NZ First’s health policy more vibes and vitamins than evidence

New Zealand First has launched its 15-point plan called ‘Make New Zealand Healthy’. The title itself raises some alarm bells, as if it wants to import the weirdness associated with US Secretary of Health, Robert F Kennedy Jr, and his Make America Healthy Again campaign to Aotearoa New Zealand.

While RFK Jr is getting plaudits for finally putting ultra-processed foods on the political agenda as the major driver of America’s obesity problem, he is being criticised for his multiple non-scientific crusades, including against vaccines, and for his political interference in railroading the scientific process to develop dietary guidelines for Americans. Please, let’s not have Kiwi versions of RFK Jr or Make America Healthy Again here.

The NZ First policy is prefaced with the principle that I and many others have been espousing for years – “We spend billions treating sickness – it is time we invested a small fraction of that money in finding out how much sickness we can prevent.”

That is the vibe of NZ First’s health policy, and Labour, Greens and Opportunity are also putting primary care and prevention policies up front in their health policies. Prevention has yet to feature in National and Act lexicons.

But what are NZ First’s policy proposals that deliver on the prevention promise? They feel like notes from a whiteboard brainstorm followed by a bit of Googling – and show close similarities to proposals on local websites, including one coincidentally called Make NZ Healthy.

Some points are little more than positive generalities like “Put prevention back at the heart of healthcare” and “Find better ways to acknowledge our nurses”. Some are obscure, such as “Ensure that informed consent is a core part of quality healthcare”. (What is the problem they are trying to fix here?) 

However, several points place an unwarranted faith in education and individual choice as the major lever for change.

If there is one thing we know about health-harming behaviours, such as smoking, drinking alcohol and eating junk food, it is that they are not due to a deficiency of knowledge.

In fact, the things that make the biggest difference to our health are population-level changes, like smokefree legislation, limiting the number of alcohol outlets and providing healthy school lunches.

Until NZ First’s biggest anti-prevention policy of repealing the Smokefree legislation came, out of the blue, in 2023, smoking rates were falling nicely under the influence of structural interventions, such as price increases, expanding smokefree environments, plain packaging, and removing tobacco visibility at the checkout counter.

Tobacco, of course, is not mentioned in the NZ First health policy, likely because of the attention that would bring to the policies they decided to introduce that favour the profits of the tobacco industry over the health of New Zealanders.

Alcohol, which costs this country $9 billion a year, doesn’t get a mention, but nutrition is in the forefront of the policy. Since this is my area of research interest, I am pleased to see this prominence. Obesity and poor diet are together the biggest cause of preventable ill-health and premature death in New Zealand, so nutrition deserves to be centre stage in prevention.

However, again, the most effective forms of prevention are not so much to do with consumer choice and vitamins as they are politicians enacting policies that create a healthy food environment, such as reducing the number of junk-food ads children see.

Health Coalition Aotearoa’s food policy expert group reviewed the evidence and came up with these top three most effective policies for improving nutrition:

strengthening and extending the Healthy School Lunches Programme
restricting unhealthy food marketing to children
applying a UK-style sugary drinks industry levy.
None of these appear on NZ First’s list.

Also, in a University of Auckland and Health Coalition Aotearoa joint benchmarking report on food policy, a group of 40 nutrition experts reviewed the current Government’s progress on healthy food policies over the past three years and found a virtual lack of any progress.

In the process, they added a few more priorities to Health Coalition Aotearoa’s policy priority list – reducing salt and sugar in certain categories of foods, a national nutrition survey, mandatory Health Star Ratings, and healthy food policies for all schools. Again, none made it into NZ First’s 15 policy proposals.

The party’s policy on nutrition is “Promote nutrition from primary school to medical school”. Good, we definitely need this foundation.

And also, “Require a full independent review of our dietary guidelines”. Yes, but let’s look at the world-leading dietary guidelines from the Scandinavian and Latin American countries, not the controversial Make America Healthy Again guidelines. Plus, we desperately need a nutrition survey to underpin those NZ guidelines because the last surveys were 2008 for adults and 2002 for children.

Then, weirdly, the policy singles out a handful of very specific nutrition topics. Nutrition in mental health, intravenous vitamin C post-surgery, and vitamin D for ‘maintaining health’. Why not a boost in priority funding for nutrition-intervention research?

However, it is not the role of political parties to act as research-assessment committees to decide the merits of competing nutrition intervention projects. Vitamin intervention research projects may well be meritorious but so are many other interventions.

The final two points in the policy are very interesting. They are both about supporting sustainable and organic farming practices. It is encouraging to see the wider determinants of health appear in a health policy. Ideally, a health policy would start by acknowledging that most of our health status is determined by factors outside the healthcare system – incomes, housing, education, transport, climate change, racism and so on.

An overarching health policy needs a strong focus on prevention up front, but at a population level, reflecting the evidence that this is where the greatest gains can be made for the cheapest price – especially policies on tobacco, alcohol and unhealthy food.

We also need the policies that follow to be coherent, evidence based and ideally widely agreed upon by experts. Hopefully, these will emerge when, as NZ First says it will, the party makes further announcements on its plan.