133 Molesworth Street
PO Box 5013
Wellington 6140
New Zealand
T+64 4 496 2000
31 March 2023
Jan Rivers
Email:
[FYI request #22000 email]
Ref:
H2023021293
Tēnā koe Jan
Response to your request for official information
Thank you for your request under the Official Information Act 1982 (the Act) to Manatū Hauora
(the Ministry of Health) on 5 March 2023 for information regarding the Women's Health
Strategy.
Before responding to each part of your request I would like to provide you with some relevant
context regarding the Women’s Health Strategy.
The Women’s Health Strategy is one of six Pae Ora health strategies mandated by the Pae Ora
(Healthy Futures) Act 2022. The other Pae Ora strategies are the New Zealand Health Strategy,
the Hauora Māori Strategy, the Pacific Health Strategy, the Health of Disabled People Strategy,
and the Rural Health Strategy. These strategies, together with the Health Sector Outcomes
framework, Government Policy Statement on Health and the New Zealand Health Plan, set
future directions for the Health System. The experiences and aspirations of rainbow
communities are being considered across all Pae Ora strategies, including the Women’s Health
Strategy.
The Women’s Health Strategy wil set the strategic direction for improving women’s health. The
scope is broad, and includes misogyny and discrimination against women, experiences and
conditions that affect women dif erently or disproportionately, and social determinants of health
that contribute to gender inequity.
The health and wellbeing needs and experiences of gender diverse people wil be reflected in
the Women’s Health Strategy where they intersect with those of women. This is inclusive of
trans women, as well as some people who may not identify as women. Gender diverse people’s
health and wellbeing needs and experiences wil also be reflected in the development of the
other Pae Ora strategies as appropriate.
From a public health perspective, we know that both sex and gender are determinants of health.
It is important that we acknowledge where trans women and other women have shared factors
that shape health care access and health outcomes. Examples of this include gender bias, and
social determinants of health such as income, housing, and experience of family violence and
sexual violence.
Manatū Hauora notes that an individual’s health needs and experiences may be shaped by
different aspects of a person’s identity including sex and gender, ethnicity, disability and socio-
economic status. To avoid losing this nuance, the strategy wil not treat women or diverse
populations of women as one homogenous group.
Each part of your request is responded to below in turn:
Please can you provide information used or generated by the Ministry over the past 2 1/2
years to include:
papers that explain the medical evidence of these 'same health issues'.
any lists of parallel health issues created by the Ministry to demonstrate the benefits of
including male people as women in a women's health strategy,
Two documents have been identified within scope of this part of your above requests relating to
‘same health issues’ and lists of parallel health issues. The documents are outlined in the table
in Appendix 1 of this letter. Where information is withheld, this is outlined in the Appendix and
noted in the document itself. Where information is withheld under section 9 of the Act, I have
considered the countervailing public interest in releasing the information and consider it does
not outweigh the need to withhold at this time.
academic and research resources used by the Ministry to identify these 'same health
issues'
Manatū Hauora has access to a large range of research databases and has engaged with a
wide range of literature while building the evidence base for the Women’s Health Strategy.
Manatū Hauora does not have a record of all research and academic resources used over the
past 2½ years to explore issues around sex, gender and health. Therefore, your above request
for academic and research resources is refused under section 18(g) of the Act.
While we do not have a record of all the academic and research resources that have been used
to explore issues around sex, gender and health over the past 2½ years, we can provide some
examples of relevant reports. For example, we note that the paper
Sex and Gender Equity in
Research by Heidari et al. (2016) provides clear definitions of gender and sex. You can read
this here:
https://researchintegrityjournal.biomedcentral.com/articles/10.1186/s41073-016-0007-
6.
Further, we note that the Royal Australian and New Zealand College of Obstetricians and
Gynaecologists identified trauma from sexual violence and intimate partner violence as a priority
for women, non-binary and trans people in their Flourish: Women+ Health Summit report to
inform the Women’s Health Strategy
https:/ ranzcog.edu.au/news/flourish-women-health-
summit/. The 2019 Counting Ourselves report also indicated that rates of sexual violence for
trans people, including trans women are very high. You can read this at:
https:/ countingourselves.nz/2018-survey-report/.
Another source of information on these issues is the 2019 Counting Ourselves report, which
indicated high rates of psychological distress among gender diverse people. While
psychological distress rates for cis-gender women are lower than those of trans women, the
New Zealand Health Survey shows that women are significantly more likely to report
psychological distress than men. You can view this at:
https:/ minhealthnz.shinyapps.io/nz-
health-survey-2021-22-annual-data-explorer/_w_11d48cde/#!/home.
The Breast Cancer Foundation NZ website provides some information on breast cancer in
rainbow communities, including in trans women. You can read this at:
https:/ www.breastcancerfoundation.org.nz/breast-cancer/types-of-breast-cancer/breast-cancer-
in-the-lgbtiq-community.
Page 2 of 4
external engagement with New Zealand organisations such as feminist, rainbow/queer
and transgender organisations who supplied information about the 'same health issues'.
One document has been identified within the scope of your above request for external
engagement. As the Ministry has not completed a formal analysis of information gathered
through engagement on the Women’s Health Strategy, this document has been withheld in full
under section 9(2)(f)(iv) of the Official Information Act. I have considered the countervailing
public interest in releasing the information and consider it does not outweigh the need to
withhold at this time.
During targeted engagement on the Women’s Health Strategy, we heard about the importance
of considering the needs of trans women in the design of mental health services and
campaigns, in provision of social supports like emergency housing. Our stakeholders also noted
that trans women, and cis-gender men, can be affected by breast cancer.
Please provide any papers that addressed the 'counterfactual' ie any materials of the kind
above that addressed concerns that including people in a women's health strategy by
gender rather than sex raised risks for the effectiveness of the strategy such as women
who do not identify as women being left out of the strategy or services intended for natal
women having to be directed towards men who identify as women.”
Manatū Hauora has not produced any papers or briefings on this topic. Furthermore, as
mentioned above, Manatū Hauora does not have a record of all research and academic
resources that are engaged with. Therefore, your above request for ‘counterfactual’ materials is
refused under section 18(g) of the Act. However, Manatū Hauora is aware of conversations
among members of the public that disagree with the inclusion of gender diverse people,
including trans women, in the Women’s Health Strategy. The Ministry’s position is that all people
are entitled to the health and wellbeing support that they need to enjoy the best standard of
health care they can, and an inclusive Women’s Health Strategy is one tool to achieve this goal.
I trust this information fulfils your request. Under section 28(3) of the Act, you have the right to
ask the Ombudsman to review any decisions made under this request. The Ombudsman may
be contacted by email at:
[email address] or by calling 0800 802 602.
Please note that this response, with your personal details removed, may be published on the
Manatū Hauora website at:
www.health.govt.nz/about-ministry/information-releases/responses-
official-information-act-requests.
Nāku noa, nā
Steve Waldegrave
Acting Deputy Director-General
Strategy, Policy and Legislation | Te Pou Rautaki
Page 3 of 4
Appendix 1: List of documents for release
#
Date
Document details
Decision on release
6 April 2022
Briefing: Initial Advice on a
Some information withheld
1
Women’s Health Strategy:
under the following sections of
Scope, process and timelines
the Act:
(HR20220479)
• Section 9(2)(a) and;
• Section 9(2)(f)(iv) -to
maintain the
constitutional
conventions that
protect the
confidentiality of advice
tendered by Ministers
and officials.
21 October 2022
Women’s Health Strategy –
Some information withheld
2
Director General of Health
under section 9(2)(a) of the
Response to Fern Hickson
Act to protect the privacy of
natural persons.
27 January 2023
Response to media request from Released in full.
3
NZ Doctor – Gender diverse
people in the Women’s Health
Strategy
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