Public health and community leaders are calling for a Government Budget tomorrow that invests in the long-term determinants of health for whānau and saves money in the long-term by preventing disease.

Health Coalition Aotearoa Public Health Infrastructure Expert Panel Co-Chair Grant Berghan says recent Budgets haven’t addressed the massive underinvestment in the health system. Now that $4b is being skimmed from existing work he says it’s hard to believe that we won’t be borrowing from the future to pay for today.

"We typically see 2-3% of the health budget go to public health, and usually less than 0.05% goes toward preventing harm from tobacco, alcohol, and unhealthy food, despite them making up about a third of preventable deaths and disease. We must see at least 5% of the total budget going into public health - over and above any COVID-19 spending. And a much greater proportion of that must go toward preventing harm from unhealthy commodities.

"Preventing harm is cheaper than fixing it up when our health system is already overstretched and understaffed. Preventative and public health spending has been eclipsed by COVID-19 spending since 2020 and whānau are carrying the costs. Our regional public health units and providers are really struggling to catch up. The longer we delay funding a comprehensive Te Tiriti-led strategy to keep people healthy, with equity at the core, the deeper the health debt we are cashing out.

"Māori health advocates are feeling cautious about the Prime Minister and Minister of Finances’ hints of spending cuts. This must not come at the expense of our communities who are already underfunded, or by slashing funding for Te Aka Whai Ora before it has had a chance to carry out its transformative mandate."

HCA Board and Food Policy Expert Group Co-Chair Associate Professor Lisa Te Morenga agrees the best bang for buck is funding the long-term determinants of health.

"Whānau face a cost-of-living crisis right now" she says. "They’re doing it really tough and paying exorbitant prices for healthy kai, but we all pay the long-term high price of preventable diseases like diabetes. While the Government might be tightening their belts, this can’t come at the expense of our kids’ futures, which is why we are calling for this year’s budget to at least double the Ka Ora Ka Ako healthy school lunches programme."

"We know Ka Ora, Ka Ako is making a huge difference for whānau hit by food insecurity, and many more tamariki desperately need that one healthy square meal a day. The cost of approximately $200 million to double this programme is a drop in the bucket compared with overall health and education spending. Not to mention it sets up healthy eating habits for life.

"Ultimately the Government needs to do more to bring down the cost of healthy food, like breaking up the supermarket duopoly and creating a national food sovereignty and nutrition strategy. But expanding Ka Ora Ka Ako is something they can do tomorrow to release that pressure valve on families."

Mr Berghan adds that the determinants of future health costs extend to having warm, dry, safe housing, living incomes, climate change mitigation, and the justice sector.

"Alcohol is a prime example," he says. "We are awaiting tagged funding in Vote Justice to make good on Minister Kiritapu Allan’s promise to reform alcohol law. This funding needs to be clearly set aside to allow comprehensive reforms with far greater community input, and iwi and hapū determination over local alcohol availability, and marketing and pricing regulation appropriate to the negative health outcomes linked to alcohol consumption. The dedicated funding needed for the alcohol reforms is just a fraction of the cost of the long term social and economic harm of inaction on alcohol policy, which will not be listed on any Government spending line tomorrow."

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