Keywords: community advocacy, health equity, health system reform, health strategy, New Zealand, rural advocacy, rural policy.

Delivering effective health care outside major cities is about far more than geography alone. This open‑access report reflects on the impact  NZ's first Rural Health Strategy has had to date on our rural and remote health systems and draws out lessons for policy, commissioning, and service improvement.

Abstract

Context: New Zealand began reform of its health system in 2018 with the commissioning of the Health and Disability System Review. The emergence of a specific rural health strategy was contributed to significantly by: the restructuring of the healthcare system with a focus on equity; the increased awareness of geographic inequities for rural communities with the emergence of high-quality research data demonstrating clear rural/urban health disparities; and the emergence of the Hauora Taiwhenua Rural Health Network as a single strong collective membership-led and driven, advocacy voice for health care in rural communities. The Rural Health Strategy was developed by the Ministry of Health and approved by government, with input from the Māori Health Authority (disestablished in 2024), Health New Zealand, other government agencies, and engagement with the health sector, stakeholders and the general public.

Issues: Historically, rural areas in New Zealand have faced many challenges in health service coverage and health outcomes compared with urban areas. Generic rural classifications have underestimated rural health needs and failed to highlight health inequities in rural communities. The new Geographic Classification for Health has now addressed this issue in New Zealand. The Rural Health Strategy identifies five priorities over the next 10 years: considering rural communities as a priority group; prevention; services are available closer to home for rural communities; rural communities are supported to access services at a distance; and a valued and flexible workforce (including integrated, broader and different workforce models). Over time, monitoring of the implementation of the priorities of the strategy, and monitoring of overall health outcomes for rural communities, will assess the progress made towards the vision set out in the Rural Health Strategy.

Lessons learned: The emergence of better information on rural health outcomes, together with effective advocacy for rural health, contributed to rural communities becoming a priority group for the New Zealand Government, thus mandating the development of a Rural Health Strategy. The resulting Rural Health Strategy is a key first step towards rural health equity and improving rural health outcomes in New Zealand. Lessons learnt through this process include, but are not limited to: the value of strong collaboration among, and advocacy by, rural health stakeholders; the role of the Office for Rural Communities in assessing rural community impacts and rural proofing policy changes across government; the importance of evidence-based policies and interventions in rural areas; the potential for fostering learning/solution showcasing across local levels; the central role of community engagement and empowerment; and the importance of emphasising Indigenous rights and cultural responsiveness in health care.