Historical Development of Aotearoa New Zealand Health System

Welcome to this topic on the development of healthcare in Aotearoa New Zealand. Here we will explore how the healthcare system we have today, came into being, including the key developments aimed at improving health and wellbeing.

Kia tīmata tātou!-Let’s get started!

Healthcare Services Today

The following is an overview of the structure of public and private healthcare services today:

• Public Healthcare: This is the part of the Aotearoa NZ health care system, provided by the government, that focuses on creating and promoting an environment and society that supports good health. It is described as: ‘the science and art of preventing disease, prolonging life and promoting health the organised efforts of society.” This means providing information, shaping polices and creating programmes that improve lifelong health, for example smoke free environments, immunisation, warm dry housing and clean air. Public health teams also assist in the management of infectious disease outbreaks. Many public healthcare services are subsidised by the government making them free or low cost. The level of subsidy and the cost can vary depending on factors such as age, income, and the type of services required.
• Primary Healthcare: Primary health is the part of the public healthcare system. It is the first, or primary point of contact for individuals with the health care system, including general practitioners (GP), dentists, pharmacists, midwives or other community-based health services.
• Secondary Healthcare: Part of public health, secondary health care is the specialist health services that people are referred to by their primary healthcare provider. For example, a GP may refer a patient with and irregular heartbeat to a cardiologist clinic at the hospital as this health issue requires more expertise than primary healthcare can provide.
• Tertiary Healthcare: Also part of the public healthcare system, tertiary healthcare are generally provided on referral from primary or secondary health providers. These services are highly specialised and involve advanced and complex procedures or treatments, including surgery,  chemotherapy, CT scans and other inpatient care.
• Private Healthcare: This refers to healthcare services for individuals that are provided by companies or businesses outside the public healthcare system. They are paid for through a person’s health insurance or out-of-pocket payments. This type of healthcare offers a wide range of services, including elective surgery, specialised treatments, preventative care, private hospitals, scanning and other tests.

Historical Time line

The healthcare system in Aotearoa New Zealand has changed significantly over time. It began with the traditional health practices of Māori, long before Europeans arrived. When Europeans settled in Aotearoa, they brought their own ideas and approaches to healthcare, which combined with existing Māori practices. Over the years, these influences shaped the public healthcare system we see today.

At the core of this journey is Te Tiriti o Waitangi (The Treaty of Waitangi), an agreement that established the relationship between Māori as tangata whenua (people of the land) and the Crown. Understanding how healthcare has developed, and how Te Tiriti plays a vital role, is essential for providing culturally respectful care that recognises Māori as the first people of Aotearoa and upholds their rights within the healthcare system.

Let’s take a quick look at what was happening with healthcare in Aotearoa New Zealand from before Europeans arrived until the late-1800s

• Before 1642 Pre-European Contact: Māori communities had well-established, holistic healthcare systems focused on physical, spiritual, and emotional wellbeing. Traditional healing involved the use of rongoā (medicinal plants), karakia (incantations), and the guidance of tohunga (healers). These practices emphasised a collective approach to health, where the well-being of the individual was intertwined with the well-being of the whānau (family), hapū (sub-tribe), and iwi (tribe).
• 1642 – European Contact: Initial interactions began with European explorers and traders. Māori health practices continued, but European settlers brought new diseases that had a significant impact on Māori populations, as they had no immunity to these illnesses.
• Early 1800s: Christian missionaries began to introduce Western medical practices, focusing on hygiene, disease prevention, and treatments based on their understanding of science. These often conflicted with traditional Māori practices but slowly started to influence healthcare approaches.
• 1840: Te Tiriti o Waitangi was signed between Māori chiefs and the British Crown, establishing a relationship of mutual respect and governance. The treaty plays a vital role in recognising Māori as tangata whenua and ensuring their rights are honoured, including access to healthcare. The Māori population had declined by 10–30%. This was due to introduced diseases, and the effects of the musket wars, and dislocation from lands that were important for agriculture and provided access good and resources
• 1847: First public hospital in New Zealand opened in Wellington. It treated poor European people – most had to pay, but the very poor (and Māori) were treated for free

The following is a time line of key historical developments that have improved healthcare in Aotearoa New Zealand from the late 1800s to the present. As you read through these developments reflect on how and to what extent these developments have contributed to improved health and wellbeing in this country.

• Late 1800s: With the increasing arrival of European settlers, hospitals were established primarily in larger urban centres. These hospitals predominantly served the settler population, while Māori faced significant challenges in accessing these services due to geographic, social, and economic barriers.
• 1870’s: Public health policies began to emerge in response to rapid urbanisation and concerns about sanitation. Efforts to improve water supplies, waste disposal, and hygiene aimed to reduce disease outbreaks. However, Māori communities were often excluded from these developments, contributing to ongoing health disparities.
• 1875: The Otago Medical School was established in creating a local standardisation of practices among medical practitioners.
• 1886: The New Zealand Medical Association (NZMA) was established to provide professional support and set standards for medical practitioners nationwide. The association aimed to raise the quality of healthcare by promoting the professional development of doctors and aligning medical practice with evolving international standards.
• 1896: Sibylla Maude, known as Nurse Maude, established New Zealand’s first district nursing service in Christchurch. This service offered free healthcare and support to those who could not afford it, particularly in rural and underserved urban areas. However, access to care for Māori communities remained limited due to systemic barriers.
• 1900s: Healthcare was a mix of traditional remedies, patent medicines, and occasional visits to expensive doctors. Healthcare was divided between orthodox medical practitioners and alternative healers, particularly homeopaths. Medical education lacked standardisation.
  Māori healthcare combined natural medicines with spiritual healing, though there was growing interest in European medicines. While vaccination against smallpox became available, many still died from infectious diseases like tuberculosis, typhoid, polio, and diphtheria, as the causes of these diseases were not well understood. Families often relied on self-diagnosis and treatment, with women in the community providing informal healthcare and midwifery, although medical practitioners also undertook midwifery.
• 1901: The Department of Public Health was established, which was a move towards a more organised and systematic approach to healthcare. In 1922, it was renamed the Department of Health,
• 1907: The Society for the Promotion of the Health of Women and Children (now Plunket) was established, to improve the health of mothers and babies
• 1911: The Māori Nursing Service was established as part of the Department of Health to provide culturally appropriate healthcare to Māori communities.
• 1912: Legislation for the compulsory medical inspection of children in state schools was introduced to ensure that children had regular medical inspections, aiming to identify health issues early.
• 1925: New Zealand introduced immunisation against diphtheria to reduce the spread of diphtheria, a deadly infectious disease, especially in children.
• 1935: The New Zealand government established a system of state-funded healthcare, expanding access to medical services for the population.
• 1938: The New Zealand government introduced the Social Security Act, which laid the foundation for free hospital care and heavily subsidised GP visits.
• 1971: The Nursing Council of New Zealand Established. This body oversees the regulation of nurses and their professional conduct, ensuring safe and high-quality care.
• 1987: New Zealand Board of Health Promoted the Treaty of Waitangi as Relevant to Health. This was a significant moment in the development of health policy, acknowledging the Treaty’s importance in guiding healthcare for Māori.
• 1992: Mental Health (Compulsory Assessment and Treatment) Act. This legislation modernised the mental health system, establishing clear rights for people undergoing compulsory treatment and assessment.
• 1993: The establishment of Ngā Ringa Whakahaere ō te Iwi Māori (Network of  Māori Traditional Healers). This network helped to integrate traditional approaches into the healthcare system. In the same year, the Department of Health was restructured and became the Ministry of Health.
• 2013: The Whānau Ora Initiative was created to empower whānau (families) by providing access to a holistic range of services. Its focus on whānau well-being—physical, mental, and emotional
• 2015: Free GP visits for children under 13 were introduced, extending the previous zero-fee scheme for under-6s. This aimed to improve healthcare access for families by offering free medical consultations and prescriptions, both during the day and after hours.
• 2022: The Pae Ora (Healthy Futures) Act 2022 was introduced to reform New Zealand's healthcare system. It established Health New Zealand (Te Whatu Ora) and the Māori Health Authority (Te Aka Whai Ora), replacing the previous District Health Boards (DHBs). These reforms aimed to streamline the healthcare system, improve access, and integrate Māori perspectives in governance and decision-making.

Watch the video below for an overview of the changes introduced to New Zealand's public healthcare system with the Pae Ora (Healthy Futures) Act 2022.

Video Title: Future of Health - the Five System Shifts

Watch Time: 3:00

Post Watch Task: Answer the following questions:

• What are the two new health organisations that were developed as part of the health reforms?
• Name the 5 key areas where change will make the biggest difference to healthcare.

Source: Vimeo

The new Act which took effect on 1 July 2022, establishes Health New Zealand and the Māori Health Authority as enduring institutions that will replace the DHB system.

It also establishes the Public Health Agency as part of the Ministry of Health, strengthening its role in overseeing health matters. The legislation marks a significant milestone by formally acknowledging iwi-Māori Partnership Boards for the first time

Healthcare Services for the Future

Since the health reforms of 2022, which established Te Whatu Ora (Health New Zealand) and Te Aka Whai Ora (the Māori Health Authority), the public healthcare system has seen efforts to streamline services, address inequities, and improve health outcomes across Aotearoa. However, with the change in government in 2023, these reforms are now under review, and potential changes in policy could lead to modifications or even the dismantling of certain structures. As governments change, so do priorities, which can reshape the direction of healthcare in response to demographic needs, funding, and political focus.

For support workers, it’s important to stay aware of changes in the health system. Understanding the aims of New Zealand’s health and wellbeing sector, along with how reforms and changes affect the services provided, helps support workers do their job better. By staying up to date, support workers can better meet the needs of the people they work with and contribute to improved care for everyone.

Click the expand button to view a model answer for question number 3. Don’t worry if your answer looks different! Compare it with the model answer and think about the key points you might have missed or could expand on.

End of Topic

Well done, you’ve finished another topic. You now understand the history of healthcare in Aotearoa and how Te Tiriti o Waitangi recognises Māori as tangata whenua. This knowledge is important for all support workers in health and wellbeing to ensure culturally respectful and effective care. Next up, we explore health models and approaches.

Keep up the great work!