Readiness Aotearoa New Zealand has a publicly funded health and disability system that is under stress and has structural access barriers for some groups that mean it does not deliver equally for all our people. 103 Our health and disability system is faced with increasing demands as people live longer, our population ages and the global costs of medical technology and pharmaceutical advances rise. For instance, an independent report commissioned by Medicines New Zealand shows that in the years 2011–2018, Aotearoa New Zealand’s health system significantly reduced access to medicines across a wide range of health conditions, such as cancer, rare diseases and mental health, compared with similar funding systems in countries such as Australia and the United Kingdom. 104 In 2018, the Government inquiry into mental health services identified that our mental health and addiction system is under pressure. Markers of this increased pressure include: •
limited or unavailable advice or support at times of crisis
•
waiting times for young people (0–19 years old) that are longer than those for all other age groups and do not meet government targets or community expectations
•
specialist services operating at capacity
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restrictive criteria being applied and health services being able to accept only the most distressed or unwell people. 105
As stated above, we are living longer, and our population is ageing. It is expected that, by 2034, older people (65 years and older) will make up 21 percent of our population. 106 This significant group of our society may be living with chronic anxiety, depression and dementia or may develop schizophrenia, psychosis or addictions late in life. 107 Recent trends in service-use data indicate that older people are less likely than people aged 25–64 years to use primary mental health care services and are especially unlikely to use psychologist services. 108 Older people may be overlooked in reporting about mental health services, in part, as a result of inconsistent service provision and a lack of national data. 109 Harms to vulnerable older people may be compounded by multiple intersecting factors, including a lack of protection for essential front-line workers’ mental and physical health and a lack of access to PPE and triage policies that prioritise younger patients. 110 Multiple medical conditions can compromise older adults’ abilities to advocate for their needs or rights. 111 A pandemic, with reduced or limited access to family, friends or carers, can exacerbate this situation. 112, 113, 114 To be ready for the next pandemic, our health care system needs to be fit for purpose and connected to our diverse communities so that we respond immediately and readily reach all our people. This includes ensuring that the system and associated committees and providers have a diverse membership, including disabled people, women, Māori, Pacific peoples, migrants, former refugees, and LGBTQIA+ including takatāpui Māori to facilitate unbiased outcomes and increase trust in the decision-making process. While the government has a key role to play, being ready also relies on individual, whānau and community involvement. During the COVID-19 lockdowns, commentators noticed that many of the most successful approaches drew on collaborative applications of tikanga Māori (for example, iwi checkpoints and care packages led by hapū and iwi). 115 As a model that has all four elements working in harmony, each one requiring the other, Te Whare Tapa Whā can teach us how to foster readiness for the next pandemic. It highlights that such readiness is about not just the physical element of health but also the elements of mental health and social and spiritual connection.
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