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INFORMATION
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Initial Advice on a Women’s Health
Strategy: Scope, process and timelines
Security level:
IN CONFIDENCE
Date:
6 April 2022
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To:
Hon Dr Ayesha Verrall, Associate Minister of Health
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Purpose of report
1 This briefing responds to your request for advice on process and timeframes for a potential
women’s health strategy. It seeks your views on the kind of strategy, its scope, development
process including engagement and resource implications, which wil determine process and
timeframes.
2 This report discloses all relevant information.
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Summary
3 There is a strong case for a women's health strategy, given Te Tiriti o Waitangi (Te Tiriti)
obligations, continuing health inequities for women, and significant fragmentation in the
system and government’s approach to women's health. Outcome inequities are often
compounded for many populations, including Māori, Pa
OFFICIAL cific and rural women, as wel as
transgender, intersex and takatāpui communities.
4 We see six potential approaches to creating a women's health strategic document, which
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have a range of document types and scopes. These range from a stand-alone cross-
government strategy and action plan to a policy statement that is included in a wider
women’s strategy or action plan. Options for scope and document type wil depend on the
development of the future New Zealand Health Strategy and a prospective women’s action
plan.
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5 We recommend a women’s health strategy with a health-focussed action plan that provides
a cross-government framework for investing in women’s health and wellbeing (Option 2b).
This option is likely to result in greater recognition of wider social determinants of health,
intersectionality and inequity than others.
6 The type and scope of the document wil determine the level of engagement, risk
management, financial implications, and development timelines. A well-designed
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engagement process would be key to mitigating risks, such as not fulfilling Te Tiriti
obligations, but would also have financial implications.
7 This paper provides a high-level overview of the implications of scope and document type
for your decision. Further advice, including a project plan, wil be provided to you based on
your preferred option.
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Recommendations
We recommend you:
a)
Note the case for a women’s health strategy, given Te Tiriti O Waitangi
obligations, continuing health inequities for women, and gaps and
b)
Agree to discuss with the Minister of Health, the Associate Minister of Health
Yes/No 1982
(Māori Health) and the Minister for Women respectively, the relation of a
• a prospective New Zealand Health Strategy
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•
He Korowai Oranga
•
a prospective women’s action plan.
c)
Note that we have developed six options to progress around type and scope
of a women’s health strategic document and that Option 2b: Strategy with a
d)
Indicate your preferred type and scoping option for a women’s health
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strategic document:
1a:
Policy statement without action plan.
Yes/No
1b: Policy statement with action plan.
Yes/No
2a:
Strategy without action plan.
Yes/No
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2b: Strategy with health-focussed action plan.
Yes/No
2c:
Strategy with cross-government
THE action plan.
Yes/No
3:
Section of the New Zealand Health Strategy.
Yes/No
4:
Section of a women’s strategy or action plan.
Yes/No
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e)
Indicate whether a women’s health strategy would include issues specific to
Yes/No
the transgender, intersex and takatāpui communities (if your preference for
f)
Note that your preferred document type and scope will dictate the
development process, including engagement, timelines, and financial
your scope and scale preferences with a proposed project plan, according to
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g)
Note that depending on the type and scope of document you choose,
consultation, and analysis on a strategy and action plan for either the health
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Caroline Flora
Hon Dr Ayesha Verral
Associate Deputy Director-General
Associate Minister of Health
System Strategy and Policy
Date:
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Date:
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INFORMATION
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Initial advice on a women’s health strategy:
Scope, process and timelines
Context
8 You have requested advice on process and timeframes for a women’s health strategy if one
is commissioned. We understand from the Departmental Report on the Pae Ora (Healthy
Futures) Bil that Ministers have agreed to recommend that the development of such a
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strategy be mandated.
9 Parts of the health sector and wider community have been advocating for a women’s health
strategy. There is a petition cal ing for a women’s health strategy currently in front of the
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Health Select Committee, brought by Angela Meyer on behalf of the Gender Justice
Collective.
10 Claims related to the impact of Crown policies and actions on the health and wellbeing of
wāhine Māori and their whānau are included in Wai 2700, the Mana Wāhine Kaupapa
Inquiry. This work is stil at the early stage of tūāpapa (contextual) hearings, with themes and
phases yet to be determined. It may therefore be several years before the final findings are
made. There are several overlaps with the claims brought forward in Wai 2575, such as
maternal mental health, alcohol exposure during pregnancy, and the Māori nurses claim.
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11 In New Zealand’s most recent examination on the Convention on the Elimination of al forms
of Discrimination Against Women (CEDAW) in 2016, the CEDAW committee recommended
that New Zealand adopt a comprehensive action plan for women. Noting the
disproportionate economic and social impacts of COVID-19 on women, in October 2021
Cabinet invited the Minister for Women to report back mid-2022 to the Social Wellbeing
Committee on progress towards addressing the impact and whether a ‘National Action Plan
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for Women’ was required.
12 This briefing discusses options for a ‘women’s health strategy’ (the strategy), although
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depending on Ministerial preference, the final document may be a different form of
strategic document, or part of another document.
A strategy for those who identify as women, or share women’s biological
realities and experiences
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13 There is currently a strong case to develop a women’s health strategy, due to:
•
Te Tiriti o Waitangi (Te Tiriti) obligations and their implications for women’s health and
the need for more mana-enhancing and equitable policies and actions for wāhine
Māori
•
continuing health outcomes inequities, particularly for wāhine Māori and Pacific
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women
•
a fragmented government and system level approach to women’s health
•
significant policy and health service gaps in women’s health, including menopause
and pelvic health.
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14 A women’s health strategy could also provide greater alignment with our international
commitments to the United Nations Sustainable Development Goals 3 and 5, good health
and wellbeing, and gender equality.
15 Strategies can be used to guide decision-making and prioritise work programmes. They also
provide a long-term vision and strategic framework to guide and connect existing work and
policy development. Strategies can be used to highlight gaps, issues and priorities, the case
for change, and form the basis for monitoring system performance and outcomes. The
process of developing a strategy is also a useful exercise in understanding the views and
experiences of the relevant population group: a critical part of developing a responsive,
person- and whānau-centred strategy.
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16 Using gender and sex to inform health policy is just one way of creating more targeted,
person- and whānau-centred health services. This strategy would be for women of al ages
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who experience women's health issues, including people who are biological y female and
people who identify as women. A broad definition of ‘woman’ is important because sex and
gender are each determinants of health, with interactions that influence health and
wellbeing in a variety of ways.
17 Intervention and strategy aimed at women’s health has the potential to be a powerful lever
to reduce inequities, with the benefits shared by dependent children, older whānau, and the
broader household. This is consistent with the Ministry for Women’s approach to initiatives
to overcome discrimination against women, noting that such initiatives wil have benefits for
the whole population.
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Women continue to face inequities and biases in multiple areas of health
18 Women make up just over half of the New Zealand population. As il ustrated in previous
health and independence reports, despite having a longer life expectancy than men, women
are more likely to spend these years in poorer health and disability.
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19 Women are also often seen as responsible for the health of others and are more likely than
men to manage multiple roles, including employment, family, child-rearing and childcare
responsibilities. The Ministry for Women notes different groups of women, and women as a
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whole, have been disproportionately impacted throughout the COVID-19 epidemic.
20 New Zealand women are more likely to report barriers to accessing care and treatment. The
2019/20 New Zealand Health Survey found that women were more likely not to visit their
general practitioner (GP) due to cost than men (15.9 percent compared to 10.6 percent) and
were less likely to fil their pres
UNDER cription (6.7 percent compared to 3.5 percent). This is
compounded for Māori, Pacific and LGBTQI women.
21 Accessing affordable, culturally and clinically safe primary and community care is vital for
women, who require regular primary and community care consultations independent of
health concerns, such as cervical and breast screening, post-partum care and contraception.
22 Evidence also suggests that there are often delays in diagnosis for many women's health
issues resulting from bias in areas such as imaging referral, and there are reports that
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debilitating conditions such as pelvic issues and menopause are ignored by health
professionals. Women also present differently to common conditions compared to men, for
example, women are less likely than men to experience chest pain with heart attacks.
Inequities also exist in public health issues, with lung cancer the leading cause of death in
wāhine Māori, who experience one of the highest lung cancer rates in the world.
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23 Gender bias exists between health professionals and their treatment of women, resulting in
inequitable health experiences and outcomes. Assumptions about gender and sex often
manifest in variance of treatment between men and women; this is especial y prevalent in
the treatment of women’s sexual and reproductive health disorders. This strategy would
therefore focus on overcoming system biases and improving health outcomes for al
women.
Priority populations within the population group of women experience poorer outcomes which are also
inconsistent with obligations under Te Tiriti
24 Māori and Pacific women, those experiencing deprivation, those who are a member of the 1982
LGBTQI community, rural women, and women in prison al have poorer health outcomes
across a suite of measures, including access to health care. Notably, women are over-
represented amongst lower income New Zealanders, and are more likely to be receiving a
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benefit, providing unpaid care, sole parenting and overal receive lower incomes than men.
The cumulative impact of structural racism, deprivation, and gender discrimination on health
outcomes is frequently multiplicative, not additive.
25 There is a need for equitable access and safe services including cultural y diverse health
services for wāhine Māori, Pacific women, and other priority groups. A strategy would
identify a set of priority groups and give prominence to the issues that are
disproportionately experienced by these groups.
26 The 2019/20 New Zealand Health Survey found wāhine Māori were significantly more likely
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to experience unmet need for primary care than non-Māori women. This includes greater
likelihood of unmet primary care need and of unfil ed prescription due to cost compared to
non-Māori women. In order to improve outcomes for wāhine Māori, we must uphold Te Tiriti
principles of partnership, equity, options, active protection, and the guarantee of tino
rangatiratanga.
27 The Mana Wāhine Kaupapa Inquiry centres upon the los
OFFICIAL s of rangatiratanga and the social,
economic, environmental and cultural loss resulting from a loss of recognition of wāhine
rangatiratanga. The Ministry is working closely with the Ministry for Women and Te Puni
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Kōkiri on a Crown research programme and an Al of Government framework to inform the
Mana Wahine inquiry. We have shared Whakamaua and Whatua, which document whānau
voice, our Te Tiriti position statement and framework and our draft Mātauranga Māori
framework with the Mana Wāhine cross-agency working groups and joint roopu
governance. UNDER
28 Evidence indicates that prioritising health resource towards women, and particularly wāhine
Māori, can have very positive effects. For example, initiatives to reduce smoking for young
Māori women have resulted in a 9.2 percent decrease in tobacco use between the
2019/2020 and 2020/2021 New Zealand Health Surveys.
The current approach to women’s health is limited, fragmented and lacking in overarching
direction
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29 While work on women’s health occurs in many parts of the Ministry of Health and the sector,
this work lacks an overal connecting framework and focuses almost exclusively on sexual
and reproductive health.
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30 There is also a lack of visibility or consideration of how policy decisions impact on the health
experiences of women. This presents two issues: we are not able to see the ‘full picture’ of
health needs; and the parts of the picture that we do see are not joined up. For example, the
current quarterly reporting on women’s health is exclusively related to women’s
reproductive bodies. However, interrelated elements of this work could be better connected,
such as contraception and abortion work.
31 This fragmented and narrow approach means that we risk disregarding the many other
health concerns women may have. This includes auto-immune conditions such as lupus and
multiple sclerosis, which are twice as common among women than men, and low bone
density or osteoporosis putting women at much greater risk of disabling fal s and fractures. 1982
This approach to ‘women’s health’ is also cis-normative, as it does not recognise, for
example, that not everyone who needs breast or cervical screening identifies as a woman.
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32 A women’s strategy or action plan is an opportunity to be more deliberate and col aborative
in our approach to women’s health, reducing the risk that particular issues fal through the
gaps and system issues such as gender bias and racism can be addressed.
The health reforms provide an opportunity to shift the government’s approach to women’s
health
33 The health and disability system reform presents an opportunity to do things differently, as
it looks to move towards an innovative, population health-based, person-centred model of
care that prevents, reduces, and delays the onset of health needs. As is explicit within the
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Pae Ora Bill principles for the health system, the reforms set a standard for a Te-Tiriti-based,
equitable health system where Māori and other population groups have access to cultural y
and clinical y safe services in proportion to their health needs, receive equitable levels of
service and achieve equitable health outcomes. Some population groups are already
benefitting from strategies that take this approach (Ola Manuia Pacific Action Plan, Children
and Youth Wellbeing Strategy).
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34 We recommend taking a Te-Tiriti-informed, population and life course approach to a
women’s health strategy, to ensure that we take a holistic view of different women’s needs
at different times in their lives to prom
THE ote and maintain their health and independence. Both
approaches prioritise equity and consider the influence of social determinants of health and
women’s interactions with the health system through their lifetime. This could achieve a
more person-centred and cohesive approach to the health system’s responsiveness to
women.
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Decisions on type and scope will determine the strategy’s development
timeline and the impact for women
Strategy type will depend on the interaction with other Government strategies
35 Usual y, population-, condition-, workforce- and sector-focused strategies sit ‘under’ the
New Zealand H
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Oranga: the government’s strategy for Māori health. Whakamaua Māori Health Action Plan
2020–2025 goes some way to updating the strategic direction and the programme of action
for Māori health.
36 There is an option for a women’s health strategy to form a chapter of a New Zealand Health
Strategy. We understand decisions are yet to be taken on when the new New Zealand
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Health Strategy might be developed, what level it might take and how it might cater for the
needs of different population groups, health conditions, system enablers and sectors within
the system. The existing strategy resulted from over 18 months of co-production involving
around 90 public meetings and face-to-face discussions with over 2000 people.
37 If a women’s health strategy precedes a refreshed New Zealand Health Strategy, we would
be able to build in flexibility for alignment between the documents. For example, by
developing a women’s health strategy with a ten-year strategic direction with actions plans
that are renewed every two to three years, similar to the Healthy Ageing Strategy. This
would also enable the strategy to align with budget cycles.
38 A women’s health strategy may also intersect with a potential women’s strategy or action 1982
plan. In October 2021, the Minister for Women was invited to report back to the Cabinet
Social Wel being Committee on whether a ‘National Action Plan for Women’ was required.
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The request included proposing an approach for setting the direction and aligning
prioritisation for women in programmes initiatives and policy across government. A range of
options are possible, and health would likely form a strong part.
39 As wel as conversations with the Minister of Health and Associate Minister of Health (Māori
Health) about the possible timing of the new health strategy and alignment with He Korowai
Oranga, we would recommend a conversation with the Minister for Women about her
intentions for a women’s action plan.
40 A women’s health strategy would need to align to other strategic documents, such as Te
Aorerekura National Strategy to Stop Family Violence and Sexual Violence, the refoc
INFORMATION ussed
Maternity Action Plan, the Healthy Ageing Strategy and its second action plan, the Kia
Manawanui mental wellbeing plan, and the New Zealand Cancer Action Plan 2019-2029.
The range of scoping options strike different balances between government priorities,
women’s health literature and women’s experiences
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41 There are several options for the scale of the strategy, which sit on a continuum of high-
level government policy statement with no new initiatives or actions, through to a fulsome,
well-consulted on strategy and programme of action.
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42 A high-level policy statement might have a narrow scope, and likely very little community
engagement. It would set the strategic direction for women’s health, could give greater
strength to the existing work programme, but not seek to commit to any significant policy
or operational changes through its release.
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43 A wider, more comprehensive strategy would set the strategic direction for future
investments in women’s health and wellbeing. It would cover a broad range of issues and
opportunities, which could include those identified by diverse communities of women as
priorities as well as those that are shown to have major health impacts for women. It would
also set priorities and include an action plan, which could be health system focussed, or
could include cross-government actions.
44 A wider strateg
RELEASED y would also give the option of including issues specific to the transgender,
intersex and takatāpui (‘rainbow’) communities. The Ministry notes this this would
encompass a broad range of issues, including very complex issues, and that there are calls
from the rainbow community for a dedicated rainbow health strategy.
45 International y, several countries have published strategic women’s health documents. Each
of these include a broad scope of women’s health issues (eg, biases, preventative health,
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and chronic health conditions), rather than only addressing sexual and reproductive health
issues. Accordingly, each of these strategies have significant public input.
Appendix One
outlines the process and scope of these strategies.
A wider scope will require more in-depth engagement and longer timelines
46 A wider scope would provide an opportunity for genuine community engagement with a
diverse representation of women on their issues and experience, and for a programme of
action that addresses systemic issues and gaps in women’s health.
47 Longer timeframes would allow for co-production with Māori, with the engagement process
prioritising the views of wāhine Māori, their whānau and wāhine Māori leaders, in alignment 1982
with the Te Tiriti of tino rangatiratanga and partnership.
48 In addition to diverse communities of women, we would also gather a wide range of ACT
perspectives across the health system including providers, funding, planning and
commissioning agencies, peak professional bodies, academics and researchers, and a wide
range of Māori and Pacific stakeholders.
49 We would use a range of engagement mechanisms, including hui, fono, workshops, forums,
a discussion document and surveys.
Please indicate your preferred of the six options below:
Option
Scope and impacts
Engagement
Resourcing
Indicative
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timing
1a: Policy
Scope:
• Targeted
Can be
4–6
statement without
engagement with
• system level direction
developed and months
action plan
government
• existing work only.
implemented
agencies and
within existing
sector groups,
baselines.
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A policy
including
Impacts:
statement with a
women’s, Māori
framework for
• better alignment between
and Pacific groups.
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coordinating and
sector and government
• No public
prioritising
activity
discussion
women's health
• statement of priorities for
document.
work
future initiatives
programmes.
• opportunity for more
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effective future
investments.
1b: Policy
Scope:
• Targeted
May require
10–12
statement with
engagement with
• system level or system
additional
months
action plan
government
and issues
resource to
agencies and
• limited to existing
implement and
sector groups,
monitor
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A policy
issues/work programme
including
actions.
statement and
• actions for health
women’s, Māori
framework for
agencies.
and Pacific groups.
women’s health
Impacts:
• Public discussion
workstreams,
document.
with an action
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plan that allows
• better alignment between
for better
sector and government
monitoring of
• opportunity for more
system and
effective future
performance
investments
outcomes in
• more effective delivery of
existing
existing services.
workstreams.
2a: Strategy
Scope:
• Engagement with
May require
8–9
without action
government
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• system level vision,
additional
months
plan
agencies and
priorities
capacity to
sector groups
• existing and potential
develop.
including
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A strategy with a
future work
women’s, Māori
framework for
• consideration of the social
and Pacific groups.
investing in
determinants of health.
• A public
women’s
Impacts:
discussion
wellbeing across
document.
• better alignment between
government
• Further public
sector and government
portfolios, and
engagement: eg,
• opportunity for more
Ministerial
via public forums
effective future
commitment to
or a public survey.
investments in women’s
new and/or
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wellbeing across
improved
government portfolios
women’s health
• potential to reduce health
services.
and broader wel being
inequities for women,
wāhine Māori and priority
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populations
• new and/or improved
women’s health services.
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2b: Strategy with
Scope:
• Engagement as
May require
12–18
health-focussed
above.
• system and issues level
additional
months
action plan
• existing and new work
resourcing for
A strategy as
• consideration of the social
community
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above, with an
determinants of health
engagement.
action plan to
• may include rainbow
allow for
specific issues.
Will require
monitoring of
additional
system and
resource for
performance
Impacts:
implementatio
outcomes in the
• better alignment between
n and
health system.
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monitoring.
• opportunity for more
effective future
investments
• more effective delivery of
existing services
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• better alignment between
sector and government
• opportunity for more
effective future
investments in women’s
wellbeing across
government portfolios
• more effective delivery of
existing services
• new and/or improved
women’s health services
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• may include rainbow
specific issues
• greater potential to
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reduce health and
broader wellbeing
inequities for women,
wāhine Māori and priority
populations.
2c: Strategy with
Scope:
• Co-design with
Will require
16–18
cross-government
relevant social
• system and issues level
additional
months
action plan
agencies (eg,
• existing and new work
resourcing for
Ministry for Social
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A strategy as
• actions to influence the
community
Development).
above, with an
social determinants of
engagement,
• Engagement with
action plan with
health
confirmation
government
actions for Health • actions for agencies
that other
agencies and
and non-Health
outside the health
agencies have
sector groups
agencies to allow
portfolio
the capacity to
including
for monitoring of • may include rainbow
contribute.
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women’s, Māori
system and
specific issues.
and Pacific groups.
performance
Impacts:
• Further public
Will require
outcomes across
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engagement: eg,
additional
government
• better alignment between
via public forums
resource for
portfolios.
sector and government
or a public survey.
• opportunity for more
implementatio
effective future
n and
investments
monitoring.
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• more effective delivery of
existing services
• better alignment between
sector and government
• opportunity for more
effective future
investments across
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• more effective delivery of
existing services
• new and/or improved
women’s health services
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• new and/or improved
services or initiatives in
health adjacent areas (eg,
housing and employment)
• greatest potential to
reduce health and
broader wellbeing
inequities for women,
wāhine Māori and priority
populations.
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3: Section of the
Scope and impacts:
TBC
Assume that
TBC
Health Strategy
• as per option 2a or 2b
resource would
depending on the scope
be through the ACT
of the document.
overal New
Zealand Health
Strategy
funding.
4: Section of a
TBC
TBC
Any significant TBC
women’s strategy
resourcing
or action plan
requirements
are likely to be
met through
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the Ministry for
Women.
We recommend option 2b: a women’s health strategy and an action plan,
with a framework for investing in women’s health and wellbeing across
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government
50 While al options would improve alignment between government and the sector, Option 2b
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wil address inequities in women’s health to a greater extent than options 1a and 1b by
committing to the funding of new and improved women's health services.
51 Social, environmental, and economic factors play a major role in women’s health, and
conversely, women’s health plays a major role in social and economic outcomes. There is
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potential for the women’s health strategy to recognise the role these determinants play and
provide guidance to agents in other government sectors on conditions and initiatives that
impact on women’s health.
52 By providing a framework for investment in women’s health and wellbeing across
government, this option also better address health inequities for key groups such as Māori
and Pacific women, and women living in deprivation, where health outcomes are largely
determined by social determinants of health such as housing, employment, and childcare.
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53 Option 2b offers the greatest level of impacts for women’s health and wellbeing that is
possible without over-burdening resource within the Ministry of Health by coordinating
actions across government, as in Option 2c. Option 2b also provides greater flexibility of
timelines than Options 3 and 4, the timing of which would be determined by the new Health
Strategy and the prospective women’s action plan, respectively.
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54 Option 2c: a cross-government strategy, with direction and actions for agencies outside the
health system, would further address the role of social determinants of health. This would
require Cabinet consideration as part of its commissioning, and would also have significant
resource implications, as the Ministry does not currently have the capacity to effectively
monitor such a strategy.
This option would include system and issue level commitments
55 Based on existing work, the case for change, and on women’s health strategies overseas, we
expect that a strategy would include many or al of the topics set out below. Other relevant
topics may be raised during consultation or engagement.
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•
Intersectionality.
•
Women’s experience of the health system, including gender bias, access barriers and
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the experiences of Māori and Pacific women and other priority populations.
•
Social determinants of health (including sex, gender and ethnicity).
•
Te Tiriti o Waitangi obligations.
•
Women’s health issues at different stages of life.
•
Health conditions experienced by women, including female cancers, autoimmune
diseases and long-term conditions.
•
Fertility, pregnancy, postpartum support and pregnancy loss.
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•
Gender-based violence, including female genital mutilation.
•
Abortion.
•
Sexual health, including access to contraception and sterilisation, and sexual and
reproductive health rights.
•
Pelvic pain (including endometriosis and chronic pa
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mesh.
•
Mental health, mental wellbeing and addiction.
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•
Women in the health workforce.
56 Opportunities to improve women’s health outcomes in each of these areas are appended
[A
ppendix Two].
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Risk Management
57 Different options for the scope, scale and positioning of a women’s health strategy raise
different degrees of risk.
58 Any combination of options is likely to raise expectations for strategies for other population
groups. Submissions on the Pae Ora Bil have sought mandated strategies for Pacific people,
Asian people, d
RELEASED isabled peoples, the rainbow community, rural and refugee communities,
children and infants as well as rare diseases, mental health, substance abuse, and medicines.
As well as providing a strategy for over half of New Zealand’s population, we would expect a
women’s health strategy to recognise the intersectionality and equity issues for different
groups of women. Longer timeframes would allow for more in-depth community and sector
engagement, research and analysis in these areas.
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59 All options present a risk of failure to meet out Te Tiriti obligations. This will be mitigated by
the strategic document being predicated on Te Tiriti principles, aligned with He Korowai
Oranga and Whakamaua and actively engaging wāhine Māori in design, development,
implementation and monitoring.
60 A high-level government policy statement without new initiatives would also be unlikely to
meet community expectations or address systemic issues and service-level
underperformance. Women may be less inclined to engage, and the strategy may have less
impact. A strong rationale and communication strategy would be required, and a monitoring
and reporting component could also be beneficial.
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61 Limited scope and short timeframes raise risks for engagement and participation. Lessons
learned in the development of other strategies stress the importance of open, transparent
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processes that do not look like a foregone conclusion and instead al ow for a genuine
partnership approach and community-led engagement.
62 Al options would raise expectations for additional investment in women’s health. Aligning
the strategy and its review periods with budget cycles could assist, as well as setting
expectations for funding and commissioning agencies. This would be particularly relevant
for any action plan component.
Financial implications
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63 The strategy would be developed in-house, led by the System Strategy and Policy
directorate, with support across the Ministry. We have capacity to run a medium-level
engagement programme but would be relying on video-conferencing and other online fora
for engagement.
64 We would need to consider carefully how to reach women who may engage less with digital
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platforms, including Māori and Pacific women, women experiencing deprivation, frail or
disabled women, and rural women. It may be possible for Health NZ or community
organisations to undertake this consultation, but this would again have resourcing
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implications and would likely be at a time of significant organisational change. It would also
mean our exposure to the issues is less direct and we lose important nuancing.
65 Additional budget would be required for a large-scale community consultation process
which would include face-to-face engagement.
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66 Should the strategy and action plan be ambitious, new initiatives and an associated
monitoring and reporting regime are likely to have financial implications. For this reason,
you may want to link the completion of the strategy and review period over its life to
budget cycles.
Next steps
67 We recommend
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colleagues, in relation to:
•
the New Zealand Health Strategy (Hon Andrew Little) and He Korowai Oranga (Hon
Peeni Henare)
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•
the response to the CEDAW recommendation for a women’s action plan (Hon Jan
Tinetti) and the report back to Cabinet.
68 If you choose to commission a women’s health strategy, the Ministry wil provide further
advice on a proposed project plan and timeline that aligns with your preferences for scope
and commencement, including the proposed approach to engagement. This advice wil also
consider how the proposed approach would best serve the needs and experiences of diverse
communities of women, including Māori and Pacific women.
69 This advice wil fol ow a short period of project planning, including engagement planning
and stakeholder mapping and any other considerations you indicate.
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Appendix One: International women’s health strategies
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Document Development process
Issues covered
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Australia:
Advisory group included experts in Aboriginal
• Maternal, sexual and reproductive health
National
health, menopause, chronic disease prevention,
• Healthy ageing
Women’s
eating disorders, obstetrics and gynaecology, and
• Chronic conditions and preventative health
Health
rural and remote medicine.
• Mental health
Strategy
A national women’s health forum was held 18
• Health impacts of violence against women and girls.
2020 - 2030 months before the strategy came into effect. After
This Strategy takes a life-course and population health approach, and so a
the forum, a consultation document and
clear focus on health equity for different groups of women. The Strategy
questionnaire was made publicly available.
includes actions for each of the five areas above, and research and data
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The strategy was also informed by a literature
collection. It also commits to a five-year review of the strategy, with 12-
review of evidence.
month and 3-year development checks to assess progress.
Canada:
Development of the strategy was guided by issues • Causes of death among women
Women’s
identified and documented in literature, and in
• Diseases and conditions of women and how they experience them
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briefs presented by women’s and health
• Women’s quality of life
Strategy
organisations.
• Risk factors and their consequences for women
1999
• Gender as a determinant of health
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The strategy’s goal was to make the health system more responsive to
women and women’s health. It sought to do this through a large number of
actions directed at:
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• responsive policies and programmes to sex and gender differences and
to women’s health needs
• increased knowledge and understanding of women’s health and
women’s health needs
• effective health services for women
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• preventive measures and reducing risk factors that most imperil the
health of women.
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Ireland:
The Action Plan was developed by the Department • Maternal health
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Women’s
of Health in partnership with the Health Service
• Sexual and reproductive health, including contraception
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Executive, the National Women and Infants Health • Gynaecological, pelvic and menstrual health
Action Plan Programme, the European Institute for Women’s
• Wider physical, mental health and wellbeing measures, including
2022-2023 Health, the Irish Col ege of General Practitioners,
menopause
and the National Women’s Council of Ireland.
• Engagement, research and innovation
• Legislation, including on assisted human reproduction and abortion safe
access zones.
Similar to the Canadian and Australian documents, the document contains a
large number of actions for improving the system and services for women in
the above areas.
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United
Currently under development. A public survey was The strategy has not yet been published. Their vision and discussion
Kingdom:
made available for a 14-week consultation period
document notes the following key themes:
Women’s
and could be completed by anyone with an interest • placing women’s voices at the centre of their health and care
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in the strategy. Individuals and organisations were
• quality and accessibility of information and education on women’s
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Strategy for also able to provide written submissions.
health
England
• ensuring the health and care system understands and is responsive to
women’s health and care needs across the life course
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• ensuring research, evidence, and data support improvements in women’s
health
• understanding and responding to the impacts of COVID-19 on women’s
health.
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The vision document also notes the fol owing priority areas, which were
identified by the public:
• menstrual health and gynaecological conditions
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• fertility and pregnancy, pregnancy loss and postnatal support
• menopause
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• mental health
• the health impacts of violence against girls.
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Appendix Two: Potential issues and opportunities 1982
Issue
Problem definition
Opportunities for future focus
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Intersectionality As a group, women have a diverse range of backgrounds, needs As this work progresses, we wil need to ensure that it links
and priorities, that differ depending on age, ethnicity, disability
with strategies and action plans such as Whakamaua and
status, parental status, and sexual orientation.
Ola Manuia, to address the multiplicative effects of
The combination impact of structural racism, deprivation, and
intersecting forms of bias and discrimination.
gender on health outcomes is frequently multiplicative, not
additive.
Women’s
This could include the effects of both conscious and unconscious Further analysis is required to understand the nature of the
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experiences of
bias, and consideration of conditions that are under-diagnosed in problem and what interventions would prevent and reduce
the health
women compared to men. Possibly due to persistent gender pay women’s experience of bias.
system including gaps, and gender roles within the family, women are more likely
gender bias,
than men to report financial barriers to accessing primary care
access barriers,
and prescriptions.
and the
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Experiences wil vary greatly between priority populations,
experiences of
including Māori and Pacific women, women experiencing
Māori, and
deprivation, older women and women in prison.
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Pacific women
and other
priority
populations
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Social
Gender and sex both have impacts on health outcomes. For
Further analysis is required to understand the biological
determinants of example gender roles and norms have important implications for and social determinants of health related to sex and
health (including, how (and whether) people access health care. Despite having a
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sex, gender, and longer life expectancy, women are more likely to spend these
gender, and what aspect of these relates to poor health
ethnicity)
years in poorer health.
outcomes.
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Ethnicity and cultural identity are also key determinants of health,
with Māori and Pacific women experiencing significant health
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disparities (including perinatal mortality and breast cancer rates).
Te Tiriti o
The impacts of colonisation on wāhine Māori continue to have
The Mana Wāhine Kaupapa Inquiry may result in action for
Waitangi
repercussions for health.
the health sector, although the hearings are at too early a
obligations
stage to say for sure. There is also overlap with WAI 2575.
Health
Conditions that can affect people of any gender but reflect the
The strategy would provide a fresh opportunity to consider
conditions
greatest burden of death and disease for women include
what is important to women and groups of women to
experienced by
cardiovascular disease, mental health disorders and
protect and promote health and wellbeing, and where and
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women,
musculoskeletal disease and cancers.
how we can build greater health system responsiveness.
including female According to the Global Burden of Disease Study 2019, non-
cancers,
communicable diseases are responsible for 83.5 percent of all
autoimmune
health loss. Women have markedly higher rates of certain
diseases and
conditions. For example, autoimmune conditions such as lupus
long-term
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and multiple sclerosis are twice as prevalent among women than
conditions
men. Women also have much higher rates of osteoporosis,
putting women at much greater risk of disabling fractures and
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falls.
Fertility,
Most women have positive pregnancy and childbirth outcomes
The refocused Maternity Action Plan wil be developed
pregnancy,
and good access to high quality, universal maternity and Well
through a Te Tiriti o Waitangi-based partnership with the
postpartum
Child Tamariki Ora services, but som
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support and
improve timely access to maternity services to some population
Pacific health strategies.
pregnancy loss
groups (approximately only 40 percent of Pacific women engage Work is ongoing on improving accessibility of maternity
with a midwife in the first trimester), address midwife workforce
ultrasound services.
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shortages, and incentivise the appropriate level of care to
The triennial maternity consumer survey is being carried
pregnant women with complex health and social needs.
out in 2022. This looks at the experiences of women and
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The majority of fertility support is provided by the NGO Fertility
whānau in the maternity system and the experiences of
NZ. Fertility services are highly expensive and largely devolved to women and whānau that have lost a pēpē/baby after 20
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the private sector. Likewise, pregnancy loss is largely supported
weeks of pregnancy. The latter survey will provide insights
by NGOs.
for the development of the national bereavement care
pathway.
Young women in state care often miss out on regular primary
care provision and health issues and support are not always
considered during transition planning. This may improve with the
implementation of Oranga Tamariki’s new National Care
Standards. For those that become pregnant while in the care of
the state, there is often a need for specialist mental health and
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support services such as smoking cessation, in addition to
maternity care.
Gender-based
Family and sexual violence are leading causes of preventable loss The Ministry’s work on gender-based violence is linked in
violence,
of health and wellbeing among women.
with Te Aorerekura; we are particularly involved in two of
including female New Zealand has high rates of family violence and sexual
the key system shifts:
towards sustainable and competent
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genital
violence and women are disproportional y affected. Women,
workforces and
towards investment in primary prevention.
mutilation
particularly wāhine Māori, disabled women and transgender
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women, experience higher levels of sexual violence and intimate
partner violence than other genders.
There are also distinctive cultural forms of abuse directed at
women, such as dowry related violence, forced and under-age
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marriage, and female genital mutilation.
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available to those who need them – both for contraception and
medicalised views of women’s bodies and social y
wellbeing purposes.
stigmatised views of sex.
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There are persistent inequities in health literacy and
Mana wāhine and Pacific led health promotion, and social
contraceptive access for young women, Māori, Pacific women,
media strategies that focus on body pride, empowerment,
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women with disabilities.
sexual and reproductive rights, and connection with
Stigma shame and secrecy that surround sexuality act as a
positive culturally significant female role models and atua
multiplier for many women, which creates barriers to healthy
can support healthy sexual expression and behaviour.
sexuality, preventing seeking contraception, treatment for STI,
requesting condom use, confidently negotiating sex, or
embracing sexual identity,
Pelvic pain
Chronic pelvic pain can be caused by many conditions such as
For several years, the Ministry has had a work programme
(including
endometriosis or pelvic floor disorders. Pelvic floor disorders can to respond to and red
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chronic pain and affect as many as 30 percent of women, with risk increasing with The Ministry has also provided guidance for health
endometriosis),
age, and following childbirth. Approximately 11–19 percent of
professionals on diagnosing and managing endometriosis.
pelvic floor
women wil undergo surgery for pelvic floor disorders in their
Further work in these areas is needed, and there is scope
health and
lifetime.
for more work on pelvic pain and pelvic floor health
surgical mesh
Women often struggle to have their presenting issues taken
general y, including quantifying unmet need.
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seriously with many experiencing late diagnoses and insufficient
management of their pelvic pathology.
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Mental health,
Women experience a range of mental health and addiction
Kia Manawanui Aotearoa – long-term pathway to mental
mental wellbeing challenges, including psychological distress, mood disorders,
wellbeing is the Government’s long-term pathway to
and addiction
anxiety disorders and substance- and gambling-related harm,
transforming mental wellbeing for all New Zealanders,
throughout their life course. Some of their mental health and
including women. It contains a recently publicly consulted
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wellbeing needs are similar to those of other population groups, and Cabinet-approved set of principles for a strategic
but some differ for reasons including biology and common life
document in the health sector.
experiences (ie, both sex and gender). Body image issues and
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gender, ethnicity, disability and socio-economic status. Each of these factors can
expose them to overlapping and compounding forms of discrimination and
disadvantage. To avoid losing this nuance, it is important that the Strategy does not
treat women or diverse populations as one homogenous group.
We are expecting that members of the public wil have an opportunity to contribute to
the development of the women’s health strategy and the other strategies required under
the Pae Ora (Healthy Futures) Act 2022, in the coming months. I would encourage you
to participate in that process.
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Thank you again for your correspondence.
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Nāku noa, nā
Dr Diana Sarfati
Te Tumu Whakarae mō te Hauora
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Media: Maia Hall, NZ Doctor
Query: Women’s Health Strategy
Does the ministry of health believe gender diverse people wil receive adequate healthcare under
the women’s health strategy?
Manatū Hauora and our health sector partners, Te Aka Whai Ora and Te Whatu Ora, are working to
achieve improved health outcomes, with the goal of Pae Ora, good health and wellbeing for all New
Zealanders, and this includes Pae Ora for gender diverse people.
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The Women’s Health Strategy is one of six Pae Ora health strategies mandated by the Pae Ora
(Healthy Futures) Act. These strategies, together with the Health Sector Outcomes framework,
Government Policy Statement and New Zealand Health System Plan, set future direction for the
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Health System.
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 may include people who
do 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.
Manatū Hauora is currently undertaking public and sector engagement on the Pae Ora strategies.
The planned engagement wil be inclusive of gender diverse people (including intersex people,
transgender people, non-binary people, and takatāpui and MVPFAFF+ gender diverse people).
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In June last year, $2.2 million in additional funding from Budget 22 was allocated to enable eight
primary health care providers to provide gender affirming care to gender diverse people. Manatū
Hauora notes that there wil be further opportunities to improve care for gender diverse people as
work continues to reform the health sector.
What importance does inclusive language play in ensuring that al women and gender minorities
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receive the best care possible?
Manatū Hauora acknowledges the importance of inclusive language in the provision of high-quality
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care. We are using inclusive language in development of the Pae Ora Strategies and wider system
transformation work. The Strategy wil use the definition of “gender” set out in Te Kawa Mataaho –
the Public Service Commission’s Rainbow inclusive language guide.
Is the inclusion of gender diverse people (those who are not women) in the women’s health
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strategy a result of not having a separate Rainbow Health strategy?
Including gender diverse people in the Women’s Health Strategy recognises that women and some
people who do not identify as women, including some gender diverse people, have shared
experiences and determinants of health and wellbeing. It is important that we acknowledge and
include those who share similar experiences in the Women’s Health Strategy, as they are likely to be
affected by similar factors that shape health access and outcomes.
Why is the minist
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ry not introducing an LGBTQ+ / Rainbow health strategy?
The recently passed Pae Ora legislation commits the Government to developing the fol owing
strategies:
• New Zealand Healthy Strategy
• Hauora Māori Strategy
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• Pacific Health Strategy
• Health of Disabled People Strategy
• Women’s Health Strategy
• Rural Health Strategy.
The six mandated strategies under the Pae Ora Bil are not intended to be the only strategies, and do
not prevent the development of further strategies in the future where these are determined to be
required.
The Pae Ora strategy engagement wil be inclusive of gender diverse and other rainbow populations.
The experiences and aspirations of rainbow communities will feature across multiple strategies,
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including the Women’s Health Strategy.
If this strategy wil successfully include gender diverse people, was there discussion around giving
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it an alternate name that might reflect this inclusion?
The name of the Women’s Health Strategy is determined by the Pae Ora legislation. The Ministry
notes that people who are included in the Strategy may share the same or similar heath experiences
to women but may not identify as women. While the Strategy wil be inclusive of many gender-
diverse people, it is not intended to take the place of a dedicated Rainbow health strategy.
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