessment and Proposal for Food-Based Recommendations: JACC State-of-the-Art Review. JACC. 76 (7) 844–857. DOI: 10.1016/j.jacc.2020.05.077

[24] Health New Zealand (2025). There is a way through. A guide for people experiencing stress, depression and anxiety. HE2570. https://healthed.govt.nz/cdn/shop/files/HE2570_There_is_a_way_through_booklet_JAN_25-WEB_d4285d44-ddac-4dc8-af38-2b30d5d3432e.pdf?

[25] Minister of Health. 2024. Government Policy Statement on Health 2024 – 2027. https://www.health.govt.nz/system/files/2024-06/government-policy-statement-on-health-2024-2027-v4.pdf

[26] Health New Zealand (August 2025). New Zealand Health Plan | Te Pae Waenga 2024-2027. Wellington: Health New Zealand. https://www.tewhatuora.govt.nz/assets/Publications/New-Zealand-Health-Plan/New-Zealand-Health-Plan-Te-Pae-Waenga.pdf

[27] Health New Zealand (March 2025). Delivery Plan. A summary of the plan to improve healthcare and achieve the Government’s priorities March 2025 – June 2026. ISBN 978-1-991139-27-6 (online)

[28] Minister of Health. 2024. Government Policy Statement on Health 2024 – 2027. Page 4.

[29] Minister of Health. 2024. Government Policy Statement on Health 2024 – 2027. Page 48.

[30] Minister of Health. 2024. Government Policy Statement on Health 2024 – 2027. Page 8. https://www.health.govt.nz/system/files/2024-06/government-policy-statement-on-health-2024-2027-v4.pdf

[31] He Ara Oranga, Report of the Government Inquiry into Mental Health and Addiction. Published in November 2018 by the Government Inquiry into Mental Health and Addiction

978-0-9941245-2-4 (print) https://mentalhealth.inquiry.govt.nz/__data/assets/pdf_file/0024/20868/he-ara-oranga.pdf

[32] Ministry of Health. 2021. Kia Manawanui Aotearoa: Long-term pathway to mental wellbeing. Wellington: Ministry of Health. https://www.health.govt.nz/system/files/2021-08/kia-manawanui-aotearoa-companion-document-sep21.pdf

[33] Ministry of Health. 2023. Kia Manawanui Aotearoa: Update on implementation of a mental wellbeing approach. Wellington: Ministry of Health.

[34] Matheson A, Wehipeihana N, Gray R, et al. (2022). Community-up system change for health and wellbeing Healthy Families NZ Summative Evaluation Report 2022. Te Whatu Ora — Health New Zealand. Wellington.

[35] Kania J, Kramer M, & Senge P, 2018. The Water of Systems Change. FSG. https://inspiringcommunities.org.nz/wp-content/uploads/2019/04/The-Water-of-Systems-Change-FSG-2018.pdf

[36] Healthy Families NZ. 10 Years of Impact. Reshaping our Systems for A Healthier Aotearoa New Zealand. https://www.healthyfamiliesnz.org/_files/ugd/44d27c_bb65d9af249949bc9d114e432cc26b0e.pdf