Policy Report
“Pae Ora – Healthy Futures”: lessons learned from the first New Zealand Rural Health Strategy
AUTHORS
Liam Glynn1,2 MD, Professor of General Practice and General Practitioner * 
Sarah Clarke3 MBChB, GradDip Rural Studies, Rural doctor and National Clinical Director Primary & Community Care
Helen MacGregor4 RN, PG Dip Health Sciences, Clinical Chief Advisor Rural
Julia Cronin4 BA(Hons), Principal Policy Analyst
Grant Davidson5 PhD, Chief Executive Tumu Whakarae
Garry Nixon6,7 MD, Professor Rural Health and Rural Generalist
Rachel Pearce3 BHlthSc, Co-Director, Rural Health in Planning, Funding and Outcomes in Health New Zealand
Joseph Scott-Jones8,9 MMsc, Pinnacle Clinical Director and Co-lead National Rural Clinical Network
Neta Smith10,11,9 (Muriwhenua – (Ngati Kuri, Te Aupouri, Ngai Takato, Ngati Kahu, Te Rarawa), Ngati Rehia and Tainui) PGDip(Business), Operational Manager, Service Manager and Co-lead National Rural Clinical Network
Jenni Vernon12 MSc(Environmental Management), Principal Advisor
Nicky Welch13 PhD, System Design Manager, Rural Communities, Rural Health, Health New Zealand
Peter Hayes1 MD, General Practitioner and Professor of Rural General Practice
Monica Casey14 MSc(Primary Care), Research Programme Manager
Veronika Rasic15 MD, Consultant
Theadora Swift Koller15 MA, Senior Technical Lead/Unit Head, Health Equity
AFFILIATIONS
1 Health Research Institute and School of Medicine, University of Limerick, Limerick, Ireland
2 Irish College of General Practitioners Rural General Practice Committee, Dublin, Ireland
3 Planning, Funding and Outcomes, Health New Zealand | Te Whatu Ora, Wellington, New Zealand
4 Manatū Hauora – Ministry of Health, Wellington, New Zealand
5 Hauora Taiwhenua Rural Health Network, Wellington, New Zealand
6 Centre for Rural Health, University of Otago, Dunedin, New Zealand
7 Dunstan Hospital, Clyde, New Zealand
8 Church Street Surgery Opotiki, Opotiki, New Zealand
9 National Rural Clinical Network, New Zealand
10 Kaitaia Hospital, Kaitaia, New Zealand
11 Mid and Far North Mental Health and Addictions Services, Te Tai Tokerau / Northern Region, Health New Zealand | Te Whatu Ora, New Zealand
12 Ministry for Primary Industries, Wellington, New Zealand
13 Rural Communities, Health New Zealand | Te Whatu Ora, Wellington, New Zealand
14 School of Medicine, University of Limerick, Limerick, Ireland
15 Department for Gender Equality, Human Rights, and Health Equity (GRE), Director General’s Office, World Health Organization (WHO), Geneva, Switzerland
ACCEPTED: 16 February 2026
Early Abstract:
Context: New Zealand began reform of the 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 healthcare in rural communities. The Rural Health Strategy was developed by the Ministry and approved by government, with input from the Māori Health Authority (dis-established in 2024), Health NZ, 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 to 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 ten 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; 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 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 emphasizing Indigenous rights and cultural responsiveness in healthcare.